A few days ago Tom Ashbrook hosted a show on NPR about the opioid addiction crisis in the US. Listening to it will blow the top of your head off, but once you put yourself back together it might set one or two of you on a new course. In essence, the show describes an epidemic that was somewhat-intentionally created by the pharmaceutical industry. No one was sitting in a back room plotting the destruction of the American public, but they were searching, as always, for a blockbuster drug and what better drug than an opium-based drug. The “need” is truly infinite. They marketed these “new” opioids as revolutionary and non-addictive and an important advance. But they were more-or-less the same ole opioids that have been around for thousands of years. And as we all know, are HIGHLY addictive. Opioids are for acute pain, like surgery and traumatic accidents, and shouldn’t be prescribed for longer than 14 days unless the patient is terminal. Nothing about this truth has changed over the decades and indeed over the centuries.

The most shocking moment in the show is when they reveal one of the early oxycontin ads which featured six REAL patients who were taking oxycontin and had “gotten their lives back because of it.” At this point in the sordid history of this drug we know that THREE of those six became severely addicted and TWO lost their lives to addiction. This is the backstory of the company’s own advertisement.

Particularly appalling is the non-action and fecklessness of the FDA. Once the epidemic was running at full tilt, what did they do about access to these drugs? Close to nothing. Until a few days ago when they APPROVED OXYCONTIN FOR CHILDREN AS YOUNG AS 11. It gets harder and harder to believe that nothing nefarious is going on in the face of such absurdity.

This sad story is a very useful lesson about the FDA and the large pharmaceutical companies —and that lesson is that you would be foolish to trust them, though I lay more blame at the feet of the FDA who are charged with protecting the public. Pharmaceutical companies are not charged with protection — they have one job and we all know what it is ($). I don’t intend to demean the good work that has been done developing life-saving drugs and vaccines, many of which are impressive accomplishments that have decreased human suffering. But I doubt any scientist who actually works at a pharma company would dispute that their primary mandate is to create blockbuster drugs, full stop. And this mandate comes with real moral risks that SHOULD be mitigated by the FDA.

I mention this story as a preface to my reaction to a new film about HPV and cancers it causes, Someone You Love. I feel sure that most of the people associated with the film mean well. But I just ask those interested in the topic to remain skeptical as I point out just a couple of things: 1. Let’s look at the language right on the front page of the film’s website. The subtitle of the film is “the HPV epidemic.” Sounds alarming, no? Yet this is from the CDC website: “Most sexually active people will have genital HPV at some time in their lives. There are often no symptoms and it goes away on its own — without causing any serious health problems.” So pretty much everyone will have it at some point in his or her life without knowledge or consequences. Like many viruses. So calling HPV an “epidemic” is silly at best, but deceptive at worst. When HPV does lead to cancer, it is overwhelmingly cervical cancer. So what are the rates of cervical cancer deaths in the U.S.? 4,074 women in the United States died from cervical cancer in 2012 (the most recent year available). So .000016 is the mortality rate in the U.S. If you know someone who has died of this disease, my condolences. These issues, when they are personal, are sheer catastrophe. But looking at the issue from a distance — which is the project of public health policy — we know that “in the past 40 years, the number of cases of cervical cancer and the number of deaths from cervical cancer have decreased significantly. This decline largely is the result of many women getting regular Pap tests” according to the CDC. Pap smears are a proven method of prevention. Furthermore, some current HPV shot series do NOT prevent all cancer causing strains of HPV (have a look at this CBS report that details a study demonstrating this as well as the more alarming finding that “Women who receive the human papillomavirus (HPV) vaccine may be more likely to be infected with certain high-risk strains of the virus than women who do not get the vaccine, according to a new study”). You still have to get your annual pap smear even if you are vaccinated. With disease and mortality rates suspiciously low for cancer-causing HPV, and the continued requirement for a pap smear, doesn’t it beg the question about why there is a big push to become aware of the “HPV epidemic”? This brings me to the second point. 2. The director openly refuses to identify the sponsors of the film. Who paid for it? Considering the amount of money at stake in the HPV war, it is disturbing to say the least that the director will not be forthright about this. (Please don’t worry: I’m not anti-vaccination, I’m merely pharma-skeptical and I hope I have demonstrated why this is a reasonable position.) Is this film a giant advertisement (unbeknownst to the subjects, of course)?

Cervical Dysplasia, a symptom-less pre-cancerous condition, is also addressed by the HPV shots, as is genital warts. So perhaps the vaccine’s best usage is for preventing these more common conditions, though once again it’s important to take heed of the following statistics: most cervical dysplasia spontaneously regresses. If left untreated, about 70% of cervical dysplasia will regress within 2 years without treatment. Furthermore, the vaccine cannot protect females who are already infected with HPV. And I can’t help but notice this: “Among women with a chronic HPV infection, smokers are twice as likely as nonsmokers to develop severe cervical dysplasia, because smoking suppresses the immune system. Chronic HPV infection and cervical dysplasia are also associated with other factors that weaken the immune system, such as treatment with immunosuppressive drugs for certain diseases.” In other words, this isn’t an isolated issue of a single virus invading the body — this is a systemic issue. I suppose targeting a virus as if it’s not related to a whole system is simply the way we live now, and clearly it is cheaper, on the individual level, to get a vaccine than to treat the systemic problems that present before and during the onset of these diseases — and that’s something — but I can’t help but be uneasy about the aggressive pushing (by a nameless entity) of a pharmaceutical fix — being recommended for every young person in the country — for a problem that, in the overwhelming majority, simply doesn’t and never will exist.

You might ask, if the vaccine can help prevent even just a small portion of warts, dysplasia and cancer, why not take it? Perhaps the answer is that you SHOULD take the vaccine — perhaps it really is as simple as that. On the other hand, it would be nice if doctors, the FDA and the medication manufacturers could perhaps acknowledge why the American public has become skeptical over the decades given the proliferation of examples like the one provided in the opening paragraphs of this essay. And let’s not pretend this is an isolated example of FDA and pharmaceutical negligence (or whatever you care to call it). We simply cannot automatically depend on large institutions — be they public or private — to protect and care for us even if their intentions are entirely good. If the medical establishment wretches every time an undereducated person refuses genuinely effective medical treatment, perhaps they should consider pointing the finger at themselves for this type of patient behavior. More straightforwardly, we all want to know the answer to some very basic questions: what is the long term effectiveness of these HPV vaccines? did we know that information before they were pushed out into the world? what percentage of patients are not returning for second and third doses of the shot and was implementation really thoroughly thought-through? what about African-American women and the finding that they don’t seem to be particularly protected by the most recent iteration of the vaccine? why was this discovery about African-American patients a surprise? Exactly how much data was gathered before it was put on the market? Given that there is no epidemic (to say the least) of cervical cancer or dysplasia or warts, why was this medication fast-tracked at the FDA?

Oh, just one more thing. An effective immunotherapy drug for HPV-associated cancers is on a path to FDA approval — it’s entering phase 3 trials. It will be a non-invasive, immune-stimulating therapy that targets “the E6 and E7 oncogenes of HPV types 16 and 18.” The same HPV types addressed by current vaccines and which cause most of the cancers. And if you remain a healthy individual, you never have to take it.