Human Papilloma Virus and Cervical Cancer

After I say that Nobel Prize in Medicine is usually given for research of little or no proven value, one counterexample I’ve heard is the 2008 prize for the discovery that cervical cancer is caused by the human papilloma virus (HPV). This should allow us to reduce cervical cancer via vaccination.

There are several things wrong with this example:

1. The predicted improvement has not been observed. The average age at which a woman is diagnosed with cervical cancer is 48 years old. To assess the effect of HPV vaccination — usually given to young girls — on cervical cancer you need to wait thirty years. Thirty years haven’t passed. The history of medicine is full of examples where treatments that supposedly worked — such as tonsillectomies, given to millions — when tested turned out to not work. The history of medicine is also full of examples where supposedly wonderful treatments (e.g., frontal lobotomies) turned out to have side effects so bad the treatment was stopped.

2. Cervical cancer is not a big source of death. In the United States, it kills perhaps five thousand women per year. Heart disease kills hundreds of thousands of people per year; so do all forms of cancer taken together. And pap smears, which cost little, actually work. “Cervical cancer is 100% curable if detected early,” says one website.

3. Because pap smears work well, it isn’t clear there is room for improvement. To find out you’d want to compare two groups: (a) pap smears plus HPV vaccination and (b) pap smears alone.

4. It isn’t clear the vaccine will work, even if HPV infection does cause cancer. There are at least 100 varieties of HPV; the vaccine protects against two. Does vaccination against two varieties increase infection by other varieties (because different viruses compete for the same niche)? Hard to rule this out. Again, there are many examples in medicine where actually helping people turned out to be far harder than experts had predicted, even when the initial idea wasn’t nonsense. An example is the oncogene theory of cancer, which also has a Nobel Prize associated with it.

In summary, not a counterexample.

Assorted Links

  • Girl brain-dead after tonsillectomy. No doubt her parents were not told (a) your tonsils are part of your immune system, an essential part of your body, and (b) tonsil removal is associated with a 50% higher death rate. As I said here, an “evidence-based” evaluation of whether tonsillectomies are good or bad failed to mention both of these things, along with a ton of other negative evidence.
  • Reverse graffiti. I think of this blog as reverse graffiti.
  • Interview with Peter Higgs. “Believes no university would employ him in today’s academic system because he would not be considered “productive” enough.”
  • UC Berkeley Psychology Department fires staff employee (in his 24th year), apparently for union activities. “Francis Katsuura created a Cal Agenda account to track all time that Paul Haller attended bargaining [sessions]. No other department has created such an account.”

Thanks to Matt Cassell.

Eric Kandel Sheds Light On Who Wins Nobel Prizes

The most interesting thing about the Nobel Prize in Medicine is its predictable irrelevance to major health problems. Year after year, the prize-winning work has failed to reduce heart disease, cancer, depression, stroke, diabetes, schizophrenia, and so on. Another interesting thing about the Nobel Prize in Medicine is that Eric Kandel, a Columbia Medical School professor, managed to win one. In 1986, a book called Explorers of the Black Box: The Search for the Cellular Basis of Memory by Susan Allport told how Kandel tried to take credit for other people’s discoveries. Not a pretty picture. Yet in 2000 he won a Nobel Prize for those or very similar discoveries. Did Allport exaggerate? Did her sources deceive her? Did Kandel — contrary to what Allport’s book seems to say — deserve a Nobel Prize?

I can’t answer these questions. However, a recent article by Kandel (“A New Science of Mind”) in the New York Times sheds light on how well he understands medicine and neuroscience. Not well, it turns out. He writes:

We are nowhere near understanding [psychiatric disorders] as well as we understand disorders of the liver or the heart.

Actually, our understanding of liver and heart disorders is close to zero, matching our understanding of psychiatric disorders. If we had some understanding of heart disease, for example, we would know why heart disease is much rarer in Japan than in the United States. Continue reading “Eric Kandel Sheds Light On Who Wins Nobel Prizes”