I would like to add:
- HPVs are extremely common: 80% of men and 90% of women will have at least one strain in their lives. Unless you plan to remain completely celibate, you are likely to contract a strain.
- Sooner is better, but vaccination can be done at any age. Guidelines often lag behind, but vaccination makes sense even if you are currently HPV-positive. While it won't clear an existing infection, it protects against different strains and reinfection (typically body removed HPV in 1-2 years). See: https://pubmed.ncbi.nlm.nih.gov/38137661/
- HPV16 is responsible for a large number of throat cancers (around 50% in smokers and 80% in non-smokers!). This affects both men and women. Vaccinating men is important for their own safety and to reduce transmission to their partners.
> Unless you plan to remain completely celibate
You can get HPV without sex too.
https://www.cdc.gov/sti/about/about-genital-hpv-infection.ht...
"HPV is most commonly spread during vaginal or anal sex. It also spreads through close skin-to-skin touching during sex"
This focuses on sex, but any virus that can be found on skin, also has a chance to be transmitted without sex just as well. Admittedly the chance here for HPV infection is much higher with regard to sex, but not non-zero otherwise. The HeLa cells also contain a HPV virus in the genome, though this was probably transmitted via sex:
"The cells are characterized to contain human papillomavirus 18 (HPV-18)"
HPV-18. I think HPV-18 may in general be more prevalent than HPV-16.
Foot warts are HPV, like from the Gym locker room
But they are not HPV16/18 and so not covered by this vaccine.
There is some clinical evidence of other strain effect. See pediatric dermatology article from a year or two ago.
>> HPVs are extremely common: 80% of men and 90% of women will have at least one strain in their lives.
This statistic seems to be used by some people to avoid the vaccine - they figure they've already had it at some point. The biggest problem with that logic is that not all strains are as dangerous and they probably have not contracted 16 or 18 specifically. The other problem is there's still a good number of people who have never had it and shouldn't assume they have because its common.
But this misunderstands how HPV works. First, there are many strains. Typical tests for oncogenic variants measure around 30 types. The vaccine I received (Gardasil-9, which I took as a male at age 35) protects against nine specific strains.
Second, the body normally clears HPV naturally after 1-2 years. However, natural infection often does not provide immunity, so reinfection can easily occur (even from the same partner or a different part of your own body).
People often assume that HPV is either a lifetime infection or that recovery guarantees immunity - neither is the case!
Does the vaccine guarantee immunity, by contrast?
Parent is overstating the case. Neither infection nor vaccination provides sterilizing immunity [1], but the general reasons to prefer vaccination are (in order of descending quality of evidence & reasoning):
1) you probably haven't had all N strains yet.
2a) you likely haven't been infected with the ones that cause cancer, because they're relatively rare.
2b) ...that is especially true if you're young and not sexually active.
2) being infected with one strain does not provide sterilizing cross-immunity against the other strains.
3) even if you've been infected with a strain, some of the vaccines have been shown to prevent reinfection and reactivation better than natural infection alone.
4) in general, the vaccination-mediated immunity might last longer or be "stronger" than the natural version, since the vaccines are pretty immunogenic, and the viruses are not.
But for point 4, it's well-known that vaccine efficacy is lower for people who have already seroconverted (cf [1]), so there's clearly some amount of practical immunity provided by infection.
[1] The vaccines are roughly 90% effective for the major cancer-causing strains, but it's not a simple answer, and varies a lot by how you frame the question. See table 2 here: https://pmc.ncbi.nlm.nih.gov/articles/PMC8706722/
Also be sure to see table 4 if you're a man. The data for biological men and women are surprisingly different!
What if you're married? Does it still make sense, if you know you won't ever be sleeping with a new partner?
A question for your doctor and your partner (and of course, you can read the data in the link I posted above and use that to influence your conversation and decision!)
I'm not being avoidant here -- medical decisions are always subjective and multi-factor, and I can't begin to tell you what you should do. (But I also sincerely believe that propagandists try to reduce nuanced data to talking points, which is equally wrong.)
Please note the caveat about gender that I just added. The data for biological men and women are very different. Also, I haven't discussed risks at all, which is the other side of the ledger -- these vaccines are pretty darned safe, but everything comes with risk, and only you can decide what level of risk is appropriate for your life.
I usually am pro vaccine. But the HPV vaccine discussion seems politicized to me. As someone who is monogamous and over fifty, I had trouble following the risk vs reward discussion. The CDC says it is only recommended for young adults so I interpret that for my case the answer is negative.
All vaccination is now heavily politicized in the US. HPV vaccination was an obvious focal point initially because of why we'd do it when we do.
The initial data says you should vaccinate somewhere around 12-14 year old girls because most of them will be HPV naive but if you wait longer they won't be any more. But too many US parents cannot imagine their little girl ever having sex and if they never have sex they almost certainly won't contract HPV so, why are we vaccinating them? Are you trying to make my daughter a slut?
If you've been a teenage American this should strike you as very silly, and doubly so if you understand biology. Teenage girls are not, in fact, celibate by default, so some of them will get horny. And if you understand biology the viral infections aren't caused by the same mechanism as pregnancy "sexual activity" is a shorthand, you can easily get infected while steering clear of anything that would get somebody knocked up. A peck on grandma's cheek is unlikely to work, but if you're sucking face for most of a Stranger Things episode that's definitely enough that you might contract HPV.
Of course if you're monogamous sure. But I'm also 50 and very polyamorous so for me it was a no brainer getting it.
Same, what is the risk/reward for someone who is and plans to be monogamous. Young or old. Cost not a concern. Give me the info and let me decide for myself, my kids, my parents.
You get to make your own health choices here, but as someone who got the vaccine in my 30s, I am glad as I didn’t know about my future divorce when I got vaccinated.
Couldn’t you have gotten the vaccine after your divorce if you wanted?
Think about your future health while your mind is clear. After the trauma of divorce is not the time.
Also, I think these questions are in bad faith.
It is actually hard to get people to change any behavior. The public health benefits should be a primary concern. Avoid vaccination if there is a downside to you personally, but that isn’t what I’m hearing from your comments.
Consider that it's possible that the person's partner may have exposed them to their then-unknown extra partners, creating one of the conditions for the divorce.
You are presuming that people are monogamous up until their divorce when infidelity is one of the top reasons for divorce.
Ha, we had this conversation with our doctor and they said not to worry about the vaccine if you are married and monogamous. It would likely have zero benefit to us at that point in time.
Now maybe that changes if you get divorced and get a new sexual partner.
It's never a guarantee in practice, the CDC says "More than 98% of recipients develop an antibody response to HPV types included in the respective vaccines 1 month after completing a full vaccination series"
> This statistic seems to be used by some people to avoid the vaccine
The FDA itself restricted access to the vaccine on the basis of age. Given that virions aren't even involved in the production process, its safety should have been deemed good enough for the entire population early on.
The reason it's not recommended for all ages is money. Not safety concerns.
Same reason you can't get Shingrix under a certain age.
I think the main reason it isn't recommended for all ages is that it wears off. If you get it before 50, when your immune system starts declining, you might end up getting shingles when you're 60 or 70.
Insurance companies used to only pay for the vaccine at 60. They've reduced it to 50 now because people (like me) were getting it in their 50's. I got it in my left eye and because my immune system is kinda shit, I still have it, though it doesn't give me too much grief now. But it did trash my cornea in that eye, so it's messed my vision up pretty good. And since there's still an active infection (after 8 years), I can't get a cornea transplant.
https://www.health.harvard.edu/staying-healthy/two-dose-shin...
My PCP actually recommended holding off until later in the 50s for this reason. There's not currently a booster so his suggestion was to play the odds & delay a bit in order to get longer protection in my elderly years.
Beg for forgiveness, don't ask permission. I got Shingrix when I was under the age of 40, and at no cost to myself even, simply by scheduling a Shingrix vaccine at CVS. It wasn't until I went back for the booster shot months later that the nurse was like "Wait, aren't you too young for this?", but they nevertheless gave me the second dose to complete the vaccine course. You can just so things.
I was unable to get a first dose just by asking the pharmacy -- they were happy to enforce the arbitrary 50 year age rule. But my PCP was happy to just prescribe it off-label. Do it; shingles is terrible and there's no reason to suffer it under 50.
I would happily pay for Shingrix.
Prepare your happy for a very profit-laden high three-figure bill.
You can get it in the UK, unsubsidised from a profit driven private company, for a mid-three figure amount.
https://www.boots.com/online/pharmacy-services/shingles-vacc...
> Price per dose:£230
> Full course (2 doses):£460
Medium 3-figure at most. $400-600 for the full two-dose series.
Worth it.
Your average HN reader can absolutely afford paying a few hundred bucks to avoid getting a potentially life-changing disease, and should. I know multiple young adults who got messed up by shingles.
Luckily, I can afford $999 to avoid experiencing Shingles.
>>>>> HPVs are extremely common: 80% of men and 90% of women will have at least one strain in their lives. >> This statistic seems to be used by some people to avoid the vaccine - they figure they've already had it at some point. The biggest problem with that logic is that not all strains are as dangerous and they probably have not contracted 16 or 18 specifically. The other problem is there's still a good number of people who have never had it and shouldn't assume they have because its common.
As people cite these statistics, it would be useful to distinguish exposure to HPV causing foot warts, etc from the much more dangerous variants. I rarely see any statistics do this sort of segmentation.
> I rarely see any statistics do this sort of segmentation.
There are multiple publications. THe easiest way to find is Gemini 3 Pro or ChatGPT Thinking + find for publications (go to link, not just rely on summary).
They differ by population and methodology. For example, here is "Age-specific and genotype-specific carcinogenic human papillomavirus prevalence in a country with a high cervical cancer burden: results of a cross-sectional study in Estonia", 2023, https://pmc.ncbi.nlm.nih.gov/articles/PMC10255022/
I mostly hear this from healthcare-fatalists arguing against people in their 40s+ getting the vaccine later in life.
What about the people who know they have 16 or 18? Should they still get it?
Yeah, I only read the abstract and looked at the plots, but this is what I hate about public health papers:
They say the prevalence of virus is down. They don't say that the cancer rate is down (granted too early to tell), nor do they talk about any adverse events or all cause mortality differences (again, probably too early to tell)
The only thing they can conclude is that the treatment given to stop the virus, stops the virus. But they don't mention any tradeoffs.
Not trying to be an anti-vaxxer conspiracy theorist, but good science needs to talk about the whole picture.
This is one research paper reporting on particular results.
It is DEFINITELY not too early to tell. Cervical cancer rates in Australia, which adopted the vaccine widely and early have decreased, and it has been widely reported ( https://www.canceraustralia.gov.au/cancer-types/cervical-can... )
Research papers are not literature reviews. This paper reports on the results of this study. And that study only investigated what it investigated.
In the case of public health, there are a bunch of organizations that keep on top of the research and maintain a more comprehensive view of their perception of the current consensus.
For day to day guidance, individuals should be referring to either those sources, or healthcare professionals.
If people are looking at individual studies like this to make decisions, something has gone very wrong.
You can’t talk about the whole picture unless you have all the parts. There’s no reason all of those parts have to come from the same study.
The first thing on your list of complaints is something that by your own admission cannot yet be determined. If you’re not trying to be an anti-vaxxer, you’re doing a bad job of it.
For those men wondering whether they should get vaccinated:
- HPV causes genital warts, HPV is permanent, doctors won't test you for HPV unless you demand it, and the tests aren't reliable, which is why they literally won't diagnose you unless you already have genital warts.
- Once you are confirmed HPV positive (again, you won't be confirmed without getting genital warts), you need to inform your partners, as it causes cancer in both men and women (but mostly women).
You missed three very important caveats that complicate the story you’re trying to tell:
1) not every strain of HPV causes cancer (iirc, the bad ones are rare).
2) many people (in fact, most people) who are active in the world have been infected with at least one strain of HPV.
3) it’s common to have asymptomatic HPV infections. you probably have one now.
one more:
4) the vaccines likely have little effect on anything unless you were vaccinated as a child (and are a biological woman).
Overall, it’s a situation where you’re asking that sexual partners “disclose” something that the partner probably already has, if they bothered to be tested for it to begin with. Moreover, nobody does these tests (in men, at least), because there’s no point to doing them, other than creating anxiety.
I will leave the nuances of bioethics to other people, but it’s not as clear a situation as you’re making it out to be.
One final thing: these infections aren’t “permanent”. They generally clear naturally in a few years.
> 4) the vaccines likely have little effect on anything unless you were vaccinated as a child (and are a biological woman).
This guidance is changing. Vaccinating men protects women. Also just because you were infected with one strain, that doesn't mean you can't contract another, possibly oncogenic one. Get vaccinated, it protects against the most common cancer-causing strains. I did, why would I want to unknowingly give someone cancer?
#4, anything that reduces cancer risk is a plus in my book, regardless to time and gender
I, a male, got vaccinated with the Gardasil 9 vaccine shortly before turning 40. Convincing my doctor to prescribe it wasn't terribly difficult, I told them a few things about my sexual history and explained some of my sexual plans, and that was that.
I wish more people would get vaccinated.
That is terribly difficult. Why the hell do I have to make an appointment weeks in advance, then take time out of my day just to get permission from some asshole who asks about my sexual history? Why can't I just walk up to the counter, say "I'll take one HPV vaccine please" and pay the money? If you want me to get vaccinated make it easy.
You can make an appointment at eg Walgreens (and probably also CVS) and pay out of pocket for the Gardasil-9 HPV vaccination without any consultation with or referral from a GP (General Practitioner) or a Specialist.
Gardasil https://en.wikipedia.org/wiki/Gardasil
https://www.google.com/search?q=gardasil+shot+cost
https://www.goodrx.com/gardasil-9/how-much-is-gardasil-witho... :
> When you have your first shot is the main factor that determines whether you will need 2 doses or 3 doses
> Without insurance, the average price of 1 dose of Gardasil is $368.82. But you could pay as little as $169.50 with a GoodRx coupon at certain pharmacies
A prescription is only required for insurance reimbursement fwiu
Because we over-rely on insurance for routine medical care, when really insurance should just be reserved for the catastrophic and everything else out of pocket (and/or directly subsidized).
I agree with that, and I don't have a problem with insurance companies demanding a doctor's approval before paying. What I have a problem with is that I can't even pay my own way without a doctor.
My GP just offered it during my physical along with the flu and COVID booster. I declined the COVID booster since I had just gotten a mild case a couple months back. Got two shots in the left arm, was sore for a day and that was that.
This is why you have to go to the grey market for medical stuff in the USA anymore. Every rich celebrety, and women with body dysmorphia knows how easy it is to get GLP-1s right now. Good and thank goodness for it.
Deregulating medical systems regarding patient choice and access to drugs is good, but you'll eventually get some bootlicker claiming that "we can't do that because SOMEONE WITH A VIRUS MIGHT USE AN ANTIBIOTIC INCORRECTLY" while ignoring the mass consumption of antibiotics by farm animals as a vector for super bugs.
Antibiotics are actually an exception to my general opinion that all medications should be available without prescription. Unlike most drugs, their use has major externalities which means there is a role for larger societal regulation of their use.
Also, are farms actually the major vector for antibiotic resistance in the human population? I was under the impression that the majority of antibiotic resistant infections occur in places like hospitals rather than among farm workers, which would seem to indicate farm animals are not the main problem (I 100% support banning the practice anyway).
Not to mention farm animals being the source of most if not all flu strains.
I did the same at 34. There's a dermatology/STI clinic in Budapest where I live that gives the shot at cost (about 130 euros) because they think people should get it.
How much did it cost? I've considered it but it seems the only option for me is to pay for it out of pocket (~$1000 for the full course), which seems kind of not worth it at this point.
Best of luck, the reason it took so long for males to be approved for Gardasil use and they slowly keep pushing it up by age is two fold:
1) if you've ever been exposed to HPV already, then the vaccine is useless
2) there is no test to determine if a male has been exposed, although there is one for females
so they just push the ages up by probability, over time. As the probability of a man being with an older and therefore unvaccinated woman decreases - since with women is the most probable - the age can rise
> 1) if you've ever been exposed to HPV already, then the vaccine is useless
This is patently incorrect. The vaccine protects against 9 variants. Having been exposed to all 9 before vaccination sounds like really bad luck.
> 2) there is no test to determine if a male has been exposed, although there is one for females
The female HPV tests, as I understand, only test for the presence of HPV in the cervix. It can be present in many other areas. No one is testing women for the presence of HPV on their hands or in their throats.
Most places now offer HPV vaccines to young boys as well. People over 40 more or less missed the boat, but they can still get vaccinated. How useful it is depends entirely on their personal circumstances and risk profiles.
> 2) there is no test to determine if a male has been exposed, although there is one for females
It is incorrect. I had it tested multiple times. It is done less routinely, usually under assumption that since it is women who are mostly at risk, why bother testing men. Which is horrible mindset in anything related to epidemiology.
See:
- https://www.droracle.ai/articles/607248/what-methods-are-use...
- https://pmc.ncbi.nlm.nih.gov/articles/PMC12256477/
- https://www.tandfonline.com/doi/full/10.1080/22221751.2024.2...
> 1) if you've ever been exposed to HPV already, then the vaccine is useless
Also no. See other comments.
> It is done less routinely, usually under assumption that since it is women who are mostly at risk, why bother testing men. Which is horrible mindset in anything related to epidemiology.
No. The general reason that people don't do the test for men is that DNA testing is extremely sensitive, and produces a lot of false positives for a virus that is widespread.
It's also not actionable. You can't treat an asymptomatic infection, and a positive leads to the same outcome they would give anyway: use physical barriers and abstinence.
(Edit: hilariously, your first link says exactly what I just wrote, at the very top of the page. Did you read it?)
The claim I refuted is that there are no test for men (there are). Not sure why you want to get needlessly argumentative here, repeating things I already linked (sic!).
Sure, test from penis has lower specificity and sensitivity that for cervix, but it is not binary "works or not" (as side note, just measuring from urethra is rarely enough [1]). Life is probability, and it is a huge fallacy to believe that things work 100% or 0%, nothing in between (rarely the case in medicine).
Results are actionable on many ways. Most important, screening for female partners, informed risk for partners or your on safety for ones partners (condoms BTW reduce infection rates, but do not fully protect, as HPV can be on other parts of skin).
[1]
> The overall prevalence of HPV was 65.4%. HPV detection was highest at the penile shaft (49.9% for the full cohort and 47.9% for the subcohort of men with complete sampling), followed by the glans penis/coronal sulcus (35.8% and 32.8%) and scrotum (34.2% and 32.8%). Detection was lowest in urethra (10.1% and 10.2%) and semen (5.3% and 4.8%) samples. Exclusion of urethra, semen, and either perianal, scrotal, or anal samples resulted in a <5% reduction in prevalence.
I quoted you, and responded specifically to the quote. The reason doctors don’t offer the test is not because of some straw man arguments (“a horrible mindset…”) involving their diminished judgment of importance of the virus in men, as you assert.
You keep saying things in these sub threads that are factually incorrect in some important way that hides nuance, or otherwise seems calculated to provoke outrage. This was another example, which I why I replied here.
no reliable test for men, then
and even if it is reliable, its utility is limited
all leads to focusing solely on probability of exposure(s)
so far the comments are adding more vectors to understanding the situation, but nothing that fundamentally changes the user experience
I think the most insightful thing is that there are 9 HPV variants some of which someone wouldn't have exposure to so its worthwhile to get the vaccine anyway
but other than that, the situation is the same. for men's age the utility of the vaccine is based on probability alone, as its a waste of resources to even attempt checking for prior/current exposure
this is what I don't understand, why is it useless? there're multiple variants, vaccination could create reaction to a different part of the virus, etc.
I feel very uncomfortable trying to talk my doctor into doing something they don't recommend. I know too many people who buy into fake medical stuff.
Why is this different? Why is pestering a doctor to give me a medicine they don't recommend a good idea?
Because doctors are human and fallible operating in suboptimal systems. Don't want to provide me with a low risk, potentially high reward, low cost intervention? I'll shop until I find a doctor who will, or source it myself. Suboptimal systems and practitioners of various quality require advocating for one's self. I had to twist Planned Parenthood's arm to get Gardasil before it was approved for older adults, even though I was paying cash out of pocket, but had no problem with a trusted PCP providing me Metformin, GLP-1 prescriptions, etc simply by arguing my case and meeting sufficient criteria it would not come back to bite them.
Doctors don't have the time or capacity to know their patients well enough to make personalized recommendations in most cases. If you show up with symptoms of X they can recommend Y and will probably ask you whether you have Z which can impact the treatment. But virtually no doctor is going to ring you up proactively and say "hey, I noticed you haven't had a HPV vaccine yet, and I think it might make sense for you because I know this and that about your risk profile".
Doctors are not all knowing, infallible oracles. They are human beings you can have a conversation with about your health. If you think something makes sense for you, you can run it past them. No one is suggesting randomly asking doctors to prescribe random shit.
The doctor likely didn't recommend it because GP is 40 years old. Most people's sex lives is comparatively... boring at that age.
Your own doctor is as likely to be a quack/have quack-like beliefs as you are. Unironically this is true! Better learn to start reading Pubmed!
Doctors/medical associations don't agree with each other on much, even at the very highest levels. For example, the USA and EU have totally different recommendations related to digital rectal exams for aging men. One believes that finding cancer in old men is important, the other claims it's bad because most of those cancers are benign and sticking a finger up an old mans butt often causes its own complications.
Yeah I just did it at 50. Only got 2 gardasil shots though. They're so expensive because only young people get them subsidized.
I heard 1 shots already conveys a lot of protection so I'm wondering whether to take the third. I'm a bit late with it too
Is there any issue for adult males vaccinating ? I seem to remember some mention of risk by my doctor when I asked about it, but I might be misremembering.
No vaccine is without risk, but the vaccine approach is based on that risk being so low (but not zero) in comparison to the risk of not vaccinating that it is vastly the better choice.
Ok that was a bad question, let me rephrase: isn't there something particularly bad about this one for males that are already adults that makes it not recommended by doctors by default?
There's nothing particularly bad for adult males.
The benefits may be statistically lower, since you may have been infected by some of the variants already, older males may have fewer sexual partners in the future, and cancer takes a while to develop.
In the USA, it is recommended by default for adults up to 26 and kinda for 27-45.
There is currently no vaccine that is zero risk
What's the risk of a vaccine? What could happen?
and in the same breathe, the risk is closer to zero than not.
Sure but specifics count. 49% is also closer to zero than it is to a 100%.
Life is generally not zero risk :)
I believe you are right. Including amorous congress and vaccines
> - Sooner is better, but vaccination can be done at any age. Guidelines often lag behind, but vaccination makes sense even if you are currently HPV-positive.
However, the vaccination is expensive (~1k) and it is difficult to find doctors who will do non-recommended vaccinations for self-payers.
YCMV
> However, the vaccination is expensive (~1k)
Depends entirely on where you are and what your healthcare situation is. Mine cost me ~100eur.
This is ultimately an American site so you can assume 80%+ of comments come from a US background (I'm not American, I've just been here longer than I should have).
(even for rest-of-the-world topics)
Are there insurance plans that won't cover it? I know that a lot of plans love not paying for things but vaccines seem to be the one thing that they all at least seem fairly good at (at least in my experience).
I am currently getting the HPV series and I only had to pay my copay for the first appointment have nothing for the second one (I am assuming it will be the same for the third)
are you under the age of 27? this is the key difference in cost of HPV vaccination
> While it won't clear an existing infection, it protects against different strains and reinfection (typically body removed HPV in 1-2 years). See: https://pubmed.ncbi.nlm.nih.gov/38137661/
The study you've quoted here is not definitive evidence of the claim you're making, and that claim is...let's just say that it's controversial. Conventional wisdom is that you're unlikely to benefit from HPV vaccination unless you have not already seroconverted for at least one of the 9 strains (6, 11, 16, 18, 31, 33, 45, 52, 58) in the current vaccine.
There's not much hard evidence to suggest that vaccination for HPV has strong ability to protect you from a strain after you've already been infected with that strain [1], as the best available data shows a substantial decline in efficacy for women over age 26 and for women of any age who had prior documented infection [2]. This study is small, unrandomized, and the measured primary outcome (anti-HPV IgG) doesn't really tell you anything about relative effectiveness at clearing an infection. The only real evidence they advance for this claim is:
> Persistent HPV infection after vaccination was significantly less frequent in the nine-valent vaccinated group (23.5%) compared to the control group (88.9%; p < 0.001).
...but again, this is a small, unrandomized trial. We don't know how these 60 people differ from the typical HPV-positive case. You can't rely on this kind of observational data to claim causality.
Vaccination is great, but let's not exaggerate or spread inaccurate claims in a fit of pro-vaccine exuberance. The HPV vaccine has age range recommendations [3] for a reason.
[1] For the somewhat obvious reason that your immune system has already seen the virus.
[2] See tables 2 and 3 here: https://pmc.ncbi.nlm.nih.gov/articles/PMC8706722/
It's also worth calling out table 4, which shows the (IMO bad) efficacy data for biological men, which is why I only talk about women, above, and why anyone who recommends vaccination without mentioning this factor is not being entirely forthright. Few people are rushing to give older men the HPV vaccine because it's not really supported by data!
[3] I believe the current guideline is under age 45 in the USA.
> Unless you plan to remain completely celibate
Uh, monogamy of both partners is also an option, not just celibacy. Not common in these times, I know, but you don't have to completely abstain from sex to be safe.
I don’t get it. Everyone online gives advice like “Ask your doctor to get the vaccine even if you’re male” but the pharmacies here in SF refused to give it to me. They said that it’s not indicated for a 35+ yo male.
So I get the theory of this thing. But has anyone actually tried this? Finally I got OneMedical to prescribe it for me for some $1.2k at which point I decided I’ll just get it abroad during some planned travel.
I decided years ago I’d do this because I was going to have girls and I wanted to minimize my daughters’ risk of cancer.
Try Planned Parenthood.
Over a decade ago I tried getting the HPV vaccine in my early 20s, but the doctor told me it wasn't recommended for men and that insurance won't cover it. I was young and didn't have the money to pay out of pocket.
I went to Planned Parenthood and got the vaccine last year. At some point they changed the recommendation to men under 45 now and I got all 3 shots free.
Honestly, though I'm glad to have finally got the vaccine it's been a pretty frustrating experience.
Oh that's interesting. Thank you. I have a friend who works there as a provider. I should be able to check before going.
That's great!
For more context, I have Anthem Blue Cross health insurance. The cost might depend on your insurance.
Just sign up for it at costco online.
Oh, that's much less: $300/dose and there's 3 doses. So that's $900 roughly. Thank you.
How did you know you were going to have girls?
Carrier screening revealed a shared genetic risk so my wife and I decided to do IVF and PGT qualified our female embryos as unaffected (coincidentally, it’s autosomal recessive).
If you want to read more: https://wiki.roshangeorge.dev/w/IVF
Just a quick point as an American living in Denmark, one of the reasons government programs like this work so well is everything is delivered digitally. We have "e-boks" https://en.digst.dk/systems/digital-post/about-the-national-... official government facilitated inboxes so when they need to notify you of vaccinations or whatever else, it arrives to your inbox. And basically 100% of residents use these systems.
I fail to see how e-boks makes this work. Younger people check their e-boks less frequently than average, so sending a physical letter to their address would work just as well if not better.
What makes it work is the public registers.
e-boks sends a text message to the phone, so I see it much faster than a paper mail.
e-boks is like gmail (and others) in that it keeps your old mail. So you can easily find old stuff, a great improvement on paper mail.
I don't even check my physical mailbox once a week.
Denmark is one of the very most digital countries. Physical mail is very much on the way out. We no longer has mailboxes to send mail, you have to go to a shop to send letters, which now cost at last $6 per letter due to the low amount of mail sent.
It is only a matter of less than 10 years before letters will be fully gone.
Thats all besides the point. Which was that e-boks is not making vaccine programs possible or successful.
I think it certainly helps, although of course anything is possible without anything.
6€ for a letter that's ridiculous.. wow
Okay, well Ireland has similar vaccination rates, broader childhood vaccination coverage, and no central medical records at all, so while e-boks may assist administration, it's certainly not necessary.
> no central medical records at all
Which is bad, we definitely should have them. Referral data appears to be managed through Healthlink, which may just be a privatised not always used medical record system.
I'm a proponent of EHRs but not necessarily of centralised medical records, which have not been shown to improve outcomes and which do impose serious privacy risks on patients.
HealthLink is a messaging system and stores no EHRs at all. eHealth is the National EHR programme aiming to roll out EHRs by 2030 nationwide.
It will be a no-opt-out centralised EHR and combined social care record.
+$100k per man vaccinated in effective economic outcomes (less cancer, longer lives, less debilitating conditions) for those who needed to hear this.
https://pmc.ncbi.nlm.nih.gov/articles/PMC2759438/
Want to boost the economy massively at next to no cost? HPV vaccinations are incredible.
I don't think that's what the summary is saying.
My reading of the following is that the cost of each additional quality adjusted life year would be over $100,000, rather than that each vaccination prompts $100k in economic value
> Including preadolescent boys in a routine vaccination programme for preadolescent girls resulted in higher costs and benefits and generally had cost effectiveness ratios that exceeded $100 000 per QALY across a range of HPV related outcomes, scenarios for cervical cancer screening, and assumptions of vaccine efficacy and duration
It has really been a great success in Denmark.
In the 1960s, more than 900 people were diagnosed with cervical cancer each year, corresponding to more than 40 cases per 100,000 Danes.
Today, that number is below 10 per 100,000 nationwide – and among women aged 20 to 29, only 3 out of 100,000 are affected. This is below the WHO’s threshold for elimination of the disease.
The data is IMO quite convincing. Harald zur Hausen pointed this out decades ago already; this is another data point that adds to the theory which back then he proposed was fairly new (not that viruses cause cancer, that is much older knowledge, but specifically the role of some HPV strains; Harald died about 2 years ago).
Lots of viruses are really oncogenic. The real success here is the ability of Denmark to track effectiveness. It sounds crazy but most countries do not have electronic health record capability to measure the effect of many interventions at population scale. Once good EHRs are rolled out, we will be able to double down on effective interventions, like this one, and vice versa.
"Lots of viruses are really oncogenic."
Hmm. Compared to what measurement? Most viruses are actually not oncogenic.
From cancer causes, oncogenic viruses are thought to be responsible for about 12% of human cancers worldwide:
https://www.mdpi.com/2079-7737/14/7/797
From what I remember, most viruses are not oncogenic in nature, so I am unsure whether the statement made is correct.
EHRs are definitely not necessary for health surveillance and many countries perform equally or better without centralised records.
I'm a proponent of EHRs, but the key value is at patient-level, not population level where other approaches perform equally well.
Sadly, no matter how good the data is, some societies will value opinions of uninformed celebrities above facts and reason, leading to a resurgence of preventable diseases.
The numbers are quite solid. People who don't want to accept the numbers, need to come up with an explanation why the data can not be trusted. With regard to oncogenic HPV, I think the data is very convincing. To me it was a lot more convincing than the SARS covid datapoints (e. g. the media constantly shifted; I noticed this with regard to Sweden, which had a bad early data due to barely any protection of the elderly, but lateron it still had better data than e. g. Austria which went into lockdown - so Austria had worse data points than Sweden overall. Japan or Taiwan had excellent data points, so the respective governments were much better than either Sweden or Austria. The most incompetent politicans acted in Austria during that time, replacing facts with promo and propaganda. The data points, though, were always solid. I remember I compared this about weekly and it was interesting to me when Austria suddenly surpassed Sweden negatively; the media here in Austria critisized Sweden early on, but once Sweden outperformed Austria in a better, more positive manner, suddenly the media no longer reported that. Private media simply can not be trusted.)
I mean the issue in this case is not celebrities, the health services in most countries will not give you the vaccine as a man, full stop.
These celebrities should serve some jailtime. Quackery is criminal, it kills people.
As bad as many celebrities/politicians are (I'm waiting/fantasizing for "cheeto in chief" to sit in the same jail cell as "bubba"), the real quacks are organized groups like Chiropractors, "Naturopaths", Multi-level-marketers, etc.
My medical insurance will pay for several literally fake/quack treatments because of this crap. If you want to wage war against Quackery I better see you going after "big Chiropractor" first.
Why limit yourself. Do both.
Agreed. But we should also stop enabling celebrities when they push popular agendas even if they are correct. For example, climate change.
Celebrities in general are quite dubous. See a certain actor suddenly promoting Palantir spysniffing on mankind. I decided that guy won't get a dime from me for the rest of my life - when actors suddenly become lobbyists for Evil, they need to not get any money from regular people really.
This is just normal not supporting things you disagree with. It's not a rule of thumb you can quickly use to discount an opinion. Ignoring actors is a pretty handy rule of thumb. Their main skill is repeating someone else's words and emoting. There is no reason to consider them smart, knowledgeable, informed, or competent.
Exhibit a: “not quackery”
Yeah, we should have a Ministry of Truth that declares things "quackery" or "misinformation" and then jails people for saying it. I can't see how this could possibly go wrong.
Quackery is already illegal in many places, it did not lead to a 'ministry of truth' or equivalent.
Quackery in what sense? It is my understanding that to be a quack in a legal sense one must first be a licensed doctor, and malpractice is covered by freedom of speech. But you referred to celebrities practicing "quackery" which I assume means that they were saying the same nonsense that could get a doctor's license pulled, and that is absolutely covered by freedom of speech.
Also, you have already admitted there is a Ministry of Truth equivalent, as such a thing is necessary to prosecute people for telling lies.
Idk the Danish approach of opennnes seems to be working for them. They acknowledge it isn't fully effective. They acknowledge that there may be a small risk of side effects. And they tell people it's worth it and to go take it.
"Since HPV vaccination was implemented in the Danish childhood vaccination programme in 2009, we have received 2,320 reports of suspected adverse reactions from HPV vaccines up to and including 2016. 1,023 of the reported adverse reactions have been categorised as serious. In the same period, 1,724,916 vaccine doses were sold. The reports related to HPV vaccination that we have classified as serious include reports of the condition Postural Orthostatic Tachycardi Syndrome (POTS), fainting, neurological symptoms and a number of diffuse symptoms, such as long-term headache, fatigue and stomach ache."
"The risk of cervical changes at an early stage was reduced by 73% among women born in 1993 and 1994, who had been vaccinated with the HPV vaccine compared with those who had not been vaccinated."
"The Danish Health Authority recommends that all girls are vaccinated against HPV at the age of 12. The Danish Health Authori- ty still estimates that the benefits of vaccination by far outweigh any possible adverse reactions from the vaccine."
https://laegemiddelstyrelsen.dk/en/sideeffects/side-effects-...
Its not like it wasn't without issues. You had the documentary from a state funded tv station that uncritically let people claim all kind of issues after getting the vaccine. It drastically lowered the uptake of the vaccine.
> They acknowledge it isn't fully effective. They acknowledge that there may be a small risk of side effects. And they tell people it's worth it and to go take it.
Those are basic bits of knowledge that apply to most vaccinations.
The problem is that the quacks diminish the positive effects, exaggerate the negatives and engage in a campaign of fear mongering that costs some people (and in some cases lots of people, see COVID) their lives. They are not only clueless, they are malicious.
From Gwyneth Paltrow, JFK Jr, all the way to Donald Trump and a whole raft of others the damage is immense. I have a close family member who now is fully convinced of the healing power of crystals and there isn't a thing you can do to reason with people that have fallen into a trap like that.
But maybe you have fallen into a trap? Maybe believing in crystals is their own damn fault rather that jailing “influencers” for inducing wrong-think.
People are gullible. Those that prey on the gullible are culpable, the gullible have problems enough as it is.
I think those who advocate for censorship are gullible and have fallen for the bush-league trap of believing that the state is on your side and exists to benefit you.
Telling lies should never be criminalized, because there is no single trustworthy arbiter of truth.
This has nothing to do with vaccines. There is a very good reason that misinformation is, and should remain legal. This simply allows the person or group who gets to define what is or is not misinformation to arbitrarily imprison anyone doing publishing they don’t like.
You really need to think through the implications and consequences of censorship laws before advocating for them.
> You really need to think through the implications and consequences of censorship laws before advocating for them.
Maybe I did?
It is possible that we just disagree on this. Clearly misinformation about medical stuff is so damaging that many places have found it necessary to have laws on the books. I'm just elevating this from a misdemeanor to an actual crime based on the outcomes.
What if 25 years ago I spoke out against opiods as highly addictive and dangerous. Remember, this was in contradiction to the scientific consensus at the time that modern opioids were not that addictive. A reasonable person could have said at the time that my claims were false and posed a danger to people who were in pain and needed this medication. In hindsight it's obvious that the scientific consensus was catastrophically wrong, but it people like you were in charge, people could be jailed for their dissent.
If you did you'd have been in very good company because the world over the scientific consensus was that opioids were addictive.
That scientific consensus you are alluding to is not what you claim it was.
Finally, we're talking about celebrities without any qualification whatsoever spreading utter nonsense causing real harm, you can look at that in isolation and compare it to you making that statement out of an abundance of caution regarding something where there is no downside. The two simply are not equivalent. Free speech absolutists always pull the same trick, aiming to refuse an obvious wrong in order to defend their bastion while forgetting that there isn't a black-or-white at all, you can have some reasonable limits on what people can and can not do and in the age of 'influencers' with global reach the danger is much more prevalent than it used to be.
Free speech is a great good, but it is not the greatest good.
A comment with an article citing published medical literature on risks associated with this type of vaccine was flagged and hidden. Why? I don't know the author nor am I a medical doctor to understand the topic at depth, so it's a genuine question. Was it misleading? If so, how? That's what the comment was asking, actually, if there were counter-points to the text, which was favorable to live vaccines (e.g. shingles) but critical of those developed with other methods. Is there no merit to that? I genuinely don't know, and since it seems impossible to discuss the topic, it's hard to say.
I sometimes vouch for incorrectly flagged posts. You got me curious, so I took a look. What I found was a blog from an anonymous conspiracist vaccine opponent claiming to be a doctor. He's a decent writer but in my estimation a loon.
So I'm fine with it being flagged and decline to vouch for it.
It was a misleading post.
For the HPV section specifically, there were at least two major omissions.
First, in his table showing autoimmune adverse effects, he has chosen to crop out the next column in the table containing the control conditions - which show very similar rates of adverse effects to the vaccine condition.
Secondly, when discussing negative efficacy in the case of existing persistent infection, he only quotes the data from one of three studies that the linked report covers. The linked report indeed covers the negative efficacy in study 013 as an area of concern. However, study 015 (which had roughly twice the number of total participants as study 013) showed no real evidence of negative efficacy. When all 3 studies are pooled together, the point estimate still says negative efficacy, (at ~-12%), however the error bars are quite wide.
Why this is tragic, is because these two omissions do actually point to failures in public communication about the vaccine. For example, the control condition in the Merck trials were a mix of saline injections (this is the traditional placebo), as well as injections with just the adjuvant (AAHS). This is less standard, and raises legitimate questions about why Merck used an adjuvant as the control, instead of just saline. There a cynical/conspiratorial angle to this question, which I think would be directionally correct.
The second omission is because I think there is a reasonable question of "are there extra risks associated with getting the HPV vaccine while having an active persistence infection", even when taking into account the different and larger study populations within the original trial data. Once again, I think the idea that both companies and public health agencies don't want to deal with a vaccine that requires testing before hand is true. I also believe that on a population level, even if there was a modest increase in risk in that specific subgroup, it makes sense to implement broad vaccination campaigns.
That said, I think the unwillingness of public health agencies to engage with this tricky area of communication and education creates these types of opening for anti-vaccine messaging. If you want a sense of "conspiracy" - here's a random review study - https://pmc.ncbi.nlm.nih.gov/articles/PMC8706722/
Notice that when reporting results, the groupings for HPV status at enrollment time are "naive" and "irrespective" - the "test positive" grouping isn't broken out.
EDIT: The article that we're discussing is https://www.midwesterndoctor.com/p/the-perils-of-vaccinating...
We got my son vaxxed for this when he was able, and the doctor doing it was quite reluctant to do it. (US; ~2001)
> Infection with HPV types covered by the vaccine (HPV16/18) has been almost eliminated. Before vaccination, the prevalence of HPV16/18 was between 15–17%, which has decreased in vaccinated women to < 1% by 2021. However, about one-third of women still had HPV infection with non-vaccine high-risk HPV types, and new infections with these types were more frequent in vaccinated than in unvaccinated women.
I wonder if we'll those non-vaccine strains will eventually become the most prevalent.
Sounds like in countries like Denmark, they are already on their way to becoming the most prevalent.
Hope we'll develop vaccines against those too.
In my EU country Gardasil 9 is the most common HPV vaccine nowadays. This protects against 9 most common strains. I would assume the same is true in other countries. We have gone from HPV 16/18 -> +6/11 -> +31/33/45/52/58 protection with 2/4/9-valent vaccines.
Another angle of why vaccinating men is important is because gay men (or more precisely those who participate in oral-penile or penile-anal sex) are at risk for these cancers, but if we only vaccinate women then we do not protect this group of men.
Also on my soapbox it's an absolute absurdity that we still do not have any HPV test for men.
Absolutely completely off the topic at hand here, but it seems like the bot and troll level goes up a lot on topics like this. A lot of people use HN data for training data, stats analysis, etc. Anyone out there figure out some good tools for trying to detect the bots in a thread like this? There are probably some good tells with throw-away accounts, account age, etc etc. In a world where misinformation is algorithmically generated and comments are a prime way that happens getting tools that can detect it is important. Hmm if there are good tools I wonder if they could be built into a plugin somehow.
At what age can you start getting vaccinated?
I don't know about Denmark, but the US CDC indicates that you can get the HPV vaccine starting at 9; with a recommendation do get it at 11 or 12.
https://www.cdc.gov/vaccines/vpd/hpv/hcp/recommendations.htm...
Everyone already knows!
HPV vaccination leads to massive reduction in nasopharyngeal, penile and rectal cancer in men.
The focus of messaging around HPV vaccination on ovarian cancer, female fertility and the age limitations for recommendations / free vaccination in some places are nothing short of a massive public health failure and almost scandal.
Just truthfully tell the boys their dicks might fall off and see how all of them quicklky flock to the vaccine.
> Just truthfully tell the boys their dicks might fall off and see how all of them quicklky flock to the vaccine.
Every male above the age of 26 is locked out of the vaccine unless you pay out of pocket, which will be €300-€500 (or even higher).
It's led to this really weird situation, where HPV vaccination for men is now recommended up to 40s but only covered up to 26yr old, and that recommendation upgrade happened relatively recently. Which means there's a whole generation of men who are told they should get the vaccine, who would have had covered access to the vaccine in the past, but are now expected to go out of pocket.
Yep, I paid for mine. male/43/Spain. Almost €400. Two shots of the nonavalent vaccine, ~€190 each.
For younger people it's three shots (second after two months, third after 6 months of the first one), now for older (over 30s or 40s, I can't remember exactly) it's recommended to get two shots (second after six months).
This seems to be changing in some areas. I am in the US, in my 30's, Male and I only had my $30 copay for the first visit (nothing for my second shot)
Promiscuity is not a healthy lifestyle and we need to stop presenting it as one. The AIDS crisis of the 1980s should have been enough of a warning. If people don't sleep around then HPV's spread will be much reduced and they will be much less likely to catch other STIs.
If people stopped driving, we would have zero car crashes.
This adds nothing. It has been repeatedly shown that stupid abstinence-driven approaches to public health do not work. It’s equivalent to saying “maybe the obesity crisis would be solved if we all just ate less”.
Moral crusades have zero place in public health and are actively harmful.
This isn't an abstinence driven approach it is a marry 'young' and then only that one partener for life.
What a truly sad life
And yet countless couples followed this path in life and are happy
Many miserable people married young and are trapped until they die.
And countless couples followed this path in life and are not happy at all, and countless individuals can't for a variety of reasons follow this path. But public health advice should also be available to them.
Psychology is a whole other matter, but if you're talking about sleeping around like Bonnie Blue then it is a form of Russian roulette and is likely to result in physical health trouble. Especially if people are having unprotected sex.
HPV spreads through oral sex as well by the way.
I am not talking about 'sleeping around' at all. Just by the look at the divorce rates around the world it is very clear that 'marry young and then never change partners' is an advice divorced from reality.
Divorce is horrible for sure but that is mainly down to interpersonal relationships.
It is a simple fact that unprotected sex with large numbers of people is very risky. We should have learnt that lesson in the eighties.
If there's somebody out there advocating for "unprotected sex with large numbers of people", you should go post at them, because I don't see that here.
The biggest barrier to disease transmission reduction, at least here in the US, is uncritical abstinence promoters like yourself. It works, at best, for a small fraction of the population, and leaves the rest woefully unprepared for the biological realities. The best solution to STDs is education. Which, yes, should emphasize that not having sex is an option, but cannot stop there.
Same goes for people who did not.
Not as sad as catching something which will damage you physically, sterilise them or even kill them.
People don't want to hear this obviously. But it is a fact STI transmission has skyrocketed since the so called sexual revolution of the late sixties. Within fifteen years, we has an AIDS epidemic.
But it is a fact STI transmission has skyrocketed since the so called sexual revolution of the late sixties
It’s the opposite of a fact. Gonorrhoea rates as an example rose significantly in the 1960s, but are now lower than in the 1940s and 1950s. This is thanks to good public health measures.
Start by making sure you’re accurately informed.
Gen z are depressed, lonely, and less sexually active then their predecessors, so you may see your desired change come to pass.
That just seems like abstinence with extra steps.
You could probably have gotten away with it a decade ago but that is a very poor plan in the far more critical of public health world of today.
Statistically nobody even knows a guy who knows a guy who's dick fell off. Serious HPV problems for men are not even common enough to be viable urban legend. You have less to back up your DARE messaging than DARE did. It's just not gonna work. The nanosecond someone who took your bait shows up to be interviewed by some Youtube talking head about side effects the already severely damaged (compared to, IDK a decade ago) credibility of the medical establishment will go up in flames.
You need to tell the truth the whole truth and nothing but the truth and let people make their own decisions. People don't "trust the experts" anymore at the scale you need for stuff like vaccination campaigns so you have to operate based on that reality.
Apparently HPV is responsible for some ~70% of throat cancers and ~30% of penile cancers in men. Seems pretty significant to me.
If nobody knows a guy who knows a guy who had penile cancer, that's probably because people are very bad about talking about genital health. I'm sure some of the men in my life have issues with erectile dysfunction, enlarged prostates, hemmorrhoids, etc. But no one is talking about those issues.
70% of throat cancers? In a world with cigarettes and chewing tobacco? I find that a very surprising number - so surprising it's almost unbelievable.
Got a source?
Think of it as shared responsibility. The tobacco and the virus are both reasons why you got cancer and died, prizes for all.
So maybe 70% of throat cancer victims have HPV, and like 70% smoked - and if those were independent facts you'd expect that about 49% both smoked and had HPV, but it's actually more than half 'cos it turns out that if you have HPV then smoking is even worse. So that's nice.
"Currently, the estimated proportion of oropharyngeal cancers testing positive for HPV within the United States is 68%–70%"[0]
[0] https://www.asha.org/practice-portal/clinical-topics/head-an...
And how many men get throat and penile cancers vs other cancers and health issues? There's a reason old men crack jokes about prostate health, erectile dysfunction and incontinence rather than their dicks falling off and are way more worried about colon cancer than rectal cancer.
I didn't say it wasn't a significant source of cancer. I said that nobody knows a guy who knows a guy who's dick fell off or some other extreme outcome. Without enough of that to back up your messaging it just won't work. You need to be honest with people, not try and scare them like you're trying to keep school kids from smoking weed in 1990.
The public messaging you're trying to engage in could perhaps have skated by in a less critical time but in the current environment it will be counterproductive.
I don't want my kid or my grandkid to get measles or some other "of immediate consequence" disease because they go to school with a bunch of unvaccinated kids because you people sullied the reputation of public health via "just push the truth a little, it'll make them take the vaccine" type endeavors.
> "you people"
JFC. I'm checking out of this conversation.
HPV is also responsible for very unsightly genital warts. I'd think people would want to avoid that if possible.
The only thing I've never understood about the HPV vaccination is that for some reason after a certain age as an adult in the United States, no primary care provider appears to recommend you get it in addition to your regular vaccination schedule.
Is the idea that you're married and have a single partner and the risk factor has dropped below a certain percentage of the population where there's little reason to recommend getting it if the likelihood is that you've already acquired HPV in your lifetime thus far?
Every other vaccination appears to be straightforward, besides HPV, and I don't know why. I've also never heard a clear answer from a physician.
Is it just that our vaccination schedules are out of date in the United States? This seems to be the most likely culprit to me.
Here's the CDC's most recent recommendations (from 2019) https://www.cdc.gov/mmwr/volumes/68/wr/mm6832a3.htm
The justification for 27-45 year olds heavily references a meeting. Based on time, author and title, I think either https://stacks.cdc.gov/view/cdc/78082/cdc_78082_DS1.pdf or https://pmc.ncbi.nlm.nih.gov/articles/PMC10395540/ should be a fair summary of the meeting (I hope...).
I don't really have time to read it all, but the basic idea is as you said - the cost-benefit ratio is off. Basically expanding from something like the current case, to vaccinating up to 45 year old will avert an extra 21k cases of cancer (compared to the base case of 1.4 million) - so about an extra 1.5% cases averted, while the direct vaccination costs are estimated to increase from 44 billion to 57 billion (+29%).
The current guidance says "do not recommend" plus "consult your doctor". You should read that as "blanket vaccination as public policy is cost inefficient in that age range" not "you as a 45 year old should not get the vaccine categorically".
Do the conspiracy theorists believe it or not?
This is one of the many reasons I think medicine is full of people who are good at memorizing but are outright stupid when it comes to problem solving and logic.