Veterans Affairs in Canada

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Dissension and Authority

As members of a state that is, by and large, trusted by the majority of the populace, United States citizens generally follow the advice of the Centre for Disease Control and the FDA. Likewise, if someone in a position of expertise – say, a family doctor or clinical researcher – says that something is good for you, it can be said that the majority of the population is inclined to believe them. However, within the last 20 years and the increasing availability of information to the general populace that would have otherwise been held in the hands of those explicitly knowledgeable in areas such as epidemiology and immunology, the erosion of blind following of explicit authorities is no longer as common. Indeed, much of the controvery surrounding the HPV vaccine is around the dissension between researchers themselves and the subsequent public awareness of this debate.

While there is not necessarily a “Doctor Wakefield” or other primary catalyst towards the rejection of HPV vaccinations as there has been with similar vaccinations such as MMR (Measles, Mumps and Rubella) , there have been a number of articles that have outlined the clashes and disagreements within the scientific community regarding HPV vaccinations. Firstly, Merck & Co began promoting HPV vaccination in 2005 – “more than a year before the trials with clinically important end points were published” (Sawaya, et al. 2007). This is an important point, as the voices of experts in medical associations are considered especially important when it comes to promoting public health; authority figures are meant to convey knowledge and expertise on issues that are in the best interest of those who are not versed in such specialized knowledge fields. This pre-promotion was soundly denounced by a number of scientific researchers, who doubted that Merck & Co could be so sure of the Gardasil effects before many of the testing phases were even completed. Beyond this, other articles, such as those purported by Slade, et Al. from the US Centers for Disease Control and Prevention and the US FDA, specifically describe the adverse effects to patients that were reported anywhere from 2 to 2.5 years following the receipt of the recommended 3 doses of Gardasil that were recommended to the target groups. Despite the fact that the majority of adverse effects were in line with other similar vaccination findings, there were reports of such serious outcomes such as pancreatitis and blood clots. As Slade's article notes, while such risks are minimal at worst, they may be seen as disproportinately large when compared to the risks of cervical cancer – which may only occur 20 or 30 years down the line. Moreover, it is hard to gain trust when one of the main researchers into the Gardasil drug, Dr. Diane Harper comes across as less than confident about the product she helped to develop. While she agrees with the FDA, CDC and Merck and & Co that Gardasil should be considered safe for most, she has stated that “the side effects reported so far call for more complete disclosure to patients” and that “they should be told that protection from the vaccination might not last long enough to provide a cancer protection benefit, and that its risks - “small but real” - could occur more often than the cervical cancer itself would” (CBC. 2009). With these issues brought to light, the public belief in a “stabilized knowledge” and trust in the old paradigm of power in the US public health system were undoubtedly shaken.

Media

Of the “ambiguous” actors and actants, it may be prudent to focus on how the Media worked to further the controversy surrounding Gardasil within the United States. Undoubtedly, Media such as newspapers, magazines, radio and television can be considered an important source of information for the masses. In the case of HPV vaccinations, the dissension amongst scientists previously mentioned were one of the aspects of the controversy that were undeniably exacerbated due to intensive media coverage. However, these scientific debates are only one facet of the Media's influence. In fact, one of the most hotly contested narratives of the HPV vaccinations in the United States was over the ethical and sexual contexts that the vaccinations represented, as well as the belief that they had an individual responsibility to protect those who could not protect themselves.

For sociologists like Laura Mamo, the main focus of the HPV debate was not necessarily the scientific debates, but rather the “visual and narrative production of “risky girlhood” in need of protection” (Wailoo, et al.). This narrative touched on the very primal feeling of protectiveness that families and societies have towards their young, and more specifically, their young females. This fact can be observed in states such as Texas, wherein which, after the state governor declared HPV vaccinations mandatory, there was a surge of “family values” groups denouncing the vaccination in Media as something that would only increase the sexual activity of their children. It was seen as a matter of a minor health risk against a major moral and societal one.

The Media also worked to highlight “personal stories” of vaccinations “gone wrong”. In these, such vaccinations were highlighted in a way that disproportionately portrayed the chances of adverse effects; feeding off of latent fears of the “unknown” that exists within the black box. That is, it was viewed as much easier to pinpoint the adverse effect as a result of something that is visible but not necessarily understood. Vaccines fit this role. You input a foreign agent into your body – something happens – and then you may feel the immediate post-vaccination effects: aching in the location of injection, wooziness, or other similar, normal effects. It is easy to extrapolate the “unknown” here and correlate it to other, larger problems that may not be linked at all. Such “personal stories” depicted in the Media only work to heighten the vulnerability that many feel, and were an important part of the HPV vaccination controversies.

Risks vs Gains

The entirety of this controversy revolves around the belief in a “body knowledge” and the potential risks of the HPV vaccination vs the potential gains. As discussed in the aforementioned paragraphs, the Gardasil vaccinations have created a discussion as to who actually “controls” the body knowledge, and who can claim to have authority over public and individual health. Is it the CDC? The FDA? Dissenting Scientists? Or is it the parent or individual being affected? Likewise, through the visions espoused through Media outlets throughout