Friday, February 27, 2009
An Open Letter to Our Health Insurance Company
Thank you so much for informing me that you would be happy to pay for the three Gardasil shots, and, I assume, booster shots as necessary, for each of my two daughters.
Imagine my joy at hearing this! Particularly, I might add, since over the last 10 years you have declined to pay for a cast for Daughter #1’s broken wrist, a splint for Daughter #2’s sprained ankle, and for most of the cost of an MRI after a head trauma. I am fortunate indeed that the $14,000 I pay you each year to insure our small and mostly healthy family means that you can now afford to pay up for Gardasil.
But here’s the thing. We’ve looked, endlessly, at the risk/reward ratio. In the US, 11,070 women will be diagnosed with cancer this year and 3,870 will die. According to the National Cancer Institute, that makes it the 14th most common cancer for women—pretty far down the list. And attention to lifestyle and regular Pap screenings can dramatically reduce even this small risk.
When Kaiser Permanente studied its members’ records, they found that more than half of the women who had been diagnosed with cervical cancer had not chosen to take advantage of their Pap smear test coverage. That’s not us. We look after ourselves, we eat our veggies, we don’t smoke and we get regular check-ups. And I appreciate Merck’s drawing our attention, albeit rather dramatically, to HPV, but with care the rewards gained by this vaccine appear to be minimal.
On the risk side, I see multiple reports of auto-immune disease and many other side-effects that may or may not be connected to Gardasil. I see evidence that side-effects in susceptible women apparently increase with each of the three shots, and I see that no-one knows if fourth, fifth, and even sixteenth booster shots, or reformulated shots, will be necessary over my daughters’ lifetime. I look at Prevnar, and think about the risks of perhaps even more vicious replacement diseases gaining ground when a shot vanquishes only a few strains of HPV out of more than 100.
So I’m going to decline your kind offer. But wait! You’re not off the hook yet.
Cervical cancer, though not a huge issue in the US, even with some 40 percent of women unable or unwilling to have regular Pap tests, is indeed a big issue in developing countries. In these countries it is the leading cause of cancer-related deaths among women, accounting for 85 percent of the 253,500 annual deaths from cervical cancer worldwide. Clearly the risk/reward ratio is turned on its head in developing nations.
So here’s what I propose. Just send our doses of Gardasil to one of those countries. Africa would be good; I’ve been there and I’m fond of it; but honestly, you can send it wherever the need is greatest. Maybe other Blue Cross/Blue Shield members, or Kaiser Permanente members, or JoeBlow down the street members—in fact anyone who chooses not to get the shots despite coverage—would like to ask their insurance companies to do the same.
How about it, ladies?