Guest Post: Preventing HPV and Treating Science Illiteracy

Yesterday, Katie Couric’s daytime talk show weighed in on HPV vaccines. It seems the lack of representation of the benefits of the HPV vaccine was disappointing as many others have pointed out. Read this from Phil Plait for a good breakdown of the segment and corresponding issues. This from Alexandra Sifferlin on the dangers of vaccine misinformation a la Jenny McCarthy. This from Matthew Herper on “Four Ways Katie Couric Stacked the Deck Against Gardasil.” And this from Seth Mookin, really illustrating how disheartening this choice was given literate showrunners.

I have not seen the segment myself but I think more information about HPV, the vaccine and what it can lead to is in order. I’m pleased to introduce Megan Tetlow’s informative guest post on HPV. Megan Tetlow is a Physician Assistant in the subspecialty of gynecologic oncology, providing healthcare to women with cervix, vulvar, vaginal, uterine, and ovarian carcinoma. She is a graduate of the University of North Carolina at Chapel Hill and Nova Southeastern University in Florida.

HPV[Photo credit: http://bit.ly/1d1U1jf]

What is HPV?

HPV (human papilloma virus) is an extremely common virus that is transmitted by sexual contact. In fact, it is the MOST common sexually transmitted infection (1). It has been estimated that 50+% of sexually active adults have had the infection (2), with general medical opinion estimating that today it is probably higher. Rates of infection are highest among young women less than 25 years old (3).

Beyond that, according to the CDC, almost all sexually active adult men and women will be infected with this virus at some point in their lives, even if they’ve had only one sexual partner (1). Additionally, while condoms do prevent other sexually transmitted diseases, they may not prevent transmission of HPV (3).

The lack of knowledge about exactly how widespread this virus is may be one of the barriers to its prevention. Last year I watched an episode of Girls, and the main character’s biggest “baggage” was that she had HPV, when in reality every person on the show probably has HPV and most of the show’s viewers as well. The bottom line is that if you are an adult who is or has been sexually active, it is likely you have or have had HPV, and are potentially at risk for the diseases associated with this virus.

There are over 100 subtypes of the HPV virus. While most of these infections will be cleared by our immune systems, scientists have identified certain sub-types of the virus (specifically subtypes 16 and 18) that are oncogenic, meaning they can give rise to cancer. Oncogenic HPV subtypes are responsible for over 99% of cervix cancers (3). These virus subtypes (16 and 18) have also been found to cause cancers of the mouth, tongue, throat, anus, penis, vulva, and vagina (4). The CDC estimates that vaccination could prevent 22,000 cases of cancer in the US each year (5).

What is the HPV vaccine?

There are two HPV vaccines currently on the market. One is a bivalent HPV vaccine (Cervarix) that works against the oncogenic HPV subtypes 16 and 18.  The other is a quadravalent vaccine (Gardasil) which protects against those two subtypes, as well as sub-types 6 and 11 that are associated with anogenital warts.

Both vaccines are given in a 3 shot series over a 6 month period. Both HPV vaccines are approved and recommended for females ages 9-26. Gardasil has also been approved and is recommended for males ages 9-26. Since HPV is sexually transmitted, the goal age for males and females to be vaccinated is at around 11, with the hopes of being able to administer all 3 vaccinations before an individual becomes sexually active.

Is the HPV vaccine safe and effective?

Both vaccines are licensed, have undergone stringent testing, and have been approved by the Food and Drug Administration for the groups listed above. The CDC and FDA have several systems to continue to monitor safety of a vaccine, including the Vaccine Adverse Event Reporting System (VAERS). VAERS uses patient reporting to track and detect possible new or unexpected adverse reactions to a vaccine (7). Of adverse events reported from 2006 to 2013 through this system, only 7.9% were classified as serious in nature; among these, headache, nausea/vomiting, fatigue, dizziness, syncope (fainting), and weakness were the most frequently reported (8).

While decades of follow-up are certainly required to determine rates of cancer prevention following vaccination, short-term follow-up results have been very promising. The National Health and Nutrition Examination Survey published this year demonstrated a 50% decrease in HPV infections caused by subtypes 6, 11, 16, and 18 in females between the ages of 14 and 19 (9). Countries like Australia that have incorporated the HPV vaccine into the national vaccination program have noticed a significant decrease in genital warts infection among young men and women (10).

What are the barriers to vaccination?

Despite encouraging results, the majority of young men and women are still not being vaccinated.  Based on results of the 2012 National Immunization Survey-Teen, who have been collecting vaccination information on teens with the CDC since 2006, found that only 33.4% of appropriately aged adolescent females had received all 3 doses of the vaccine (8).

Additionally, over 23% of parents surveyed stated they did not plan to vaccinate their child (8). Why are adolescents not getting vaccinated against high risk HPV? In the same study, the most commonly listed reasons against vaccinating were parents felt the vaccine was not needed or not recommended, safety concerns, lack of knowledge about the vaccine and/or diseases it prevents, and that their daughter is not sexually active (8).

As a health care provider, I hear apprehension from parents that vaccinating their child will somehow cause them to be sexually promiscuous or that they are condoning sexual intercourse among adolescents, which is certainly not the case. If an adolescent ever has intercourse over the course of his or her lifetime with just one partner, then he or she is at risk for HPV and HPV-related diseases including cancer.

Overall, these results illustrate how dire education is needed—for patients, parents, friends, and the public. If you are a twenty-something male or female, consider vaccination. If you are a parent who would like to reduce the risk of your child getting cancer but have reservations, tell your healthcare provider and get more information. Only through increased education and awareness can we hope to prevent HPV-related cancers and one day cure science illiteracy.

References

  1. Centers for Disease Control and Prevention. Genital HPV Infection—CDC Fact Sheet. Centers for Disease Control and Prevention. 2010.
  2. Myers ER, McCrory DC, Nanda K, et al. Mathematical model for the natural history of human papillomavirus infection and cervical carcinogenesis. Am J Epidemiol 2000;151:1158–71.
  3. Kevin A. Ault. Epidemiology and Natural History of Human Papillomavirus Infections in the Female Genital Tract. Infect Dis Obstet Gynecol. 2006; 2006: 40470.
  4. Cogliano V, Baan R, Straif K, et al. Carcinogenicity of human papillomaviruses.
    Lancet Oncol 2005;6:204.
  5. Centers for Disease Control and Prevention. HPV Vaccination- CDC fact sheet. Centers for Disease Control and Prevention. 2013.
  6. Centers for Disease Control and Prevention. Sexually Transmitted Diseases Treatment Guide- Human Papilloma Virus. Centers for Disease Control and Prevention. 2010.
  7. Centers for Disease Control and Prevention. Vaccine safety: HPV Vaccination. Centers for Disease Control and Prevention. 2013.
  8. Centers for Disease Control and Prevention. Human Papillomavirus Vaccination Coverage Among Adolescent Girls, 2007–2012, and Postlicensure Vaccine Safety Monitoring, 2006–2013 United States. Centers for Disease Control Morbidity and Mortality Weekly Report. 2013.
  9. Markowitz LE, Hariri S, Lin C, et al. Reduction in HPV prevalence among young women following vaccine introduction in the United States, National Health and Nutrition Examination Surveys, 2003–2010. J Infect Dis 2013;208:385–93.
  10. Ali H, Donovan B, Wand H, et al. Genital warts in young Australians five years into national human papillomavirus vaccination programme: national surveillance data. BMJ 2013;346:f2032.
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Guest Post: How a two hour commute changed my research (for the better)

This guest post is written by Amanda Keener, a graduate student at UNC-Chapel Hill in Microbiology and Immunology interested in science writing. You can check out more pieces from Amanda at http://amandabkeener.wordpress.com/. Here she offers excellent advice on maximizing productivity and minimizing stress in grad school. The floor is yours Amanda!  

I’ll never forget the time I responded to my lab mate’s complaints about his twenty minute commute to campus by asking “well, why do live so far away?”  To me, there was no reason to live more than a few miles away from lab. I expected to work long hours and had no desire to have to do more than hop on a free town bus or a bicycle at the end of the day.  I found a happy little rental in a walkable, well-bused part of town and stayed there for over three years.  In that time, I met a guy, he moved to a thousand miles away, we stayed together, we got engaged,  he moved back to my state and we decided to get married.  His new job was two hours away from my happy little rental, so we’d both have to make sacrifices if we wanted to live together. This is how I ended up commuting fifty miles to lab each way—a situation I mourned and resented at first.  I now recognize the positive impacts it’s has had on my research, and see lessons in it that other students may also find useful.

Image

Partitioning real life from lab

I’m quite effective at keeping my private life out of work, but I sure have trouble keeping work out of my private life.  My research could be on my mind at any time of day, any day of the week—especially when something in lab isn’t going right.  It was hard not to feel guilty about not being in lab when I lived only two miles away.

Being fifty miles away is actually kind of freeing.  I’m not tempted to beat myself up over not going to lab on the weekend.  I’ve had to discern what’s urgent and what’s not. On weekdays, the drive home is a fantastic “de-fusing” period that allows me reset before I walk in the door. I have a completely separate, satisfying life at home, and I’m allowed to enjoy it even if I’m in the midst of troubleshooting frustrations at lab.

Intentional scheduling

Once I moved I knew I had to shape up my schedule. Commuting costs me two hours a day and I can no longer run home for dinner during an incubation or set up an experiment that would require a 5 minute step on a Saturday or Sunday. My time is now starkly partitioned. I plan my experiments weeks in advance and only schedule certain types of assays on certain days of the week.  This means I have built-in time for planning experiments and writing up results.  It also means that on long experiment days I can immediately start working without spending an hour in the morning drinking coffee and writing protocols.  This works especially well for long term animal studies because it lets me give my PI (and myself) realistic expectations for my progress.  I am more flexible with shorter day-to-day experiments, but set weekly deadlines so I don’t put anything off for too long.

Fine-tuning my research

My first couple of years in lab were defined by a pattern of constant, often thoughtless “doing.” I felt that as long as I was active, I must be making progress. But a pile of uninterpretable data isn’t exactly progress. I realized if I was going to justify my new commuting lifestyle, I needed to be more critical about which experiments absolutely had to be done to answer a specific question. I stopped doing experiments just because they were suggested by my advisor or a collaborator in passing.  I decided I would only set up experiments that I felt truly fit into my research plan.

Of course this hinged on actually having a research plan, so I had to commit to one that I could point to when my PI brought up rabbit trail experiments to do. This doesn’t mean she can’t convince me that an experiment fits, but it forces her to take a comprehensive view of my project, even if just for an hour before she gives me a list of things to do and goes off to think about someone else’s project, a grant, invoices, etc. (I’m not against exploratory or risky research. I just don’t think it’s advisable for a graduate student late in her career.)

Respect for my time

Before moving, I thought nothing of a quick trip to lab over the weekend. This strategy often backfired, though, because I was more likely to put off tasks during week and dissipate my focus and productivity in lab. Moving has forced me to be more efficient while I’m in lab, and to reserve weekends for reading and writing. If there are enough tasks to fill up several hours on a Saturday, I consider the drive worthwhile, but taking control of my calendar helps me avoid that. What it really comes down to is having respect for my time.

Respecting my time helped relieve that guilty feeling that used to come when I left lab at 3pm, even if I intended to spend the rest of the evening analyzing data. I came to realize I’m not in a corporate job, I’m not a customer service representative and I don’t have to hang around until someone needs my services. I am in lab to learn skills, do experiments, and confer with my advisor and others about my science. There is an appropriate level of making yourself available to help others in the lab, so I’ve had to learn to communicate my schedule to be respectful of their time as well.

Carpooling

About six months into my commuting life I found a carpool buddy on a listserv. He too is a grad student and is commuting due to his and his wife’s job circumstances. Carpooling (and commiserating) with a fellow grad student has had a great impact on my outlook on school. In the past, I could go for months without having a conversation with another student about troubles in lab and the frustration of an uncertain future. My isolation gave me a sense that I was the only one having those troubles. Comparing experiences and brainstorming several times a week with another student has broadened my perspective.

No regrets

Sometimes I really miss this one long steep hill that I used to ride my bike down on the way home from work. I would bounce my front tire up and down while the houses and trees whooshed past me on either side. But at the end of my ride, all there was to come home to was Skype.  I don’t regret the trade-off I made. Yes there are many downsides—like increasing my carbon footprint—but I’m glad to have had a chance to redefine my approach and outlook on lab research. My situation won’t last much longer, and in the meantime, I just offset my carbon footprint by eating less red meat.

How Batteries Work

Our entry to the NC ACS Chemtube competition, please vote for us by clicking the like button on youtube.

I recruited some very talented friends to make this latest one. I’m learning so much with each video, wish I could spend all my time just making explainer videos. I would blog about behind the scenes action, but I’m gearing up for a stress-ridden, laser-focused, Battle Royale style job search which will probably consume my life. It is tough out there so I will be lucky to find a competitive job in less than 6 months. But as an ever optimistic organic chemist that always puts too many things on her daily to-do list, it would be awesome to have that settled before writing my thesis this spring, just to lower the chances of my head exploding.

Hope you enjoy this video!

I wrote a book review

So I wrote my first book review on Dr. Paul Offit’s “Do You Believe in Magic: The Sense and Nonsense of Alternative Medicine.” It appeared in the August UNC TIBBS (Teaching Initiatives in Biomedical and Biological Sciences) Times newsletter (http://tibbs.unc.edu/wp-content/uploads/2013/07/TIBBSTimesAug2013.pdf). To be honest, writing the piece was incredibly stressful, like I might really have an ulcer now. Writers who review books for a living, consider me impressed and sympathetic. What a challenge to decide what parts to highlight when there is an abundance of amazing and heart-wrenching stories while also capturing the essence of the book. But it really was worth it and thanks so much Erin for putting it in the newsletter, I appreciate the opportunity to write about this important book.

Science vs. Sensationalism: A High-Stakes Battle

In 1970, ten-year old Joey Hofbauer died of Hodgkin’s disease, a treatable cancer of lymph tissue. Doctors’ estimated that Joey had a 95% chance of survival through radiation and chemotherapy, but his parents tragically opted to treat him with a natural remedy called laetrile, coffee enemas, massive doses of vitamin A and raw liver juice. Social services attempted to intervene through the courts, but faced with financially powerful laetrile advocates, a movie star and a burgeoning social movement, their efforts to save Joey’s life were denied.

Joey’s story was one of Dr. Paul Offit’s earliest encounters with alternative medicine and opens his latest book, “Do You Believe in Magic: The Sense and Nonsense of Alternative Medicine.” The case contains all of the staples of a fraudulent alternative medicine movement: a desperate and vulnerable family, a charismatic alternative medicine doctor, a celebrity advocate and a highly profitable industry. This cast of characters assemble in each of his accounts, always ending with a tragic and preventable death. This narrative structure is repetitive, but highlights alternative medicine’s perpetual reliance on the same tactics and treatments for a range of unrelated diseases.

Book picture

Image: http://bit.ly/19A88xK – And yes, everytime I picked up the book I did wonder if someone had thrown up on the corner

In the book’s most captivating chapter, Offit reveals how the dietary supplement industry’s successfully positioned itself as separate from the pharmaceutical industry to justify its deregulation at the cost of public safety. The industry spent billions of dollars to pass the Dietary Supplement Health and Education Act in 1994, which blocks the FDA from regulating the safety of vitamins, supplements or amino acids. Referred to by the New York Times as the “Snake Oil Protection Act,” this deception was made possible by a powerful publicity campaign. Industry lobbyists recruited politicians and movie stars to spread the message that the government was attempting to limit the American people’s right to choose their vitamins. The public not only accepted the deregulation of the vitamin industry, they demanded it. It was the FDA’s worst defeat, one that millions of American’s are paying for.

Only 170 of the 51,000 herbal supplements in the market have undergone any safety testing. Yet a recent poll shows that 58% of the American public believe that over the counter supplements are approved by the FDA. An investigation of 450 supplement manufacturers found that half had significant problems, from lacking ingredient lists to contamination with rat droppings and urine. Money, power and greed drive this $34 billion dollar a year industry even though about 50,000 adverse reactions to supplements are reported each year.

Paul_Offit picture

Photo: Dr. Paul Offit, Wikipedia Commons

Yet alternative medicine has not survived on dishonesty and charisma alone. Offit illustrates the power of the placebo effect and warns against underestimating it. One therapy he targets is the ancient practice of acupuncture. Studies show that there is no difference in patient relief when needles are placed in correct or incorrect position or whether standard or retractable needles are used. The placebo effect has specifically been proven in pain alleviation. In response to pain, spicy foods, or exercise the human body can produce endorphins, which have the same effect as morphine. In an experiment in 1978, patients were given morphine, a placebo, or naloxone, a drug that blocks endorphins, after dental surgery. Individuals from the morphine and placebo groups reported feeling less pain while those that received naxolone did not.

Offit allows that using the placebo effect can be ethical if the patient is at low risk, low cost or low burden. However, he specifies four ways in which alternative medicine becomes harmful quackery. This happens when practitioners recommend against conventional therapies, promote potentially harmful therapies and charge inordinate amounts of money that bankrupt people. Lastly, it is most dangerous when it promotes magical thinking and discourages scientific literacy, which is the only defense against those who would exploit disease for their own gain. At its best, alternative medicine provides placebo induced comfort, but at its worse it bankrupts families and kills people.

#Chemsummer – Grilling with Family

Sometimes I get intense cravings for a succulent beautifully medium rare steak. I’m talking about a piece of meat the size of my face.  It has to be seared over an open flame, and if that is not the plan I don’t even bother looking at those rib-eyes, NY strips, and T-bones at the store.

westpointsteakhouse steak

[Image credit: http://www.westpointsteakhouse.com/]

I don’t often succumb to the temptation of buying steaks. My family all agree that I am the cheapest member, so if I’m going to buy a steak it’s going to be done right. I season my steaks with just salt and pepper then sear them to a deep shade of brown. For this effect, I rely on the Maillard reaction. In this reaction high heats cause amino acids and sugars to react then break down into new compounds that give meats the distinct color and flavor. I’m also looking for some nice caramelization which happens when sugars are broken down by heat.

As soon as the steaks hit the grill, they have my undivided attention. Overcooking an expensive piece of meat is not only emotionally tragic, it’s also bad for your health. The National Cancer Institute has identified that heterocyclic amines (HCAs) and polycyclic aromatic hydrocarbons (PAHs) found in charred meat, are mutagenic, which mean they cause changes in DNA and increase the likelihood of cancer.

“HCAs are formed when amino acids (the building blocks of proteins), sugars, and creatine (a substance found in muscle) react at high temperatures. PAHs are formed when fat and juices from meat grilled directly over an open fire drip onto the fire, causing flames. These flames contain PAHs that then adhere to the surface of the meat.” – National Cancer Institute

That means if I’m watching a steak on the grill, don’t talk to me.

Last month I had the good fortune of going on a parent sponsored vacation to Portland for my sister Thuy’s graduation from medical school. The trip was an great break from subsisting on a graduate program stipend.  Upon arriving to our AirBnB rental home, equipped with an outdoor grill and lovely backyard, a cookout was immediately suggested and approved, starring steak from a local butcher.

Yo dog all up in my grill

[Image credit: http://bit.ly/181TlJ8, LOVE this cartoon, that makes it relevant ]

We fired up the charcoal grill with my brother-in-law Nolan elected to the helm with three enthusiastic helpers in Thuy, Ryan and I. We each had uninvited but valuable insights to share regarding the cooking of the steak. I commended him for having the foresight to start the fire early. We had to let the lighter fluid, most likely petroleum based, burn off so our precious meats wouldn’t take on an unpleasant taste.

Then there was some serious debate over whether or not to cover the grill while it heated up. Nolan had the lid on with just the flue open to let in air, a member of the fire triangle along with heat and fuel. Like The Fellowship of the Ring, The Two Towers, and The Return of the King, it takes all three to be successful. Thuy was campaigning to go lidless to let more air in for a hotter grill, anxious to get the right sear on the steak. Ryan and I chimed in with our support, oh yes the grill definitely should be hotter and why don’t we add some of these briquettes.

Nolan disagreed but feeling outnumbered, he tried to distract us by telling a story about the origins of charcoal briquettes. Apparently in the 1920s, Henry Ford was amassing tons of excess wood scraps and sawdust as by-products of his assembly line. He decided to form them into briquettes for outdoor cooking and sold the idea to his cousin E. G. Kingsford. So Ford started the popular American tradition of grilling out and the Kingsford Company is still the nation’s leading manufacturer of charcoal.

Ford charcoal

[Image credit: http://bit.ly/182XqAe]

To our advantage, Nolan had to leave to pick up his parents from the airport, and we immediately dumped in the rest of the briquettes. Within ten minutes the fire became so hot that we had to put oven mitts on just to hold the grilling tongs. The Korean BBQ spareribs and the prawns cooked in about thirty seconds flat. I mentioned this was a vacation, right? Finally the steaks hit the grate with three pairs of eyes on them that didn’t quit their gazes until the meat was safely resting on the plate. We agreed never to tell Nolan how close we came to ruining the food. A vow we promptly broke that evening as we all laughed about the story over a delicious family dinner.

#ChemMovieCarnival: BSG – Need I say more?

First, I’d like us all to agree that 1) Battlestar Galactica is a captivating, beautifully crafted series that explores the intricacies and limits of humanity and 2) that no actress has ever fully embodied a character as much as Katee Sackhoff has with Starbuck. However, like most successful works of science fiction, they have taken certain liberties with the laws of physics and science at large. As a dedicated fan of the show I have participated in more than a few discussions of its storyline, logistical and moral quandaries, mostly with my labmate Dale, a post-doc and fellow BSG analyst. Here’s one example of pretty blatant science side-stepping. (FTL travel will be accepted as fact for the purposes of this post).

How are they simulating gravity?  The show never addresses this fundamental force that allows the characters to walk around in their daily lives aboard the ship. Gravity can only be simulated in 3 ways: By a large object with inertial mass (i.e. planet), by rotation of the spaceship which acts through the simultaneous effects of centrifugal and centripetal force (see Newton’s third law), or by linear acceleration. Although it’s possible the fleet could be using this last strategy, the careful viewer will realize that many times the Battlestar has been forced to hold its position as it waits for returning vipers in order to make a jump. And they always seem to jump to specific coordinates, so to use linear acceleration they’d also have to tell the fleet which direction to continue heading upon arrival.

BSG

So according to this picture, only the circular ship in the top middle is likely to have full-time gravity. You can sign me up for that one.. bone and muscle deterioration? No thanks.

This just happens to be a pet peeve of mine and there are many more examples so certainly add more as you please! A quick google search turned up this book, an official guide to the science of Battlestar Galactica for those compelled to research this topic further (on my reading list now). The fact that most of the technology supporting the fleet’s survival is currently not in existence, I think takes nothing away from personal enjoyment of the series. Really, it challenges us to test the limits of our imaginations and what we might achieve even beyond the confines of this world.  So say we all.

Update: after sleeping on this post, I realized this was supposed to be chemistry themed not physics..I just got excited about BSG and totally forgot where I started.. hope everyone doesn’t mind too much!