Pharmaguy's Insights Into Drug Industry News
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Pharmaguy's Insights Into Drug Industry News
Pharmaguy curates and provides insights into selected drug industry news and issues.
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On Twitter, HPV Vaccination is Viewed Positively

On Twitter, HPV Vaccination is Viewed Positively | Pharmaguy's Insights Into Drug Industry News |

Background: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. There are several vaccines that protect against strains of HPV most associated with cervical and other cancers. Thus, HPV vaccination has become an important component of adolescent preventive health care. As media evolves, more information about HPV vaccination is shifting to social media platforms such as Twitter. Health information consumed on social media may be especially influential for segments of society such as younger populations, as well as ethnic and racial minorities.

Objective: The objectives of our study were to quantify HPV vaccine communication on Twitter, and to develop a novel methodology to improve the collection and analysis of Twitter data.

Methods: We collected Twitter data using 10 keywords related to HPV vaccination from August 1, 2014 to July 31, 2015. Prospective data collection used the Twitter Search API and retrospective data collection used Twitter Firehose. Using a codebook to characterize tweet sentiment and content, we coded a subsample of tweets by hand to develop classification models to code the entire sample using machine learning procedures. We also documented the words in the 140-character tweet text most associated with each keyword. We used chi-square tests, analysis of variance, and nonparametric equality of medians to test for significant differences in tweet characteristic by sentiment.

Results: A total of 193,379 English-language tweets were collected, classified, and analyzed. Associated words varied with each keyword, with more positive and preventive words associated with “HPV vaccine” and more negative words associated with name-brand vaccines. Positive sentiment was the largest type of sentiment in the sample, with 75,393 positive tweets (38.99% of the sample), followed by negative sentiment with 48,940 tweets (25.31% of the sample). Positive and neutral tweets constituted the largest percentage of tweets mentioning prevention or protection (20,425/75,393, 27.09% and 6477/25,110, 25.79%, respectively), compared with only 11.5% of negative tweets (5647/48,940; P<.001). Nearly one-half (22,726/48,940, 46.44%) of negative tweets mentioned side effects, compared with only 17.14% (12,921/75,393) of positive tweets and 15.08% of neutral tweets (3787/25,110; P<.001).

Conclusions: Examining social media to detect health trends, as well as to communicate important health information, is a growing area of research in public health. Understanding the content and implications of conversations that form around HPV vaccination on social media can aid health organizations and health-focused Twitter users in creating a meaningful exchange of ideas and in having a significant impact on vaccine uptake. This area of research is inherently interdisciplinary, and this study supports this movement by applying public health, health communication, and data science approaches to extend methodologies across fields.

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GSK Withdraws HPV Vaccine Cervarix from US Market

GSK Withdraws HPV Vaccine Cervarix from US Market | Pharmaguy's Insights Into Drug Industry News |

Facing “very low market demand,” GlaxoSmithKline has decided to pull out of the U.S. market with the HPV vaccine Cervarix, a spokesperson told FiercePharma. It’s a move that gives Merck a stranglehold on the market as public health officials work feverishly to boost vaccination rates.


GSK’s last shipments were made on Aug. 31, according to a supplier note to customers. Last year in the U.S., GSK’s vaccine earned just £3 million of an £88 million ($107 million) worldwide total. That’s in comparison to Merck’s global total of $1.9 billion for the Gardasil franchise.


The move gives Merck complete control of the U.S. HPV vaccine market as public health officials push for higher HPV vaccination rates. A sex stigma, safety concerns, antivaccine campaigns and other factors have hindered uptake for a vaccine class once anticipated to reel in $4 billion to $10 billion by optimistic analysts.


CDC figures last year placed HPV vaccination rates at 40% for girls and 21% for boys, far short of a U.S. Department of Health and Human Services goal of 80% for both boys and girls by 2020.


To combat the low rates, organizations including ASCO and the National Cancer Institute have urged more vaccinations. In a joint statement, NCI’s cancer centers called the vaccines “tragically underused.”


Merck, for its part, launched an ad campaign to put the onus on parents to get their children vaccinated (read “Merck Ad Blames Parents & Asks: ‘Mom, Dad, Did You Know’").

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In Line with Merck Campaign, NBC Nightly News Reports Effort to Vaccinate Against HPV

In Line with Merck Campaign, NBC Nightly News Reports Effort to Vaccinate Against HPV | Pharmaguy's Insights Into Drug Industry News |

Public health officials the findings of a study are especially upsetting because the cancers can be prevented with a vaccine given to pre-teens. View the video here.

Pharma Guy's insight:

This news coverage is timed and fits perfectly with Merck's campaign; i.e., Merck Ad Blames Parents & Asks: "Mom, Dad, Did You Know";


Who says news media “routinely exploit consumer fears” and “look for stories that show how dangerous prescription drugs can be”? DTC in Perspective Chairman Bob Ehrlich, that’s who. Read: Should News Media "First, Do No Harm" When It Comes to Covering #Pharma Drugs?; 


Here are some numbers from the CDC (found here:  "Of the 38,793 cancers that occurred each year in the United States at anatomic sites associated with HPV, approximately 30,700 can be attributed to HPV. Of these, 24,600 cancers are attributable to HPV types 16 and 18, which are included in all current HPV vaccines, and 28,500 are attributable to high-risk HPV types included in the 9-valent HPV vaccine. Ongoing surveillance for HPV-associated cancers using high-quality population-based registries is needed to monitor trends in cancer incidence that might result from increasing use of HPV vaccines and changes in cervical cancer screening practices."

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Marketing Gardasil Vaccination in the Halls of Colleges & Universities

Marketing Gardasil Vaccination in the Halls of Colleges & Universities | Pharmaguy's Insights Into Drug Industry News |

Wandering the halls of a college or university campus can be enlightening in seeing how the pharmaceutical marketing machine is insinuating itself into the lives of young people.


Last month, while giving a public lecture at the University of Victoria, I spotted a glossy poster entitled, “Reasons Why You Should Help Protect Yourself Against HPV.” It featured a man and two women staring provocatively into the camera. Since consumer-directed advertising of pharmaceuticals is illegal in Canada, I wondered what this drug ad was doing on a university bulletin board.


No doubt designed to entice university students of both genders to start worrying about something they’ve probably never even heard of – HPV (Human Papilloma Virus) – it included this bold stat that helpfully stokes fear: “It is estimated that 75% of sexually active Canadians will have at least one HPV infection during their lifetime.” After making the link between HPV, cervical cancer and genital warts, the poster hits the students with the sales hook – I’m paraphrasing here – “Come on down and get your Gardasil 9 vaccinations and your student health plan will save 80% of the cost!” For debt rattled students, the chance of saving $400 must surely be very enticing because, well, genital warts? Oooh, gross.


The grossest thing about this poster was the missing safety information related to the vaccine. But if you looked closely, you could see it had been covered up, as was the manufacturer’s name, Merck, with a sticker showing the potential cost savings. The headline “Gardasil is available at UVIC Health Services for Men and Women” was followed by how the three-dose regime of the Gardasil 9 vaccine would cost students $480 out of pocket but only $96 with their undergraduate Extended Health Plan. What a bargain!


If you held the poster up to the light, you could just make out the safety information. In this case, the vaccine was related to a number of minor things and the classic cover-all statement, “As with any medicine, there is a very remote chance of a vaccine causing a serious injury or death.”


In my world of researchers, the university’s attitude seems quaint and naive given that many people worldwide consider the HPV vaccines to be poster children for “controversial.” Even though it’s designed to prevent infection by some strains of the sexually transmitted human papillomavirus (HPV), the vaccine has yet been proven to reduce cervical cancer rates. And the potential for harm is real and troubling.


Evidence from the company-sponsored, randomized trials used to approve the vaccine have shown it was generally safe, but ‘real world’ experience has been very different. In the US, for example, up to the end of September 2015, there were 37,474 adverse reaction reports made to the federal Vaccine Adverse Events Reporting System (VAERS) associated with Gardasil. These reports include 209 deaths. What does one make of this? It’s unclear because these deaths are deemed ‘associations’ and one cannot conclude the vaccine alone was directly responsible.


[The author, Alan Cassels is a drug policy researcher in Victoria. His most recent book, The Cochrane Collaboration: Medicine’s Best Kept Secret, has just been published. Follow him on twitter @AKECassels]

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Doctors Urged to Forget Conversation with Parents About HPV Vaccination and Just “Announce” It’s Time To Do It!

Doctors Urged to Forget Conversation with Parents About HPV Vaccination and Just “Announce” It’s Time To Do It! | Pharmaguy's Insights Into Drug Industry News |

OBJECTIVE: Improving provider recommendations is critical to addressing low human papillomavirus (HPV) vaccination coverage. Thus, we sought to determine the effectiveness of training providers to improve their recommendations using either presumptive “announcements” or participatory “conversations.”


METHODS: In 2015, we conducted a parallel-group randomized clinical trial with 30 pediatric and family medicine clinics in central North Carolina. We randomized clinics to receive no training (control), announcement training, or conversation training. Announcements are brief statements that assume parents are ready to vaccinate, whereas conversations engage parents in open-ended discussions. I.e., Some of the doctors received training to propose the HPV vaccine to parents like any other vaccine, automatically assuming parents were ready to vaccinate their kids. Other doctors were trained to engage in open-ended discussions with parents about the vaccine, while a control group received no training at all. HPV vaccination coverage was 5 percent higher in clinics where doctors presumed parents would opt for the HPV vaccine. The study’s authors say that strategy may be more effective because it allows parents to sidestep discussing sex — which can be a hang-up for some — but still lets parents ask questions if they choose.


A physician led the 1-hour, in-clinic training. The North Carolina Immunization Registry provided data on the primary trial outcome: 6-month coverage change in HPV vaccine initiation (≥1 dose) for adolescents aged 11 or 12 years.


RESULTS: The immunization registry attributed 17 173 adolescents aged 11 or 12 to the 29 clinics still open at 6-months posttraining. Six-month increases in HPV vaccination coverage were larger for patients in clinics that received announcement training versus those in control clinics (5.4% difference, 95% confidence interval: 1.1%–9.7%). Stratified analyses showed increases for both girls (4.6% difference) and boys (6.2% difference). Patients in clinics receiving conversation training did not differ from those in control clinics with respect to changes in HPV vaccination coverage. Neither training was effective for changing coverage for other vaccination outcomes or for adolescents aged 13 through 17 (n = 37 796).


CONCLUSIONS: Training providers to use announcements resulted in a clinically meaningful increase in HPV vaccine initiation among young adolescents.

Pharma Guy's insight:

Wow! This is a low in doctor-patient relationship. So many tactics have been proposed to increase HPV vaccination, but this seems to be the most anti-patient yet, even worse than blaming the parents (read “Merck Ad Blames Parents & Asks: ‘Mom, Dad, Did You Know’"; and “Marketing Gardasil Vaccination in the Halls of Colleges & Universities”;


Also read: “More Parents Refuse Vaccination for Their Kids. Why? Not the Reason You Think”;

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Majority of Parents Do NOT Support HPV Vaccination School-Entry Requirement

Majority of Parents Do NOT Support HPV Vaccination School-Entry Requirement | Pharmaguy's Insights Into Drug Industry News |

Background: The number of states proposing school-entry requirements for human papillomavirus (HPV) vaccination has increased over the last decade. However, data are currently limited regarding parents' support of such laws. We sought to obtain the first national estimates of parents' support of HPV vaccination school-entry requirements.

Methods: A national sample of 1,501 parents of 11- to 17-year-old children completed a web-based survey between November 2014 and January 2015. Analyses used multivariable logistic regression to assess correlates of support for school-entry requirements for HPV vaccination.

Results: Overall, 21% of parents agreed that laws requiring HPV vaccination for school attendance “are a good idea,” and 54% disagreed. If school-entry requirements included opt-out provisions, agreement increased to 57%, and only 21% disagreed. Parents more often agreed with requirements without opt-out provisions if they were Hispanic [OR = 1.53; 95% confidence interval (CI), 1.05–2.22], believed HPV vaccine was as or more important than other adolescent vaccines (OR = 2.76; 95% CI, 1.98–3.83), or believed HPV vaccine was effective for preventing cervical cancer (OR = 2.55; 95% CI, 1.93–3.37). Parents less often agreed if they resided in Midwest states or believed that HPV vaccine was being pushed to make money for drug companies (both P < 0.05).

Conclusion: Opt-out provisions almost tripled parents' support for HPV vaccine school-entry requirements. Our findings suggest that race/ethnicity, attitudes about HPV vaccine, and region of residence may influence support for requirements without opt-out provisions.

Pharma Guy's insight:

Read “Merck Ad Blames Parents & Asks: ‘Mom, Dad, Did You Know’”; and “Marketing Gardasil Vaccination in the Halls of Colleges & Universities”;

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Merck Ad Blames Parents & Asks: "Mom, Dad, Did You Know"

Merck Ad Blames Parents & Asks: "Mom, Dad, Did You Know" | Pharmaguy's Insights Into Drug Industry News |

On the heels of a recently renewed push by researchers and doctors to encourage HPV vaccinations, Merck--maker of market-leader Gardasil--is out with a new HPV awareness campaign that puts the onus of vaccination on parents.


In the TV ad, a young adult woman with cancer caused by HPV is shown in a series of pictures that go back in time. She wonders whether hier parents just didn’t know about the vaccine that could have protected her when she was 11 or 12. “Mom, Dad, Did You Know?”, she says poignantly. The ad ends with a female voiceover asking, “What will you say?”


Most recently, an analysis of 58 studies on the vaccine since 2007 was compiled and evaluated, led by Royal Women’s Hospital at the University of Melbourne, Australia. It found a 90% decrease in HPV cases in countries with the highest vaccination rates, even though the HPV shot still lags other childhood vaccinations. In the U.S., only 40% of girls and 21% of boys have received the HPV vaccination, according to the CDC.


Gardasil brought in $1.9 billion in sales last year--which would sound like more if forecasts hadn't once pegged the HPV vaccine market at $4 billion in annual sales. The other HPV vaccine, GlaxoSmithKline's Cervarix, had sales of about $128 million last year.


The Merck spokeswoman said the awareness campaign is needed because in its own survey of 858 parents last year “about 85% were familiar with HPV, but only about 50% knew about the link between the virus and cancer.”

Pharma Guy's insight:

Dr. Dalbergue, a former pharmaceutical industry physician with Gardasil manufacturer Merck, said: "I predict that Gardasil will become the greatest medical scandal of all times because at some point in time, the evidence will add up to prove that this vaccine, technical and scientific feat that it may be, has absolutely no effect on cervical cancer and that all the very many adverse effects which destroy lives and even kill, serve no other purpose than to generate profit for the manufacturers."; 

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Vaccine Reduces HPV in Teenage Girls, But Many Physicians Don't Recommend It to Parents

Vaccine Reduces HPV in Teenage Girls, But Many Physicians Don't Recommend It to Parents | Pharmaguy's Insights Into Drug Industry News |

A vaccine introduced a decade ago to combat the sexually transmitted virus that causes cervical cancer has already reduced the virus’s prevalence in teenage girls by almost two-thirds, federal researchers said Monday.

Even for women in their early 20s, a group with lower vaccination rates, the most dangerous strains of human papillomavirus, or HPV, have still been reduced by more than a third.

The news is likely to serve as a welcome energizer in the tumultuous struggle to encourage HPV vaccination in the United States. Despite the vaccine’s proven effectiveness, immunization rates remain low — about 40 percent of girls and 20 percent of boys between the ages of 13 and 17. That is partly because of the implicit association of the vaccine with adolescent sexual activity, rather than with its explicit purpose: cancer prevention. Only Virginia, Rhode Island and the District of Columbia require the HPV vaccine.

There are several obstacles to greater coverage rates in the United States. In other countries, the vaccine is often given in two doses, particularly to girls younger than 15. In the United States, it is given in three doses. An immunization advisory committee to the C.D.C. will convene this week to learn more about the efficacy of the lower dose.

And in some countries, the vaccine is either mandatory or at least offered at school, its cost covered by a national health care system, making administration more streamlined and comprehensive. Such measures helped Rwanda achieve a 93 percent immunization rate in girls. Australia, where the vaccine is offered free to schoolgirls, accomplished a 92 percent reduction in genital warts in women under 21, a study showed.

But in the United States, the vaccine is largely optional.

“Multiple studies have shown the importance of a strong provider recommendation for increasing vaccination coverage,” said Dr. Lauri E. Markowitz, a medical epidemiologist at the National Center for Immunizations and Respiratory Diseases, a division of the C.D.C., who led the research for the latest study.

But studies show that many primary care providers either do not recommend the vaccine to parents and patients or do so halfheartedly. Some doctors are reluctant to discuss the vaccine because the conversation may dance uncomfortably around sexual activity. They may want to use their limited appointment time for health topics that parents may be more willing to engage.

Pharma Guy's insight:

I guess the reports of the demise of HPV vaccines was greatly exaggerated. Read " Former Merck Doctor Predicts that Gardasil will Become the Greatest Medical Scandal of All Time"; 

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