Monday, March 23, 2009

Cost? depends on who's counting

Much in the business of medicine is made of the "cost effectiveness" of a treatment. A recent example is Gardicil, the new vaccine that provides immunity against four strains of the HPV or human papilloma virus. Two strains are responsible for about 70 % of cervical cancer and the other are responsible for about 90 % of genital warts.

I have heard many arguments against the vaccine. Some of them have been from mothers who tell me that their daughters will never have sex until they are wed. To them I simply ask if they can be that sure about their future son-in-law. A few of the arguments come from physicians who say that the number of cases of cervical cancer that will be prevented is not that great while the cost of the vaccine is tremendous. To those physicians, who I might add, are not gynecologist, I reply they must not be aware of all the time and money spent on the precancerous problems. Preventing even the agony and the fear that patients experience after being told that they have a virus that potentially could cause cancer seems worth the price.

Today I saw a 34 year old with cervical cancer. I also saw a 17 year old with genital warts. I can't help but believe that both of these could be prevented by proper education, safer sexual practices, and in the case of the 17 year old possibly by Gardicil.

One treatment that receives a great deal of advertising dollars are the medications for male erectile dysfunction. I have never heard any cost effectiveness discussions where these medications are concerned. Also much has been made of the safety of these medications as many of the patients who need them also have heart disease.

Conclusion: It is easy to see that the cost depends on who is doing the counting.
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