Government Panel Recommends HPV Vaccine for Boys

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A federal advisory committee voted on Tuesday to recommend that boys aged 11 and 12 be vaccinated against human papillomavirus, or HPV, to protect against anal cancer and cancers of the mouth and neck. The new guidance mirrors that for girls aged 11 and 12, who have been advised since 2006 to receive routine HPV vaccinations.

The HPV vaccine is already approved by the government for males aged 9 to 26 to prevent genital warts and anal cancer, but the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) had not issued a formal recommendation for routine vaccination in boys until now.

In part, that's because when the vaccine was approved for use in boys and men in 2009, there wasn't enough evidence to justify the cost of population-wide vaccination. The HPV vaccine is expensive, costing hundreds of dollars for the three-dose series.

Since 2009, however, studies have provided additional information on the benefits of vaccinating boys, helping to lead to the ACIP's current, unanimous decision. In February, for example, researchers reported that the HPV vaccine prevented 90% of genital warts in men who were not infected with the virus before immunization. The vaccine was also found to be 75% effective in protecting against anal cancer in a study of primarily gay men. There is also early evidence that it protects against certain penile and throat cancers, and recent data suggest that HPV is increasingly responsible for some mouth and throat cancers, which have been on the rise — probably because of increasing rates of oral sex.

With 20 million Americans infected with HPV each year, the new recommendations for boys will be an important part of cancer prevention in coming years, according to public health expert. Anne Schuchat, director of the CDC's National Center for Immunization and Respiratory Diseases told reporters that "Today is another milestone in the nation's battle against cancer."

MORE: HPV Linked to More Oral Cancer Than Smoking

Now that the CDC's committee has officially recommended the vaccine for boys, most private insurers are likely to start paying for it.

HPV infection is the most common sexually transmitted disease in the U.S. Most sexually active men and women will acquire the virus at some point in their lives. In most people, infections will clear on their own, but in some, persistent infections can cause genital warts or cancer, including cervical, vaginal and vulvar cancers in women and anal cancer in men. The most widely used HPV vaccine, Gardasil, manufactured by Merck — to which the ACIP recommendation applies — is designed to protect against the four high-risk strains of the virus that contribute to warts and cancer.

For the most part, the ACIP's advice for vaccination in boys involves the same reasoning behind the recommendation for girls aged 11 to 12: that immunizing youngsters as part of routine childhood vaccination programs — despite the fact that they are not necessarily sexually active or at high risk of HPV infection — ensures that more people will be protected against HPV early on.

Of course, the issue of sexual activity has been the sticking point for many parents of youngsters who are eligible for the vaccine. That concern is largely responsible for low vaccination rates in girls. Despite the data showing that the HPV vaccine prevents cancer, only 44% of girls aged 13 to 17 had received one dose of the vaccine, and only 27% had received all three doses in 2009. The vaccine is supposed to be given before girls become sexually active.

MORE: With the HPV Vaccine, Two Doses May Be Just as Good as Three

The low vaccination rates in girls help justify the cost of vaccination in boys. If more males are protected, then they will be less likely to pass the virus to females. "If the boys are also immunized, it reduces the transmission back and forth," Dr. William Schaffner, chairman of the department of preventive medicine at Vanderbilt University School of Medicine, who attended the CDC meeting as an adviser but not a voting member, told CNN.

However, some experts expect the vaccine to be an even tougher sell in boys than in girls, in part because anal cancer is relatively rare in men and because most cases are in homosexual men. Some parents may say, "'Why are you vaccinating my son against anal cancer? He's not gay! He's not ever going to be gay!' I can see that will come up," Dr. Ranit Mishori, a family practice doctor in Washington, D.C., and an assistant professor at the Georgetown University School of Medicine, who supports the ACIP's recommendation, told the AP.

For its part, the American Academy of Pediatrics included the HPV vaccine in its schedule of routine vaccinations for 9-to-18-year-olds, released in February.

MORE: Vaccine Safety: New Report Finds Few Adverse Events Linked With Vaccines

Alice Park is a writer at TIME. Find her on Twitter at @aliceparkny. You can also continue the discussion on TIME's Facebook page and on Twitter at @TIME.

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Government wins key NHS bill vote

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12 October 2011 Last updated at 15:49 GMT Earl Howe said a vote to delay "could well prove fatal" to the Health and Social Care Bill The government's controversial NHS bill for England has cleared a crucial hurdle after peers rejected a proposal to send it for further scrutiny.

The House of Lords voted 330 to 262 against an amendment which would have referred parts of the bill to a special select committee.

Health Minister Earl Howe said it could be altered further to address concerns, but any hold-up could "prove fatal".

Peers have also rejected an amendment to block the bill altogether.

That amendment was put forward by Labour peer and former GP Lord Rea, who argued it was never a manifesto commitment by either the Conservatives or the Liberal Democrats.

It was rejected by 354 votes to 220.

The Health and Social Care Bill - which will now proceed to a normal committee stage in the Lords - would increase competition and put GP-led groups in control of buying care in their areas.

Ministers say the changes are vital to help the NHS cope with the demands of an ageing population, the costs of new drugs and treatments and the impact of lifestyle factors, such as obesity.

Continue reading the main story Ross Hawkins Political correspondent, BBC News

Two battles won, a war still to fight - these much debated changes to the NHS still have a long way to go. Labour failed to kill the bill, but they were never likely to succeed.

Lord Owen's idea of an extra committee, which could have meant extra delay, was also defeated.

But winning votes is one thing, changing noble minds quite another.

Plenty of peers fear the bill could make the Health Secretary less responsible and less accountable for the health service.

Some of them want more changes when they get to discussing the details. The government has hinted they may get them.

And could Labour try to create yet more delays? They say that is not their plan but government whips will keep a close eye on anyone attempting to talk the bill to death.

They say the bill, which has already been substantially altered following criticism from NHS staff and Liberal Democrat MPs, now has wide support.

But leading medical professionals have warned that the proposals are still unpopular.

"Choice is fine but to have choice ahead of quality and delivering consistent healthcare, seamless healthcare for patients, is going to result in a chopped-up health service with little bits competing with other little bits," Dr Laurence Buckman, a senior representative from the British Medical Association, told BBC Breakfast.

Labour's shadow health secretary Andy Burnham said the "fight" over the bill would go on, despite the vote on Wednesday.

"It will be debated now over a number of weeks, even months, in the House of Lords - line by line, clause by clause - and Labour will be wanting changes to this bill, substantial and drastic changes to it, so this is far from over," he told the BBC.

Andy Burnham: 'It's a sad day for the NHS'

"The government are digging in here, they're digging in for the long haul and that's not going to help our National Health Service."

The amendment calling for referral to a special select committee, which allows witnesses to give evidence, was tabled by two crossbench peers - Lords Owen and Hennessy.

They said the bill raised serious constitutional issues, particularly aspects relating to the role of the health secretary in overseeing the NHS and the role of the regulator, Monitor, in promoting competition within it.

'Shopping'

Lord Owen argued a special select committee was the only way of looking at "the complexity of this new relationship we are trying to establish" between patients, clinicians and the secretary of state.

"Health is not a public utility," he warned. "Health is different."

Lord Owen insisted his was not a "wrecking" amendment and said his select committee would complete its scrutiny by 19 December - in good time for the bill to complete its usual stages.

Continue reading the main story Jan 2011: Commons First and Second readings. Approved with no rebellionsFeb - Mar: Commons committee stage, various amendments accepted on competition4 April: Bill "paused" following widespread criticismApril - June: "Listening exercise" conducted by NHS Future ForumJune - July: Bill sent back to Commons committee stage. MPs approve further amendments prompted by listening exercise 6 - 7 Sep: Commons report stage and Third Reading - approved with four Lib Dem rebelsSep: Bill arrives in the LordsOct 12: Lords reject bids to block the bill altogether and to send parts of it to a special select committee Christmas? Ministers would like the bill to get royal assent by then but even without further delays, there are still several stages to go throughApril 2013? Further delays notwithstanding, NHS commissioning groups due to take charge of budgets thenLabour supported the amendment, and Baroness Thornton, who leads for them on health in the Lords, said the bill would turn "patient choice into shopping", while healthcare would become a "traded commodity".

However, for the government, Lord Howe, told peers the proposed changes would "liberate the NHS" and improve patient care in England.

"The bill does not do anything that might or could lead to the privatisation of the NHS," he said, summing up.

The minister said he was considering amending the bill to require Foundation Trusts to publish details of how their non-NHS earnings were benefiting NHS patients.

He said he was also tabling an addition to the bill on the duty of the secretary of state in relation to the education and training of NHS staff.

Lord Howe insisted any further delay at this stage could risk the entire legislation - which ministers want to become law by the end of the current parliamentary session next April.

"The House must have proper time to examine the bill but the proposal put forward by Lord Owen could result in delay, which could well prove fatal to it," he said.

And former health minister Lord Darzi, who wrote a report on the future of the NHS for Gordon Brown, has said the health service "must embrace change" or risk "falling back".

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HEALTH MANAGEMENT. U.S. government draws fire for pulling doctor data

n">(Reuters) - Consumer advocates and journalism groups are fighting a U.S. government move to cut public access to a database of malpractice claims and damages paid by doctors around the nation.
The Association of Health Care Journalists (AHCJ) and Consumers Union on Thursday joined several groups in criticizing curbs by a U.S. health agency earlier this month on public access to a database of malpractice settlements over concerns of a breach of one doctor's confidentiality.
Since 1986, the Health Resources and Services Administration (HRSA) has tracked troubled doctors' records in the National Practitioners Data Bank, an electronic database that, by law, is confidential and open only to hospitals, state licensing boards and other eligible healthcare entities.
However, the HRSA has also been stripping the database of any identifiable elements and making it available online to researchers, patients and the media through a so-called Public Use File.
That file has been down after a Kansas City Star reporter combined the data from it with his research of court records to identify details about a local neurosurgeon and later run a story exposing the doctor's history of being sued for alleged malpractice.
"As soon as HRSA became aware that in this case, a reporter was able to use the data in the (Public Use File) to obtain information about a specific physician we had no choice but to follow the law and remove the (Public Use File) from the website until we can find a way to make as much information as is it legal to disclose available as quickly as possible," said the agency's spokesman Martin Kramer in an email.
"The law is clear; information about individual practitioners in the NPDB is to be confidential."
The reaction from the Obama administration, which has pledged greater transparency, has puzzled journalists who for years have used the publicly available anonymous data to expose medical malpractice.
"Nothing else has changed; just their interpretation (of the law) seems to have changed," said Charles Ornstein, president of the AHCJ whose letter was also signed by the presidents of the Investigative Reporters and Editors group and the Society of Professional Journalists.
"If anything, the agency erred on the side of physician privacy," the letter said.
Journalists also criticized HRSA's warning letter to the reporter, Alan Bavley, before his story ran, telling him he could be hit with a civil monetary penalty for naming the physician based on confidential data from the file.
(To read the HRSA letter, see r.reuters.com/rys73s ; to read AHCJ's letter, see r.reuters.com/sys73s)
"The responsibility of the agency (HRSA) is to ensure that they do not provide any identifiable information in the data base, and that responsibility has been met for 15 years," said Lisa McGiffert, director of the Consumers Union Safe Patient Project, a consumer advocate that also sent a letter to HRSA.
HRSA's Kramer said he could not speak to what has happened in the past.
It remains unclear when and in what format the public version of the data bank may return online. For now, researchers can contact staffers at the data bank with specific research questions, Kramer said.
Other consumer groups including Public Citizen have sent letters to the HRSA, to which the health agency will respond "in a timely fashion," the spokesman said.
(Reporting by Alina Selyukh; Editing by Richard Chang)

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