Merck - Gardasil: the cat is out of the bag; it's a pig in a poke

Stick with me guys.... Insider is not torturing his metaphores here!

The phrase "pig-in-a-poke" refers to a scam originating in the late Middle Ages, when pork was scarce, but apparently cats were not.

The scheme entailed the sale of a "live suckling pig", in a "poke" (bag).

The wriggling bag actually contained a cat, not particularly good eating - I'm given to understand, which was then sold, unopened, to the sucker.

If the buyer was smart, before purchasing he would take a look in the sack and so "let the cat out of the bag"!

Now, back to Gardasil and the pig in a poke argument.

Merck's campaign to mandate Gardasil vaccination of pre-teen girls notched its first two victories in February in Texas and Virginia.

Five states are moving on bills similar to Virginia's mandate. And several states have agreed to provide young female residents free inoculations with the vaccine that targets four strains of Human Papillomavirus (HPV).

Curiously absent from the debate in Virginia's General Assembly was... well... debate.

Few, anywhere, have suggested Gardasil is a product no one really needs, at any price, much less the $360 base price, plus another $180 or more for three office visits and doctors' fees.

The synchronized nationwide barrage of more than 30 state bills, supported by Merck's multimillion-dollar TV ad blitz, should have raised curiosity about the appearance of urgency.

Merck's message was ominous: HPV will infect 75 percent of sexually active U.S. women in their lifetime. Some strains of HPV cause cervical cancer, the "second-most common cancer worldwide." Gardasil "may help prevent" two strains of HPV which together account for 70 percent of cervical cancers.

While technically true, these statistics on HPV and cancer prevalence are more deceptive than relevant. There is an HPV epidemic: About 25 million American women age 14-59 are currently infected with HPV, according to research published last month in the Journal of the American Medical Association (Feb. 27).

But being infected with HPV does not mean one will get cervical cancer, much less die from it. Most strains of HPV are eliminated by one's immune system -- 70 percent are cleared within one year and 91 percent within two years.

That leaves only about 10 percent of women infected with HPV who will develop persistent infections. It typically takes 10 to 15 years for a persistent infection to develop into invasive cervical cancer.

Pap tests in that period can detect and eliminate precancerous cells before they develop into cancer and invade healthy tissue.

As Dr. Adriane Fugh Berman writes in an excellent review:

Cervical cancer is uncommon in the United States. This is not an emergency; this is not SARS.

Listen only to public health people without conflicts of interest.

There’s time for a discussion – but ban industry from the room in which any decisions on public health are made.