Friday, February 27, 2009

Dear Blue Cross: Here’s Where to Send Our Gardasil Shots


An Open Letter to Our Health Insurance Company

Dear BlueCross/BlueShield,

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?


Anonymous said...


This is a wonderful piece. Well done. My now 19 year-old daughter is one of the thousands of girls and young women who have experienced adverse side-effects from Gardasil. I wish I knew now what I did then...I most certainly would have donated my daughter's 2 doses to another young girl who doesn't have access to regular health care. Maybe I should call my doctor's office and ask him to put the third dose into the mail.

teacher3rs said...


For those reading Kristin's column, please join the girls that have experience adverse side-effects and the sign the petition to Pres Obama and Congress to Investigate Gardasil Risks, NOW!!!

Joe Bloe said...

lets turn back the hands of time and give up all our medical fact..let's start writing on stone tablets again. You all are much too young to have seen the disabling affects of polio or rubella..if you dont want it. fine..dont get it. but dont send out useless messages about a vaccine you know nothing about . oh sure. you got your Ph D off the internet and that makes you an expert on it.lest I forget .
did any of you ever think of underlying medical conditions or exacerbating risk factors -smoking,drugs , OC's the list goes on. but hey...who am i to ruin your blog ...hmm..Just like you i guess ??

Joe Bloe said...

and I am sure the people in Africa would love free doses..if you know these places you know how appreciative they are of any health care..DA's

Kristin said...

Dear Joe,

Au contraire. I'm a big fan of the polio vaccine; I've written articles about polio and my kids sure got their shot. Is it perfect? No. But are the rewards worth the risks? Yes.

My daughter just got her meningitis vaccine. Meningitis is rare, but devastating, so yeah, she got it before heading off to college.

Gardasil is different. We've weighed the risks and the rewards and for our family, it came up short. Each family needs to consider their own circumstances. My kids have autoimmune disease in the family, so for us, potential triggers have to be carefully considered.

Incidentally, you didn't mention the HUGE risk factor of smoking for cervical cancer. You're up to 27 TIMES more likely to have a persistent HPV infection if you smoke.

Yep, they'd sure be glad of free Gardasil in Africa. That's why I wrote the post.

Anonymous said...

Hi Kristin,

Came across your blog while trying to get a final answer on insurance coverage for Gardasil. What was the outcome of your letter? What has been the outcome on your daughters' health? Assuming this many years have passed, they must have been exposed to some strain of HPV by now. Would you say that avoiding the Gardasil Vaccine has been a good decision for your daughters' health in the long run?