Dr. Doe: Welcome to Sexplanations, I'm Dr. Lindsey Doe, clinical sexologist, and this is Dr. Aaron Carroll, a medical doctor, who also wrote this book, in addition to this book, this book, this book..

Dr. Carroll: It's The Bad Food Bible. It grew out of some columns, and actually some episodes we made on our show, Healthcare Triage, talking about how the science behind so much of nutrition and what we think of as "bad food," or foods that we shouldn't be eating, isn't that good. And a lot of the stuff that people tell you you absolutely must avoid is not harmful, and in some cases, it's not sometimes healthy.

LD: I consider you to be an expert in a lot of things, and one in particular. It is HPV, the Human Papilloma Viruses. Also the insistence on vaccinating young people.

AC: I mean, the reason we vaccinate people is to try to prevent them from getting illnesses that they would otherwise get. And vaccines in general have been probably one of the greatest public health achievements of the last century, if not of all time. I mean, vaccines are amazing. There are diseases we've eradicated just because of vaccines.

So the HPV vaccine is a newer one. But the idea is that we're trying to prevent people from getting infected with Human Papilloma Virus, which is a virus that causes a bunch of sexually transmitted illnesses, but also is associated with later cancers: with cervical cancer, with anal cancer, and even with some throat cancers now. And so if we can get people vaccinated so that they don't get infected, it should prevent those cancers, and millions of people from getting them.

LD: So the idea behind a vaccine is that you're giving a dead or weakened version of the virus to the person's system, the immune system responds to that, and so when the full force virus comes in, you already have antibodies to fight it off.

AC: Correct. So you did a great job there. So yes. So the way that the body works is that when it sees a bad germ, it has to build things, antibodies, to try to grab onto it so that the body knows to clear it out. And once it's learned how to build and construct this certain antibody to attack something, it then records it so it can do it forever and ever and ever. But sometimes when you get infected with some viruses, even if you grab onto it, you can't fully eradicate it. The chicken pox vaccine, for instance. If you get infected with real chicken pox, the reason people get zoster, or they get infected later, like, it's not that they got sick again, it came out of their nervous system, where it had lain dormant, and reinfected them from within. So if we can prevent people from getting chicken pox in the first place, they won't get, you know, the later disease. So it's a lot about prevention. It's: we have to actually get people vaccinated before they could ever become infected with HPV, which means, of course, we have to get them pretty young.

LD: But my confusion then is that if you have hundreds of strains of this virus, 40 to 60 of them are sexually transmitted?

AC: Mmm hmm.

LD: Why is it that we're targeting young people? Obviously because they haven't maybe had uh, sexual contact that would contract the virus, but why not give it to everyone so that you're at least preventing some strains that they haven't gotten?

AC: Most adults who have not been vaccinated have come into contact with so many of them already that there's just a limited efficacy.

LD: OK.

AC: It just doesn't do as much.

LD: Darn.

AC: Uh, the only to sort of get that full prevention is to get in early, before people see the virus at all. And people become sexually active at reasonably young ages, so if we don't get them vaccinated before that's going to occur, it is too late. Because once they've actually been infected with the regular virus, the vaccine just doesn't work as well.

LD: Aaron does the Healthcare Triage, and in one of his shows about HPV and the vaccine, you say, "You need to do it before you touch genitals."

AC: Mmm hmm.

LD: And if you don't want to get the vaccine, then don't ever, ever, ever, ever, ever, ever touch genitals.

AC: Yeah, and that's where we get to. You can say, ok you probably don't need to be vaccinated if you just make a commitment never to be sexually active in any way possible, ever, but that's just not realistic.

LD: Mmm.

AC: And it probably isn't even healthy. So...

LD: [laughs]

AC: ... the idea is that, you know, we just want to vaccinate children before this occurs. I mean, we could make an argument that they could start even earlier. It's just unfortunately because of the way people view this one vaccine, a lot of parents don't want their kids to have it and a lot of people remain unprotected.

LD: And they don't want their kids to have it because they think that it will increase sexual activity?

AC: That's the most highly cited reason. And of course they've done studies, we cite these on our show all the time, where they can look at girls or boys who have been vaccinated or not vaccinated and then see whether they are more or less sexually active. And there's no relationship at all between whether kids get vaccinated and whether they have more sex, or unprotected sex, or whether they get pregnant. It just doesn't occur. But some people just believe that, and because they believe that, they think that giving kids the vaccination gives them a license to go have sex. In other words, it removes this barrier which otherwise would keep them from being sexually active. That does not bear out in reality.

LD: No!

AC: All we're doing is leaving kids unprotected.

LD: So what is the medical stance on the HPV vaccine?

AC: Oh, that pretty much all children should be getting it, you know, I'm not even sure what the recommendation on year is now. It might be 11 or 12 or 13, but certainly, it's got to be young enough that it's before sexual activity. And we, I see parents all the time in my practice where they are trying to push it later and later, and there's just no reason to. In fact, it's dangerous, the way that we talk about this vaccine differently. There's been some interesting recent research showing that doctors approach this one differently because they're so worried about what parents are going to think about it and treating it differently is what's making its uptake so low that by even just sort of fostering this idea that this vaccine's different than the other one gives parents permission to think that their kids don't need it and that's just not the case.  We should treat this like measles.  We should treat this like any other vaccine.  They should just get it.

LD: What advice would you give to people who maybe don't have adults making decisions for them, they aren't super sexually active or at all, but they're considering getting the vaccine?

AC: You don't have to be sexually active to think about this, just like you would with anything else.  You don't wait until after the fact before you do it.  We have to do this ahead of time.  It's anticipatory, so I would not be waiting until I think I'm going to be sexually active before I would start the course of HPV vaccine.  It is a multiple series of vaccine, it takes time to do.  We should be doing it before, and if people are making decisions for themselves, in fact, this is one of the things I do get emails from kids who say, my parents won't let me have this vaccine and that's when I say you should talk to your pediatrician, you should talk to your doctor, because there are things that you can get treated for and things that you are going to need that you can have a conversation with your physician about that they will keep in confidence and I'm not sure where the law comes down with respect to vaccines on all sides but anytime you have a concern like that, you should talk to your doctor.

LD: If I start the vaccine, so I get shot one and then become sexually active, does it mess up the rest of the vaccination?

AC: So you get protection with each subsequent vaccine.  No vaccine is 100% effective, let's start with that.  It just isn't.  So, you know, even when kids are vaccinated against measles, some kids will get it.  We're just trying to decrease the odds and we're trying to get up to the point where we have herd immunity and it's just unlikely that people are gonna get sick.  So each shot you get is better than not, but finishing the series is best.  That will give you the most protection, and again, it's not that if you had sex in between you'd be in danger.  What would really matter is if, if you get the vaccine and you had sex and you were exposed to the virus, there's a less of a chance you got infected, but if at any point you did get infected, as we said before, the vaccine doesn't really do that much good after that.  I think it was (?~7:25) said if we can get all the young women and men now vaccinated, that we could prevent millions of cases of cervical cancer and save lives.  We're not talking about small numbers.  It's huge numbers of the good that we can do if we can get everyone vaccinated.

LD: The vaccine can prevent cervical cancer and genital warts?

AC: So yes, it'll, it should prevent all of that, but the end result that we most care about is cancer, because that's the one, of course, that could kill you.  

LD: And it's cancer in the vagina, the cervix specifically, the anus of the people who are having anal penetrative sex oral.

AC: Yeah, or even throat cancer with oral, with oral sex, absolutely.  I mean, it is, it is linked to cancers anywhere you think that sexual activity might occur and there's a link between HPV infection and bad cancer.

LD: All genders can be infected by HIV and all genders should get the vaccine.

AC: Yeah, get vaccinated, absolutely.  I mean, this is one of those where, bizarrely, they started with only recommending the CDC's recommendation said only female.  I mean, that is what they came out with at the beginning, which I think was because they so badly wanted to pitch this as preventing cervical cancer that they didn't even want to acknowledge that anything else existed and so that was the hook that they thought they could get this by people who might be afraid that this was the sex vaccine.  Other genders are involved in sexual activity that could lead to women getting cervical cancer, so we start with that, but it turns out it's associated with all these other cancers that people of any gender can get, so that's why they've now expanded it to say that everybody should be vaccinated.  There's still a lot of bad thoughts about this vaccine.  It is viewed differently than others and uptake is still significantly below what we'd like it to be.

LD: Would we like it to be 100%?

AC: In an ideal world, yes.  I mean, it'll never be 100%, because some people can't get a vaccine.  It just happens because they are, they are either immunocompromised or they are ill, so one of the things I always say is you often need to get vaccinated not because you're going to get sick.  You need to protect the others who can't get vaccinated.  One of my favorite stories about this was looking at the varicella vaccine, so the one that prevents chicken pox.  Every year in the United States, decades ago, some number of babies died from chicken pox infection every year.  Now, babies less than one year of age can't be vaccinated.  They can't.  They're just too young.  The vaccine is not recommended yet, so we start kids at one age, but since we started vaccinating kids at one age, no babies have died of varicella because if we get the vaccine rates high enough, there just isn't enough virus out there that we protect the elderly, we protect the immunocompromised, we protect the babies, we protect the people that can't protect themselves, because that's the goal.  So we'll never get to 100%, but we want to get high enough that the pool of actual illness out there is low enough that you really reduce the chances somebody could get sick.  If we get vaccinations high enough, these diseases theoretically could be eradicated.

LD: Well, thank you, medical field.  

AC: I wish I could take credit for that.  We could do better though.  We're not, we're not doing all that we could to make this happen.

LD: And you're doing an amazing job of educating both on Healthcare Triage and then coming on to our channel, Sexplanations.

AC: Oh, say the same of you.  Thank you very much.

LD: It's awesome.  Cool.

Both: Stay curious.  

LD: And buy Aaron's book and go to Healthcare Triage.

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