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Dear Ms Mountjoy,

I refer to your Spotlight SW broadcast last evening on this subject from an Exeter girls' school. As a good journalist, I am sure you would agree that information you broadcast should be as complete and as balanced as reasonably possible. The duty of the BBC is not to project populist material in the way the government has already done on this subject, with key facts absent.

This programme, and a previous national BBC programme, focused on the agent which might trigger cervical carcinoma in later decades. It rightly stated that immunization did not cover all HPV types. It also stated that the virus was sexually transmitted.

What neither programme told its wide audience was that predominant causes of transmission of this oncogenic virus are
1. promiscuous sexual intercourse - thereby increasing the risk of transmission of the virus and individual infection

2. the absence of barrier contraception.
Thus, the youngster (and perhaps an illogical parent) is not being properly informed as to how they might best defend themselves.
It is much worse than that however. The key factors in HIV transmission are the same as 1 and 2 above of course. A very important message for good health has gone by default. Nothing that HPV immunization can do, or that your broadcast said, will have influenced the spread and incidence of HIV at all. Indeed, it might further stimulate its spread by invoking an aura of false safety. And, for the time being, HIV infection is incurable.

Two secondary matters to consider:-
3. Currently, immunisation is not effective against 30% of HPV. Once herd immunity rises towards the 70% of HPV which are being immunized against, is it at least possible that the incidence of the '30% types' against which there is no acquired immunity will rise and cause an increasing threat.

4. The focus is again on the female gender in bearing responsibility for attempts at sexual health. This might suit the 'liberationist' but it is a poor way of promoting sexual health in young people. The emphasis is almost all on the contraceptive pill and away from male responsibility in the act.
I encourage you to have a broader programme and to involve a GP, a public health specialist and a sexual disease doctor. The latter will tell us the reality of unlimited promiscuity, lack of respect for others and absent barriers. All that has happened so far, is the promotion of the beneficence of a government which steadily dismantles the NHS. The only obvious 'official' person on your programme was entitled 'Devon NHS' or similar, Ms Tracy Fabiano. I see she is from the Devon 'PCT'. She is probably not a qualified medical practitioner.

I reflect on the fact that HIV is a rarity in Gaza where I visit often.

This is noted throughout those populations with Islamic beliefs. The sexual mores are strict. I do not know the incidence of cervical cancer there.

I am certainly no expert in this field. I am a retired orthopaedic and trauma surgeon. I did have a good training in all fields at St Mary's.

For truth David Halpin MB BS FRCS

ps The Gardasil advert for daughters and mothers. Devoid of all useful information but one can choose a nice wallpaper or mouse mat courtesy of Merck. - your programme for ease

Dear Ms Mountjoy,

I am looking forward to your reply on this most important subject.

I have studied the Devon PST and the NHS web sites since writing to you.

I have noted that Ms Fabiano is a PA/support manager on one site, qualifications not stated. The NHS consent form for this immunisation course is interesting. If the parent does not wish its child to receive the injections, that parent is required or encouraged to sign to that effect. I cannot recall anyone in the system asking me to get a patient to sign a form if they had decided not to have an operation.

Slides for professionals

No 34 'robust arrangements are in place to obtain consent'. Meaning?

Another point - does not your professional code require you to maintain anonymity when you are dealing with the medical care of children. Whether Mrs Macan was happy for her child to be publicised in this manner is not relevant.

David Halpin FRCS 01364 661115

Sally Mountjoy wrote:

Mr Halpin,

Thank you for your email. You have pinpointed a constant frustration of mine, working as I do for a daily news programme. There is always a great deal more information I would like to broadcast than there is time available to do it. As a result, we have to be content with telling the story in a digestible form and reflecting any tensions and disagreements as we perceive them.

I realised the vaccine was effective only against 70 per cent of HPV and believe we reflected that.

I mentioned in passing the moral controversy the vaccination presents for some people but there would not have been time to discuss the various medical opinions about it.

I have had an email in response to the piece we broadcast from a woman who runs a charity offering support to women suffering from gynaecological cancers. She was pleased with the report because it raised awareness of the issue. She takes the view that, despite its shortcomings, the vaccine will save lives.

Thanks for your interest.

Dear Sally,

Thank you for replying. I have some knowledge about the media and understand your frustration. The subject requires a half an hour at least, and not about 3/4 minutes on a magazine/local news programme. I cannot remember what other items were included that evening, but if I was editor! I would have spiked at least one other in order to allow you to give more depth. I see your problem so often eg the presenter looking fierce in an interview with SW Water about the usurious charges. But the underlying facts which I have written about are not shown the light. There is not enough time.

I presume Devon PCT brought this to Spotlight's attention.

I do not know your background so please forgive me if I am telling my grandmother .... There are facets to this immunization programme which must be covered. Instead, the shallowness that you were constrained by, gives an altogether false sense of security. Take chlamydia. Its incidence is rising in young adults (about 20% in some reports), as it is with the other STDs. What was said and shown the other night will have no good influence on its incidence. Indeed, it might stimulate it. What does this mean? It means trips to the GP with pelvic inflammatory disease and possibly to what we called the venereology clinic. Tubal stenosis means infertility with all the recurrent probings and anxiety. It also means ectopic pregnancy. Some women will die of that, as they will occasionally with laparoscopy for infertility (bowel perforation/infection). All of these risks would be lessened if young people were given the full facts and not a rosy illusion.

I encourage you to speak to the editors with the aim of getting a proper programme on this. Meanwhile, I am going to make a formal complaint to my doctor colleagues on the PCT. Girls are not 'being kept healthier'.

Best wishes David H

Cervical cancer jab pioneered by 12 and 13-year-olds in city
Tuesday, September 30, 2008, 23:00 Express and Echo
GIRLS at Isca College of Media Arts have become the first in Exeter to be vaccinated against cervical cancer. Seventy girls were given the new human papilloma virus immunisation.

It protects against the HPV virus which causes cervical cancer and pre- cancerous cell changes to the cervix. The immunisation programme is part of a nationwide scheme rolled out in schools to protect 12 and 13-year-old girls against the two virus types that cause over 70 per cent of cervical cancers. Mandi Street, head teacher at Isca College, said: "This is about protecting young girls so that they feel confident when they get older that they are protected against cervical cancer.

"The decision to take part in the programme was left to the girls and their parents and we have been very pleased that the vast majority, 80 per cent, of Year 8 girls decided to go for it. "Everything has gone very well with minimal fuss."

Tracy Fabiano, immunisation coordinator for Devon Primary Care Trust, said: "This is an exciting time in Devon. Isca is one of the first schools to have the vaccine. "It will be the first of a series of three. The girls will have another in two months' time and then a third six months later." Most schools in Devon are participating in the programme, which is to continue for the next six weeks to cover the entire county, and, until 2011, a catch-up programme will immunise girls up to the age of 18. Jessica Macan, of St Leonard's, is the mother of Isca pupil Polly Macan, 12, who was one of the 70 students to be immunised yesterday. Mrs Macan said: "I wanted Polly to have the vaccine because cancer is a horrible disease in any form and if Polly can have something to prevent her from getting it then that is a good thing. "The school sent us a letter and leaflet and the nurses talked to the girls, and I talked to Polly, and we agreed that it is the right thing to do. "Whenever you put your child through a vaccine there is always some amount of anxiety involved, so I did a lot of research and looked on the internet and felt it was the right thing for Polly." Polly said: "The vaccination was fine. I thought it would hurt more than it did.

"I decided to get it because I don't want cervical cancer when I'm older. "It was nice to have it at school because I had all my friends around me." Yvonne Hazell, from Alphington, was also at Isca School while her daughter Megan Hazell, 12, received the vaccine. She said: "Cancer is such an awful disease and anything that protects Megan against it will be a great thing. "I have a daughter who is 19 and I would like to see her have the vaccine at some point, too."

Megan said: "I was quite nervous before I had the vaccine, but afterwards it was fine. "It's best to protect yourself now than to be sorry later."