Cervical cancer is almost completely preventable. So why are we failing?

We could have essentially eradicated cervical cancer by 2040.

We’ve had the “miracle” vaccine for 13 years. We’re still nowhere close. What is to blame?

Religious extremist paranoia about “promiscuity” that would see a woman die of an almost completely preventable cancer rather than ensure every 12 year old girl (and boy) gets vaccinated.

A very small minority of profoundly backwards thinkers is holding the public’s health hostage. And they’re doing it with our tax dollars.

https://www.tvnz.co.nz/one-news/new-zealand/sexual-health-experts-concerned-drop-in-number-young-people-getting-hpv-vaccine

12 years ago, handheld ultrasound allowed medical students with 2 days training make more accurate diagnoses than specialist cardiologists with decades of experience. Why has virtually nothing changed in the 12 years since this study?

“The diagnostic accuracy of medical students using an handheld ultrasound device after brief (18 hours) echocardiographic training to detect valvular disease, left ventricular dysfunction, enlargement, and hypertrophy was superior to that of experienced cardiologists performing cardiac physical examinations.”

https://www.ajconline.org/article/S0002-9149(05)01111-2/fulltext

I have to look at this article every now and then to remind myself of the power of technology and the limitations of our “traditional methods”. I read it and feel amazed at how far science has progressed in taking medicine from the age of quackery and patent medicines, to the era of bedside ultrasound, where even a med student with just 2 days training can look deep into the body and figure out its story. With greater expertise than an expert cardiologist.

Then I remember that this article is 12 years old! And I realise that our medical students still get only the most minimal education in ultrasound. The don’t come out of med school comfortable, or even proficient. Even our most advanced trainee hospital registrars often don’t learn to perform ultrasound competently before leaving training.

And that’s when I remind myself that tradition and arrogance go hand in hand.

“This is how we do things here.”

The very people that set the agenda, the ones that build the curriculum, head the departments and medical schools, and make the big decisions, are almost by definition the ones who have been there the longest and mastered the old ways. They are entrenched. Whether those old ways are better or worse, they are not keen to change them.

What’s the answer? A/B testing.

This is a concept that comes from the loathsome world of marketing, where people learn to manipulate people to sell things and make money. But the A/B test concept is a good one.

Set up a mini-experiment with Group A trying the old way, and Group B trying the new way. See which one “wins”. Then bring in another new idea, to compete against the winner. It’s cheap, quick, and effective. And we virtually never do it in medical education. Or hospital administration, to be honest.

If we set up mini experiments more often we could answer questions quickly and accurately. Which method leads to greater accuracy? Which traditional training techniques work? And which ones just have seemed effective all these years but actually aren’t.

We could apply A/B testing everywhere. Which methods of documentation are faster and more efficient? Which consent forms are more easily understood by patients undergoing surgery? Which tests are useful in our specific setting, and which are a waste of money, pain, and time?

A/B testing allows us to figure out the answer to a question in real life. What we do instead in medicine is to almost always leave it up to the most senior doctors, educators, and administrators to come up with their best ideas and write them up in a policy.

A policy that never gets tested against anything else. Madness.

https://www.ajconline.org/article/S0002-9149(05)01111-2/fulltext

Commentary: Euthanasia drugs article in the NZ Herald.

Unapproved use of an approved drug is often called “off-label” use. This term can mean that the drug is:

  • Used for a disease or medical condition that it is not approved to treat, such as when a chemotherapy is approved to treat one type of cancer, but healthcare providers use it to treat a different type of cancer.
  • Given in a different way, such as when a drug is approved as a capsule, but it is given instead in an oral solution.
  • Given in a different dose, such as when a drug is approved at a dose of one tablet every day, but a patient is told by their healthcare provider to take two tablets every day. (source: fda.com)

I’ll be talking to 1News this week about religious schools not allowing cervical cancer vaccinations.

Is there anything more spiritually bankrupt than putting roadblocks up to teenage girls’ vaccination, ensuring some of them will needlessly get cervical cancer decades later?

If this is true (I just learned of it last week) — that religious schools taking PUBLIC funding are not allowing the Ministry of Health to give out cervical cancer vaccine information, and not allowing them to vaccinate kids at schools, there is only one answer: yank their funding. Immediately.

Religious schools can get hundreds of thousands of dollars of taxpayer funding each year. Yet some of them appear may be harming society, compromising public health, and causing women (and men) to get cancers that could have been prevented with a simple vaccination. It’s just not right and shouldn’t be tolerated.

You shouldn’t be allowed to contribute to cancer deaths AND take taxpayer money for it. That should be a law on the statute books, if not a commandment in a holy book.

“Thou shalt not take taxpayers’ money while allowing preventable cancer deaths,” and

“Thou shalt not create fear in order to control the women (and men) in your congregation.”

Cervical cancer: easily preventable. And yet we keep failing.

We have a vaccine that could have already eliminated the vast majority of cervical, anal, and head-and-neck cancers in New Zealand. Yet hundreds of our people continue to die every year…needlessly.

What is standing in our way? Religious extremism and misogyny. Fear and power.

Fear built up by manipulative religious leaders. These men literally want to keep the power to decide whether women will live or die.

Stone-age beliefs stay with us even now. Just look at modern religious fundamentalism and the antivaxx movement. Logic is a human tendency, sure — but so is paranoia and magical thinking. We are never too far away from witch-burning, hero-worship, and flat-Earthers.

Ignorance and stupidity will always be with us, but we can’t let these few people drag the rest of society down. They’re certainly trying to. And winning. Every year 50 women die from cervical cancer. Those deaths can be prevented — we’ve been able to vaccinate against cervical cancer for more than a decade. But we’ve missed the chance. Our vaccination rates are low. Everyone 9-26 should be getting the vaccine, but tens of thousands of Kiwis are not.

So 20 years from now, our daughters will still be dying of cervical cancers that were preventable. This should infuriate us as a society, knowing we could have prevented young women dying with a cheap vaccine, but didn’t.

The cervical cancer vaccine does not cause girls to be promiscuous, it just prevents them from dying of cervical cancer.