'The Talk' interview

Here's the interview about the case on 'The Talk'. Julie Chen brings up the case right off the bat. The one-on-one discussion with Sharon Osbourne is at 4m40s in.



A few other things that are worth checking out:

• Google Scholar: ROSSITER v. EVANS, Iowa: Court of Appeals 2009
• JN.S's blog: A Story of Courage
• HealthKicker via: Art_Is_War423: GEEZ! Take Responsibility for your Sexual Actions!
• Daree's Insights: My Number is None of Your B-I-Bizness
• OnPoint News: Iowa Court Affirms $1.5M Verdict
• Secrets of a Blue-Eyed Vixen: Would You Sue?


Finally ladies and gents... come on. Finish your Gardasil vaccine. It could save you repeated hospital visits, money, and your life.

On evidence

Weeks ago, a doctor wanted to discuss the case of Rossiter v. Evans. She's a well-respected public speaker on health issues who's been on the winning side, and of course, she asked some questions to sate her curiosity.

One thing she asked: Hey, wasn't Alan Evans a pilot?

Yes. It's impressive that she'd notice something like that. Here's why it mattered to her, and to the case: pilots get a physical before they're licensed. It's supposed to involve a detailed description of their medical history, past and present - even medications they've taken.

Then this doctor wanted to know - so, where were the records from Alan Evans' flight physical? Ah, an even better question. Just like several other important things, they were requested and never received.

Which brings us to this discussion about the lack of medical records on Alan's end at trial.

Most people know that Alan Evans was questioned extensively about his past initially: in 2004, he said he got tested every six months or so, never had a bad result, never had been exposed to anyone with anything, hadn't had sex with anyone in the last six months, and colorfully referred to that period as a dry spell. He talked about his past STD testing in detail and made sure to highlight his responsible, conscientious dentist self in relating that he was free and clear. And that all got explained at trial.

Which, in turn, created some problems for Alan. One, he admitted that he was sexually active during the six months immediately preceding the start of this relationship. Now, combine that with this: those STD tests he claimed to have had? He never produced even one. What's worse, at no point during the trial did he attempt to explain their absence. Credibility, meet wood chipper.

But to be fair, Alan did produce a medical record. Just one. And it may have worked to his disadvantage. How? Well, he tested negative for a few STDs in 2007, after he was served with the lawsuit. The ones he tested for were irrelevant to the litigation because they were never in question - it was never said that he transmitted (or ever had) them in the first place. 

So what was purpose of his one medical record, legally speaking? It was submitted to the court alongside his affidavit and a motion for summary judgment - the consequence of this effort, had it been successful, would have been the dismissal of the lawsuit. But wait a minute - the tests he had weren't even comprehensive and definitely didn't include an HPV test. So the reasonable reaction here would be along the lines of, So what?

Alan didn't have an HPV test saying that he was negative - ever - because an FDA-approved test for men doesn't exist. Remember, HPV was the focus of the trial, so it was the main thing that mattered. So what was he trying to say, or get the court to do, with his record and affidavit? Let's let him try to explain that in his trial testimony. Here, it starts off with Alan being asked about the contents of his own affidavit. Now might be a good time for you to go grab some popcorn.

Q: Look at paragraph 7. Could you please read what you said in paragraph 7 to this jury?
EVANS: "I have never tested positive for HPV."
Q: Have you ever been tested for HPV?
EVANS: My understanding is there is no test for males for HPV.
Q: Did you know that when you wrote this sworn statement saying you had never tested positive for HPV?
EVANS: I didn't know if there was or wasn't.
Q: You just made a sworn statement to the Court implying that you had been tested and you're negative without even knowing that could be true?
MR. KOURY: Objection, Your Honor. He never said he's been tested and he was negative. His response --
THE COURT: Well, again, Mr. Koury, you have a right to redirect. What's your objection?
MR. KOURY: My objection is that it's a misstatement for Mr. Tronvold to say you were tested and found negative.
THE COURT: I believe he's reading from the affidavit, so that's overruled.
Q: Could you please read paragraph 8 of your affidavit to the jury, and what's it say?
EVANS: "I had blood drawn and submitted for a physical on May 11, 2007 and was found to have no sexually transmitted diseases."
Q: And that statement would imply that you don't have HPV, correct?
EVANS: To me it says that whatever diseases that you can test for with a blood test were found to be negative. There is a host of STD's that you cannot make that inference from on a blood test, but any ones that you can draw from -- you know from a blood test were tested, and I was found to not to have those is what that says to me.
Q: Okay. Let me ask you it this way. As we sit here today, you can't be tested for HPV or know one way or the other, correct?
EVANS: My understanding the only way a male can know if he has HPV for sure is if he has warts.
Q: Okay. This case is only really primarily about HPV, the claim against you, correct?
Evans: There is some other claims, but that's the primary one, yes.
Q: I guess I should have made that more clear. Sexually transmitted disease claim is about HPV, correct?
EVANS: Correct.
Q: Okay.
EVANS: Oh, and others also, she -- bacterial vaginosis.
Q: Was your intent to get rid of both of those claims with this affidavit?
EVANS: Well, again, I said a little bit ago that I don't see that this affidavit is saying anything about getting rid of the claim.
Q: Okay.
EVANS: My intent was just to give an honest statement about what I've been through so far in regards to this case.
Q: So it was the intent to convince somebody you don't have and have never had HPV. I'll ask that question.
EVANS: At the time that I answered that, I wasn't aware if there was or wasn't a test for men for HPV, and so I wanted to make it clear to the Court that I had never taken an HPV test and got a positive result from it and saying, yes, you have tested positive for HPV. That's why I made that statement.
Q: Okay. I'll try -- do you remember most of your testimony from yesterday?
EVANS: This is a hard place to be in for a good recollection, to be honest.

Oh my.

Put yourself in his shoes and answer some hypothetical questions. If you went to the doctor to get tested for STDs, wouldn't you specifically ask to be tested for the one that you've been sued for transmitting - HPV? And wouldn't you think that any knowledgeable doctor would tell you that there is no test for men? So isn't the fact that a man generally can't be tested for HPV something you should have known pretty easily, and certainly should have known before you signed a sworn statement? Couldn't Google tell you the same thing in about 2 seconds?

In another brief submitted at the same time as his affidavit, one part says, "As of May 11, 2007, the Defendant was clear of sexually transmitted diseases, specifically, HPV." That's interesting, since he wasn't even tested for HPV. And no one - not even a doctor - can tell that someone is negative for HPV just by looking, because most people who are positive don't show symptoms - and if a person ever has symptoms, they're not always readily apparent. Warts and cancer can both develop internally.

If Alan Evans really wanted his affidavit to be clear and honest, shouldn't he have said something like, 'I have never taken an HPV test' instead of saying he'd never tested positive for a test he couldn't even get? You'd think that would be kind of important, since this dude is claiming to to be trying to be "clear" and "honest."

The other big thing about medical records? One girl came to testify in Alan's defense at trial - Shalan Schramm - the same one he knocked up. And get this: at trial, Shalan Schramm she said she'd never been tested for HPV. Here's her testimony on cross exam.

Q: You've never been tested for HPV to your knowledge, have you?
SHALAN SCHRAMM: I don't think so. I have a medical record that has HPV, and it says negative, but I don't remember requesting, unless -- I don't know.
Q: Are you familiar with the fact that HPV tests are normally only requested when you have an abnormal pap smear?
SHALAN SCHRAMM: No.
Q: So if you have an HPV test in your records, that might indicate that you did have an abnormal pap smear?
SHALAN SCHRAMM: No, I don't, because the records I have say that all my paps have always been clean, but on the bottom there is little corner of, like, other -- chlamydia and just other things, and they are all checked just negative, but I've never asked for an HPV.
Q: So you really aren't telling this jury you've had an HPV test then?
SHALAN SCHRAMM: I don't think so. I don't believe so.

So on the stand at trial, she doesn't think she's ever had an HPV test. That really doesn't seem like an appropriate topic on which to be wishy-washy. Obviously, the jurors didn't buy what she was selling.
 
Because it doesn't make sense. Regardless of her choice to defend Alan, it seems like most women who cared about their own health would have wanted - no, demanded - to be tested for their own safety and/or knowledge. And in light of Shalan Schramm's choice to defend him, the best way she could have done so would have been to show that in spite of the fact that she was having sex during the relevant period, she had an actual negative HPV test at some point after that. In order to do that, all she had to do was go and get tested. That's it. And if that was too much to ask, she could done something even easier, like bolster her credibility by backing up everything she said with records, instead of asking the jury to take her word on something that would have been so simple to show with documentation. Instead, she brought no medical documents whatsoever with her to trial. Zero. It was a glaring absence. In the words of Carolyn Wells, "Actions lie louder than words."

But here's the kicker: you have to have personal knowledge to testify about an issue. If she'd (allegedly) never been tested, there was no way she could possibly know for sure that she was definitely free of HPV, and she couldn't tell the jury with certainty that she's HPV-negative at trial.

Take a minute to let all that sink in.

So back to the folly. Over a year later, after the Court of Appeals and the Supreme Court put their stamp of approval on the jury's decision, someone was desperately flailing to defend Alan in online comments, and even went so far as to volunteer this lil' fib: That "Court docs" showed that Alan Evans and the woman he impregnated "both had medical records there that were both 100% free from STD's." [sic]

Right. I wonder, if the intellectual who posted that were to sit down and take a simple lie detector test, do you think they could beat it? Most people get that polygraphs are nothing but hocus pocus, but still, I can imagine it having serious potential for hilarity - maybe something like this.

New study on HPV and men

First spotted on MSNBC:

"We found that there is a high proportion of men who have genital HPV infections. At enrollment, it was 50 percent," said Giuliano, whose study appears online in the journal Lancet.

Read that again. Half of men had genital HPV infections at enrollment in the study. They're not saying these men simply had it at some point in their lives and cleared it. Half of those men were testing positive for at least one type of HPV on day one. And the high rate of HPV was true across all age groups for guys. Also, "[w]hereas risk of HPV decreases with increasing age in women, men seem to have a stable risk for acquiring new HPV infections throughout their life." (Purchase the full text here.)

The distinction is important. Other studies have estimated that there's a good chance that most people - both genders included - will have HPV at some time in their lives. This new study is saying something unique about men, because this is talking about males at this very moment - not at some point within a lifespan, but right now.

Aside from the 50% prevalence on day one, the study also reflects that over 1500 new infections were contracted during the study. It's possible to have more than one strain at once. If you get a new strain, it's a new infection.

What else makes men different? Well, it appears that once guys contract HPV, they hold on to the virus for a longer time. In other words, their bodies don't clear the virus as easily as women can - assuming they clear it at all:

"What is different is men seem to have high prevalence of genital HPV infections throughout their lifespans." She said it appears that women are better able to clear an HPV infection, especially as they age, but men do not appear to have this same ability.

Remember, number of lifetime partners is the #1 risk factor for getting HPV. In light of that, everyone should have a look at this part of the study:

Clearance of oncogenic HPV infection decreased in men with a high number of lifetime female partners

and

Men who had sex with more than 50 female sexual partners were 2.4 times more likely to have a cancer-causing HPV infection than men who reported having only one or no sexual partners.

(Ahem - consider that alongside this information.)

One last thing. The men in this study all got tested for HPV. Yes, you read that correctly - although there is currently no FDA approved test for men in a clinical setting, when it comes to research, it's a different story. It's how the researchers were able to say that half of the men had HPV at enrollment.

At each visit, three specimens of penile and scrotal cells were obtained from the coronal sulcus, glans penis, penile shaft, and scrotum for the detection of HPV DNA and for HPV genotyping.

And then we have the bigger picture. The purpose of this study was to inspire the development a cost effective model for vaccinating men. It speaks volumes for why we have to change the way we think about HPV. It's not just scary for women, it's scary and a problem for men too. And it's the responsibility of both genders to be on the lookout for it, to get vaccinated, and to be aware of their status so we can make this virus a thing of the past. HPV causes serious health problems for men and women.

The first thing, and the easiest thing people have to do: get Gardasil.

And the second thing that has to change that's just as important: testing for HPV in men needs to be made available outside of a research setting, period. There's no good reason why not. Why isn't it? No clue, but maybe it's just the myth that it doesn't affect men, so it's not their problem, so there's really no utility in having a test for men, because apparently, you know, knowing your HPV status is useless information. Reason begs to differ. Men deserve to know for the same reason that women deserve to know: so that they can protect themselves and their partners.

Misconception #11: If I know I have HPV, or if I've already had sex, I can't/shouldn't get Gardasil.

Not true. You can and you should get vaccinated, whether you're male or female, between the ages of nine and 26, regardless of whether you've been sexually active or not. Gardasil vaccinates against four types of HPV - two high risk types that cause 70% of all cervical cancers, and two low risk types that cause 90% of genital warts. And even if you do have one type, it's possible you don't have the other three, so you can and should still get the Gardasil shot.

The myth about only being able to get vaccinated if you're a virgin probably stems from the minimum age that boys and girls can get the vaccine - nine years old. The reason the vaccine is available at nine? To reduce the likelihood that the recipient of the shot has already been exposed to one of the types. It definitely doesn't mean that once you've been sexually active, it's too late. It's just that the sooner you're vaccinated, the better, because the vaccine has the best chance of protecting you against all four strains when the likelihood of having already been exposed is lowest. And parents, don't forget: even though your kids might not be having sex yet, HPV can be transmitted without actual intercourse.

Also related to 'the sooner the better' theory when it comes to this vaccination: The #1 risk factor is lifetime number of partners. And that little factoid is probably why Alan Evans refused to report his number of partners - repeatedly - prior to trial.
This is Post #11 in the series, Debunking HPV Myths. For other parts of the series, click here.

Misconception #10: The HPV test is always run as part of your pap smear.

Nope. You usually have to ask for the HPV test in addition to your pap, unless your pap came back abnormal!

I've heard that some doctors will suggest it without the patient asking, and others don't. Really, I can't think of one good reason not to be tested every time you get a pap smear.

So yes, ladies - in addition to getting your regular paps, you need to ask for the HPV test while you're at your appointment. Make sure you ask the doctor treating you directly. Double check to make sure they actually add the HPV test to your pap, because sometimes they forget.

Update: I recently went to my gyno for a pap smear and for an HPV test. I do it every 6 months. I made it very clear to the doc that I wanted the HPV test included with my pap, and made sure it was understood that that part, in particular, was pretty important to me. And of course, I later found out that the HPV test wasn't added as I'd asked. My doctor is excellent - comes highly recommended and is well-respected in the medical community. But it just goes to show that even if you say exactly what you want, and get assured that all the right boxes have been checked, there's still a chance a mistake will be made. Always follow up and ask specific questions to make sure you got the information you asked for.
This is Post #9 in the series, Debunking HPV Myths. For other parts of the series, click here.

Misconception #9: I had a normal pap, so that means I don't have HPV.

Not necessarily. A pap smear and the HPV test are two different things. The HPV test is run from the same sample that a pap is, but it's a separate test. The pap smear itself isn't looking for the HPV virus, it's looking for cancer, cell abnormalities, and infections - in other words, it's looking for symptoms - not just of HPV, but of all kinds of problems.

It's entirely possible to have a normal pap (no symptoms in the visible/tested area) and still have HPV. Having a normal pap just means that those particular sample cells looked normal when viewed microscopically. It's also important to remember, a pap won't indicate cancer in , say, your mouth - or anywhere else HPV causes problems - because it's only testing one area of your body. See Part 1, Misconception #1 for a breakdown of where else HPV can affect your body.

On the flip side: having an abnormal pap doesn't always mean you do have HPV, either, which shows why it's important to get tested and to follow up to find out for sure what's going on. Up to 10% of paps showing abnormalities are false positives. Check out this excerpt from an article entitled "Should We Abandon Pap Smear Testing?" by Dr. Richard DeMay:

"At the individual level, if a healthy woman were screened every 3 years from age 18 through her mid-70s, for a total of 20 Pap smears, and the false-positive rate were 5%, there is an almost 2 in 3 chance (64.2%) that she would experience at least 1 false-positive result.4,6 (If screened every year, for a total of 60 Pap smears, there is approximately a 95% chance of at least 1 false-positive result.)"

Hormonal and bacterial changes, yeast infections, recent sexual activity, and other harmless things can cause a pap to be abnormal as well.

This is Post #9 in the series, Debunking HPV Myths. For other parts of the series, click here.

Misconception #8: Having a positive HPV test and having symptoms are the same thing.

No. They're. Not.

People make this mistake all the time. Drives me nuts.

Keep 'em separate: the thing that we're looking for (HPV) and the effects that thing can have (symptoms). You can have the thing without seeing the effects. In other words, you can have the virus and not have symptoms. You can even transmit the virus without symptoms. This is why it matters whether you've been exposed, guys and gals. This is why it matters that you ask for the test, gals. The fact that it's present and the fact that it is or is not doing something to your body are two different things.

The moment you're exposed to HPV is simply the time that the virus enters your body. Again, the HPV test looks for the virus, not the symptoms. You don't start showing symptoms immediately, because symptoms take various amounts of time to develop. The virus has to invade your cells, replicate, and take over - which doesn't happen immediately. Some people will show symptoms within weeks or months after exposure (even pre-cancerous lesions can come on really fast, like they did for me), and for others, it can take years.

This is Post #8 in the series, Debunking HPV Myths. For other parts of the series, click here.

Misconception #7: I might've been exposed to HPV, but it'll take months/years for me to find out, because I have to wait and see if I get symptoms.

Not true! Women can request the HPV test at any time following exposure and the test is capable of detecting the virus, even if it hasn't had time to invade cells. The test is looking for the virus itself, not cancer, warts, or lesions - so it will indicate the presence of HPV regardless of whose cells (yours or a recent partner's) were grabbed in the sample. The test is also super sensitive, meaning that it'll detect a relatively small number of HPV virions, in chemical terms. The test is so sensitive, in fact, that if you test negative for HPV, your chance of developing a high grade lesion on your cervix in the next three years is close to zero!

And guys and gals, if you think there's a chance you were exposed to HPV, that should be all the warning you need. Please don't ever represent that you're free of the virus if there's a chance that you're not.

This is Post #7 in the series, Debunking HPV Myths. For other parts of the series, click here.

Misconception #5. I know I have HPV, but I never developed a symptom, or I don't currently have symptoms, so I don't have to tell my partners.

I touched on it before, but I want to hit it harder. It's selfish, cruel, and/or stupid to say or think that you don't have to tell partners you have HPV. Oh yeah, and a legal risk. Although someone didn't develop symptoms (yet?), that doesn't necessarily mean they they won't develop symptoms, are 100% clear of HPV, can't transmit HPV, or that their partner won't develop a symptom upon contracting it. Yes, HPV can be transmitted even if you don't have symptoms. It's hard to predict whose HPV will progress, and there are a lot of risk factors. But just because you're asymptomatic doesn't mean your partner will be.

And if you're reading this thinking that no one could be so treacherous, have a look at this comment by matterofopinion, random kook:

I don't need to tell anyone I sleep with that I have it, I don't have to worry about anyone suing me, my names [sic] not plastered over the Internet, and don't have a million dollars sitting in the bank. And like I said it's a Domino [sic] effect, [sic] not too many virgins out there. And there's no test or cure for a male, they don't have a cervix, won't get cervical cancer, or should I say pre-cancerous cells. And, my ex's [sic] won't know whom they got it from, or have to worry about it unless their girlfriend/wife gets it.

Not only does matterofopinion have no idea how it affects men, she seems to be fully aware that she's risking the health of others. She even discusses the potential for future partners of her partners to contract the virus thanks to her. She seems to have no problem whatsoever hiding the fact that she's had HPV from the people she's with. So basically what she's saying is that she'll never get caught transmitting the virus, so she's not going to let the cat out of the bag, except online, anonymously. It would be funny if it wasn't so pathetic. matterofopinion also referred to surgery to remove pre-cancerous lesions as "the price a woman has to pay for having sex." With that kind of backwards thinking, the poor girl should hurry back to her time machine and hightail it to the 1950s before it's too late.

The bottom line is that it's not for one person to decide whether or not to put someone else's health at risk, especially when it comes to something as intimate and personal sexual health and cancer. Realize that if you're going to be intimate, the decision as to whether or not your partner gets exposed is not yours to make. It's theirs. This is called basic human decency. Have some.

This is Post #5 in the series, Debunking HPV Myths. For other parts of the series, click here.

Misconception #3: HPV always stays dormant for years and years.

In some cases HPV does stay dormant for a long time, but it absolutely doesn't have to. In younger females, it's been observed that precancerous lesions can come on aggressively and rapidly. I, for example, went from no HPV and years of back-to-back perfectly normal paps to HPV positivity and CIN3 in less than a year's time. (CIN3, and HSIL — which stand for grade 3 cervical intraepithelial neoplasia and high-grade squamous intraepithelial lesions, respectively — are precursors to cervical cancer.)

Not only are lesions like these aggressive, but they "are common early events among women with incident HPV infection" and, interestingly, "the interval between incident HPV-16 or HPV-18 infection and biopsy-confirmed CIN grade 2–3 appears to be relatively short."

How short? According to a study by Winer et al.,

Contrary to the theory that prolonged infection is necessary for progression to high-grade neoplasia [11–13], our results support the hypothesis that HSILs are often an early manifestation of HPV infection in young women. Half of the incident cases of biopsy-confirmed CIN grade 2–3 in our study occurred within 14 months of an incident HPV infection.

And what about warts? They show up even faster:

The median time between detection of incident HPV-6 or HPV-11 infection and detection of genital warts was 2.9 months (IQR, 0–5.7 months).

Something to think about, no?

This is Post #3 in the series, Debunking HPV Myths. For other parts of the series, click here.

Misconception #2: All about strains of HPV

Strains are a major source of confusion, even for some medical doctors and others in the health industry. Some basic questions for this blog: Are there different strains of HPV? (Yes! Many!) What do the strains do? (Depends on which strain.) Can you have more than one strain of HPV at once? (Absolutely.) Which strains are the most common? (High risk types 16 and 18.) Does Gardasil help if it only covers four strains? (Yup, and read on for explanation.)

Let's kick things off with the statements of a commenter going by the screen name Dr Williams, whose full name is probably Dr. Mark Williams, which we know thanks to another genius who replied to him by first name repeatedly. Do you think this is the guy? Anyway, it all began with Dr Williams proudly proclaiming his medical background:

First of all, let me start by saying I am not afraid to hide behind some screen name. My name is Dr. Williams, M.D.

Oh yes, and this is important:

Alan and I have been best friends since we met our freshman year in college.

While Dr Williams was discussing whether Dr. Alan Evans had warts, he went off on a bizarre tangent about "the cancer causing kind" of warts. Say what? This statement he made regarding the visual diagnosis of "cancer causing" warts versus "the bumpy strand" is something to behold:

He does not have warts. And even if he did, there is no way by looking at them to tell if they are the cancer causing kind. I guess a future conversation may be.. [sic] "so, do you have warts?", [sic] um [sic] yes." what [sic] genotyps [sic] are they, the cancer causing kind or just the bumpy strand?" ummmm... [sic] I don't know.

No, really. Is this a joke, in more ways than one? 
It's common knowledge that the strains of HPV that cause genital warts do not cause cancer. This isn't information you have to dig for or have a medical degree to know; it's plastered everywhere. Cancer-causing strains and warts-causing strains are two different things. And you can definitely have more than one strain at a time.

Keep in mind that Dr Williams made these statements after directing everyone else to get as edumacated as he is on the subject of low risk strains by visiting CDC.gov.

I hope people took his advice on that one point and read the CDC website, because on a page labeled "basic information," the CDC comes right out and obliterates his nonsense about "cancer causing" warts in one sentence:

The types of HPV that can cause genital warts are not the same as the types that can cause cancer.

Shortly after this leg of the tantrum-tirade and as part of a list of attempted scapegoats to blame for the consequences of his friend's actions, Dr Williams sniffled about his perceived "ignorance of the jury." Dr Williams went on to seethe that the Muscatine jury wasn't "informed" about cancer-causing warts. Um, the reason the jury wasn't informed of "cancer causing" genital warts is because they don't exist. Both medical experts explained HPV to the jury for hours, and that piece of information the CDC provided above was one of the things covered. Fortunately for those who value the truth, the legal system is a place where medical facts are taken into consideration, not bullshit some blowhard pulled out of his ass to defend his bestest buddy, who showed no regard for innocent people who might have relied on his posts. 

It's a good story, but I digress. It'd take a chapter of a book to fully explore the bitter, factually incorrect, facially inconsistent and puerile ravings contained within the comments and e-mail correspondence (oh yes, he sent me e-mails too - another time, perhaps?) from Dr Williams.

Here's a second commenter whose ignorance is worth learning from: rosiejr1. Notice that rosiejr1 also claims to know a thing or two about STIs thanks to her line of work with the CDC, so you had better listen up! Or not.

I am a CDC Rep at a local health department in TN, which is top ten for ALL STD's. [sic] Obvoiusly [sic] the courts had some medical experts in it, but [. . .] only one strain can cause cervical cancer.

Rosie is scary uninformed. HPV is a family of viruses. There are many strains — almost 200 that we know of so far — and like I said, different strains do different things. We're mainly talking about the ones transmitted via intimate contact. There are roughly 40 of those. This group can be divided into two types: high risk and low risk. As discussed before, high risk strains can cause cancer. Low risk strains can cause warts.

So let's get down to pointing out the incorrect information that this supposed 'CDC Rep' is carelessly broadcasting to the masses: Does just one strain cause cancer like rosiejr1 said? Um, no. To simplify things to the point of seroius inaccuracy is unacceptable — especially after bragging about how she's in the medical field, so that people will buy what she's saying.

HPV isn't simple, so don't try to make it simple. To give you an idea of how many strains of HPV can cause cancer, the Hybrid Capture II High Risk HPV test looks for 13 different high risk (e.g. cancer-causing) types — 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, and 68. It tests for the most common types, but that's not all of them. For example, there are at least two more well-known high risk types not included in that test: 73 and 82. There's also a test for low risk types, which looks for 5 different strains : 6, 11, 42, 43, and 44. And once again, that's not all. Examples of other low risk types not included in the test are 54, 61, 70, 72, and 81.

The HPV vaccine known as Gardasil protects against four distinct strains: two high risk strains (strains 16 and 18, which together cause 70% of all cervical cancers), and two low risk strains (strains 6 and 11, which together cause 90% of all genital warts). Those four strains cause the vast majority of the most common health problems caused by HPV, which is why it makes sense to get the vaccine. You'd think someone who works as a "CDC Rep" would know that much simply from experience, maybe while talking to people about Gardasil or something in her day-to-day work. But you'd be wrong. Maybe you should be worried, too.

UPDATE: The FDA approved Gardasil to help prevent anal cancer caused by HPV, the vast majority of which is, in fact, caused by HPV.

This is Post #2 in the series, Debunking HPV Myths. For other parts of the series, click here.

Misconception #1: HPV isn't harmful. It's not a big deal.

Believe it or not, people really do say this kind of thing. Let's kick this one off with a snippet of a comment by pdx97216:

Despite how The Talk made it sound, HPV is not life threatening. [sic]

They said it so matter-of-factly. And yet, they're so factually wrong.

Cervical cancer. Vulvar cancer. Vaginal cancer. Penile cancer. Anal cancer. Bladder cancer. Head, neck, mouth, and throat cancers.

What do these things all have in common? Meh, they're all cancer, and cancer kills people. No big deal, right? Notice anything else? Oh yeah, those cancers can all be caused by HPV.

Almost all cervical cancer is caused by HPV. This year, 11,000 women will develop cervical cancer in the United States, and about 4,000 of them will die. Worldwide, cervical cancer is the #2 cause of death among women. In a year's time, on this planet, over a quarter of a million women will die from cervical cancer. What about the number that develop it and don't die? Double the number to a half a million worldwide. What about the number, in this country alone, that develop CIN (cervical intraepithelial neoplasia, or cervical dysplasia, a potential precursor to cervical cancer)? About 400,000 in the US every year. That's a lot.

But there's more cause for concern, for men and women alike. HPV causes
• between 50 and 80% of vulvar cancer
• at least 70% of vaginal cancer
• 50% of penile cancer
•85% of anal cancer
• 39% of oral cancers
• and bladder cancer.

This isn't hard to figure out. HPV can be life-threatening and people die because of it.

Put aside the medical problems for a second. What about the financial side of HPV? This isn't something you see talked about much, but it should be. How much does it cost to treat cervical cancer? In 2000, it cost an individual over $20,000 to treat cervical cancer in the early stages, and $37,000 to treat a late stage case. What if they don't have insurance? What if their insurance drops them from coverage for the very type of cancer they have? What if their insurance drops them from all cancer coverage, like mine did? In 1996, the direct medical care costs of treating cervical cancer in this country were estimated at $1.7 billion. That's an old number. What do you think it is now?

We probably haven't reached the limit of our knowledge regarding the damage that HPV can do, but we do know that death is a possible result. To downplay its severity is to deny reality.

This is Post #1 in the series, Debunking HPV Myths. For other parts of the series, click here.

Debunking common myths about HPV: A series

So here's the deal: we've been in the middle of a move (finally complete — whew!) and I've been working on this writing for some time now. I'm not finished, and I keep coming across more things I want to add, so I'll post it in parts over time. Welcome to Part 1. UPDATE: I originally posted this series in two big chunks, but after seeing how many people were landing on the page looking for answers about HPV, I decided to break it down into individual myths and answers to ease navigation.

So there's much to discuss. On with the myth debunktion! Get ready to hear from some kooks, and my take on their kookery — I found that they really helped illustrate some excellent points. In other words, they provided the perfect opportunities for some fisking.

DEBUNKING HPV MYTHS
Misconception #1: HPV isn't harmful. It's no big deal.
Misconception #2: All about stains of HPV.
Misconception #3: HPV always says dormant for years and years.
Misconception #4: It's impossible for men to know they have HPV. Or, HPV doesn't affect men.
Misconception #5: I know I have HPV, but I never developed a symptom, or I don't currently have symptoms, so I don't have to tell my partners.
Misconception #6: If you wear a condom, you won't get HPV.
Misconception #7: I might've been exposed to HPV, but it'll take months/years for me to find out, because I have to wait and see if I get symptoms.
Misconception #8: Having a positive HPV test and having symptoms are the same thing.
Misconception #9: I had a normal pap, so that means I don't have HPV.
Misconception #10: The HPV test is always run as part of your pap smear.
Misconception #11: If I know I have HPV, or if I've already had sex, I can't/shouldn't get Gardasil.

For the whole series, click here.

In other news, here's my interview on The Talk with Sharon Osbourne in case you missed it. I'm humbled and honored that I got to speak to millions of viewers on a Friday afternoon, and I had a fabulous time. I met so many wonderful, inspiring, brilliant people — the producers, the crew, and the fellow guests. I'm hearing from hundreds of men and women who want to share their stories and can relate in all kinds of ways. And there's more on the horizon — details to come!

Like I said before, there's one thing I'd change about my interview: I wish I'd had an opportunity to discuss the details about HPV and the prevention of cervical cancer in particular. There wasn't time. That's how TV works, and I knew that going into it. Given that limitation, my hope was that people would look into it on their own — and I know they have, which is even better. But I want to help it happen both ways, so I'm going to blog about the misconceptions I didn't get to bring up that I think are important.

And I hope everyone enjoys the series and finds it helpful. It's a rare occasion, but every now and then I come across people who have no idea what HPV is. However, the majority of those I talk to have at least some knowledge of HPV, and much of this is a result of Merck's Gardasil campaign, which is an excellent resource . The trouble is, even with all the opportunities to get the facts, there are still too many misconceptions about the virus. The danger is when people rely on bad information. I understand that because there are so many strains of HPV, so many factors, and so many potential unknowns, the details can be confusing. But getting the basics right is a huge step in the right direction.