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February 23, 2007
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NOW Transcript - Show 308
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Transcript - February 23, 2007

BRANCACCIO: Welcome to NOW.

How about a cure for cancer? That would be wonderful... but what scientists can offer now is a way to help prevent one deadly cancer—cervical cancer—which kills about four thousand American women each year. It's a new vaccine that stops a virus that leads to this form of cancer.

But here's the thing. This virus is sexually-transmitted. That means efforts in several states to make the new vaccine mandatory for young girls have run afoul of those who fear it will encourage sexual activity.

Senior correspondent Maria Hinojosa and producers Peter Meryash and Dan Logan have our report.

HINOJOSA: Just this month, in his state of the state address, Texas governor Rick Perry proposed an ambitious initiative ... a three billion dollar commitment in the fight against cancer.

PERRY: There will be 95,000 Texans diagnosed with cancer this year. And 34,000 Texans will lose the fight.

HINOJOSA: Many will die from cervical cancer ... nearly thirty seven hundred women in the United States this year alone.

But there's some good news on that front ... a new vaccine that can prevent seventy percent of cervical cancers.

And governor Perry has just made Texas ... the first state to require its use.

PERRY: For the first time ever, we have a vaccine that can prevent a cancer ...

HINOJOSA: So governor Perry has ordered all girls entering sixth grade in Texas to get this life-saving vaccination.

Texas may be the first ... but 18 other states and the District of Columbia ... are all now considering similar mandates.

And across the country ... these efforts have ignited a controversy.

That's because the vaccine is for a sexually transmitted virus ... and many social conservatives object to the government intruding, as they see it, into a private, family matter.

SPRIGG: There are some instances, some diseases that are easily transmitted through casual contact where there may be a really compelling public health justification for—some sort of mandate. However, that's not the case here. We're talking about a sexually transmitted disease. And so we don't feel that that public health justification for a mandate exists.

HINOJOSA: In fact, opposition comes from several directions. Some are worried the mandate comes too soon ... the vaccine was only approved by the FDA last year. Others are concerned with the profit motive of Merck, the big drug company that's been pushing this forward.

But for many, it all comes back to sex. It sends the wrong message, said one critic ...

... "This is telling girls that they can be promiscuous and still be safe."

Perhaps in anticipation of these concerns ... governor Perry's order, like most of the other state proposals ...
Gives parents the chance to "opt-out" ... in other words, to refuse the vaccination for their daughters.

PERRY: I understand the concern some of my good friends have about requiring this vaccine, which is why parents can opt-out if they so choose. But I refuse to look a young woman in the eye who suffers from this form of cancer and tell her we could have stopped it, but we didn't.

HINOJOSA: But that wasn't enough for the critics. So now, governor Perry ... a Christian-conservative ... Is facing efforts by his traditional allies ... to repeal the mandate.

All this ... over a vaccine everyone agrees ... could save lives.

The vaccine is called Gardasil ...

You may have seen the commercials ...

"one less" ... for each woman the vaccine can protect ... by blocking strains of the sexually transmitted human papilloma virus, or HPV ... that cause 70 percent of all cervical cancers.

If you pay attention, you'll notice how young some of the girls in the commercials are. That's because, experts say, the best time to give the vaccine ... is before kids become sexually active.

FREED: The vaccine won't do any good once people are already infected with the strain of the virus that's gonna cause them to get cancer. The only way that this is gonna be successful is immunizing people before they're exposed.

HINOJOSA: Dr. Gary freed is a pediatrician and professor ... who also heads a national panel of experts that advises the government on the use of vaccines.

By immunizing children at 11 years of age or 12 years of age, we're almost guaranteed that they would not have been exposed to this virus.

HINOJOSA: And that's why the centers for disease control recommends the vaccine be routinely given to girls ... 11 and 12 years old.

But it's the move toward requiring the vaccine ... That has sparked all the controversy.

We went to Michigan ... where legislation has been introduced two years in a row now ... To see how the battle has been playing out.

In Lansing, we caught up with Beth Charles, who had brought her 14 year old daughter Sarah to the pediatrician for a check-up.

CHARLES: I didn't even realize we had a Gardasil injection or something out there for HPV until the doctor said there's this vaccination now. She told me about it. And absolutely, let's have it.

HINOJOSA: Even though Sarah is too young to be sexually active, says her mother ... better to get the protection ahead of time ... instead of waiting until it's too late.

CHARLES: There's no crystal ball that says that she'll be completely protected. But if there's anything I can do as a parent to help that, then that's what I'm gonna do.

HINOJOSA: Sarah's pediatrician, dr. Miriam Behar, agrees. In fact, her own daughter has already received two of the three required vaccine doses.

Dr. Behar says it's critical to vaccinate girls at this age.

BEHAR: Studies show that—by the time that 11-year old gets through high school, there's—50 percent chance that she'll have already had sex. And I think it's—it's fine to teach abstinence. The problem is, it doesn't work, and the kids are having sex anyway. So we'd like them to be safe, and we'd like them to—not—not contract diseases that are gonna have long-term consequences later on.

HINOJOSA: And those consequences can be devastating. You don't have to travel far in Michigan to find out.

Sara Ylen lives with her family near Port Huron. For her, the vaccine has come too late. She was diagnosed with HPV in the summer of 2001.

YLEN: For me, it progressed rather quickly. It was, I have a really aggressive strain, so it spreads quickly and causes a lot of pain.

HINOJOSA: Had you ever heard about HPV? Did you know what it was?

YLEN: Prior to my diagnosis, I had never heard of it.

HINOJOSA: And when they said, "Sara, you have HPV," you thought—

YLEN: I was terrified.

She had every reason to be scared. Less than three years after learning she was infected with HPV ... Ylen was told she had cervical cancer. It eventually reached stage four ... spreading to other parts of her body.

She opted for radical chemotherapy treatments ... and for two years, battled the cancer into remission. But then, just two months ago, Ylen had a relapse.

So once more, she's back in chemo ... With treatments every two weeks. It takes a big toll on her, her husband, and two young sons.

YLEN: They feel like they've lost something. They know technically mom is still around. But for six months it felt like their mother was gone. And that's just not something any child should have to go through.

HINOJOSA: Cervical cancer also hits close to home with another Michigan native ... Patty Birkholz. She watched a good friend succumb to the disease.

So as a leading republican in the state senate ... she helped introduce legislation requiring the vaccine for all sixth grade girls in Michigan.

BIRKHOLZ: I'm doing this in her honor. Because I know that she would want this to happen. She would want every young women to have the shots in order to prevent the HPV virus and—and cervical cancer.

HINOJOSA: Senator Birkholz says ... there's been widespread support among Republicans and Democrats for the measure.

But resistance from social conservatives ... most of them men, she says ... has been difficult to overcome.

BIRKHOLZ: Some of them are concerned about the discussion about premarital sex that they think is going to occur.

HINOJOSA: Last year, the same legislation sailed through the state senate ... and nearly passed the house.

But in the wee hours of the morning, at the very end of the session ... opposition from social conservatives helped kill the bill.

STAHL: This disease is not airborne, but a sexually contracted one. Are we suggesting a license for promiscuity?

HINOJOSA: Last year, republican Jack Hoogendyk was one of the state representatives to vote against the vaccine requirement. The legislation is under consideration again this year ... and Hoogendyk says, he'll vote against it.

HINOJOSA: When you're out in your district—

HOOGENDYK: Yes?

HINOJOSA: —what do your constituents say about this?

HOOGENDYK: One of the concerns that I'm hearing from them is—is this just another example of government reaching further then it really needs to, government telling parents how to raise their children, when—when parents have enough intelligence to know that if this is a good thing to do they'll—they will do it, without the government mandating that they do it.

HINOJOSA: But there's a way in which parents can actually say—you know—they can write down, "No we don't"—

HOOGENDYK: Sure.

HINOJOSA: —"Want this vaccine."

HOOGENDYK: Well that's true. But I still think it's a mandate, because you either mandated to take your child to get the vaccine or you're mandated to provide a written statement to the school that you've refused. That brings into play the whole issues of—you know—are parents being mandated to do something by the school —that I think is totally unnecessary? The only thing that's important is that the parents have the information.

HINOJOSA: Representative Hoogendyk proposes a publicity campaign ... including public service announcements to let people know about the vaccine.

Dr. Freed, the chair of the country's National Vaccine Advisory committee, says ... that doesn't go far enough.

FREED: I'm also for getting the word out. And I'm also for publicity campaigns. But I'm also for trying to get as many young women for whom this vaccine is recommended, to get the vaccine to help prevent them ever having cervical cancer in their lifetime. If we don't have a mandate, I don't think the issue of this vaccine is likely to get in front of parents and children as eas—as easily as it would be otherwise.

HINOJOSA: Dr. Freed wants to make sure the mandate is done right ... That schools aren't over-burdened ... and that there's enough funding to cover the nearly $400 cost of the vaccine for those not covered by insurance or the government.

But Representative Hoogendyk worries a mandate will be a burden to this cash-strapped state. What's more, he says ... Michigan should not rush into this ... after all, the vaccine hasn't been on the market for very long.

Remember Vioxx, he says ... another Merck drug. It was approved by the FDA ... and then had to be withdrawn ... over safety concerns that it caused heart attacks and strokes.

BIRKHOLZ: It's an argument that is probably not without some validity. But on the other hand, I think we have—it's—this is a huge health issue. So, to sit back and say, "We've got this medicine that's been tested; it's gone through the trial procedures; we're going to sit on it?" I don't—to me that doesn't make sense.

HINOJOSA: In fact, the vaccine has been tested in 11,000 women ... And, experts say, it has an exceedingly good safety record. It's too early to know whether booster shots may be needed in the future ... and women who get vaccinated, doctors say, should still get regular pap smears.

Nevertheless ... critics see a worrisome financial incentive behind Merck's lobbying efforts in state legislatures.

SPRIGG: So as we—follow the money trail, we are beginning to—to see that—there is a little bit something more than public health concern at work in this push for vaccine mandates. There is—apparently the financial self-interest of—of Merck itself.

HINOJOSA: The company won't disclose how much they've spent pushing for the HPV vaccine mandates. But certainly, Merck stands to make millions upon millions of dollars ... if 6th grade girls across the country are required to get vaccinated.

Back in Texas, questions have been raised about what role the governor's former chief of staff, now a Merck lobbyist, may have played in the decision to require the vaccine. Under fire for that ... and its push in a number of other states ... Merck announced just this week that it was suspending all lobbying efforts for the HPV mandate.

The company told us ..."the conversation needs to focus on women's health and cervical cancer ... we're concerned that our role in supporting school requirements is a distraction from that goal."

And some in the medical community are concerned as well ... they say the rapid push for a mandate could backfire ... and scare people away from this, and even other vaccines.

But, bottom-line ... many social conservatives believe there is a better alternative ...

SPRIGG: The only way to—the only 100 percent effective way of—of protecting yourself is through—sexual abstinence until marriage and—sexual fidelity within marriage to an uninfected partner.

HINOJOSA: Of course, even that may not be enough. Remember Sara Ylen. She contracted HPV in the worst way imaginable: she was the victim of a sexual assault.

YLEN: In May of 2001, I had been grocery shopping, and I was attacked in a parking lot. And I was raped. And it was two months after that that I ended up in the ER again in—in severe pain. And that's when they diagnosed me.

HINOJOSA: And at that moment, when you're being told, "You're a victim of rape, and now you have a sexually transmitted disease that could cause cancer," you thought—

YLEN: I thought, "I'm never gonna be rid of this. I'm never gonna be free from what happened that day in the parking lot. This is—this—I'm a prisoner to this for the rest of my life."

HINOJOSA: When you see the politicians kind of battling back and forth in your state House about this HPV vaccine, what goes on for you?

YLEN: It's angering. To me it's not a political matter. To me it's a matter of providing something that saves people from living the excruciating battle of fighting cancer.

HINOJOSA: Ylen is tough as nails ... and her doctors are optimistic about her recovery. But she knows she's still fighting for her life.

YLEN: I feel like I'm playing Russian roulette right now. So far I've managed to avoid being terminal. But at some point, it's my fear that that's the point it's gonna get to. And I'm young. I—I shouldn't be dealing with this right now.

HINOJOSA: Her kids are tough, too. The first time they learned mom would lose her hair from chemo ... they shaved their heads in solidarity ... so she wouldn't feel alone.

Ylen supports the vaccine mandate ... but whether it becomes law or not ... she hopes young women and their parents will take some hard earned advice ... and get vaccinated.

YLEN: Take the opportunity you have. It could save you a lot of heartache in the future. It could save you from feeling like you're a slave to a disease that you have no control over.

BRANCACCIO: You can find out more on plans for the hpv vaccine in your state by going to our website... pbs.org is the jumping off place for that.

There are a lot of people talking about president bush's surge of troops in Iraq, but not many have the boots on the ground experience of our next guest: Seth Moulton after graduating from Harvard in 2001, his family was less than pleased when he decided to join the Marines. He went on to serve two tours in Iraq as a lieutenant. He's now been accepted at Harvard business school.

BRANCACCIO:
Well, Seth, welcome.

MOULTON: Thank you very much.

BRANCACCIO: So, I hear that you had a chance to go to the Harvard Business School? You must be jazzed to not have to think about going back to—the horror that is Iraq.

MOULTON: Yeah, not at all. That's—that's absolutely not the way I feel. It's very, very hard to leave Iraq behind. I think about it every single day. And, especially with the war still going on, so much still up in the air, and—and so many Americans still over there. And Iraqis, too, I have an awful lot of Iraqi friends. And—it's very, very hard to—to forget about that, and to—to really just try to move on, back here in the States.

I mean, when you're in Iraq, every single day, your work affects people's lives. You have a very tangible impact on the lives of a lot of Iraqis and a lot of Americans. And often, it's over questions of life and—life or death. And—you know, in some ways, life back in America is a little bit of a let down, compared to that. It's just hard to feel—like you're doing anything that's—that's nearly as significant.

BRANCACCIO: Look, we all want to finish what we start, as a country, as a soldier. But take a look at a recent report, this month, on Iraq from the non-partisan Council on Foreign Relations. It argues that victory, however defined, can no longer be won militarily, that the politics of Iraq have to sort themselves out, however horrible that may be. And the report argues for a phased withdrawal from Iraq.


MOULTON: Well, I think that a precipitous with—withdrawal is—is probably the worst decision we could make right now.

We have to look very carefully at—I mean, I hate to say it, but in some ways, avoiding the worst. And, present—preventing a regional conflagration, preventing some sort of—genocide in Iraq—you—you know, on a level even greater than what we see already with the sectarian violence. We need to very seriously look at what kind of commitment is required for that.

What, 21,000 more troops? in principle, the President's idea of a surge is good thing. But I fear that it may be too little, too late. The 20,000 troops just isn't gonna cut it.

BRANCACCIO: Well, what would it take?

MOULTON: I would—I—I mean, I'm certainly not a strategic expert, but I would have to say something on the order of 100,000 minimum. And, I think that we have to be a lot more honest about, really, what our goals are in Iraq, what constitutes winning. And—and what it's really gonna take to get there. And—and—and—you know, if it means that we need 100,000 troops, then we have to be willing to commit that.

If it means that we have to have a draft, then that's a question that we need to ask—the Congress and the American Public. And, if we can't do that, if we're not willing to pony up that kind of effort and that kind of commitment, then—then we do need to look at—at withdrawing. And—and—and try to find the best way out of this mess, given—given what we're willing to commit to.

BRANCACCIO: You just said, maybe, a draft. That would require a sacrifice of the American people that they may not be prepared for, but certainly was not advertised by the administration, when the case was being made to go to war.

MOULTON: Well, I—I don't think that we've ever been really given fair expectations about what this is going to take, how long it's gonna take. And—we also have never really been asked to do anything, a—aside from the people in the military. I mean, the American public has never been asked to sacrifice anything for this war, and the war has already been going on for longer than World War II lasted. That's—that's—to me, that's shocking.

I think there are an awful lot of young Americans, just like myself who would actually be very willing to go and serve in a place like Iraq, if they were simply asked. But, they've—they've never been asked. I mean, we were told to go shopping on September 12th, and that was it.

BRANCACCIO: Seth, you know the—on the ground troop politics of saying, "draft," in America. When you say draft, isn't it true that public support for the war, would just vaporize?

MOULTON: Listen, if we really want to win this war, our level of effort has to go up by orders of magnitude, and maybe it will take a draft.

I think one of the—one of the best points that that report makes, right at the beginning, is that—you know, our—our level of effort just hasn't been anywhere near commensurate with the perceived strategic stakes of failure.

It's a problem for the war effort, because everywhere you go in Iraq, there are not enough troops, there are not enough people in the State Department—there are not enough people—ex—experts of reconstruction or establishing a civil government, establishing the court system.

I mean it's—there's across the board, a ter—terrible lack of effort. But, I think it's also a problem back here, in the United States, when you have a country that is just so incredibly divided between the one percent that's fighting this war and the 99 percent that feels like we're not even in a war, right now.

Well, Seth, thank you very much.

MOULTON: Thank you.

BRANCACCIO: And that's it for NOW. From New York, I'm David Brancaccio. See you next week.



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