Medical experts are speaking out against the Toronto Star's Feb. 5 front page investigative feature on HPV vaccine Gardasil — even after Star publisher John Cruickshank told CBC's As it Happens that by running the article, the paper failed.

The Star's Wednesday editorial by Juliet Guichon and Dr. Rupert Kaul calls the Gardasil story troubling and disappointing, and the editorial's headline, "Science shows HPV vaccine has no dark side," challenges the original article's suggestion that Gardasil is linked to medical complications in young women.

Despite the Star's effort to correct the story's first claim — that Gardasil has a dark side — by making drug transparency the revised article's focus, Ottawa-based medical expert Dr. Yoni Freedhoff says the damage has been done: The Toronto Star hurt public trust in Gardasil.

It's the result of the paper's anecdote-as-data reporting, he said.

"This is an anti-science article. This is an article that basically tells the public that anecdotes are data, and they aren't. Anecdotes are anecdotes."

Freedhoff, who describes Gardasil as exceedingly safe, told CBC host Marcy Markusa on Wednesday's Information Radio that the Centres for Disease Control (CDC) studied Gardasil and found the vaccine poses no risk for autoimmune disease or death.

Side-effects

"Right now, the side-effects that we know to be true with Gardasil are local," Freedhoff said.

"You can have pain and swelling at the site of the injection. There's a slight increased risk of fainting."

Gardasil was developed by pharmaceutical company Merck and the vaccine is used to prevent four types of human papillomavirus (HPV): 6, 11, 16 and 18.

It was authorized for use in Canada in July 2006, and in February 2010, the Biologics and Genetic Therapies Directorate autorized Merck to expand Gardasil's use to males between nine and 26 years old.

The vaccine protects men from genital warts, which are a symptom of HPV types 6 and 11.

But the drug is best known for its ability to protect women, who are authorized to be vaccinated in Canada between ages 9 and 45, from cervical cancer.

HPV to cancer

Because HPV is a virus, its blueprint, or DNA, allows it to replicate only, according to CBC's house doctor Peter Lin.

But to do that, it needs what Lin calls photocopy equipment found in human cells. Specific viruses can access that equipment through particular cells in the human body.

"Some [virus cells] have a key to get into our lung cells," he said, using certain strains of the flu as an example.

HPV 16 and 18 cells have the key to cervical cells. 

After the sexually transmitted infection enters the cervix, which is the door to the uterus or womb, it uses those cells to replicate. To do this, the HPV cell must get to the basal (base) layer, where new cells are made before they move to top layers during maturation.
 

HPV

In this graphic created by CBC News, an HPV cell enters the basal (base) layer of cells in the cervix lining. There, it copies itself, replicates and its DNA is spliced into the DNA of new cervical cells. This is the beginning of cancer.

In some cases, HPV cell DNA gets spliced into the DNA of cervical cells, which marks the beginning of cervical cancer.

Winnipeg-born obstetrics and gynecology specialist Dr. Jennifer Gunter, who criticized the Toronto Star's Gardasil feature on her blog hours after it appeared online, told CBC cancer-causing HPV cells eliminate a repair mechanism that scouts for genetic damage.

"Normally, the cell recognizes the defect and corrects the error," she said. "The cancer-causing HPV can deactivate this mechanism and mutated cells are free to divide. Some of these will become cancer."

Gardasil in Canada

"The vaccine helps prevent not only the cancer, but also all the issues of being positive for a cancer-causing virus," Gunter said.

"Pap smears detect the problem after it happens. The vaccine helps prevent it."

If cases where the vaccine was administered without incident are any indication, that's precisely what Gardasil is doing in Canada. 

By June 2008, more than half a million doses of the vaccine had been distributed, CBC reported.

In Manitoba, the vaccine is an option for Grade 6 girls in schools across the province. It became available for no charge as part of routine childhood immunizations in Manitoba in September 2008.

Since then, the National Committee on Immunization (NACI) has recommended Gardasil for use in males, and that has been authorized in Canada, too. 

NACI reported the vaccine could be particularly important to men who have sex with men (MSM). Compared to the general population, MSM have disproportionately high numbers of HPV infection, particularly vaccine-preventable, high-risk types 16 and 18, according to Manitoba Health.

In March 2014, girls and women born on or after Jan. 1, 1997 became eligible to receive Gardasil free of charge in Manitoba, and if a woman's health-care professional considers her to be at an increased risk for HPV, she can also receive the vaccine at no charge.

But Freedhoff says some will not take advantage of those opportunities after reading the Toronto Star's story.

Prognosis for public trust

The Toronto Star's Gardasil story featured young women who were vaccinated and also had medical problems. Those stories are different than stories about women who developed complications because of the vaccine, according to Freedhoff.

"There were photographs of deceased girls and women with [nasogastric] tubes. Then, there's this one little line that sort of suggests well, there's actually no proof that any of these stories had anything to do with Gardasil, but take it for what you will, the public," he said.

His prediction for the prognosis for public trust in Gardasil? 

"As a consequence of this story, I suspect that there will sadly be people who don't get vaccinated," Freedhoff said.

"[People] who will develop cervical cancer. And that's really a horrible thing for the Toronto Star to have done."