[WHIP CRACKING, COUGH]
Lindsey: Welcome to Sexplanations! I'm Dr. Lindsey Doe, clinical sexologist,
and this is Dr. Aaron Carroll, a medical doctor, who also wrote this book
in addition to this book, this book, this book!
Aaron: It's The Bad Food Bible. It grew out of some columns
and actually some episodes made on our show, The Healthcare Triage, talking about how
the science behind so much of nutrition and what we think of as bad food or
foods that we shouldn't be eating isn't that good, and that a lot of the stuff
that people tell you absolutely must avoid is not harmful in some cases it's
sometimes healthy.
Lindsey: I consider you to be an expert in a lot of things and one
in particular is HPV, the human papillomavirus, also the insistence on
vaccinating young people.
Aaron: I mean, the reason we vaccinate people is to try to
prevent them from getting illnesses that they would otherwise get, and vaccines in
general have been probably one of the greatest public health achievements of
the last century, if not of all time. I mean vaccines are amazing. There are
diseases we've eradicated just because of vaccines. So the HPV vaccine is a
newer one, but the idea is that we're trying to prevent people from getting
infected with human papillomavirus, which is a virus that causes a bunch of
sexually transmitted illnesses but also is associated with later cancers, with
cervical cancer, with anal cancer, and even with some throat cancers now. And so,
if we can get people vaccinated so that they don't get infected, it should
prevent those cancers and millions of people from getting them.
Lindsey: So the idea behind a vaccine
is that you're giving a dead or weakened version of the virus to
the person's system. The immune system responds to that, and so when the
full-force virus comes in, you already have antibiotic -- antibodies to fight it off.
Aaron: So you did a great job there. So yes. So the way that the body works is that
when it sees a bad germ, it has to build things, antibodies to try to grab on to
it so that the body knows to clear it out. And once it's learned how to build
and construct the certain antibody to attack something, it then records it so
we can do it forever and ever and ever. But sometimes when you get infected with
some viruses, even if you grab on to it you can't fully eradicate it.
The chickenpox vaccine for instance. If you get infected with real chickenpox,
the reason people get zoster or they get infected
later life is not that they got sick again; it came out of their nervous
system, where it had lain dormant and reinfected them from within. So if we can
prevent people from getting chickenpox in the first place, they won't get the,
you know, the later disease. So it's a lot about prevention. We have to
actually get people vaccinated before they could ever become infected with HPV,
which means of course we have to get them pretty young.
Lindsey: But my confusion then
is that if you have hundreds of strains of this virus, forty to sixty of them are
sexually transmitted... Why is it that we're targeting young people -- obviously
because they haven't maybe had sexual contact that would contract the virus --
but why not give it to everyone
so that you're at least preventing some strains that they haven't gotten?
Aaron: Most adults who have not been vaccinated have come into
contact with so many of them already that there's just a limited efficacy.
It just doesn't do as much. The only way to sort of get that full prevention is to
get in early before people see the virus at all. And people become sexually active
at reasonably young ages, so if we don't get them vaccinated before that's going
to occur, it is too late. Because once you've actually been infected with the
regular virus, the vaccine just doesn't work as well.
Lindsey: Aaron does The Healthcare Triage,
and in one of his shows about HPV and the vaccine, you say you need to do it
before you touch genitals.
Aaron: Yeah!
Lindesey: If you don't want to get the vaccine, then
don't ever ever ever ever ever ever touch genitals.
Aaron: Yeah I mean that -- that's where we get to.
It's like you can say, "Okay, you probably don't need to be vaccinated if
you just make a commitment never to be sexually active in any way possible ever!"
But that's just unrealistic and it probably isn't even healthy.
Lindsey: [laughs]
Aaron: So the idea is that, you know, we just want to vaccinate children before this occurs.
I mean we can make an argument they could start even earlier. It's just
unfortunately because of the way people view this one vaccine, a lot of parents
don't want their kids to have it and a lot of people remain unprotected.
Lindsey: And they don't want their kids to have it
because they think that it will increase sexual activity?
Aaron: That's the most highly cited reason. And of course they've done
studies -- and we cite these on our show all the time -- where they can look at
girls or boys who have been vaccinated are not vaccinated and then see
whether they're more or less sexually active, and there's no relationship at all
between whether kids get vaccinated and whether they have more sex or
unprotected sex or whether they get pregnant. It just doesn't occur. But some
people just believe that, and because they believe that they think that giving
kids the vaccinations gives them a license to go have sex. And in other
words, it removes this barrier which otherwise would keep them from being
sexually active. That does not bear out in reality.
Lindsey: No!
Aaron: And really all we're doing is leaving kids unprotected.
Lindsey: So what is the medical stance on HPV vaccine?
Aaron: Oh! That pretty much
all children should be getting it -- you know, I'm not even sure what the
recommendation on year is now. It might be 11 or 12 or 13, but certainly it's got
to be young enough that is before sexual activity. And I see parents all the
time in my practice where they are trying to push it later and later.
There's just no reason to. In fact it's dangerous the way that we
talk about this vaccine differently. There's been some interesting recent
research showing that doctors approach this one differently because they're so
worried about what parents are going to think about it, and treating it
differently is what's making its uptake so low. That by even just sort of
fostering this idea that "this vaccine is different than the other one" gives
parents permission to think that their kids don't need it, and that's just not
the case. We should treat this like measles. We should treat this like any
other vaccine. They should just get it.
Lindsey: What advice would you give to people who
maybe don't have adults making decisions for them? They aren't super sexually
active or at all, but they're considering getting the vaccine?
Aaron: You don't have to be
sexually active to think about this. Just like you would with anything else, you
don't wait until after the fact before you do it. We have to do this ahead of
time. It's anticipatory. So I would not be waiting until I think I'm going to be
sexually active before I would start the course of HPV vaccine. It is a multiple
series vaccine. It takes time to do. We should be doing it before. And if people
are making decisions for themselves, and kids -- in fact, this is one of the things -- I
do get emails from kids who say, "My parents won't let me have this vaccine."
And that's when I say you should talk to your pediatrician. You should talk to
your doctor. Because there are things that you can get treated for and things
that you are going to need that you can have a conversation with your physician
about, that they will keep in confidence. And I'm not sure where the law comes
down with respect to vaccines and all sides, but anytime you have a concern
like that, you should talk to your doctor.
Lindsey: If I start the vaccine -- so I get Shot One
and then become sexually active, does it mess up the rest of the vaccinations?
Aaron: So, you get protection with each subsequent vaccine.
No vaccine is a hundred percent effective.
Let's start with that. It just isn't. So you know, even when kids are
vaccinated against measles, some kids will get it. We're just trying to
decrease the odds and we're trying to get up to the point where you've heard
immunity and it's just unlikely that people are going to get sick. So each
shot you get is better than not, but finishing the series is best. That will
give you the most protection. And again, it's not that if you had sex in between
you be in danger. What would really matter is if you get the
vaccine and you had sex and you were exposed to the virus, there's a less of a
chance you got infected. But if any point you did get infected, as we said before,
the vaccine doesn't really do much good after that. I think it was Tom Freiden
at the CDC who said if we could get all the young women and men now
vaccinated, we could prevent millions of case of cervical cancer and save lives.
We're not talking about small numbers.
It's huge numbers of the good that we could do if we could get everyone vaccinated.
Lindsey: The vaccine can prevent cervical cancer and genital warts?
Aaron: So yes! It should prevent all of that, but the end result that we most
care about is cancer because that's the one of course that could kill you.
Lindsey: And it's cancer in the vagina, the cervix, specifically the anus if people are
having anal penetrative sex?
Aaron: Even throat cancer with oral sex.
So absolutely. I mean, it is linked to cancers anywhere you think
that sexual activity might occur, and there's a link between HPV infection and that cancer.
Lindsey: All genders can be infected by HIV and all genders should be vaccinated?
Aaron: Absolutely. I mean, this is one of those where bizarrely they
started with only recommending -- the CDC's recommendations -- that only female... I mean,
that is what they came out with to begin with. Which I think was because
they so badly wanted to pitch this as preventing cervical cancer that they
didn't even want to acknowledge that anything else existed. And so, that was the
hook that they thought they could get this by people who might be afraid
that this was "the sex vaccine." Other genders are involved in in sexual
activity that could lead to women getting cervical cancer, so we start with
that, but it turns out it's associated with all these other cancers that people
of any gender can get. So that's why they've now expanded to say
that everybody should be vaccinated. There's still a lot of bad thoughts
about this vaccine. It is viewed differently than others, and uptake is
still significantly below what we'd like it to be.
Lindsey: Where do we like it to be 100%?
Aaron: In an ideal world, yes. I mean you know, it'll never be a hundred percent
because some people can't get a vaccine. It just happens because they are
either immunocompromised or they are ill. So one of the things I would say is you
often need to get vaccinated not because you're going to get sick: you need to
protect the others who can't get vaccinated. One of my favorite stories
about this was looking at the varicella vaccine, so the one that prevents
chickenpox. Every year in the United States -- decades ago -- some number of babies
died from chickenpox infection every year. Now babies less than one year of
age can't be vaccinated. They can't. They're just too young. The vaccine is
not recommended yet. So we start kids at one age. But since we've started
vaccinating kids at one age, no babies have died of varicella. Because if we get the
vaccine rates high enough, there just isn't enough virus out there that we
protect the elderly, we protect the immunocompromised, we protect the babies,
we protect the people that can't protect themselves. Because that's the goal. So
we'll never get to hundred percent, but we want to get high enough that the pool
of actual illness out there is low enough that you really reduce the chance
that somebody could get sick. If we get vaccinations high enough, these diseases
theoretically could be eradicated.
Lindsey: Well thank you, medical field! Aaron: [laughs] I wish I could
take credit for that. We could do better, though. We're not doing all
that we could to make this happen.
Lindsey: And you're doing an amazing job of educating both on The Healthcare Triage
and then coming on to our channel Sexplanations.
Aaron: Oh, say the same of you. Thank you very much.
Lindsey: Awesome. Cool. Aaron: Thank you.
Lindsey and Aaron: Stay curious!
Lindsey: And buy Aaron's book and go to The Healthcare Triage!
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