6 ms·

I think it’s funny how in the US the vaccine schedule says not to get the HPV vaccine if you’re over 45. That means that insurance won’t cover it and I even str

I think it’s funny how in the US the vaccine schedule says not to get the HPV vaccine if you’re over 45. That means that insurance won’t cover it and I even struggle finding a doctor who will administer it because it goes against the guidelines. The rationale is that if you’re 45, you probably already have HPV. But that assumes that you’ve been sexually active all that time. It doesn’t take into account people who were monogamous until their 50s and then started having sex with new partners.

opello 2y ago
Exactly. It'd be nice if primary care physicians approached the request with an open mind and had the real conversation about any risk/reward. I don't know if there's any risk to taking the 9-valent version if you might have been exposed to one that it covers. But why isn't it valuable to have protection from the other 8? My bias is climbing the hill of convincing on this front 5 years ago and being on the receiving end of a pretty dismissive attitude. But I got my way and think it was the right choice.
- 9x39 2y ago
  I had a similar experience with my GP. I was essentially dismissed outright (in surprising contrast to an otherwise dynamic/vigorous interest in my health) and am planning on revisiting this with a different GP soon. While I allow for myself just being ignorant, wrong and vulnerable to working myself up into health scares, I couldn’t help but wonder if men looking into HPV vaccines are brushing up against a doctrinal problem, in that whatever protocols and literature exist for the med field don’t study and don’t mention male-HPV interactions enough to warrant action (or even interest) from GPs as a group.
  - opello 2y ago
    I'd have hoped things improved in the last 5 years but maybe you can avoid the GP altogether and schedule it like a flu shot through the pharmacy? I noticed it was in the list at Walgreens this year anyway. Best of luck with it!
  - 31carmichael 2y ago
    I live out of the country and visit once per year. I'm 49 and it was absolutely impossible to receive the shingles vaccination, even if I paid cash. Ridiculous.
FirmwareBurner 2y ago
>schedule says not to get the HPV vaccine if you’re over 45. That means that insurance won’t cover it If it makes you feel any better I live in an EU country with one of the best healthcare systems, or so we keep hearing, and here the public health insurance only covers it for those under 30. What a joke. And Europeans keep saying how much worse the American system is.
- formerly_proven 2y ago
  Here it actually depends on which pseudo-private-public insurer you have. Most have age limits for coverage, the most common one being 25 or 26. The lowest seems to be 19 (what a joke, it's in the catalog for <=18), many don't cover it at all. Total cost (no discounts, since not covered) seems to be about 700-800 €. > And Europeans keep saying how much worse the American system is. There's a reason the comparison is always the average/median situation in the EU vs. the worst possible situation you could be in the US.
- jeroenhd 2y ago
  I don't know about the quality of our local healthcare system, but I'm a little annoyed that I didn't qualify for the free HPV vaccination but people two years younger than me did. The government invited anyone born in an 8 year period and about 20% responded. I wish they'd given me the option to take part in the program even if I wasn't actively invited, it's not like there's a shortage because of high demand; even among kids the vaccination rates are only at 50% to 60% thanks to the rise of antivax parents and covid misinformation. I'm not going to start a fight with the local healthcare call center to let me pay the 200-300 euros for a vaccination they think I shouldn't be getting according to every piece of information they publish about it. I know the government is trying to cut costs on healthcare and all, but the resistance the idea that someone without a cervix may benefit from a HPV vaccination annoys me to no end. Out of all possible healthcare cost cutting measures, charging hundreds for vaccines against diseases that are widely present within the borders of the country must be the stupidest. That said, I'd much rather take the annoying European healthcare system over the American one. I can get every vaccine out of pocket twice a year and still be cheaper off than with your average American health insurance.
avidphantasm 2y ago
I got it when I was around 40. Before getting the three doses, I would get 3-4 nasty viral sore throats per year (white blistery lesions, very painful). Now I get zero. I was probably on my way to getting throat cancer like Michael Douglas. Hopefully I have avoided or at least forestalled that.
- ivewonyoung 2y ago
  Thought it doesn't help against the strains that you're already infected with? Hence the min and max ages in the guidance.
  - throwitawayfam 2y ago
    There is some evidence that it can help against self inoculation and immune response to an existing infection https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2020.00188/full https://www.frontiersin.org/journals/immunology/articles/10.... https://www.sciencedirect.com/science/article/abs/pii/S0090825818311636 https://www.sciencedirect.com/science/article/abs/pii/S00908...
  - abracadaniel 2y ago
    From what I’ve seen, it’s been shown to be effective against existing infections, as well as preventing it from progressing to cancer.
    - Avalaxy 2y ago
      I can't find anything about this, do you have any papers?
      - toomim 2y ago
        I don't think it's been tested in studies, but I can offer that I had hand warts for 7 years until I got the HPV vaccine, and the hand warts suddenly disappeared after dose 2. HPV functions by cloaking itself from your immune system. The reason why treatments like freezing work is not by removing the HPV -- it's by stimulating your immune system to look at the area around the wart. Then your immune system can get past the cloaking, and recognize the HPV, and then it destroys it. So functionally, it makes total sense that the HPV vaccine would clear existing infections, and anecdotally, lots of patients (such as myself) have seen HPV clear after getting the vaccine. It's a shame that our bureaucracy doesn't have the incentives to run the studies to acknowledge it institutionally.
InsideOutSanta 2y ago
I also got the vaccine at 44 (years later than it is recommended where I live in Europe), because: - It targets multiple HPV strains, and even though I've been sexually active, I'm probably unlikely to have all of them, so there is some future protection - It helps prevent reinfection - There is evidence that it helps reduce the risk of progression to a cancerous state, which is also something that can happen for males I didn't even bother to talk to a doctor, I just called a women's clinic, made an appointment, and paid for it myself. They were surprised, but super happy and supportive. All three injections cost me the equivalent of 160 US$.
- tecleandor 2y ago
  What country is that? I'm 42, male/ Spain, and I also have to pay for them out of pocket, but it's around 190€ EACH of the three doses.
  - ValentineC 2y ago
    It's similarly expensive here in Singapore, so I got just one dose. Some studies have suggested that even one dose of Gardasil 9 is enough: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(24)00009-3/fulltext https://www.thelancet.com/journals/langlo/article/PIIS2214-1... https://pmc.ncbi.nlm.nih.gov/articles/PMC7455166/ https://pmc.ncbi.nlm.nih.gov/articles/PMC7455166/ https://pmc.ncbi.nlm.nih.gov/articles/PMC10480621/ https://pmc.ncbi.nlm.nih.gov/articles/PMC10480621/
  - InsideOutSanta 2y ago
    It's possible that I'm misremembering the cost and confusing the cost for a single injection with the total cost. It was a while ago.
- Avalaxy 2y ago
  > There is evidence that it helps reduce the risk of progression to a cancerous state I have not been able to find this. Do you happen to have a link to a paper?
Retric 2y ago
It’s not just that older people are more likely to have HPV but also there’s significantly less time for it to progress to cancer at that age. 45 may be young enough to be worth it if the treatment was free, but at ~1,000$ the net benefit is more questionable.
- Spooky23 2y ago
  I’m 47. My girlfriend is 32. Wouldn’t be nice to not unknowingly infect her with a virus that I cannot detect or control?
  - Retric 2y ago
    Are you suggesting you’re going to be having multiple partners while in that relationship? If so then sure it might be a benefit (assuming neither was already infected) though having her get the shot would still be a good idea even if you had already received it. Anyway, at 45+ we are talking something in the range of 10’s of million dollars per cancer case prevented depending on assumptions. That doesn’t mean it’s a terrible idea, just that there’s probably somewhere more productive to do with those resources.
    - Retric 2y ago
      PS: That sounded judgmental, I simply meant as a vaccine it doesn’t remove an existing infection. So multiple partners post 45 need to happen before it’s going to make a difference, but people with active sex lives are very likely already infected.
    - Spooky23 2y ago
      I didn’t read it judgmentally. Who’s to say? Maybe I’m a swinger? Maybe I’m divorced? Maybe I’m dating a few people? Maybe that relationship will run its course? HPV isn’t an STD that condoms address from a risk mitigation perspective. If I’m an adult and identify a risk to my doctor, why shouldn’t a cheap safe and reliable preventative measure not be accessible? It’s a bizarre proposition to be tabulating the potential future value in this conversation. I can casually ask my doctor for a cialis prescription, which has a similar cost and it will be covered, no problem. If i have a wart caused by an HPV variant, it will be frozen off for a few hundred bucks, no problem. I think the reality is that the age ranges were picked because for the purposes of the trial process, it was the most convenient.
Gibbon1 2y ago
I feel annoyed that it seems the system conflates guidelines due to economic reasons with medically indicated ones. And with the HPV vax they keep upping the age limit. Bonus was the British study that showed a clear decline in dementia in elderly that got the shingles vax. Shows up because almost everyone born before a hard date got it and no one after did.
doctorpangloss 2y ago
The typical Hacker News reader probably spends $180 on restaurants and takeout per week.
Traubenfuchs 2y ago
I consider this idiotic policy close to a public health scandal because: - There are 200+ HPV strains, the vaccine is directed against the worst 9 but even provides cross protection to some more. You might have some of the magnificent 9, but not all. - HPV strains can be overcome by the immune system and leave your body. You might get the vaccine while you currently have none of them. - There is tentative evidence that the vaccine has curative effects.
odomus 2y ago
Agreed. And by the logic whereby everybody over a certain age is more likely to already have HPV if they were "active", vaccination should be even more recommended to people >45 who start dating again after a monogamous life, right? Because the assumption would be that they don't have it yet, and they are now starting to have sexual encounters with people who are more likely to have it. More couples are divorcing after age 50 than ever before, so this is not just abstract theory. Also last time I checked the statistics for HPV strains like HPV-6 or HPV-16, only 5% or less of males were infected by that specific strain. So on a single-strain basis it's not quite "you probably already have it". Cumulatively, it is no doubt higher considering all strains, but the argument against vaccination for all strains on the basis that recipients may already have a few of those strains seems flawed.
stared 2y ago
As I male, I paid for mine (Gardasil-9, protecting against 9 types of HPV). There are two reasons: one is for personal protection (and most throat cancers are caused by HPV, odds which are likely much more skewed if one does not smoke), and the other is epidemiological - protecting other people, dear ones directly, and the rest of the population by extension. The myth that it is "only for teenagers" or "before sexual interactions" is a myth. I mean, the ideal scenario is to vaccinate before any potential for infection. Yet, plans to have any sex life it is beneficial. AFAIK, it even helps to clear out existing infections (and well, 80% of men and 90% of women get HPV at least once in their lifetime).

opello 2y ago

Exactly. It'd be nice if primary care physicians approached the request with an open mind and had the real conversation about any risk/reward. I don't know if there's any risk to taking the 9-valent version if you might have been exposed to one that it covers. But why isn't it valuable to have protection from the other 8? My bias is climbing the hill of convincing on this front 5 years ago and being on the receiving end of a pretty dismissive attitude. But I got my way and think it was the right choice.

9x39 2y ago
I had a similar experience with my GP. I was essentially dismissed outright (in surprising contrast to an otherwise dynamic/vigorous interest in my health) and am planning on revisiting this with a different GP soon. While I allow for myself just being ignorant, wrong and vulnerable to working myself up into health scares, I couldn’t help but wonder if men looking into HPV vaccines are brushing up against a doctrinal problem, in that whatever protocols and literature exist for the med field don’t study and don’t mention male-HPV interactions enough to warrant action (or even interest) from GPs as a group.
- opello 2y ago
  I'd have hoped things improved in the last 5 years but maybe you can avoid the GP altogether and schedule it like a flu shot through the pharmacy? I noticed it was in the list at Walgreens this year anyway. Best of luck with it!
- 31carmichael 2y ago
  I live out of the country and visit once per year. I'm 49 and it was absolutely impossible to receive the shingles vaccination, even if I paid cash. Ridiculous.

FirmwareBurner 2y ago

>schedule says not to get the HPV vaccine if you’re over 45. That means that insurance won’t cover it If it makes you feel any better I live in an EU country with one of the best healthcare systems, or so we keep hearing, and here the public health insurance only covers it for those under 30. What a joke. And Europeans keep saying how much worse the American system is.

formerly_proven 2y ago
Here it actually depends on which pseudo-private-public insurer you have. Most have age limits for coverage, the most common one being 25 or 26. The lowest seems to be 19 (what a joke, it's in the catalog for <=18), many don't cover it at all. Total cost (no discounts, since not covered) seems to be about 700-800 €. > And Europeans keep saying how much worse the American system is. There's a reason the comparison is always the average/median situation in the EU vs. the worst possible situation you could be in the US.
jeroenhd 2y ago
I don't know about the quality of our local healthcare system, but I'm a little annoyed that I didn't qualify for the free HPV vaccination but people two years younger than me did. The government invited anyone born in an 8 year period and about 20% responded. I wish they'd given me the option to take part in the program even if I wasn't actively invited, it's not like there's a shortage because of high demand; even among kids the vaccination rates are only at 50% to 60% thanks to the rise of antivax parents and covid misinformation. I'm not going to start a fight with the local healthcare call center to let me pay the 200-300 euros for a vaccination they think I shouldn't be getting according to every piece of information they publish about it. I know the government is trying to cut costs on healthcare and all, but the resistance the idea that someone without a cervix may benefit from a HPV vaccination annoys me to no end. Out of all possible healthcare cost cutting measures, charging hundreds for vaccines against diseases that are widely present within the borders of the country must be the stupidest. That said, I'd much rather take the annoying European healthcare system over the American one. I can get every vaccine out of pocket twice a year and still be cheaper off than with your average American health insurance.

avidphantasm 2y ago

I got it when I was around 40. Before getting the three doses, I would get 3-4 nasty viral sore throats per year (white blistery lesions, very painful). Now I get zero. I was probably on my way to getting throat cancer like Michael Douglas. Hopefully I have avoided or at least forestalled that.

ivewonyoung 2y ago
Thought it doesn't help against the strains that you're already infected with? Hence the min and max ages in the guidance.
- throwitawayfam 2y ago
  There is some evidence that it can help against self inoculation and immune response to an existing infection https://www.frontiersin.org/journals/immunology/articles/10.3389/fimmu.2020.00188/full https://www.frontiersin.org/journals/immunology/articles/10.... https://www.sciencedirect.com/science/article/abs/pii/S0090825818311636 https://www.sciencedirect.com/science/article/abs/pii/S00908...
- abracadaniel 2y ago
  From what I’ve seen, it’s been shown to be effective against existing infections, as well as preventing it from progressing to cancer.
  - Avalaxy 2y ago
    I can't find anything about this, do you have any papers?
    - toomim 2y ago
      I don't think it's been tested in studies, but I can offer that I had hand warts for 7 years until I got the HPV vaccine, and the hand warts suddenly disappeared after dose 2. HPV functions by cloaking itself from your immune system. The reason why treatments like freezing work is not by removing the HPV -- it's by stimulating your immune system to look at the area around the wart. Then your immune system can get past the cloaking, and recognize the HPV, and then it destroys it. So functionally, it makes total sense that the HPV vaccine would clear existing infections, and anecdotally, lots of patients (such as myself) have seen HPV clear after getting the vaccine. It's a shame that our bureaucracy doesn't have the incentives to run the studies to acknowledge it institutionally.

InsideOutSanta 2y ago

I also got the vaccine at 44 (years later than it is recommended where I live in Europe), because: - It targets multiple HPV strains, and even though I've been sexually active, I'm probably unlikely to have all of them, so there is some future protection - It helps prevent reinfection - There is evidence that it helps reduce the risk of progression to a cancerous state, which is also something that can happen for males I didn't even bother to talk to a doctor, I just called a women's clinic, made an appointment, and paid for it myself. They were surprised, but super happy and supportive. All three injections cost me the equivalent of 160 US$.

tecleandor 2y ago
What country is that? I'm 42, male/ Spain, and I also have to pay for them out of pocket, but it's around 190€ EACH of the three doses.
- ValentineC 2y ago
  It's similarly expensive here in Singapore, so I got just one dose. Some studies have suggested that even one dose of Gardasil 9 is enough: https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(24)00009-3/fulltext https://www.thelancet.com/journals/langlo/article/PIIS2214-1... https://pmc.ncbi.nlm.nih.gov/articles/PMC7455166/ https://pmc.ncbi.nlm.nih.gov/articles/PMC7455166/ https://pmc.ncbi.nlm.nih.gov/articles/PMC10480621/ https://pmc.ncbi.nlm.nih.gov/articles/PMC10480621/
- InsideOutSanta 2y ago
  It's possible that I'm misremembering the cost and confusing the cost for a single injection with the total cost. It was a while ago.
Avalaxy 2y ago
> There is evidence that it helps reduce the risk of progression to a cancerous state I have not been able to find this. Do you happen to have a link to a paper?

Retric 2y ago

It’s not just that older people are more likely to have HPV but also there’s significantly less time for it to progress to cancer at that age. 45 may be young enough to be worth it if the treatment was free, but at ~1,000$ the net benefit is more questionable.

Spooky23 2y ago
I’m 47. My girlfriend is 32. Wouldn’t be nice to not unknowingly infect her with a virus that I cannot detect or control?
- Retric 2y ago
  Are you suggesting you’re going to be having multiple partners while in that relationship? If so then sure it might be a benefit (assuming neither was already infected) though having her get the shot would still be a good idea even if you had already received it. Anyway, at 45+ we are talking something in the range of 10’s of million dollars per cancer case prevented depending on assumptions. That doesn’t mean it’s a terrible idea, just that there’s probably somewhere more productive to do with those resources.
  - Retric 2y ago
    PS: That sounded judgmental, I simply meant as a vaccine it doesn’t remove an existing infection. So multiple partners post 45 need to happen before it’s going to make a difference, but people with active sex lives are very likely already infected.
  - Spooky23 2y ago
    I didn’t read it judgmentally. Who’s to say? Maybe I’m a swinger? Maybe I’m divorced? Maybe I’m dating a few people? Maybe that relationship will run its course? HPV isn’t an STD that condoms address from a risk mitigation perspective. If I’m an adult and identify a risk to my doctor, why shouldn’t a cheap safe and reliable preventative measure not be accessible? It’s a bizarre proposition to be tabulating the potential future value in this conversation. I can casually ask my doctor for a cialis prescription, which has a similar cost and it will be covered, no problem. If i have a wart caused by an HPV variant, it will be frozen off for a few hundred bucks, no problem. I think the reality is that the age ranges were picked because for the purposes of the trial process, it was the most convenient.

Gibbon1 2y ago

I feel annoyed that it seems the system conflates guidelines due to economic reasons with medically indicated ones. And with the HPV vax they keep upping the age limit. Bonus was the British study that showed a clear decline in dementia in elderly that got the shingles vax. Shows up because almost everyone born before a hard date got it and no one after did.

doctorpangloss 2y ago

The typical Hacker News reader probably spends $180 on restaurants and takeout per week.

Traubenfuchs 2y ago

I consider this idiotic policy close to a public health scandal because: - There are 200+ HPV strains, the vaccine is directed against the worst 9 but even provides cross protection to some more. You might have some of the magnificent 9, but not all. - HPV strains can be overcome by the immune system and leave your body. You might get the vaccine while you currently have none of them. - There is tentative evidence that the vaccine has curative effects.

odomus 2y ago

Agreed. And by the logic whereby everybody over a certain age is more likely to already have HPV if they were "active", vaccination should be even more recommended to people >45 who start dating again after a monogamous life, right? Because the assumption would be that they don't have it yet, and they are now starting to have sexual encounters with people who are more likely to have it. More couples are divorcing after age 50 than ever before, so this is not just abstract theory. Also last time I checked the statistics for HPV strains like HPV-6 or HPV-16, only 5% or less of males were infected by that specific strain. So on a single-strain basis it's not quite "you probably already have it". Cumulatively, it is no doubt higher considering all strains, but the argument against vaccination for all strains on the basis that recipients may already have a few of those strains seems flawed.

stared 2y ago

As I male, I paid for mine (Gardasil-9, protecting against 9 types of HPV). There are two reasons: one is for personal protection (and most throat cancers are caused by HPV, odds which are likely much more skewed if one does not smoke), and the other is epidemiological - protecting other people, dear ones directly, and the rest of the population by extension. The myth that it is "only for teenagers" or "before sexual interactions" is a myth. I mean, the ideal scenario is to vaccinate before any potential for infection. Yet, plans to have any sex life it is beneficial. AFAIK, it even helps to clear out existing infections (and well, 80% of men and 90% of women get HPV at least once in their lifetime).