09th June 2014 | by Philippe de Chazournes
Your opinion, please, Madam Health Minister!
We certainly live in ‘remarkable’ times! These are times when one has to fight on a daily basis for common sense to prevail and for the stretching or bending of reality to be stopped. Unfortunately, the world of medicine is not protected from this current weighty trend.
Today, certain treatments really beg the question as to what purpose they serve. The release of a new curative or preventative medicine should bring a serious ray of hope to today’s patients as well as to future and potential patients, but the reality of the situation falls far short of such expectations. It’s a “truly uneven playing field” between those in the know (or who claim to know) and have access to vast logistical resources for making themselves heard, and those who seek independently and sometimes find the truths which they are not supposed to know but who don’t have the resources to disseminate them.
What are we talking about? You must already have heard, over recent months, reports of the increasing number of doubts surrounding the Gardasil vaccine (cf. Dossier HPV/Gardasil, in French), the growing number of questions being raised, the claims and promises which are wearing thin. Yes, we are talking about that HPV (Human Papilloma Virus) vaccine against cervical cancer, a vaccine expected to be heavily recommended for all young French girls as part of the new cancer plan announced only a few weeks ago by President François Hollande. This vaccine is 100% reimbursed by the French Social Security and has been incorporated into the ROSP (Rémunération sur Objectif de la Santé Publique, Public Health Target Compensation), the doctors’ ‘performance contract’ which compensates target levels reached. There is even discussion of vaccinating schoolgirls without their parents’ consent!! Read here (in French)).
In response to this and always with an attitude of open and transparent, contrasting and challenging interrogation and questioning, we drafted this petition… Our, Your HPV petition, petition of courage and honour (in English)… already signed by more than 1000 prescribing practitioners.
Madam Health Minister, you should have been informed of this by President François Hollande last March. A few days ago, you should also have received a letter co-signed by nearly 200 doctors with practices all over France, doctors who have courageously agreed to the publication of their names at the bottom of the letter you can find by clicking on this link: I am a French doctor and I am signing this letter. This is a substantial number of signatures considering our limited circulation resources.
This petition and the letters sent by registered mail and signed by a large number of health professionals should really have deserved a bit more of a reply than a simple postal receipt. The absence of a response shows a lack of consideration for the differing opinions which are essential in a democratic debate.
The problem with this “cervical cancer” vaccination goes way beyond the very nature of what it is supposed to prevent. It is a typical example of the nonsense behind certain decisions, whether “conservative” or “liberal”, based on no serious scientific evidence and contrary to all logic. We are talking about political decisions which go beyond the reticence of our own health authorities who advise organized Pap smear screening campaigns above all else, a practice which unlike what other European countries are doing, has never been fully rolled out across France. Cf here the BEH of May 2014 (Weekly Epidemiological Bulletin in French).
Your support for this vaccine is implicitly shared by a good number of French MPs who in spite of the many warnings, refuse to demand a more in-depth enquiry into whether the benefits really do outweigh the risks, not only for individuals but for society as a whole and not only from a medical but also from a financial standpoint. Their silence has now become deafening.
We are far from an EBM (Evidence-Based medicine) approach in which the clinical decision of the prescriber (but why not also that of the politician?) requires consideration of the following three criteria: the results of a clinical examination, the patient’s ‘preference’ and scientific data. This is the medicine I was taught over all those years when I was correspondent at the Haute Autorité de Santé (French High Authority for Health), a medicine based on a continuous dialogue between serious scientific evidence and the individuality of each patient. Not the prescriptive, countable, not independently validated medicine they are trying gradually to force further and further down our throats (cf. Dr. Delepine de Garches’ pediatric cancer department which will be closing, with your blessing, in coming weeks (cf. cancer business – in French).
Madam Health Minister, you have not even taken the energy or the time (apart from a few comments in the media not based on any significant information) to reply to the questions asked by thousands of patients, midwives and doctors, working both in hospitals and in their own surgeries, both GPs and specialists. We therefore take note of your disdain and your cavalier attitude towards a matter as serious as this and we conclude that basically, you are just not ready to be transparent about the decisions taken regarding this vaccination. As such, you will bear the consequences if Gardasil is added to the already too numerous health scandals in our country.
Attempting to vaccinate everyone against every possible disease, in total disregard for all common sense and without any valid scientific justification is the best way to move closer to the ‘anti-vaccine’ camp and this would be dramatic because unfortunately, we tend to forget rather quickly that vaccines have already saved and will save many more millions of lives.
The publication only a few days ago of the Bulletin Epidémiologique Hebdomadaire (Weekly Epidemiological Bulletin) by the Institut de Veille Sanitaire (Health Watchdog) (cf. BEH of the 20th May 2014) only serves to reinforce our doubts about the justification of this cervical cancer vaccination, and this right in the middle of a public accounts crisis. This is a vaccine poorly adapted to the real viral ecology of the cervix and which has so far proven to be only 20% effective, all HPV vaccines combined. Research however reveals undeniably that Pap smear screening can virtually eradicate cervical cancer and at a considerably lower cost.
Today we are calling out for you to return urgently to validate scientific evidence, in spite of the probable pressure you, your advisors and the experts in charge of this matter may be under (cf. OMERTA dans les laboratoires pharmaceutiques in French).
Madam Minister, we invite you to follow through and implement what you recommended on the 22nd of April this year when you visited the Charles Bertheau vaccination centre in the 13th arrondissement of Paris:
“We must inform, explain and be transparent”. “There is no reason to conceal anything”, “a calm, peaceful and composed discussion based on rigorous scientific research”.
We are ready to support you in this approach and as such, we invite you to a meeting we are organizing to take place on Monday the 23rd of June from 2pm to 5pm in Paris, near the National Assembly. We hope to have speakers both for and against this vaccination to present their respective points of view with respect and composure.
We would be honored if you would introduce the debate and if you could take part in the reasoned and reasonable exchanges which will take place without mockery or personal attacks, so that medical reason may once again prevail.
We know that you have a very busy schedule but so do we!
You are a decision-maker but we are not!
On the other hand, we, like you, are responsible for our acts and in particular for our prescriptions and…… our injections!
So Madam Minister, considering your responsibility which is yours and yours alone, considering your determination to pull out all the stops to guarantee the good health of our fellow citizens but also:
– With appeal to the precautionary principle so as not to jeopardize the health of the thousands of women who have been told to get vaccinated;
– With appeal to the respect and consideration you should have for all the health professionals who are legitimately concerned about this vaccination;
– But above all with appeal to the democratic need for a debate between contrasting views,
We invite you to support this event intended to be both constructive and collaborative for greater quality and effectiveness in health care.
It would be a shame to turn a deaf ear to questioning and doubts. Far better would it be to accept and discuss them because often our supposed certainties seem to be no more than the echo of our own doubts!
Dr. Philippe de Chazournes is a GP practicing in La Réunion. Over the last decade, he has been the regional correspondent first for ANAES (Agence nationale d’accréditation et d’évaluation en Santé, French National Healthcare Accreditation and Assessment Authority) and then later for HAS (Haute Autorité de Santé, French High Authority for Health). He is dedicated to credible and evidence-based medicine, a medicine not influenced by any industrial or institutional conflicts or links of interest, and always strives to remain diligent and constructive.
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The SaneVax Team would like to thank Helen Kimball Brooke for providing the translation of Dr. deChazournes’ post.