Mishpacha on HPV: Letter to the Editor

Updated: Dec 20, 2019

Dear Editor,


As pediatricians, we were deeply dismayed by the recent opinion piece by Yonoson Rosenblum, “A Shot In The Dark.” During the recent measles outbreak in New York, we learned that some of our frum communities had inadequate access to accurate information about vaccines. They were therefore more vulnerable to misconceptions and inaccuracies spread by both "anti-vaxxers", as well as other misinformed community members. We have been working hard since then to try to make reliable and accurate vaccine information available to our frum communities.


Unfortunately, Mr. Rosenblum's piece contains significant fallacies and misrepresentations about the HPV vaccine. Contrary to Mr. Rosenblum’s assertions, the vaccine is no longer so new - it was approved initially in 2006, but clinical trials had started back in 1997. The HPV virus can cause cancer- 99% of cervical cancers are caused by it – but also genital warts (100%), anal cancer (90%), throat cancer (70%), and recurrent respiratory papillomatosis, which can occur in babies born to mothers with HPV. HPV may also be involved in other diseases, including nonsmokers’ lung cancer. The current HPV vaccine protects against 9 types of HPV, covering the ones which cause most of the cancers. HPV causes about 35,000 cancers per year in the US, and the HPV vaccine can prevent 90% of these cancers. HPV is a very common virus. There are about 79 million Americans who are currently infected with HPV, and every year, about 14 million more become infected with it. About 80% of sexually active people have been exposed to HPV. HPV infections initially do not cause any symptoms, and although the body can sometimes clear it, if the infection persists, it can cause precancerous and then cancerous changes over a long period, sometimes more than 20 years.


Although "following a chaste and monogamous Torah life" can significantly decrease the chances of getting an HPV infection, significant risk remains. Unlike many other infections that we tend to associate with intimate contact, the HPV virus is too common not to pose an ongoing threat to us all. It is not just for "high risk" people. Furthermore, the frum community is not immune to behaviors and circumstances that put its members at risk of contracting HPV. While we all strive to follow Torah law and raise our children to do so as well, there are still community members who make mistakes. It would be tragic for them to suffer permanent harm from HPV infection, even if they are able to do teshuva and rejoin the fold. There are also ba’alai teshuva who become integral members of our communities. They and their spouses also deserve protection from the errors of their youth. Finally, no matter how vigilant we are in protecting our children, some of them do come into harm’s way. As physicians, we have both, rachman litzlan, treated frum children who were the victims of sexual abuse or molestation. These children have so many injuries, both physical and spiritual, to heal from-HPV infection should not have to be one of them. The Torah tells us to follow a modest lifestyle (וְהַצְנֵעַ לֶכֶת, עִם-אֱלֹהֶיךָ), and we must all do our best to do so. However, the Torah also tells us to take all necessary precautions to keep ourselves safe (וְנִשְׁמַרְתֶּ֥ם מְאֹ֖ד לְנַפְשֹׁתֵיכֶ֑ם). Vaccines, including the HPV vaccine, are an important way for us to do so.

Pap screens (and the new HPV test) are certainly essential parts of preventive healthcare for every woman, but they are NOT an acceptable alternative to the vaccine. Pap smears allow early detection of HPV infection, but do nothing to prevent or treat it. Preventing infection by the virus is much better than detecting it! It is important to do everything we can to prevent HPV transmission, including following a Torah lifestyle and getting the HPV vaccine, as well as continue ongoing screening in order to initiate early treatment should an infection still occur. We need both - the vaccine and the testing.


The HPV vaccine is extremely safe, and much less invasive than the treatments for HPV-induced cancers, which can require surgeries, chemotherapy, and radiation. There is no actual evidence that the HPV vaccine increases cervical cancer (the one recent paper to even suggest this was retracted for inaccuracies and questionable practices in data collection and analysis, as discussed below), and there is plenty of evidence that the vaccine prevents precancerous changes to the cervical mucosa. There is also emerging evidence of actual cancer prevention (remember that it takes decades for some HPV cancers to develop, so several studies that began in the 1990s are now reaching publication).


There is no “preliminary evidence that HPV vaccines may lead to increased cervical cancer.” We believe that Mr. Rosenblum is referring to the now-retracted article in the Indian Journal of Medical Ethics from April 2018, written by a man who lied about his name, research affiliation, and data. It is truly a measure of the insidiousness and danger of anti-vaccine propaganda that even Mr. Rosenblum and your prestigious magazine were fooled by this charlatan. There is, in fact, robust evidence that the HPV vaccine prevents precancers and emerging evidence that it prevents cancers as well.


There is no reason to believe that the same vaccine that safely and effectively prevents HPV infection and precancerous lesions caused by HPV will not also prevent HPV-caused cancers. Evidence continues to mount with each year that passes since the vaccine was approved. A recent (2019) and very powerful meta-analysis by Drolet, et al., which looked at the data from 65 different studies, shows a very large drop in HPV-associated lesions, including more invasive precancerous ones in teens and young adults, after HPV vaccination.


So, based on abundant safety and efficacy data (which we will be happy to forward to you upon request), we strongly disagree with Mr. Rosenblum’s assertion that the HPV vaccine is not “remotely necessary” for frum individuals. If you don’t believe us, ask fellow Jew Jason Mendelsohn, who was diagnosed with stage IV throat cancer caused by HPV, and now advocates as “Superman HPV.” Sadly, you can’t ask Laura Brennan, also a passionate advocate for the HPV vaccine, because she died at age 25 of cervical cancer from HPV. Due to the stigma associated with HPV (which is made worse by editorials like Mr. Rosenblum’s), there may not be many frum people willing to come forward with their HPV related illnesses, but we should know that we are not immune to this very common virus. As frum Jews, we believe in getting the best health care as part of Hashem’s mandate to us to safeguard the bodies He created for us b’tzelem Elokhim. We also believe that we are all responsible for each other, as “Kol Yisrael Arevim Zeh Bazeh” ( כל ישראל ערבים זה בזה). If even one person who reads Mr. Rosenblum’s piece and chooses not to get the HPV vaccine later develops a preventable HPV-associated cancer, Mr. Rosenblum and Mishpacha magazine will bear responsibility. We plead with you to publish a correction or rebuttal to Mr. Rosenblum's essay to correct the misconceptions it endorses and provide accurate information on this lifesaving vaccine for your readers.


Sincerely,


Alisa Minkin MD

Community Pediatrician

&

Maureen Nemetski MD, PhD, FAAP

Pediatric Emergency Medicine Physician


Co-chairs, Preventive Health Committee

Jewish Orthodox Women's Medical Association

health@jowma.org | www.jowma.org

Dr. Maureen Nemetski, MD, PhD is an Attending Physician in Pediatric Emergency Medicine at the Hackensack Meridian Health Joseph M. Sanzari Children's Hospital. She obtained her MD/PhD from New York University School of Medicine, where her graduate research focused on computer-aided antimalarial drug design. She then completed a Pediatrics Residency at New York Presbyterian-Weill Cornell Medical Center and a Fellowship in Pediatric Emergency Medicine at the Children’s Hospital at Montefiore. She grew up in Brooklyn, is one of six siblings, and is the mother of four children. As a Peds ER doctor, she sees children with a diverse array of injuries and illnesses. But she would much rather prevent those illnesses than treat them, which is what led her to JOWMA's Preventive Health Program. As Chair of JOWMA's Preventive Health Committee, Dr. Nemetski created JOWMA's Vaccine Initiative Hotline to combat the recent measles outbreak among the Jewish community in NY. She is currently developing JOWMA's new Community Health Hotline to provide general health education uniquely tailored to the health needs of the Orthodox Jewish community.


Dr. Alisa Minkin received her Bachelor's in Science from Johns Hopkins University after which she attended NYU School of Medicine. Dr. Minkin then attended Brookdale graduating their Pediatric residency program in 1993, and has been board certified since then. Dr. Minkin is a proud member of JOWMA and co-chair of the Preventative Health Committee.

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