|August 30, 2006|
Dear Dr Frieder,
I read with great interest your article about the new HPV vaccine Gardasil (Protect Your Daughter From Cervical Cancer) that appeared in the Santa Monica Mirror.
I recently had an abnormal Pap smear, and like the patient you mention in your article, I too was frantic. But my first step was to go for another Pap smear rather than ago into a total panic, and Im glad I did.
The second Pap was normal, and a third was normal as well. What concerns me now is that I have since discovered that almost every woman I know has had a similar experience, that is, an abnormal Pap followed by a normal Pap. I wonder, does this mean that the abnormality resolves itself or that the first Pap was incorrect? Is there a medical explanation for why abnormal to normal Paps are such a common experience?
Since my almost panic, Ive become interested in HPV and have been doing some research. Rather than leading to greater understanding, I am confused by the difference between what Ive read and what you write. Your article states that HPV affects over 20 million American men and women. I could not find a study that gave information on numbers of men diagnosed with HPV. Could you please send me or refer me to some data on how many American men actually have HPV?
I also wonder how HPV is tested for in men. Can you shed some light on this? My own gynecologist said shes never heard of HPV testing for men. This seems odd to me since HPV is described as a sexually transmitted disease. Shouldnt men take charge of their health by testing, too? Do you test for HPV in men? And do you know how often cancer follows a positive HPV screening in men?
Im also having difficulty locating a study that demonstrates a causal relationship between HPV and cervical cancer. All I can find are studies that indicate a correlation, but no causation. Ive asked three doctors about that, including the one who did my Pap smears, and she cant find any studies that demonstrate causation, either, so we both need your help!
About the new Gardasil vaccine, your article says that it has no known side effects. Does this mean no known immediate side effects or no known long term side effects?
One last question, and this may be stupid, but how does anyone know the HPV vaccine prevents cervical cancer if you get the shot at age nine (as you suggest) but dont become sexually active for another 10 or more years, and most cases of cervical cancer (from what Ive read) appear in women over age 35?
I look forward to gaining insight on this important topic and thank you for very much for your time.
PS How is the frantic patient in your article doing?
Dear Santa Monica Mirror reader,
Thank you for your email and your interest in my article. Im very glad that this subject is getting attention and provoking your good questions. As far as providing you with further information, Im sorry but I just dont have the time to respond to all of the inquiries that Ive received.
Im a private physician with limited time. If you have specific concerns regarding your own health, Id be happy to see you for a consultation. If youd like an appointment, please call my office.
If you have general questions regarding the subject of HPV and Cervical Cancer, Id suggest that you research the following web sites:
Thanks again for your interest. I apologize for this form letter, and hope youll understand. Best wishes,
Richard Frieder, MD
PS. Ms. Casey, Your letter indicates a great deal of insight and curiosity. I think youll find the answers in these references.
Dear Dr Frieder,
Thank you for your reply. I appreciate you taking time from your busy practice to write to me.
Unforunately, I do not live in the Santa Monia area. I was passing through on my way to San Francisco and picked up the Mirror at a market. A consultation is not possible for me.
What is possible is to recompense you for your time in providing me with the answers and references I seek. Also, if you are affiliated with or support a charity, I would be happy to make a donation on your behalf in exchange for your help in providing answers to my questions.
Please let me know if I may reimburse you for your time. In the meanwhile, I would appreciate a reference for the number cited in your article of 20 million American men and women with HPV. I assume you have this close at hand since the article appeared in the August 24-30 edition of the Mirror.
Thanks again for your time.
Hi Ms. Cohen,
Im enclosing the Gardasil product information found on their web site for your review. This is citation with regard to 20 million Americans who have had HPV. I dont know the specific literature that they used, but this fact is common knowledge, as is the fact that HPV is the cause of cervical cancer, and is supported by a large body of literature.
Id really encourage you to get guidance in this area from your regular OBGYN. He/she really should be able to answer all of your questions.
Id be happy to have a phone consultation with you regarding your questions if that is your preference. I can also provide you with research studies if you wish, but this would be costly, and you can get the same information yourself. If you really want to talk to talk to an expert in the field, Id call Dr. Wiesmeyer who is the Director of the Student Health Center at UCLA, as he was one of the principle researchers on this vaccine. You could also have a consultation with Dr. James Lilja (a GYN oncologist) in the bay area.
Richard Frieder, MD
Hi Dr Frieder,
Thank you for referring me to the Gardasil web site.
While the site is interesting, the information there seems geared toward promoting the vaccine and does not answer my specific questions. For example, Gardasil says the 20 million number of HPV carriers cited in your article is an estimate, not an actual case count. It also notes that the claim that 50% of sexually active people catch HPV is an estimate, rather than an established fact.
The site gives no explanation as to why the HPV vaccine is only for girls and women ages 9 to 26 or why it might be prohibited for use by boys and men. Why would a vaccine for a sexually transmitted disease be restricted to use only among females?
The site also gives no information on HPV testing for men or even a link to where one can learn more. Do you test the male partners of the women in your practice who come up positive for HPV or recommend a lab where their husbands and boyfriends can go? What test does a man ask for to screen for HPV?
The site does state that cancer of the cervix...is caused by certain types of HPV but again, without a reference.
As I mentioned, Ive spent many hours searching for references to what you, my own doctor and other experts call common knowledge, without finding the studies or data upon which this common knowledge is based. I am an intelligent person who can find my way around the internet and a library yet the most basic information seems uncommonly hard to find.
At this point, Im reaching out to you, an expert in your field and an advocate for Gardasil, and offering to pay you for your help, directly or through a donation to the charity of your choice.
Would $2,500 suffice as recompense to answer the questions in this email? Please let me know.
Hi Ms Cohen,
You're clearly a very intelligent and educated person with many good questions. I'm afraid I can't help you any further in this matter. I respectfully refer you to the resources that I've given you for your further investigation.
Richard Frieder, MD
Dear Dr Frieder,
I dont understand. You are the author of a pulbished article that enthusiastically promotes the new HPV vaccine but are unable to answer a few simple questions about the vaccine or HPV despite a generous offer to compensate you for your time.
Can you at least give me the name of the HPV test used for men and the name of just one study that demonstrates HPV causes cervical cancer?
In exchange, I will send the offered recompense of $2,500 to The Make a Wish Foundation, a charity which brings joy to the lives of children with terminal illness.
To date there has been no further communication from Dr. Frieder.