CANCER-PREVENTION VACCINES

Probably oversold but hopeful



A vaccine could cut the number of cervical cancer deaths in Britain by more than three quarters - saving more than 800 lives each year. The figures were revealed by a computer model that is used by experts funded by GlaxoSmithKline - which makes the Cervarix vaccine - to work out its effectiveness.The model was based on the assumption that all 12-year-old girls in the UK (376,385) were vaccinated, and that women continued to participate in the cervical screening programme. It means that the lives saved would be in addition to deaths prevented by screening.

The vaccine is targeted at girls who are not yet sexually active and protects them against infection from the human papilloma virus (HPV), which causes cervical cancer. The vaccine is used against HPV 16 and HPV 18, the commonest cause of the disease. However, in trials the vaccine has also been effective against two other HPVs, 45 and 31, the third and fourth most common strains. If this is the case deaths could be cut by a further 3 per cent.

In practice, it is unlikely that every girl would be reached. But if only 80 per cent were vaccinated cancer cases and deaths are predicted to fall by 61 per cent. It is believed that HPV 16 and 18 are also involved in cancers of the vulva and vagina. While they are comparatively rare, the vaccine could also protect against them.

The study, which was carried out by a team that included the HPV researcher Dr Eduardo Franco, of McGill University in Canada, and Michael Drummond, of York University, will be presented today at the International Papillomavirus Conference in Prague.

Yesterday the conference heard of new results from a rival vaccine, Gardasil, made by Merck and to be marketed in the UK by Sanofi Pasteur. Gardasil is designed to protect against HPV 6, 11, 16 and 18 and the results reported yesterday suggest that it is also effective against 31, 45, 52 and 58. Margaret Stanley, professor of epithelial biology at the University of Cambridge, said: "These data are very exciting as they show that Gardasil may potentially provide some protection against additional cancer-causing human papillomavirus strains to those specifically targeted by the vaccine. "This means there is the potential that it could protect against strains which are responsible for approximately 85 per cent of cervical cancers."

Both vaccines should also protect against the precancerous stages of cervical disease, causing fewer abnormal smears. When such smears occur women need further investigations and treatments. The GlaxoSmithKline study suggests that its vaccine will reduce abnormal smears by half and treatments for pre-cancerous lesions by up to 59 per cent.

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Obesity warriors not listening to the people

Most Australian parents believe exercise, rather than banning junk food ads, is the way to combat childhood obesity. At my research company, Crosby/Textor, we monitor the opinions of hundreds of thousands of people every year. I can confirm that many of these people agree with the host of commentators on obesity: Australia has a fat problem and it needs to be addressed.

It's at this point that the public (that's you and me) seem to part company with so many of the commentators on how to tackle the problem. I haven't done a scientific study of opinions expressed recently in the media by these people - professional or otherwise - but I have been surprised by the lack of balance in the debate.

For most of us it is an equation that necessarily has two sides: calories in, calories out. Yet most of the prescriptions for action focus on the calories in component (food) and give little or no attention to the calories out bit (exercise). Read this newspaper regularly and you'll see several articles with various people demanding that television advertising of food be restricted or that so-called fat taxes be added to some products.

Something didn't seem to add up with this approach, but I couldn't understand it until I took off my pollster's hat and put on my parent's hat. Then it was clear enough: the remedies suggested didn't line up with my experience as a parent. Life is not as simple as controlling what ads the children see or the price of a chocolate bar. Any parent knows that raising children is a jigsaw of demands and opportunities and the challenge is to make the pieces fit.

I wondered how other parents felt about this, so I put my pollster's hat back on and asked them. This was the question put to a scientifically representative group of 400 Australians: "Thinking now about the issue of childhood obesity. Would you say that addressing childhood obesity is more about getting children to eat less fatty foods, or more about banning television ads for so-called 'junk' foods, or more about getting children to exercise more and have more active lifestyles? And would that be much more or somewhat more?"

The results were remarkable. Seven per cent said the answer was much more about children eating less fatty foods and 6 per cent said it was somewhat more about fatty foods. So that's only 13 per cent in total who think the focus should be on restricting fatty foods. Another 7 per cent said it was much more about banning TV ads for so-called junk food and 4 per cent thought it was somewhat more about food ad bans. So that's 11 per cent who think the answer lies in banning TV advertisements.

How many thought it was much more about getting children to exercise more and have more active lifestyles? A little more than 56 per cent. And another 17 per cent said it was somewhat more about exercise and active lifestyles. In all, more than 73 per cent of the 400 people we surveyed across Australia think solving obesity is more about the calories out side of the equation. And fully four in five (80 per cent) people with dependent children agreed that exercise and an active lifestyle are the solution.

So why do a majority of ordinary Australians think so uniformly about the type of practical action needed? Again, I think it's about common sense and common experience. Except for people who live way out in the bush, Australians have access at every supermarket and shopping centre to an amazing variety of food. They can choose between fresh food or processed, high fat, low fat, lots of sugar or none at all, high GI or low GI. A key word here is choice; people choose from this huge range what they want to eat and unless we're planning to fundamentally change our society, they will be free to do so for a long time to come.

None of this is to underestimate the daily personal struggle necessary to ensure we and our children have a healthy, balanced diet. Generally, we know children will get their fair share of lollies and soft drink and chips, and that we have to see to it that they also have water, fruit, dairy, meat and vegetables: good, commonsense food. I don't know one parent who finds this easy but we all accept that the responsibility lies with us.

We also know that many children aren't as active as we were when we were kids. Television, DVDs and computer games are implicated but, like soft drinks and lollies, they are products that we as parents have to regulate.

Much more fundamentally, we have become frightened to let our children out of our sight, worried about the risk of pedophiles or busy roads or some other concern. Many of us are unwilling to allow our children to walk or ride to school, or to disappear on their bikes for an afternoon. We don't like them running around the neighbourhood unless another parent is prepared to watch over them, and we don't feel comfortable about them going to the corner park to kick a ball around.

Yet with both parents working or obligated in some other way, or simply having to prepare dinner or get the housework done, or ensure that the children do their homework, there is often no time to take them to the park or the local pool.

If we're serious about the threat posed by obesity, we must look far more realistically at the circumstances that are creating it and take practical steps towards real change. We need to ensure we have the community infrastructure and physical infrastructure in place to support parents. For example, we should re-examine the role of schools in this issue, including ideas such as health tests and organised activity before and after normal school hours (given that on-site care is already a fact of life for many, we might as well use the opportunity).

We also need to properly assess our fears for our children. If roads are unsafe for cycling, let's build more bike tracks. If we need more police on patrol, let's have more police. If we need public transport to be more frequent and closer to our homes, then let's urge our governments to make that kind of infrastructure investment. If we need to build more healthy activity into the school day, then let's do that.

Parents bear the greatest responsibility when it comes to childhood obesity, but they don't bear it alone. We are collectively responsible for the society we live in and must collectively respond to threats to our collective wellbeing.

That's why we give authority to governments and bureaucracies. These have the power to act on some of the systemic barriers to exercise and active lifestyles.

In the meantime, commentators on obesity need to move outside the five-star comfort of the conference circuit and start connecting with the real issues real people face rather than push simplistic solutions that miss the point entirely. They need to listen to what the public is saying. In this survey, the public is speaking very clearly.

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Just some problems with the "Obesity" war:

1). It tries to impose behavior change on everybody -- when most of those targeted are not obese and hence have no reason to change their behaviour. It is a form of punishing the innocent and the guilty alike.

2). The longevity research all leads to the conclusion that it is people of MIDDLING weight who live longest -- not slim people. So the "epidemic" of obesity is in fact largely an "epidemic" of living longer.

3). It is total calorie intake that makes you fat -- not where you get your calories. Policies that attack only the source of the calories (e.g. "junk food") without addressing total calorie intake are hence pissing into the wind. People involuntarily deprived of their preferred calorie intake from one source are highly likely to seek and find their calories elsewhere.

4). So-called junk food is perfectly nutritious. A big Mac meal comprises meat, bread, salad and potatoes -- which is a mainstream Western diet. If that is bad then we are all in big trouble.

5). Food warriors demonize salt and fat. But we need a daily salt intake to counter salt-loss through perspiration and the research shows that people on salt-restricted diets die SOONER. And Eskimos eat huge amounts of fat with no apparent ill-effects. And the average home-cooked roast dinner has LOTS of fat. Will we ban roast dinners?

6). The foods restricted are often no more calorific than those permitted -- such as milk and fruit-juice drinks.

7). Tendency to weight is mostly genetic and is therefore not readily susceptible to voluntary behaviour change.

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