To the Editor: I would like to respond to the Special Communication on marketing human papillomavirus (HPV) vaccine by Drs Rothman and Rothman.1 Vaccination against the most virulent types of HPV is an extremely valuable innovation. The current cervical cancer prevention system is effective but expensive, intrusive, nonspecific, and statistically insensitive.2 Clinicians in the United States treat thousands of women each year with HPV disease fated to regress, with consequent monetary and emotional costs, procedure-related injuries, and perinatal morbidity due to cervical compromise.3 - 4 Human papillomavirus is the cause of cervical cancer. The US Food and Drug Administration (FDA) has approved HPV vaccination as safe and effective, reflecting the opinion of cervical cancer experts that vaccination will decrease the burden of not only cervical cancer, but also precancer, with fewer abnormal Pap test results, colposcopies, and cervical treatments.5
Educational materials regarding HPV vaccination were developed by the American Society for Colposcopy and Cervical Pathology (ASCCP). These materials were peer-reviewed by the ASCCP board of directors. Financial support was disclosed, including funding from Merck. Information was adapted from the FDA-approved package insert, data presented at Advisory Committee on Immunization Practices meetings, or the Morbidity and Mortality Weekly Report. I am personally unaware of input by Merck into the development of the educational materials.
The authors argued that ASCCP failed to emphasize vaccination of high-risk populations. Of sexually active women, 80% will acquire HPV, although most clear infection, so all women are at risk. Cervical cancer rates are highest in unscreened women.
ASCCP did accept funds from a variety of sources, including HPV vaccine manufacturers, for its educational efforts. Funding for this purpose has not been available through government or nonprofit sources. Until a mechanism is developed to decouple education from industry funding, it will be necessary to use income from a variety of sources, including industry, to support ASCCP's continuing educational mission.
Financial Disclosures: Dr Massad reported having received honoraria for course presentations by the ASCCP; for review of enduring materials from the ASCCP that were funded by Merck, Digene, and Roche Diagnostics; and for organizing and executing a meeting of the Society of Gynecologic Oncologists that was funded by Merck, GlaxoSmithKline, Hologic, Roche, and Qiagen.
Additional Information: Dr Massad is a former chair of the Practice Committee and former board member of the ASCCP.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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