The many factors in considering vaccinations

       DEAR DR. ROACH: How many people must buy the three-part series of HPV vaccine for about $500 to prevent one case of cancer? You easily can find the facts if you bother to check. I am not saying that there are no benefits to the HPV vaccine or that it isn’t safe. I am saying that all claims about medicines should be checked; otherwise, we are just believing blindly in an educated elite, just like religion.
       If I have a 0.0001 percent chance of getting a particular disease, what do I care if my chances of getting it are decreased to 0.00001 percent if it costs us all millions of dollars in insurance premiums? — K.J.
       ANSWER: I agree with you that claims about medications should be checked, and vaccines, like other treatments designed to prevent future problems, should be held to a higher standard than drugs used to relieve symptoms.
       It’s important to consider both the costs to an individual and the costs to society. For an individual, dollar costs of the treatment are only part of the equation. An individual needs to consider possible side effects, and his or her particular risk for developing the condition. In the case of human papilloma virus, the virus is spread by intimate activity, most commonly beginning in the teens and 20s. The vaccine is effective when given before infection, which is why it is recommended to be given at age 11 or 12, prior to exposure. (Before age 15, a two-dose series is recommended; it’s a three-dose series for those over 15.)
       The dollar cost is high for the series, but most insurance companies cover it. So, for most individuals, it’s a decision of whether reducing the risk of future cancer (cervical cancer for women, head and neck cancer for men and women) is worth the risk of side effects, which are usually mild and last no more than a day or two. To me, that’s an easy decision.
       For a society, making a decision is much more complex. Public health experts most commonly use a metric called “cost per quality-adjusted life year saved” abbreviated “QALY.” The published estimates for the HPV vaccine vary, but average about $20,000 per QALY, a number usually considered cost-effective. If future head and neck cancers are considered (they should be, since the evidence is mounting that HPV vaccine indeed will protect against HPV-related cancers of the head and neck, among others), then society actually might save money by vaccinating children before exposure. Cancers are very expensive to treat, and preventing them is not only good medicine, it’s good economics.
      

DEAR DR. ROACH: I had been taking 2,000 IU of vitamin D-3 for the past three years, and my new endocrinologist doctor reduced the dosage to 1,000 IU. Can it be harmful to take too much D-3? — D.M.P.
       ANSWER: It can be dangerous to take too much vitamin D, but it is uncommon to see and would be really unusual with a dose of 2,000 IU a day. Toxicity is uncommon at doses less than 4,000 a day.
       I have seen only a few cases of vitamin D toxicity in my career. One was from a mistakenly written prescription; another was from a person who was convinced that more was better and took far too much of the supplement. The toxicity in vitamin D excess stems mostly from the high blood calcium, which comes from the bones. In the short term, it causes confusion, muscle weakness and vomiting, and if too much vitamin D is taken for a prolonged time, the bones can be damaged from low calcium and the kidneys may develop calcium stones.
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       Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or request an order form of available health newsletters at 628 Virginia Dr., Orlando, FL 32803. Health newsletters may be ordered from www.rbmamall.com.
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