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Comment by LorenPechtel | Hacker News Reader

It's not approved for those over 45. (AFIAK, simply because so few people in that age group would have risk without having had prior exposure. Basically only those who had divorced or lost their long time partner.)

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This is not true any more. The vaccine has been shown to lower cancer risk for those who already carry the virus, so it is recommended even for people who are HPV positive

That's interesting and I would like to take, can you give me a link/ ref for citation?

This is a totally predictable result, there are dozens of HPV strains and the vaccine will immunize against 9 of them that are high risk.

So, unless you are a sex worker or similar, it's unlikely you "have" all of them to the point where the vaccine is completely useless. You might later get infected with a strain that you didn't yet have, and it's precisely the one that kills you.

so how would one in the US go about getting it? gardasil?

That feels like a wild assumption to me - we really think people 45+ aren't having casual sex? less casual sex maybe, but I would imagine still a decent amount, statistically.

If you’re having casual sex at 45+ you probably already carry HPV.

Yeah that makes much more sense as an explanation than OP.

Maybe, but all 9 cancer causing strains covered by the vaccine? HPV also clears on its own usually after some time afaik.

There are over 30 strains of HPV with just 2 causing the majority of cancers. So sure, most people may have had some strain of it, but that's not really relevant unless immunity is broad across strains.

Sure, but you probably don't already have all the strains which can cause cancer.

Or, you could have been suddenly cheated on and exposed, or divorced and recently entered the dating market, or thinking about opening up your relationship after decades of monogamy.

But the number of such people is low, it would not be easy to find candidates for the trial. Just because there are some doesn't mean there are enough to make it worthwhile for the drug company to do the testing to be able to market it to such groups.

The original criteria was for people who had not already been exposed.

And over 45s that engage in casual sex have almost certainly been exposed. Those who don't have prior exposure probably have few or one partner in a marriage or marriage-like situation and thus are not likely to be exposed. Yes, they could be cheated on or the like but exposure is not expected so effectiveness can not be measured.

It's not "recommended" but your PCP can prescribe it off-label if you ask -- just ask.

I met with a new PCP a few weeks ago and it was recommended to me (at age 43). I got the first shot with the 2nd and 3rd scheduled for the coming months.

The issue is getting it covered by insurance. Otherwise it can cost over $1,000 for the full course of shots.

You can get costs down somewhat (half that) even uninsured with GoodRx.

Thanks for the recommendation! It seems like a good option, but afaict you still need to get your doctor to write you a prescription, and they may have to administer the shots as well:

https://support.goodrx.com/hc/en-us/articles/360000707483-Ho...

I'm sorry, but you sound like the people who try to get me take ivermectine for Covid. "just get it off label" or "tell the doctor you just got back from pauea new guinea and saw worms in your stool."

I know you are very well intentioned, but American's actually have very good doctors.

This is very different from recommending horse dewormer; if you can't tell the difference, I'm sorry.

When I'm in my doctor's office, and the doctor is saying "don't do that" it is quite hard to tell the difference.

Did you actually ask your doctor and receive that guidance, or is this purely a hypothetical?

Multiple times. I’ve specifically asked about this vaccine again and again.

I’ve had a few GPs in the past 20 years. They’re consistent.

I admit it’s weird. And ideologically I feel like a bit of a laggard.

But I’ve had both the conversation with my doctor, and the conversation with online “smart people who know better than my doctor” many times.

Ok, great. I'm just asking people to have that conversation.

Ivermectin is also used by dermatologists to fight face parasites that cause bad acne.

Ivermectin is also used to treat COVID in countries that have endemic parasite outbreaks. COVID responds well to steroids, but so do parasites. Giving steroids to someone with parasites causes the parasites to become much stronger, and trigger reactions from the immune system: fever, etc.

I ideally you could test for parasites, but time and resources don't allow for that in many countries. So if it's generally safe to just give ivermectin along with steroids when treating COVID - in countries where parasites are common.

Maybe I'm wrong about this. Maybe I'm making it up. Don't listen to what I say. Listen to your doctor.

In case you aren't aware, horse de-worming is just one use of ivermectin. The fact that it's used for that doesn't make it merely a horse de-wormer.

> Ivermectin is an antiparasitic drug. After its discovery in 1975, its first uses were in veterinary medicine to prevent and treat heartworm and acariasis. Approved for human use in 1987, it is used to treat infestations including head lice, scabies, river blindness (onchocerciasis), strongyloidiasis, trichuriasis, ascariasis and lymphatic filariasis. It works through many mechanisms to kill the targeted parasites, and can be taken by mouth, or applied to the skin for external infestations.] It belongs to the avermectin family of medications.

...and even a Nobel was given to its inventor (for its benefits for humans).

> American's actually have very good doctors

Doctors aren't setting the rules on who gets what vaccine and when. RFK Jr is. Health insurance companies are.

RFK Jr wasn't doing anything worth talking about during the multiple times in the past 15 years my doctors have told me it wasn't recommended.

Please do not turn mainstream medical advice into a fringe position.

It's a standard vaccine for preteen/teen boys now too. If your doctor has been telling you not to get it for the past 15 years, they've been doing you a disservice.

I haven’t been a preteen boy for the past 15 years.

I got 3 doses of gardasil at 37 in Norway. I do not want to expose women to a potentially deadly virus (plus I’d also like to avoid having penile cancer and mouth/throat cancer myself). If your doctor is seriously advising you against taking the vaccine, you should consult another doctor for a second opinion.

I trust my doctor ... he's not some quack. I've looked online (multiple times over the years) and he's simply applying federal guidelines.

Family members have died from cervical cancer so I get it. I also made sure my younger children received this vaccine.

There a ton of vaccines I could seek out. Why HPV specifically?

> There a ton of vaccines I could seek out. Why HPV specifically?

Assuming you are not commenting in bad faith, my reasons are in my original comment: "I do not want to expose women to a potentially deadly virus (plus I’d also like to avoid having penile cancer and mouth/throat cancer myself)."

And I really don’t either. Close relatives have died from cervical cancer. I care about it a lot.

Ideologically it feels weird, but when the doctor says it’s not recommended, what do I say?

I’ve never fallen in the recommended categories. I’ve been to doctors overseas where I do fall in the recommended categories, but even they say to follow the advice off my “home practitioner.”

And while I’m at it, how do I generalize the ethics behind this? Which medicines should I ignore doctors advice and take anyway?

It more like “I’d rather not have a current or future partner go through a painful LEEP procedure or cervical cancer because I exposed her to HPV”

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