The Megyn Kelly Show - Truth About the HPV Vaccine： A Megyn Kelly Show Debate and Discussion, with Dr. Kristen Walsh and Allison Krug ｜ Ep. 565

00:00:00.440 Welcome to The Megyn Kelly Show, your home for open, honest, and provocative conversations.

00:00:12.160 Hey everyone, I'm Megyn Kelly. Welcome to The Megyn Kelly Show. Today we're taking a deep dive

00:00:17.120 into the debate surrounding the Gardasil vaccine. And if you have a adolescent or teenage child

00:00:24.940 you've been spoken to about this, but it can affect adults too. You can get this thing up to age 45.

00:00:31.580 The vaccine was first developed for use in American children in 2006. The drug is said to

00:00:37.280 help protect against the human papillomavirus, better known as HPV. HPV can eventually lead to

00:00:44.820 cervical cancer, at least some strains of it. So this vaccine has often been touted as a vaccine

00:00:50.800 against cancer. Sounds amazing, right? Who wouldn't want that?

00:00:54.940 But even before all the controversies surrounding the COVID vaccine, parents were becoming concerned

00:01:01.660 about Gardasil. It is something my friends and I have discussed at length. My core friend group in

00:01:07.580 New York, we all made friends when our daughters were two and in preschool together. And now they're

00:01:13.180 all 11, 12, right around there. And we are all being asked to make this decision for our kids.

00:01:19.260 And you met one of them, my friend Yael. She came on in the Vegas show and she and I were talking.

00:01:24.060 She's like, okay, you've got to do a show on this because there are a lot of parents out there

00:01:27.840 who don't know what to do. And you know what? I am one of them. I've got a 13 year old boy and a 12

00:01:33.320 year old girl and I haven't gotten this vaccine for them yet, but I've been told by the pediatrician

00:01:38.400 I should. So what's the story? Do we, do we just trust a pediatrician who says that to us? Or do we

00:01:44.360 have to do our own research? Cause those same pediatricians told us to get the COVID vaccine

00:01:48.380 for our kids. And now I'm very glad I didn't. Anyway, that's the reason we're bringing you

00:01:53.140 this show today. We're not here to tell you what to do. This is not medical advice. I have a

00:01:58.300 jurist doctor, not an MD kind of like Dr. Jill Biden. She's a fake doctor. And so am I 0.85

00:02:05.200 the real doctors are the MDs, but we're trying as a news item to break down what we know and what we

00:02:12.920 don't know about this vaccine and give you some things to think about and then write down your

00:02:17.680 own questions for the people you trust, whether it's your doctor and maybe it's not even your

00:02:22.420 pediatrician. Maybe it's somebody outside of that particular field. We have both sides well

00:02:28.100 represented for this discussion. Dr. Kristen Walsh is a board certified pediatrician in New Jersey.

00:02:34.180 She graduated from Harvard and then went on to receive her medical degree from the University of

00:02:38.160 Missouri School of Medicine. She's been practicing for over 20 years. Dr. Walsh is the mother of twin

00:02:44.280 teenagers, and she believes parents should get the vaccine for their kids. Also with us today,

00:02:50.280 Allison Krug. Allison is an epidemiologist who earned her master's degree in public health

00:02:55.280 from the University of Virginia. During the COVID pandemic, Allie worked with some of the doctors

00:03:00.160 whose names you've come to know and likely trust, including Vinay Prasad and Marty McCary,

00:03:05.680 to try to help parents understand the potential risks of the COVID vaccine, including myocarditis

00:03:11.920 at a time when you weren't allowed to utter that word. She is the mother of two teenage boys,

00:03:17.400 and she believes this decision for parents is far more complicated than the CDC, FDA, and Merck,

00:03:25.600 again, the manufacturer of Gardasil, would have you believe. Kristen and Allie, thank you both so much

00:03:31.020 for being here today. Thank you, Megan. Thanks for having us. Sure. It's great to see you.

00:03:35.400 I really do appreciate it because all my mom friends and I have been debating this,

00:03:40.300 and we don't know. We don't do this for a living. Usually, you do what your pediatrician tells you.

00:03:46.540 And I think this vaccine kind of had a rap that was more controversial, as we said in the intro,

00:03:52.500 even before COVID. But during the whole COVID debacle and being misled so many times by the

00:03:57.960 public health officials, in particular about vaccines, many of us who were not previously

00:04:02.560 vaccine skeptical, like yours truly, have become a little vaccine skeptical. I don't just trust my

00:04:09.520 pediatrician with a knee-jerk reaction now. So anyway, I really do appreciate you guys coming

00:04:14.640 on and actually debating because so many people don't like that either. So anyway, we'll kick it

00:04:18.940 off. All right, let me start with you, Dr. Kristen Walsh. Can you give us the short sell for why you like

00:04:27.260 this vaccine and you think it is valuable for parents to have with respect to their children?

00:04:33.220 Yeah. I mean, I think it's like every medical decision we make for kids. You're weighing the

00:04:37.580 pros and the cons. And for me, I have a lot of experience with this vaccine. I've been a

00:04:42.820 pediatrician for a while. I've been giving it to my patients ever since it basically was recommended

00:04:48.420 and came out around 2006. And I think that the cancer burden from HPV is so high. If you look at

00:04:58.240 unvaccinated adults, about half of them are carrying strains of HPV and not all of them cause cancer.

00:05:05.060 Some of them cause genital warts, but it's just not a very easily avoidable virus. I think if you're

00:05:11.860 going to be sexually active, it's pretty common. It's pretty much out there. And in other words,

00:05:20.140 you don't really have to do anything crazy to get this virus. And you can be from a very religious 0.90

00:05:26.000 family and do everything right and wait to have sex till you're married and still get it, honestly.

00:05:31.180 So I think in that scenario, the disease burden is such and the vaccine safety is such, from my

00:05:37.640 experience, from the data, that it's a pretty straightforward decision for most kids that the

00:05:43.260 benefits outweigh the risks.

00:05:45.940 Okay. And when you say half of adults are carrying HPV, this is one of the stats that I read in the

00:05:52.220 packet and getting ready for this, that it could be even higher than that, that it could be like

00:05:56.460 the vast majority of adults walking around out there have HPV. Now, what does that mean, doc?

00:06:04.620 What does it mean if you have HPV? What do you have?

00:06:08.580 Yeah. Well, I mean, viruses, we sort of live in this relationship with viruses all the time.

00:06:14.520 You know, if you've ever had chicken pox like I did as a kid, that virus is still around somewhere

00:06:20.240 hiding in your nerves of all weird places. So some viruses your body just clears and gets rid of,

00:06:25.840 and actually quite often the body clears HPV within a couple of years, but sometimes it doesn't clear

00:06:32.300 as easily. Sometimes it causes just sort of bad cytolatical changes in your cells that lead to

00:06:39.560 cancer. Sometimes it causes genital warts. So, you know, many of us are carrying HPV and we'll never

00:06:47.080 have symptoms. We'll never have cancer. We'll never have genital warts. We'll never know we have it and

00:06:51.120 our body will clear it. And that's great. But the problem is you just don't know if you're going to get

00:06:55.720 one of the benign strains or one of the bad strains. And they're the bad strains. There are

00:07:00.540 multiple of them. They're common enough that you want to try to avoid them if possible.

00:07:05.220 When we say the bad strains, do we mean the cancer causing strain or?

00:07:09.660 And I would say genital warts too, because, you know, I know that's not cancer, but it's also not

00:07:14.740 pleasant. And the problem is you can get those things treated, lasered off, whatever, and you're

00:07:19.540 still carrying the virus. You didn't clear it just because the warts got treated. Like your body will

00:07:24.540 clear it or not. But, you know, until then, your partners are very susceptible. You can't really

00:07:30.880 prevent transmission with a condom because a lot of times it's just close skin-to-skin contact.

00:07:35.900 So there's these viruses that cause cancer and there's the viruses that cause genital warts and

00:07:40.680 they're just different strains of the same virus. And then is there some other group of strains that's

00:07:46.080 like benign that causes neither one of those things? Yeah. And they all have numbers. So

00:07:50.960 like the cancer causing strains are like, I think 16 and 18 are the big ones. I always forget which

00:07:56.220 ones cause genital warts because the numbers don't get thrown around as much. But I think for oral 0.51

00:08:01.540 cancer, it's always like either 16 or 18 and that there's nine of them that cause cancer, which is why

00:08:09.640 Gardasil 9 has the name 9 in the end, because that's the newest strain of that or the newest,

00:08:14.500 you know, iteration of the HPV vaccine. It protects you against nine cancer causing strains.

00:08:19.580 I think there's actually maybe even 12. Allie would know the answer to that. Probably.

00:08:24.880 25.

00:08:26.320 Yeah. Okay. See?

00:08:27.600 So isn't this the line of HPV that famously Michael Douglas and Catherine Zeta-Jones admitted

00:08:33.960 they were dealing with that caused his throat cancer? Allie, good time to bring you in. I'm sure

00:08:40.060 you're familiar with that case. I mean, I only mentioned them because they went public with it.

00:08:43.840 And he said he caught cancer. I mean, he said not to be geographic, but I think from oral sex with 0.99

00:08:50.540 his wife who had HPV. I mean, I don't know that case, to be honest, Megan, I live under a rock a 0.98

00:08:56.820 little bit. So it's really an honor and a privilege to be here. And certainly with Dr. Walsh as well,

00:09:02.520 who I know I've known through the COVID pandemic. And she's been a phenomenal pediatrician. And I'm very

00:09:09.180 fortunate to share this time with her talking about this important issue. My children were vaccinated

00:09:14.560 prior to COVID. I marched my kids into the immunization clinic and we got our vaccines.

00:09:19.800 I really did not think about vaccines other than rotavirus. And I did decline that one,

00:09:24.740 but every other vaccine we've marched right in and we've gotten them. We're a military family.

00:09:28.120 When we go overseas and move, we have to get marched in and get Japanese encephalitis and other

00:09:32.100 things. The way that the COVID vaccines were handled, the oversight, and specifically the way

00:09:38.900 that the severe adverse event myocarditis was handled, actually a serious adverse event,

00:09:44.300 really caused me to lose confidence in the FDA and the CDC and the ACIP, quite frankly,

00:09:49.400 because they were pushing it for kids going to camp before we really had settled whether or not

00:09:55.720 myocarditis was a serious signal. So my confidence was shaken. And following that time,

00:10:03.020 I decided that it was important to actually really look into other vaccines and decided to look into

00:10:08.880 the HPV vaccine, quite frankly, because it was the one that I had heard virologists and others talk

00:10:13.340 about as being the most unassailable cancer preventing vaccine that we have, the very best that we have.

00:10:20.080 So I decided to look into it and try to figure out whether or not, you know, I had full confidence

00:10:26.380 in that vaccine.

00:10:28.900 Okay. And so, so you try to take an honest, deep dive into, is this safe or isn't this safe? And,

00:10:35.720 you know, you heard Kristen, Dr. Walsh say, you know, half adults could be more than that are carrying

00:10:40.820 this thing and that the cancer burden is so high. That's why it's worth it. That's, that's why I would

00:10:46.120 say back in the city, my OBGYN was like, you're definitely giving it to your daughter and you,

00:10:53.480 you should give it to your boys too. And she gave it to her daughter. She was practicing what she

00:10:57.980 preached, you know, saying as, as in, you know, Kristen's a pediatrician, but my OBGYN is of course

00:11:05.000 in women's reproductive health. And she was saying, you, you don't know how devastating it is when

00:11:11.440 cervical cancer happens to somebody and it potentially could have been avoided with this

00:11:16.660 shot, you know, or double shot. Or if you, depending on how late in life you get it, it's

00:11:20.580 a triple shot, but that's her point. She was coming in from the dealing with the women once 1.00

00:11:24.640 they have the cancer point. So why isn't that just ball game right there? Yes. It, it can prevent 0.90

00:11:29.880 cancer done. I'm getting it. Right. And it should have been. And that's the notion I brought into

00:11:34.800 actually even looking into this vaccine in the first place, because who wouldn't want to prevent

00:11:37.940 cancer. But then the more I started digging, I've spent over a hundred hours on this and I've

00:11:42.500 really only scratched the surface, I believe in beginning to understand my clear position on this,

00:11:47.440 but I came away asking more questions than I felt were answered. For instance, as Dr. Walsh alluded to

00:11:54.800 90% of all of these infections are handled by the immune system within a year or two. So you build

00:12:01.360 actually natural immunity, which is another lost story that we saw happen with the pandemic as well. We

00:12:07.400 neglected to discuss the importance of natural immunity. And quite frankly, I'm a huge fan of

00:12:12.540 mucosal immunity. This is another virus that, you know, begins on the other side of the mucosa and

00:12:17.580 that's where the first battle is fought is at the mucosal layer of the cervix. Let me clarify that and

00:12:22.500 then I'll give you back the floor. So what you're saying is you may catch HPV and never know as, as

00:12:30.200 Kristen was saying, you may never know you have it. You had intercourse, you have it, but your body is

00:12:34.940 resolving it without you knowing anything. So you are, so you have natural immunity to a lot of

00:12:40.480 these strains without even knowing it, just the same way we, a lot of us did with COVID. Some of

00:12:45.040 us had COVID and didn't even have any symptoms and wouldn't have even known we had COVID if it

00:12:49.500 weren't for the constant testing. And therefore we had natural immunity. You're saying same thing here.

00:12:54.720 Same thing here. Yeah. I mean, your cervix, you know, I'm sure most people have been through health

00:12:58.860 ed in school and they know what the cervix is and where it is. And so it's outward facing at the top of

00:13:03.080 the vagina. And so when you do have sex, I mean, you actually are exposing the cervix and the vagina 1.00

00:13:09.520 to organisms, including the HPV virus. And so that's where the first battle is actually fought.

00:13:14.880 Oh, sweet. We do have that picture. We have a, we have a medical picture of a cervix. Very nice. I

00:13:19.080 asked for that. So it's just really important to think about the mucosal layer, which is, you know,

00:13:24.600 our airways lining our nose all the way down, you know, through our gut, which quite frankly,

00:13:29.460 constitutes most of your immune system in your gut. And that's why it matters what you eat.

00:13:33.520 But also in the vagina as well. You can hear, I have a cold. I'm recovering from a cold. That 0.98

00:13:38.280 battle is being waged in my upper airways before it gets to my lungs. Same thing is true here with HPV.

00:13:44.360 That battle is being waged in the epithelium of the cervix. And yes, some of these really bad strains

00:13:52.600 do find a way to wedge themselves between the cells and get down to the basal layer where they do get into

00:13:57.940 the cells at the basal layer of the epithelium and they start to cause mutations. And that can cause

00:14:03.200 the warts that you might see rise up to the surface, right? If you have warts on your hand or somewhere

00:14:07.460 else, you can actually see them hard to see on the cervix unless you go and get screened, which gets

00:14:12.160 to my next point. The first point, point one was 90% resolve on their own. Point two is getting the

00:14:17.620 vaccine actually doesn't remove the importance of getting routine pap screenings. So that's something

00:14:25.140 I wasn't frankly aware of either. We still need to ask women to go in for screenings every three 0.99

00:14:29.960 years. And so if we are giving them like essentially false hope that, you know, boom, you're done. This

00:14:35.020 is a home run. You're not going to get cancer. We're actually giving them some misleading information

00:14:39.460 that they do need to keep going in and get screenings. And the women, unfortunately, who are 1.00

00:14:43.700 getting cervical cancer and dying of cervical cancer are the same women who face structural barriers to 0.99

00:14:50.160 care that put them at higher risk for either not getting screened or not being able to follow up

00:14:54.740 on important treatments for abnormal screens. So I have a couple of other points to make.

00:14:59.760 That was one of my questions, Allie, in reading your talking points before this segment and the data,

00:15:04.540 which was if you are a woman in America, you likely are encouraged to go to your OBGYN for your

00:15:11.040 annual, right? That's what we all call it. We go in for our annual and they give you a pap test every

00:15:15.080 time. They're constantly doing that. I mean, it's unpleasant and you don't really love it.

00:15:18.700 I think in America, under most health and health plans, you get one of those a year.

00:15:23.200 So if you're somebody here in the modern, you know, first world of the United States

00:15:27.320 and you're doing that, it really did make me wonder whether you need this vaccine at all,

00:15:32.640 because that will maybe it's not going to detect one of the quiet strains and you don't really care.

00:15:40.100 I imagine it'd be nice to detect or, you know, I'm talking about the vaccine. It'd be not it'd be

00:15:44.560 nice to avoid any of this nonsense. But my point is, the one you really care about is cancer.

00:15:50.640 And are the pap smears, have they been working effectively

00:15:53.880 to save the lives of any woman who might have cervical cancer? 0.99

00:16:01.500 Kristen, do you want to talk?

00:16:02.500 Well, there's a couple points I would have about that. So first of all, going back to natural

00:16:10.200 immunity for a second, like I definitely agree that I don't think we got good public health

00:16:15.960 messaging about natural immunity regarding COVID. I think that natural immunity for COVID is durable,

00:16:23.180 long lasting. It seems to me to be at least as good as vaccine immunity, if not better. I mean,

00:16:28.580 I think, if anything, the signs are pointing to better. But unfortunately, that does not seem to

00:16:34.820 be the case with HPV. And it's partly, I think, because of some of the stuff Ali was highlighting,

00:16:40.140 it's a virus that stays in your sort of your epithelium, like the mucus membranes. And if it

00:16:46.060 gets, you know, if it worms its way down, it can sort of cause cancerous changes in those cells right

00:16:52.080 where it infected you. But it doesn't really get into the bloodstream very much so that actually your

00:16:58.120 body doesn't mount as good of an immune response against it. So it's just, in this case, I think

00:17:04.920 it's pretty clear cut that natural immunity is not great and certainly not even close to what

00:17:09.680 vaccine immunity gives you for the HPV virus. As far as pap smears go, so there's a few things to

00:17:18.360 unpack here. And actually, I think Ali found the study that I had remembered reading, which there was

00:17:26.000 one sort of European group that said, hey, you know, if you are vaccinating young girls before

00:17:32.460 they're sexually active, they really don't need many pap smears because the HPV vaccine is so effective.

00:17:38.660 If, you know, if you can get people vaccinated before they're exposed to any strains, I think

00:17:43.220 this study recommended like three pap smears in your lifetime. And I think, you know, that's actually

00:17:48.820 what I tell people is what I think. But the problem is, it's very difficult to tease out,

00:17:54.400 right? When we make, we have to make sweeping recommendations for society. And I think it would

00:17:58.540 get a little difficult to be like, well, did you get the HPV vaccine before you started having sex? 0.98

00:18:03.480 And then it's unclear, like, is it oral sex? Was it like French kissing, which, you know, 0.97

00:18:08.100 has been known to transmit HPV in very rare cases. So it gets very dicey trying to figure out who this

00:18:14.000 population is. And I mean, I think that I have plenty of the patients who are that population. And honestly,

00:18:19.180 I tell their mothers about that study. And I say, that's what I think, you know, your daughter really

00:18:24.480 needs is only three pap smears probably in her lifetime. But the other point is that we do wait, way too

00:18:31.480 many pap smears in this country. I've had the same experience every time you go, you know, and they pretty

00:18:36.600 much make you go every year, they want to do a pap smear. And the recommendations are not even, you know,

00:18:41.580 I think the recommendations are every three years, you know, for most of us, most of the time.

00:18:45.240 So I didn't even know that. We do way too much. Why have I been subjecting myself to this year

00:18:49.440 after year? I think I have overly aggressive doctors. Well, I guess we all do, because I

00:18:54.920 think we've all had that experience. I've never, I mean, maybe next time I go, you know, I have sort

00:18:59.780 of a new OBGYN. So maybe she'll be like, hey, you, you had this last year, you don't need it for

00:19:04.040 another two years, and then I'll be so happy. But we'll see. I mean, thrice in a lifetime sounds

00:19:08.960 magnificent, because it's, you know, as I say to the audience, the males, it is not a pleasant

00:19:13.520 experience. It's not hell on earth or anything, but it's not something, if you could take a pass

00:19:17.180 on it, you'd probably say yes. So that's, so three times in a lifetime, if you've gotten the HPV

00:19:23.460 vaccine prior to your first sexual encounter, that's something you tell your patients?

00:19:29.220 That's, I say, that's probably all you need. Like, that's not probably all that, you know,

00:19:33.720 people are going to propose to do to you, but that's probably all you need. And then the other

00:19:38.480 point here is that, unfortunately, you know, this is not a great experience. Like, if you,

00:19:44.200 like, yes, if we are doing extremely frequent pap smears, we will probably pick up, you know,

00:19:49.540 these precancerous lesions early. And, you know, we can save a lot of lives that way. But, you know,

00:19:55.760 trust me, if you ever know anybody, like, thank God, I haven't had to do this myself. But if you

00:19:59.880 ever know anybody who's had to have one of those LEAP procedures to take off, like, sketchy precancerous

00:20:04.480 cervical scraping, because I was just talking to a friend of mine, no one who I've mentioned on this

00:20:09.280 show. And she was saying she got the HPV vaccine, then they detected after the vaccine, nonetheless,

00:20:16.080 they've detected possible problematic cells on the cervix. And then she had to have a cervical 0.99

00:20:20.560 scraping, which sounds just awful. And she said, indeed, it was. Is that what you're talking about?

00:20:25.780 No, there's even worse stuff than that. There's stuff where they have to take a laser and excise,

00:20:30.460 like part of your cervix. And I've actually known people like normal people who didn't do anything

00:20:35.700 crazy in college that the rest of us weren't doing, you know, who had to have that done. And

00:20:39.960 it's extremely painful. So I think, you know, all of us, you know, I don't have a daughter. But if I

00:20:45.200 did, I would certainly not want her to go through that. So I think the more of that we can prevent,

00:20:49.640 the better. And it's also just scary, you know, if you get a pap smear result, and even if they're

00:20:53.780 like, hey, this is questionable, we need to do this again in two months, then you're like,

00:20:57.240 sitting around for two months, hoping you don't have cancer. And, you know, I think the more of

00:21:02.380 that we can prevent, the better. All right. So this, this is exactly where I was when I was

00:21:06.580 reading the packet in advance of this alley. I was like, I'm getting it. I'm going to get it. I'm

00:21:11.260 too, I'm too old to get it. But I'm going to get it for all three kids. Because the Michael Douglas

00:21:14.780 thing, I did go back and check. Yes, he did. He did indeed in 2013, reveal to the Guardian that his

00:21:20.300 illness was the result. He had cancer, broke cancer. His illness was the result of

00:21:24.740 contracting HPV, which experts believe can be brought on by cunnilingus. So it was sort of

00:21:31.980 a very revealing moment for the couple, but kind of a good one, you know, net net, because it called

00:21:36.940 attention to the issue. And I think most people thought this was a female issue only. And it's 1.00

00:21:40.940 not, it can, it can affect men as well, as outlined there. So this is the point where I was like, I'm

00:21:45.500 getting it. But then you've taken a deep dive into some of the side effects. And indeed, it's,

00:21:50.700 it's dark, because there's a mass litigation going on right now. It's been consolidated in

00:21:55.660 the state of North Carolina. And in that case, and they're going to have to prove their case,

00:22:00.320 they're going to have to prove most importantly, causality related to the vaccine. People have

00:22:04.300 died, kids, you know, young kids, 12, 13 years old, died, boys and girls after getting the vaccine.

00:22:12.360 That's it's one in a million, they say, but that's enough to make most parents say, and I'm

00:22:15.980 out. So talk about the side effects. Well, I mean, if I could, I could just circle back for

00:22:22.400 just a second. I do agree with Dr. Walsh that it is a battle at the mucosal layer, a battle that is

00:22:30.440 generally won. But interestingly enough, the studies show that the antibodies following natural infection

00:22:35.440 and vaccination end up approximating each other after about a year. The battle is really not fought

00:22:41.020 systemically. So we and we are also neglecting to talk about the T cells and their involvement in

00:22:46.800 protecting us against, you know, the HPV 16 and 18, which are the worst, there are nine

00:22:51.780 that Gardasil protects against, but there are 12 oncogenic strains, meaning cancer causing strains.

00:22:58.200 And so we're just not really talking about the full picture that our immune system provides as far

00:23:03.140 as protection for us. The other thing that I wanted to bring up is that studies have looked at

00:23:08.720 the protection of natural immunity and actually using the control group in a trial in Costa Rica

00:23:13.480 and found that there was 50% protection against neoplasias that do lead to cancer. So cervical

00:23:20.240 intraepithelial neoplasia two or higher CIN two or higher. I don't understand a word you're saying.

00:23:25.680 So, yeah, I understand. So, so those are pre-cancer. So, but if your audience is trying to look up these

00:23:30.580 studies and understand what CIN is, it took me a little bit to figure that out. So CIN is pre-cancers and

00:23:36.560 the grading is one, two, and three, three is worse. So what we're trying to do is measure outcomes that

00:23:41.500 are meaningful and the outcomes that are meaningful are cancer. And so CIN three leads to cervical cancer 0.74

00:23:48.640 a fraction of the time, somewhere between 0.5% and 4% within 12 months. Not all of the CIN threes even 0.62

00:23:55.180 lead to cancer. So again, I just think full disclosure to parents is important about the full spectrum of,

00:24:00.740 you know, potential risks and getting to your point, Megan, about side effects. The side effects

00:24:06.480 that they are talking about for this vaccine, beyond what the CDC acknowledges, which is anaphylaxis,

00:24:12.900 which is 26 per million, syncope, which is fainting is 82 per million. CDC admits in its own studies

00:24:18.920 that those are much higher than other vaccines. Clotting is about two per million. I think those are

00:24:24.700 some things that really, if we were smart about reducing harms and really optimizing the benefit,

00:24:29.620 I think that it would make sense to talk about risk factors for clotting. So family risk factors,

00:24:35.000 hereditary risk factors, even using birth control are risk factors for clotting. Those potentially could be

00:24:41.860 conversations you could have. You could run a blood test before you give the vaccine. And finally, probably

00:24:47.160 the most obvious thing we should talk about is, do we really need two doses or three doses, as you mentioned

00:24:53.200 earlier, Megan, depending on age. So the World Health Organization just released in November 2022

00:24:58.700 an updated recommendation, acknowledging that the evidence is very good for the protection of one

00:25:04.160 dose, as far as antibodies, as well as long-term outcomes. So, you know, the option exists for what

00:25:09.880 they call an off-label, one-dose recommendation. And I think parents should be informed of that. But

00:25:14.980 here in the U.S., we're just simply not talking about it. CDC, ACIP, AAP, even in the AAP's red book,

00:25:20.400 it still says the routine, you know, on-label, two or three doses. And as a matter of fact,

00:25:25.580 I was really surprised to find that they even say, hey, if the interval is too short between

00:25:30.160 any of the doses, you should restart, which is frankly just crazy. There's no reason I would

00:25:35.720 ever advise anyone to do that because the longer the interval, the better, which we found with COVID

00:25:40.740 too. So maybe, maybe red books in the middle of revising that. I don't know. I just, I found it

00:25:45.180 and it struck me as, you know, yet another indication that we're not really providing parents

00:25:48.820 in the U.S. with full disclosure. And I apologize. There's a lot I want to go over there and also

00:25:54.040 give it back to Dr. Walsh in a second. But let me just ask you, the reason some believe they're

00:25:58.920 having adverse reactions to this vaccine is in this vaccine, as I understand it, there's a form of

00:26:05.640 aluminum. It's like a special form of aluminum that Merck dreamed up. And we've had RFK Jr. on this

00:26:12.800 show repeatedly to talk about how he has nothing against certain vaccines. What he does have against

00:26:18.140 certain vaccines is when they put mercury in them or as a preservative, or when they put aluminum in

00:26:24.380 them. And that, you know, he says it's a neurotoxin. And I think we can agree that it's a neurotoxin.

00:26:31.000 I don't think even his critics would dispute that aluminum is a neurotoxin, but there's also something

00:26:35.820 in there that, that helps it cross the blood brain barrier. So there's something in this vaccine that

00:26:42.780 helps it cross the blood brain barrier, according to what I read. And it also has this form of

00:26:47.800 aluminum. So now you're basically injecting aluminum into your kid's brain and trying to

00:26:52.900 make it as easy as possible, which is, I believe why some, some think we get a high percentage of

00:26:58.760 adverse reactions to the, to Gardasil. Is that correct? Well, it's somewhat correct. I would say

00:27:05.340 that, you know, aluminum has been used for, you know, a very, very long time as an adjuvant to get the

00:27:10.840 attention of the immune system. And that's not really very shocking. I think the difference with

00:27:15.480 this Merck, AAHS, which is a different one. I'm not going to say the full word, but AAHS is their

00:27:22.900 adjuvant. It is a proprietary adjuvant and it was used. The thing that frustrates me most probably

00:27:27.700 about this is the clinical trials are not all that helpful. So they enrolled a good number of people

00:27:31.940 up to 18,000, if you look across all the studies, but it was an active comparator. Only 306

00:27:37.840 had a saline placebo. The rest of them had this adjuvant, which we know may cause harms because

00:27:44.200 looking at the adverse event rates, they're roughly comparable between vaccine and placebo,

00:27:48.860 which tells you that adjuvant is not terribly safe. So I do wish that the trials had been done

00:27:55.060 better. Just to clear that up because the placebo had the adjuvant in it. It just didn't have the thing

00:28:01.500 that prevents HPV. Right. It didn't have the little VLPs, the virus-like particles. So that's the worst

00:28:07.340 case scenario. So you don't even get the cancer causing thing if you're in the placebo group

00:28:10.700 and you get the aluminum thing. Right. And then, and then what I, what I heard Ali is that then post

00:28:17.700 that because the, the trial participants were like, Hey, the people who got the actual drug,

00:28:23.020 they're not going to get cancer. You were in the placebo drug, uh, drug group. And so those people

00:28:27.200 were like, Oh, give me the real deal. So then they had what, four, maybe six shots of a shot that

00:28:34.260 had the aluminum in it, which I I'd be very upset if I were in the placebo group and later found out, 0.99

00:28:40.200 holy shit, how much aluminum did they stick in me? Sorry, go ahead. 0.96

00:28:44.560 Yeah, no, I think it's a good question. You know, uh, Mark's own package insert shows that

00:28:49.240 roughly 2.3% in both the vaccine and the placebo group had new onset autoimmune issues. Like I had to

00:28:55.060 read that twice. 2.3% is a big deal. Um, so I just wish that the FDA oversight had,

00:29:01.300 was more stringent. I wish that they weren't allowed to do active comparators. I wish that

00:29:05.640 they'd been forced to publish every single study. I wish that, um, people had not had to invest three

00:29:10.600 years of their lives combing through, you know, clinical study reports and, you know, petitioning

00:29:15.400 the manufacturers to release data so that we could actually do the proper meta-analyses to look at these

00:29:19.620 adverse events. Um, it's just really very frustrating to try to get to the bottom of the equation, which

00:29:25.460 matters, which is risk versus benefit. And I don't feel as an epidemiologist to, you know,

00:29:31.420 cut my teeth on this during COVID looking at myocarditis. I don't feel like I have enough

00:29:35.380 data to really fairly square this up. Mm-hmm. I know that's the search. So Kristen,

00:29:40.820 can you speak to, uh, what Allie was just saying? She challenged you on your statements about the

00:29:46.300 immunity is really not that great from catching one of these early HPV strains. You know, you were

00:29:52.640 suggesting I wouldn't rely on it. And she was saying it's stronger than you're stating. And don't

00:29:56.480 forget about T cells. I mean, when, when, you know, you guys approached me about coming on about this

00:30:04.400 topic, I really tried to, um, sort of start from zero. Like I didn't know anything about this

00:30:11.120 vaccine. I went to all sort of the top quality medical journals and pulled a bunch of studies

00:30:16.800 on safety and efficacy. So this one is the international journal of gynecological cancers.

00:30:24.000 And what they say about that is the natural immune response for HPV is insufficient to control for new

00:30:31.040 infections and is far lower when compared with the high levels of sero response and the high

00:30:36.520 efficacy observed against persistent infections after HPV vaccination. And I saw that across like

00:30:42.260 five or six different papers that I looked at. And I was really looking at the big summary,

00:30:46.580 you know, papers that the meta analysis, and I, I see this over and over. So I, and I, I'm the first

00:30:54.560 to tell you, like I said, like, I think natural immunity works great for some things, not so great

00:30:58.980 for others works great for chickenpox. That's why we don't make kids get the chickenpox vaccine if

00:31:03.560 they've had chickenpox, but natural immunity to the flu is pretty crummy, which is why I personally

00:31:08.800 choose to get a flu vaccine every year. Um, and I think HPV is one of the ones that it just doesn't

00:31:15.320 work that great. And the vaccine works so much better. Um, and you know, regarding the aluminum,

00:31:21.980 I think, you know, the, it's, some of this is unavoidable because vaccines, what do they do?

00:31:29.480 They stimulate the immune system, right? So they're teaching your immune system to fight off these

00:31:34.440 diseases without you getting sick or dying. So it's sort of like, if we, if we don't want vaccines that

00:31:41.320 have any adverse events whatsoever or adverse effects or side effects, or, you know, not one

00:31:47.020 tiny unpleasant thing happens. I think it's sort of like sending a bunch of military recruits to West

00:31:52.260 Point and being like, but we don't want them to get any bruises. Okay. Like it's not very realistic.

00:31:57.320 You know, you are, I don't, I don't like the oversimplified analogies, which we saw so many of

00:32:02.520 during COVID sort of humanizing viruses, but you know, the immune system is like, it's there to fight off

00:32:08.560 nasty little microbes who want to infect you. So I think, you know, we do have the technology,

00:32:15.000 which is so great. I mean, vaccines are pretty much, you know, one of the greatest public health

00:32:20.340 interventions of all time, like somewhere behind clean water and, you know, uh, clean sewers and

00:32:25.760 stuff. But, um, you do have to stimulate the immune system for a vaccine to work. You know,

00:32:30.500 the same is for, it goes for measles vaccine, all the vaccines have to do that. And that's why I think,

00:32:35.420 you know, as far as some of the stuff RFK junior says, there's some problems with that. Everything

00:32:41.000 should be up against a saline placebo. It's hard to do a blinded trial that way because, you know,

00:32:45.860 pretty much everybody's going to know that all they got was saline if nobody, you know, ever gets

00:32:50.780 any soreness in the injection site or, I mean, so that's one problem. But also if you're talking about

00:32:56.160 going back and redoing a bunch of safety trials, it's not ethical to compare, you know, a vaccine that's

00:33:02.780 known to be pretty well safe and effective, which is the standard of care against a placebo. That's

00:33:08.160 not the standard of care for, for diseases that we know are already killing people. So, you know,

00:33:12.660 you can talk about, and this is not my area, but you can talk about what should be the placebo for

00:33:17.000 a brand new vaccine that we don't already have a standard of care for. But I mean, I don't know,

00:33:22.280 you know, I try to like, I'm a general pediatrician, whatever brand Merck is using, I will tell you this,

00:33:28.320 like everything is proprietary with the pharma companies. They are constantly updating vaccines.

00:33:33.060 They're constantly updating adjuvants. They're constantly updating everything. So I don't know

00:33:37.180 anything about that particular, you know, brand of aluminum, but I do know that kind of aluminums

00:33:44.460 and everything, I think probably Allie would acknowledge this too. We all eat seven to nine

00:33:48.780 milligrams of aluminum each day. It's found in antacids, aspirin, antiperspirants. So we all get a

00:33:54.680 lot of exposure to aluminum. It's one of the elements in the earth's crust. Your immune system

00:33:58.820 doesn't necessarily differentiate whether you ate it or, you know, it was injected. So I, well,

00:34:05.080 I mean, the big thing, but what about this thing? I mean, like my understanding is that there's

00:34:08.660 something in the, in the Gardasil vaccine that helps it pass, as I said, the blood brain barrier

00:34:14.300 and, and my, my deodorant doesn't have that. So it seems like it's extra risky to be injecting

00:34:22.640 aluminum alongside something that, that allows that facilitation.

00:34:27.300 Yeah. I mean, I, again, like I'm not a vaccine developer and sometimes my patients are like,

00:34:32.420 do you know every last ingredient in this vaccine? I'm like, no, you're drinking a Diet Coke. Do you

00:34:36.800 know every last ingredient in that? I drink Diet Coke too. I probably don't want to know all the

00:34:40.760 ingredients, but you know, we do have to have some trust in the safety of the manufacturing process.

00:34:45.360 I will say that I've been giving the Gardasil 9 vaccine for, for pretty much as soon as it came

00:34:51.160 out too. I have not noticed. And that was like the big difference between the, whatever we were

00:34:55.680 using before in the Gardasil 9, like they updated the adjuvant. I have not noticed anything with my

00:35:00.700 patients as regards increased severe effects. Now, when I looked at this data and I think there are

00:35:06.660 some areas where, you know, Ali and I would, would probably agree. So I looked at a bunch of safety

00:35:12.300 data and I saw like, I think, you know, serious adverse events. I mean, that's going to be the case for

00:35:17.920 any vaccine with the flu vaccine. I think there's a one in a million chance of Guillain-Barré syndrome.

00:35:22.040 I think it's a little higher with this vaccine. I actually saw sort of wildly differing numbers.

00:35:26.840 You know, one study I found from France, which was like 2 million people thought it was several per

00:35:31.460 hundred thousand and another said, you know, eight per million. But I think these serious adverse events,

00:35:37.880 if you're in the single digits per million vaccines given, that's really not very significant. I mean,

00:35:43.860 I'm not here to tell you that a vaccine's not a medical intervention, never has any serious

00:35:48.680 reactions. Obviously that's not true, but they're exceedingly rare and they're so much more rare

00:35:53.880 than the chance of getting this kind of cancer, you know, which is now preventable. And I think

00:35:58.760 that's what most parents want to know. They want to know like, which is the bigger risk for my child

00:36:03.100 and whether we're talking about what adjuvant they use or serious adverse reactions. I don't,

00:36:08.860 you know, I think that it's still so clear to me that the benefits outweigh the risk. I actually

00:36:13.680 think that they probably, you were saying the number per million of, of syncope. I think that's

00:36:18.300 probably a gross underestimate. I mean, that's the one thing that I tell parents about. There's two

00:36:22.500 things. One, the vaccine is a little more painful than most. And I mean, the, the studies I pulled say

00:36:27.760 it's, it's something to do with the salts they use in the actual, you know, vaccine components,

00:36:33.280 but either way it does hurt a bit. And, um, that to me gets to the syncope question. Adolescents

00:36:40.240 tend to pass out. I mean, I know I did, you know, when I was 16, like, you know, when I would get my

00:36:46.880 period, I would just drop like a stone. And my dad is a physician. He got pretty sick of that. So like

00:36:52.840 he dragged me to the gynecologist just because of that. So, you know, adolescents tend to not need 0.99

00:36:59.180 much of an excuse to pass out anyway. So you introduce a painful stimulus, like a vaccine.

00:37:03.880 Yes. I have seen that. That is the one like adverse event that I have actually seen on the

00:37:08.500 ground after, you know, however many years it is since 2006, giving this vaccine, I have had a

00:37:14.180 patient pass out, you know, it helps to, if I always tell parents, like, you're really supposed to give

00:37:19.060 it lying down anyway. Most of us maybe don't do that every time, but we do. I do ask, I say like,

00:37:25.100 does your kid get woozy at the sight of blood or, you know, have they ever passed out before

00:37:29.620 for any reason? And if they have, I will give the vaccine lying down and make them stay there

00:37:33.820 for 15 minutes, you know, just to make sure that doesn't happen.

00:37:37.040 That doesn't seem like one of those deal breakers. I mean, it's not pleasant,

00:37:39.540 but it doesn't seem like a deal breaker. You get down to the list of the other alleged adverse

00:37:44.000 events, the more severe ones, and then you've got our attention. But I understand just because

00:37:48.640 they allege it in a lawsuit, just because they, people go to Merck and complain doesn't mean

00:37:52.860 that they've proven causality, you know, and, and in the same way now you have so many people

00:37:57.560 saying, I have long COVID, I have long COVID. And you say, do you, or do you, are you just kind

00:38:02.700 of lumping preexisting mental health and other issues into this umbrella? Those claims have to

00:38:08.240 be tested now in a court of law to see if in fact they were caused by this vaccine. And indeed,

00:38:14.100 even if they were, how, how rare are they to your point? Like there, some risk will be acceptable

00:38:19.880 to a lot of parents to avoid these potential cancers. All right. There's much, much more to

00:38:24.160 discuss, including what, how is Merck marketing this? Were they, were they solving a problem

00:38:29.760 that really wasn't that widespread? Did they lead us to believe it was more widespread than it actually

00:38:35.500 is? And does the government have a stake in this vaccine being mandated? We're seeing a bit more

00:38:42.000 of those mandates, even with respect to this vaccine. And we'll talk about that and much,

00:38:46.140 much more next. Let's spend a minute on Merck because I do think the stake that the drug

00:38:55.040 manufacturer has in pushing the vaccine is relevant. Just ask Pfizer or Moderna. So Merck,

00:39:04.360 they're the ones who came out with this drug in 2007. And by 2008, they decided to market it this

00:39:10.200 way. We'll take a look at the original ads pushing it. I chose to get vaccinated because I'll do everything

00:39:14.780 I can to help protect myself from cervical cancer. I chose to get vaccinated when my doctor told me

00:39:19.980 HPV can affect women my age and how Gardasil can help protect me. Gardasil is the only cervical 1.00

00:39:24.860 cancer vaccine that helps protect against four types of HPV. Two types that cause 70% of cervical

00:39:30.600 cancer and two more types that cause other HPV diseases. I chose to get vaccinated after my doctor

00:39:36.300 told me cervical cancer isn't the only HPV disease Gardasil helps prevent. I chose to get vaccinated

00:39:41.900 because my dreams don't include cervical cancer. Gardasil. Gardasil. Gardasil. You have the power

00:39:48.040 to choose. It's very effective. Choose no to cancer. Okay. Yes, I agree. I also would like to

00:39:56.820 choose to say no to cancer. Well, then it became more controversial. This one in particular got a

00:40:01.580 little sticky in terms of parental blogging and just the internet being what it is. And now they've

00:40:06.840 changed their approach. Here's a more recent pitch by Gardasil. And it's the only vaccine that's out

00:40:11.680 there. There was another one for a while, but now this is it. If you want to get the HPV vaccine,

00:40:15.000 it's Gardasil by Merck. 2016, found a different way of messaging. Here it is.

00:40:19.220 I have cervical cancer from an infection, human papillomavirus. Who knew HPV could lead to certain

00:40:26.760 cancers? Who knew my risk for HPV would increase as I got older? Who knew that there was something

00:40:33.040 that could have helped protect me from HPV when I was 11 or 12, way before I would even be exposed to it?

00:40:38.540 Did you know, mom, dad?

00:40:42.300 Oh my God. I'm sorry, but that is too much. That's just too much. Kristen, I'll start with

00:40:49.240 you on it as the pediatrician. That's absurd. That's trying to guilt you. You gave your kid

00:40:53.580 cancer by not getting them this vaccine.

00:40:56.020 I do find the emotional blackmail of parents disturbing. And I think we're seeing it

00:41:00.460 in other arenas now, like, you know, not to go into a whole rabbit hole, but, you know,

00:41:07.200 some of the message parents of kids with gender issues are getting about if you, it's either

00:41:12.060 aggressive gender, gender confirming therapy, or you're choosing your child's suicide. I think 0.66

00:41:17.220 that's horrible. And I am not for, for any of that. I mean, I guess, you know, companies can market

00:41:24.400 the way they wish, but I am always going to disapprove of emotional blackmail of parents.

00:41:29.140 And honestly, it also reminds me of, um, a lot of the, the ways that public health chose to

00:41:34.580 communicate during COVID, right? It was less about sort of giving factual information and being honest

00:41:40.700 about what's known and not known. And it was more about what can we say to make people behave a certain

00:41:45.260 way. And that was their whole thing. And I, to me, when you talk about medicine, that's,

00:41:50.260 that's the paternalistic way of practicing medicine. It was very common in pediatrics when

00:41:54.160 I started out. And I always said to myself, like, I am not going to practice this way. I'm just going

00:41:58.500 to tell people like the facts and the truth and invite them to make their own decision and, you know,

00:42:03.080 give my opinion where appropriate, but I am really not a fan of that heavy handed, you know, way of,

00:42:08.080 of trying to make people do what you want them to do.

00:42:11.140 You know, there's, there's a question, Allie, about Merck and whether this drug was a savior because it had

00:42:18.240 been involved in a bunch of litigation over, um, what was it? It was, uh, Vioxx. Yeah. Yeah. Vioxx.

00:42:25.740 And, um, there was a, there was a suggestion that this drug may or may not stop HPV, but it

00:42:32.920 definitely stopped the bleeding from the Vioxx litigation that Merck was facing. And that sort of

00:42:37.600 desperation in that 2016 ad only makes me suspicious of them. I, it makes me say like, you're pushing that

00:42:43.500 hard to guilt parents. You, that sounds like a financial motivation more than, I don't know.

00:42:48.480 That doesn't sound like altruism to me. I don't know. I mean, full disclosure, I worked for Merck.

00:42:53.140 I really appreciated the approach the company took to training. I was worked for the Merck vaccine

00:42:58.300 division. I sold to public sector, um, correctional facilities, military bases, health departments.

00:43:04.280 Um, I hold the company in high regard. Um, so just letting you know that my bias is pro vaccine here.

00:43:11.180 Um, if we get a chance, I'd love to talk about meningitis vaccine before college, because that

00:43:15.420 one, that one is clearly a no brainer for me. So, um, I, I don't know that it makes any sense to

00:43:22.660 assume a purely financial motive, um, vaccine pipelines are many, many years in development.

00:43:28.580 I do also agree with Dr. Walsh though, that the emotional black male appearance and that, um, 1.00

00:43:34.700 that one campaign in particular about who knew, or did you know mom was terrible. Um, so I really

00:43:41.160 think that, you know, we need to talk to parents about the facts and, and make sure that there's,

00:43:45.480 you know, truly informed consent. I think we ought to talk about the risks of disease. We ought to also

00:43:50.320 be able to talk about the risks of vaccines because there are risks. Anytime you do a medical intervention,

00:43:55.460 there are risks. And in particular for vaccines, you're introducing these to previously healthy

00:44:00.500 people. So I think it is paramount that we be clear on what they are and that we really do good

00:44:06.000 risk benefit analyses, which honestly, I'm very surprised to find coming at this now, you know,

00:44:11.460 um, for both COVID and now for HPV, taking a really hard look at it. I'm really surprised to find that

00:44:16.380 the math is just not there. And, you know, here I am in my kitchen doing the math and I just,

00:44:22.100 that's not acceptable. Like we've actually really need to have a third party, non-biased,

00:44:27.360 not FDA affiliated, you know, open source, maybe, you know, recruit citizens and do an open,

00:44:32.500 you know, access, you know, best modeling effort. What is the real risk benefit analysis here

00:44:38.140 and bring our best minds to this. So I don't, I don't know that I necessarily agree it's profit

00:44:44.260 motive entirely there. We're also seeing that Merck is, you know, building a new plant in Virginia,

00:44:48.740 Elkton, Virginia to, um, ensure that access to this vaccine is available globally, which I totally

00:44:55.040 support. I think that's another thing we haven't talked about is low and middle.

00:44:58.180 Well, that's a different thing. If you're over, if you're in some third world country and you don't

00:45:01.500 get any pap screening at all. Yes. I mean, I think everybody can, and then the risk benefit analysis

00:45:06.860 changes. But as we talked about here in the, you know, first world country of the United States,

00:45:11.220 very different calculation where they're forcing the pap screen around you every time you turn around,

00:45:14.540 my God, I was like, next time I go to my OBGYN, I'm going to cross my legs. Stay away.

00:45:18.100 I don't need this. I had no idea I had that power that this was perhaps not necessary.

00:45:24.900 Well, we can, we can all try it and see how it goes.

00:45:28.680 Why does he keep coming at me? Oh, oh no. All right. Listen, a moment of levity. We're going

00:45:33.480 to come back and we are going to get into those side effects, uh, in detail and some of the more

00:45:38.260 disturbing allegations. And what about boys? What about boys? I mean, our eldest is a boy. This is

00:45:43.940 how it first got suggested to me that we should, we should give our then 12 year old boy, this

00:45:47.620 vaccine. What are the risks to them? And have they done in depth studies studies on the risks

00:45:52.040 for our, for our boys? Uh, Kristen and Allie stay with me. Don't forget folks, go ahead now while you

00:45:57.580 have a second and subscribe to us over at youtube.com slash Megan Kelly. If you want to watch this show

00:46:02.720 with your eyes instead of listen, just with your ears on Sirius XM radio live every day at noon East.

00:46:13.700 So on the subject of Merck, um, in the first quarter of 2023 alone,

00:46:20.240 Gardasil sales rose 35% to 2 billion above expectations of 1.7 billion. That is in the

00:46:27.940 first quarter of this year alone. So Merck is not looking at bankruptcy anytime soon. This vaccine

00:46:35.660 has been a godsend for them. Um, there is a question about what, how many doses you should

00:46:42.900 get. The recommendations are children who start the vaccine series before they're 15 can get two

00:46:47.660 doses. Those who started at age 15 or older, it's three doses. And the FDA in 2018 approved

00:46:55.500 Gardasil nine, the one that does the nine strains of potential cancer for individuals, 27 to 45.

00:47:02.280 So up to 45 year olds can get it. And then they say no. However, in 2009, CBS news ran a story,

00:47:10.340 uh, hosted then by our friend, Dr. Cheryl, or not doctor, but Cheryl Atkinson. Now she's independent

00:47:15.640 in which, um, Dr. Diane Harper, one of the lead researchers for the original Gardasil Merck drug,

00:47:21.740 she helped in design to, uh, and carry out the phase two and phase three safety and effectiveness

00:47:26.280 studies for Gardasil. She spoke out and her main issue was that the data showed Gardasil lasted

00:47:32.840 only five years. And again, we've been discussing the parallels with the COVID vaccine. It's that's

00:47:38.800 what it reminds me of. It's like, well, what am I going to take these risks for? If the, if the

00:47:42.880 immunity runs out after a couple of months in the COVID vaccine and maybe five years for Gardasil,

00:47:49.020 and I'm giving it to my 11 year old who ideally will not be having sex in the next five years, but

00:47:54.820 you know, even if she does, it's like, it's only going to protect her. What for like maybe one

00:48:01.540 partner is that worth it? And she says, if we vaccinate 11 year olds and the protection doesn't

00:48:06.960 last, we've put them at harm from side effects, small, but real for no benefit. She says the benefit

00:48:11.880 to public health is nothing. There's no reduction in cervical cancers. They're just postponed unless

00:48:18.820 that protection lasts for at least 15 years and over 70% of all sexually active females of all ages 0.77

00:48:24.440 are vaccinated. Um, and then points out that the number of women who die from cervical cancer in the

00:48:29.140 U S every year is small, but real, but it's small because of the success of the pap screening program.

00:48:36.120 That's what's been catching the cases and helping women stop dying from cervical cancers. So how about

00:48:43.320 that? Does it last? That's the question. I'll start with you on that doc. Does, does it last? Do we know?

00:48:48.080 I think it does. I mean, we have a lot more experience now than we did before. Um, you know,

00:48:54.740 we've been giving this vaccine. I think the pre licensure trials started, I think it was like

00:49:00.060 1997, but the, it was licensed in 2006. So I think we, we definitely have information now that there's

00:49:07.940 really no waning of immunity after at least 15 years. This vaccine is based on the same technology

00:49:12.920 as the hepatitis B vaccine, which I think immunity is been shown to last like 30 years. So I don't

00:49:19.560 have any concerns about this. I, you know, the, all the data I reviewed show that it, it does seem to

00:49:25.280 last a long time, long enough. We don't know how long, but actually you were talking about the

00:49:30.020 extended the age. And I actually made the decision right before I turned 45 to, to get the Gardasil

00:49:34.860 vaccine, um, under the wire because I mean, I I've been happily married. It'll be like 25 years next

00:49:41.520 year, but you know, unfortunately you don't know what can happen in life. You know, you never really

00:49:46.520 know if you're going to ever be out there on the dating scene again. And I just thought, you know,

00:49:50.940 I don't have any safety concerns. I've been giving this vaccine for a long time. Why, why wouldn't I do

00:49:56.160 it? Just why wouldn't I take that extra step to protect myself in case? So I, I, I did that

00:50:01.360 for myself actually. Hmm. What do you think of that alley of the subject of does it last? I mean,

00:50:06.400 are we now in a situation where they're going to have to get boosted every five years or 15 years

00:50:10.180 or what have you? I don't think so. Honestly, I agree with Dr. Walsh. Like, uh, we, we know, um,

00:50:16.260 and Dr. Harper, I think was interviewed a couple of years ago, um, on that note. And so we do have

00:50:20.700 more data. Now we do have, uh, three different studies in the UK, Denmark, and Sweden, um, looking at 10

00:50:26.120 years of real world data. And, um, it looks really, really promising if we vaccinate young girls.

00:50:31.360 Um, but again, I think that, I think that we're not paying attention to the big picture. The big

00:50:36.980 picture is 0.7% lifetime risk of cervical cancer. Um, it's not in the top 10 for cancers for women,

00:50:45.240 um, cancer rates or deaths. The death rate was 2.4 per a hundred thousand in 2006. So pre-vaccine era,

00:50:54.840 it's now 2.4 per a hundred thousand. So we've dropped 0.2 per a hundred thousand or one in five

00:51:00.660 hundred thousand or two in a million over that time. And I just, I do wonder, you know, granted

00:51:06.120 some would say, Hey, Allie, we've only vaccinated, you know, 40 to 50% of kids that will only get

00:51:11.420 better. That's true. But you know, it's, it's protecting against nine of 25 oncogenic strains.

00:51:16.440 And we do know that, you know, the U S is already doing very, very well with cancer prevention,

00:51:21.360 using screening and treatment. Um, the big concern is in other areas. So I just, I, I do think that

00:51:29.080 we are doing again with this, what we did with the COVID vaccine, and that is not risk stratify.

00:51:34.820 We are not really talking about who's at high risk for progression. You know, persistent HPV

00:51:40.540 infection is what's necessary to cause cancer. And you increase the odds of persistent HPV infection.

00:51:46.500 If you do a couple of things, for instance, having multiple sex partners, three or more is kind of

00:51:51.980 where they looked at in the literature. Um, that changes the vaginal microbiome to be honest. Now

00:51:57.540 we're talking about the microbiome quite a lot. Ask you, do you mean like at once three or four,

00:52:03.660 that's a small number over a lifetime. Yeah, that's over a lifetime. But again, I mean,

00:52:08.260 most of the HPV exposure is in the younger girls is what they're finding. And so actually the risk

00:52:12.120 of cancer goes down in the late twenties. Um, the, the risk of new infection, I should say the odds of

00:52:17.440 picking up cancer actually are it later. So it takes a decade or more for this persistent infection

00:52:23.120 to turn into cancer. So it's really difficult. Um, you know, the vaccination is important early on,

00:52:29.240 really, hopefully before you start having sexual encounters to prevent infection, it doesn't do

00:52:35.360 much if you've already been infected. Okay. So that's where natural immunity comes in. If you've

00:52:39.280 already been infected, then you're counting on that to protect you. But again, it's 0.7% lifetime risk,

00:52:44.820 even with that prevalent, um, rate of HPV in the population, which some would say it's 80% lifetime

00:52:51.620 odds that you're going to get HPV. So it's just not, it's not a guarantee that you're going to get

00:52:56.120 cancer. In fact, far from it. I don't know why we don't talk about 90%, um, protection from natural

00:53:01.680 immunity more than we do. We almost present it as the, the odds are like nearly certain that you're

00:53:08.240 going to have cancer. And I just find that that's such a flawed way of prevent or presenting the data.

00:53:12.960 Um, this is important. Talking a lot about relative risk reduction, not absolute risk

00:53:17.420 reduction, um, which is something we did with COVID as well. So we're magnifying risk to try to

00:53:22.400 Merck leads us to believe in its advertising and elsewhere that it is solving a, a crisis of cancer

00:53:30.680 that is killing young women in America. And that is not true about cervical cancer. In fact, uh, the, 0.93

00:53:37.120 the average age for the development of cervical cancer is 50, 50 years old. It is not something that

00:53:41.720 typically strikes young women. Um, and to your point, now this is from the national cancer 0.87

00:53:46.460 institute. We were talking about how many people are going to get HPV and you might, you know,

00:53:50.800 the odds are you, you have it or had it and you don't even know, um, that what they say is nearly

00:53:57.460 all sexual active, sexually active people are infected with HPV within months to a few years of

00:54:03.180 becoming sexually active. This from the national cancer institute, around half of those infections

00:54:07.720 are with a high risk HPV, HPV type. Um, so you've got, yeah, like they say low risk HPVs cause genital

00:54:16.900 warts or do nothing. High risk HPVs can cause increased risk for cancers of the cervix,

00:54:22.700 anus, anus, uh, oropharynx, which is the throat in the back of the tongue, tongue, vulva, vagina, 0.84

00:54:29.400 and penis. That none of those sounds enjoyable, of course, obviously, but the odds of contracting 0.97

00:54:34.960 are very, very slim, uh, high risk HPVs cause 3% of all cancers in women and 2% of all cancers

00:54:40.620 in men. But Merck comes on the scene, like watch out, you know, the young women are in danger and

00:54:47.320 we've got the solution. And here, here's our ad to show you all the women who are flocking to it. 0.66

00:54:51.860 And now here's our ad to guilt the parents who aren't getting it. And to your point, you know,

00:54:56.000 there, Ali, it's, it's not entirely honest the way they're marketing it and the way they're talking

00:55:00.280 about this problem that they're trying to solve. Right. And if I could just add, I know I, I threw

00:55:05.080 a lot of numbers at you, but the thing that strikes me is, you know, over a decade of time watching our

00:55:10.500 cancer rates, our death rates, mortality rates, they're not really budging a lot. And, you know,

00:55:16.080 we've had this vaccine for quite some time now over 13 years. And I, you know, granted if we

00:55:22.200 vaccinated more people, maybe we'd see it budge more, but we would have to vaccinate many, many people 0.81

00:55:27.120 in order to prevent one cancer. And that's the math that I'd like to see people talk about more.

00:55:30.980 I haven't seen anybody other than one Canadian model calculate this. And I've done my own math.

00:55:35.500 The Canadian model says we need to vaccinate between 300 and 9,000 people to prevent one cancer

00:55:41.840 between 300 and 9,000 people. And that depends on the modeling data. So how effective is the vaccine?

00:55:47.360 Does it last for a lifetime? So I did my own math using the UK study, a fair comparison of two cohorts,

00:55:53.820 the same age, screened the same amount of time, one vaccinated, one unvaccinated. I come up with

00:55:59.160 7,500, probably reasonable. There's probably a range, but again, around 7,500 people to prevent

00:56:05.180 one cancer. What I have not seen discussed thoroughly is how many harms are caused when

00:56:11.360 we vaccinate that many people. And if you use the Merck data, if you use the package insert rate of 0.04%

00:56:17.380 of serious adverse events, which are defined by law as a hospitalization or a disability,

00:56:22.580 new onset hospitalization or prolonged hospitalization or death, then we're coming

00:56:27.960 up with maybe three harms if I'm vaccinating 7,500 people to prevent one cancer. So again,

00:56:34.440 like we need somebody to actually go through all of the available data and give us this math.

00:56:40.920 Hmm. What about that, Doug? Because the low number of people actually getting cervical cancer,

00:56:46.800 I mean, especially if you look at the young people, but even if you look at people

00:56:49.360 who are 50 plus, it's, it's a relatively low number and it's not one of the cancers that it's

00:56:55.820 not. I mean, I think breast cancer has got a 10 to one ratio over cervical cancer in terms of its

00:57:00.780 frequency. That's, that's one everybody is worried about, you know, does, is it worth the risk of these

00:57:06.820 side effects that we're going to get into?

00:57:08.480 Um, well, it's interesting you say that. I mean, I consider the HPV vaccine a safe and effective

00:57:15.320 vaccine against cervical cancer. You know, what if we had a safe and effective vaccine against

00:57:19.560 breast cancer? Wouldn't that be great? So, you know, I do actually think part of the, um, I'll,

00:57:25.860 I'll circle back to what you were saying about the disease burden, but I think part of the hesitation,

00:57:29.900 and I've always felt this way since we started giving this vaccine and I saw the reactions to

00:57:34.480 parents. I was a psychology major and I do think that Freud was onto something and, you know,

00:57:40.180 people talk about how there's two groups of people that never have sex and it's your parents

00:57:44.280 and your children, right? So like your kid is 11, they're 12. You don't want to hear about them

00:57:49.260 having sex someday. And like anything that's sort of is, is attached to that or alludes to that.

00:57:54.800 You're like, no, no, none of that. No, thank you. But at the same time, if you ask most parents,

00:57:59.160 like, would you like to have grandchildren someday? They almost always say yes. So I do think,

00:58:04.480 that some of the sort of reflexive opposition that I see from parents is a little bit Freudian in

00:58:11.000 nature. And I don't know that there's any way to get around that, but also regarding, what's that?

00:58:17.820 You're like, not my sweetheart. No, she would never. Exactly. Exactly. Um, also regarding disease

00:58:22.940 burden, you know, when I was reviewing data for this one crazy statistic I came across is that when we

00:58:28.600 look at the most common childhood vaccines that we're giving in this country, we lose like less

00:58:34.400 than a hundred, you know, people a year to like, you know, pertussis, tetanus, measles,

00:58:40.240 if you add them all together. But if you look at cervical cancer, it's about 4,000, you know,

00:58:46.120 women a year. So that's a crazy disease burden in terms of death compared to even, you know,

00:58:53.180 things that we consider serious diseases that we all know we want to prevent with vaccines like

00:58:57.540 measles and bumps. And, um, so I think that's important to round that out. The breast cancer

00:59:02.640 numbers are just around 40,000 a year. Keep going. Right. Right. So it would, to me, it would be

00:59:06.980 great if we had a safe effect of breast cancer vaccine for, for girls. Wouldn't that be amazing? 0.97

00:59:12.260 Um, and that is the number is not 4,000 a year in the cervical cancer department because of

00:59:17.600 Gardasil. You know, no, I think that it, it is partly due to Gardasil and, and partly due to

00:59:24.400 screening, but I will say, you know, there are now studies we've had Gardasil has been out long

00:59:29.940 enough. I mean, the main problem with determining efficacy for the end point of cervical cancer is

00:59:34.740 exactly what you guys were talking about. It takes 20 to 25 years to develop after you're exposed to

00:59:39.060 HPV, but now Gardasil has, or HPV vaccines in various forms have been around long enough that

00:59:44.100 the studies are starting to come out that, that do show actual cervical cancer prevention. There was a

00:59:49.460 2020 study that showed that risk of cervical cancer among participants who initiated vaccination prior

00:59:55.940 to age 17 was 88% lower. So there's a, and there's a few bigger studies that I came across that are

01:00:02.380 actually looking at the ultimate endpoint of cervical cancer and showing incredible efficacy of, of the

01:00:08.200 vaccine. And, you know, there's, there's, um, other epidemiologists that like I follow on Twitter

01:00:14.940 that I trust. And they, they pretty much all have that take too, that, you know, this is, this vaccine

01:00:20.840 is, is pretty much a home run in terms of safety and efficacy. Um, now I, back to what you said before,

01:00:26.580 Megan, I think that it is indisputable that there have been a small number of children or young people

01:00:32.420 who have died within days to weeks of receiving these, this vaccine. And the research that I did,

01:00:37.960 the studies that have been, or the cases that have been investigated, they were not shown to be

01:00:42.600 related. So, you know, you and I both know that a train can go by at noon, but the train didn't make

01:00:47.080 me hungry for lunch, you know? So there's that, you know, we don't want to make a false association

01:00:51.560 between correlation and time and, and causation. Um, so I do think that's important to acknowledge

01:00:57.100 as well. And that's going to be the case for any vaccine. Like, you know, somebody is going to die

01:01:00.940 after any given vaccine. And it is important to find out if it was from the vaccine, obviously,

01:01:05.400 but I think a lot of these cases that have been investigated regarding HPV, it was determined not to be

01:01:10.180 related so far anyway. No, it's true. It's like, whenever you're, I was talking about this last

01:01:14.780 April of, um, of 22, I got Lasix on my eyes. And, um, I was talking to the doctor about how,

01:01:23.240 if anything were to happen to my eyes, let's say in May or June or July, I was, I knew I was going to

01:01:29.120 be blaming the Lasix, you know, even though who, who the hell knows? And he said, that's a risk doctors

01:01:34.240 think about all the time. It's like, whatever bad happens to this patient within X time from the

01:01:39.380 surgery or whatever the procedure is, I'm going to get blamed. And that's why we have to look at

01:01:43.680 what are the common side effects? What, how many cases did this side effect happen in how closely

01:01:48.460 to the vaccine? There are ways of, you know, being able to tie it as opposed to this, this one weird

01:01:53.460 event, this one random, um, you know, God forbid death or what have you, you do need more proof.

01:01:58.140 That's why I actually liked the lawsuit in a court of law. These plaintiffs are going to have to prove it.

01:02:02.420 You don't get away with a big judgment without proving causality. This vaccine caused the death.

01:02:06.800 So it's a good forum in which to do it. Can I ask though, about one of the biggest,

01:02:11.920 I don't know if we call this a side effect or what, but one of the arguments against the vaccine,

01:02:17.980 and I'll ask you this, Kristen, is that if you do already have one of those HPV strains in you,

01:02:25.700 you know, your body fought it off, nothing happened to you. You've got some level of natural

01:02:30.220 immunity in there. Maybe it's not great, but it's in there that if you then get Gardasil,

01:02:34.860 so, you know, you're not the 11 year old who's never had sex. You're, you're an adult who's had

01:02:40.540 sex and you have the strains in you already without knowing it, that you are increasing 0.87

01:02:46.000 your risk of cancer that you're re the number I was given here is that there's up to a 44.6%

01:02:54.780 increased risk of developing advanced abnormal pre-cancer cells or worse. In other words, Merck's

01:03:03.540 studies suggest that its vaccines may cause cancer in women previously exposed to HPV. This is citing

01:03:13.560 information from 2006 that's got red flags on it. I just don't know. Like if that's a thing,

01:03:20.100 we should definitely talk about it. Well, first I think, you know, this is a pretty complicated

01:03:26.860 thread to unwind because, you know, one thing that I think we've already alluded to is that

01:03:32.280 the home run area for this vaccine is for sure, you know, both boys and girls who haven't been

01:03:38.880 exposed to any strains of HPV. And in my mind, if you're able to vaccinate them, then like that's

01:03:44.220 pretty, we don't have many guarantees in medicine, but I can almost guarantee that that child is not

01:03:49.480 going to get an HPV related cancer. But however, if you've already been exposed to certain strains

01:03:55.420 of HPV, it will not, you know, negate the effects of the strains you were already exposed to.

01:04:01.100 I do think that the efficacy in, you know, women 25 to 44, like that next group where clearly,

01:04:08.620 you know, a lot of them have already been sexually active, possibly been exposed to some strains.

01:04:13.660 I actually thought that efficacy was pretty good. The number I saw was 41%.

01:04:17.420 Now that doesn't sound great if we're talking about like the flu maybe, but if we're talking

01:04:22.420 about a potentially deadly cancer, I'll take a 40% or 41% risk reduction. Um, I, I did not come

01:04:29.420 across, you know, what, the only thing I did come across relating to what you're saying is

01:04:33.940 there was a question of whether the HPV vaccine, I mean, I think that it has some fancy immunological

01:04:41.060 name, which, which probably Allie knows, but essentially like the question is, do you make someone

01:04:45.340 more susceptible to non-vaccine serial serotypes, you know, sort of pathogen substitution?

01:04:50.340 Is that negative vaccine efficacy?

01:04:53.220 Right. We've had some of those same discussions around the COVID vaccines too. And it's, I think

01:04:56.940 there's a lot that's not known. Like, are you more susceptible to strains that aren't covered by

01:05:00.380 the vaccine? But, you know, when I looked into it, the, what had been researched showed no clear

01:05:06.280 association, but I'm not, I'm not saying that's not a thing and it shouldn't be looked at further.

01:05:11.600 Um, well, let me ask you this. Do you know, if you've got one of those HPV strains in you,

01:05:16.300 but you, it didn't do anything to you, is it knowable? Would you be testing negative for HPV?

01:05:22.080 So there's separate, so there's pap smears, but then there's also direct HPV tests. And I think

01:05:27.280 the recommendations get very murky. Like I just looked at them yesterday and they're very hard

01:05:30.940 to remember because it's something like a pap smear every three years or a pap smear every six years,

01:05:36.820 but an HPV test every three years. So they're separate and you can do those tests. Um, and I

01:05:42.800 think that it, it doesn't, to me, it didn't give you like a lot of great information. I mean, I think

01:05:48.640 when most people are answering this question for themselves, and I think what you're really asking

01:05:51.920 is like, if I've already been sexually active and I'm a woman in my twenties, like early twenties,

01:05:57.300 let's say, is it still worth it for me to get this vaccine? And I personally would say yes,

01:06:01.560 because I think it has shown good, like you probably, even if you have one of the bad strains,

01:06:06.240 you probably don't have all of them. You probably don't want any more of them. You probably don't

01:06:09.880 want genital warts. And so to me, like when I really looked at all the, the safety issues and 0.54

01:06:15.720 everything, I still thought there was a clear benefit for sexually active women up to a certain 1.00

01:06:20.400 age. And I even saw like, you know, there's probably people are living longer and I, this is not

01:06:25.440 my area, like elderly people are not my area, but I, I looked at a, you know, some study looking at

01:06:30.260 increasing STDs among elderly people. And they were asking like, should we be giving elderly

01:06:34.480 people the HPV vaccine too? Cause some of them are, you know, getting STDs at an older age.

01:06:39.660 They're out of control down there. It says hashtag goals. So Allie, what about that? Because this is

01:06:46.600 based on in part, um, RFK junior, his group, children's health defense, uh, they, they cite a

01:06:53.760 2006 vaccine and related biological products advisory committee, uh, discussion on the results

01:06:59.220 submitted for the license application for the clinical development program of Gardasil. So this

01:07:03.260 is from a license application from Gardasil. And they say, uh, there was potential shown for

01:07:09.640 Gardasil to enhance disease among a subgroup of subjects who had evidence of persistent infection,

01:07:14.700 uh, with a vaccine relevant HPV types at baseline. So in other words, these are people who did have the

01:07:19.640 HPV strain, then they got the vaccine, and then they had this sort of negative efficacy where they

01:07:25.480 were more likely to get it than they would have been if they hadn't gotten the vaccine.

01:07:30.900 However, in 2013, the journal of national center cancer Institute wrote up those 2006 results and

01:07:37.780 said regarding the suggestion, there's evidence that HPV vaccine vaccination may enhance disease

01:07:43.480 among some who have been already infected with an HPV vaccine type. Uh, they say these results from

01:07:49.900 the clinical trials must be interpreted with great caution. The observed negative vaccine efficacy,

01:07:55.480 was not statistically significant. And the group had more baseline risk factors for the development

01:08:02.200 of one of these cancerous strains than the placebo group. So back again, we're sort of at like,

01:08:08.140 huh, that sounds scary. Let's not do it. And then you hear something that's like, no,

01:08:11.820 this balances it out. They use caution. They haven't proven anything, but it still leaves me like,

01:08:17.640 huh? What, what should I believe? Yeah, no, I agree with you. It's a good question to ask. And I do

01:08:23.160 think, uh, I agree with Dr. Walsh. We should keep an eye on that, but I looked at that data too. And

01:08:26.940 it did look like that, you know, once you dig down into really tiny subgroups, there are imbalances

01:08:32.460 between the subgroups that might also be associated with those folks having a higher risk. So I'm not

01:08:37.860 sure, um, what to think about that in particular. What I do care about is a couple of things. One is

01:08:43.380 Cochran. Um, the Cochran review takes a look at evidence, all of the evidence and, you know,

01:08:49.660 makes, um, uh, declares its point of view on lots of things. Like for instance, you remember the,

01:08:57.240 the most recent, um, Cochran review of masks, um, and the brouhaha that erupted after that. Cochran

01:09:03.280 also looked at HPV vaccine in 2018. And that review really struck me, um, because there was internal

01:09:11.200 dissension over the findings and a complaint that the Cochran review team had not actually looked at

01:09:17.700 all of the available evidence. And one of, um, the team members, um, actually went out and spent

01:09:24.100 three years trying to gather more evidence and did a meta analysis of the adverse events and also the,

01:09:30.480 um, outcomes that we care about like cancer. And I found, um, you know, speaking to this question of

01:09:36.480 older women and should they get the vaccine or not? The thing that kind of jumped out at me there

01:09:40.240 had more to do with adverse events and possible cardiac risk than anything else. So when I dug

01:09:46.000 down into the 200 pages of supplemental data, um, I noticed that something that correlated also with

01:09:52.460 the CDC findings from a JAMA article, um, which was a two-year study, and that's where they found 32

01:09:57.800 deaths. And again, to Dr. Walsh's points, um, it's very hard to decide is it vaccine related or not.

01:10:04.920 That causal association is not there, but of the 32 deaths, 20 head records, 70% were after the HPV

01:10:11.760 vaccine alone. And in looking at the trial data, which I think is even better than real world data

01:10:17.780 and VAERS reports, the trial data, which randomizes people to vaccine, or again, this active placebo,

01:10:23.680 the excess cardiac risk was among the women who got Gardasil, um, versus the adjuvant. There were zero

01:10:33.020 cardiac disorders in the adjuvant group, which is really interesting to me because remember we were

01:10:37.760 saying, wow, it's kind of problematic that it was an active comparator. So for me, I, I am not sold

01:10:43.520 on older women, um, getting this. And I think that that should be looked at more. Um, and again, so look 0.97

01:10:50.620 at, uh, and getcha Jefferson and Jorgensen. Those were three people who were involved in the original

01:10:56.660 Cochran review took a great issue with how it was conducted and then invested considerable time in

01:11:02.000 petitioning the manufacturers for all of the data. Um, and there's some also discussion about,

01:11:07.940 as you alluded to earlier, did the, um, participants know that they were given a placebo or not? Was it,

01:11:13.700 they were led to believe it was saline, but it really wasn't. So I have a lot of issues with the

01:11:18.380 trials there, um, and the way they were conducted and the transparency of the data.

01:11:22.980 Hmm. And you don't want to have issues. You want to be able to trust the drug manufacturer.

01:11:28.260 You want to be able to trust the FDA, but we don't, I mean, a lot of us don't after the whole

01:11:35.500 COVID debacle and how they misled. And the cardiac issues were arrhythmia and it was myocarditis that

01:11:42.300 was noticed. And, you know, that's something I care a lot about having researched myocarditis now

01:11:46.040 for three years following COVID. And I did actually meet the mother of a girl who died and she actually

01:11:51.060 won in vaccine court. Um, and it was an arrhythmia after her third dose. So, you know, I, I do think

01:11:55.860 there's something there. Um, and I do think we need to look at this and if we're not convinced

01:12:00.480 that it's efficacious, I think that the way forward is Dr. Harper mentioned self-testing for HPV

01:12:05.860 infection. I think that's something really interesting. We should take a look at. She told

01:12:09.460 me that it's, um, I interviewed her, um, as part of my preparation. She told me that it's,

01:12:13.780 is covered by insurance. So I think women should ask about HPV testing. Um, and eventually 1.00

01:12:18.560 like a COVID test, except you stick the swab someplace else. I want to say it's more like

01:12:22.700 a tampon. Um, but it's beyond my scope, but I really, I would love it if the two of you

01:12:26.500 looked into that. The other crazy thing that women should think about is, you know, one 1.00

01:12:30.300 of the most common elective procedures and medically required is hysterectomy. If you

01:12:34.900 have a hysterectomy, you no longer have a cervix. So I think that's something that women also 1.00

01:12:39.120 need to think about because, uh, this may be TMI Megan, but a lot of women I know myself included 1.00

01:12:43.820 went through terrible menorrhagia in my late forties. Um, after my childbearing years, I

01:12:49.440 was on an iron drip, like getting a bag of iron because I hate surgery so much. I'd never

01:12:54.380 been under general anesthesia. I'm a marathon runner. I'm out there with acute anemia running

01:12:58.420 marathons of, you know, on the base in Yokosuka, um, because we were in lockdown and I still didn't

01:13:03.880 want to get a hysterectomy. I was so freaked out about it. And I eventually did. So, you know,

01:13:08.060 I do think that women who are going through terrible anemia because of menorrhagia should

01:13:11.960 talk about that. And I forgive me. I don't know what menorrhagia is. What is that? It's

01:13:15.860 like terrible bleeding. Okay. It's like a pint and a half. So if you're, if you're in that situation,

01:13:20.840 don't ignore it, talk about it. And you know, the incidents that we've been talking about is of

01:13:25.340 cancer and in mid forties is, you know, kind of thirties to forties is where it's highest.

01:13:30.840 It's worth taking the whole picture into consideration. I think, you know, I, uh, thank you

01:13:35.500 for telling us that and revealing something personal. I will, I will, no, no, no. I will respond in kind

01:13:39.560 years ago. Uh, after I had all my kids, I had an ovarian cyst. It was benign. It wasn't cancerous

01:13:45.240 at all, but it needed to come out because it was growing. And if those things burst,

01:13:48.760 it's rather unpleasant. So it could be done laparoscopically. It was like an absolute

01:13:53.060 nothing. I couldn't believe the ease with which they, they took it. And they said, when we go in,

01:13:58.420 if it's too intertwined with the ovary, we're going to take the ovary. And I said, that's fine. I'm done

01:14:02.800 having my kids, but I I'll have the other ovary anyway. Fine, fine, fine. Everybody agreed. That was the plan.

01:14:06.960 And then the doctor said, because even though it wasn't cancer, it was like a cancer doc or the

01:14:12.380 reproductive system, one of those guys. And he said, while I'm in there, do you mind if you're

01:14:16.400 done having your kids, if I take your fallopian tubes, I'm like, well, why do you want my fallopian

01:14:21.220 tubes? What do you, what do you, why are you interested in those? And he said, the research

01:14:26.580 shows that all at that time, he said, all of the most pernicious forms of ovarian cancer begin

01:14:33.340 in the fallopian tubes. And then my OBGYN told me not all the most pernicious, all, all the ovarian

01:14:41.500 cancer begins in your fallopian tubes. So if you're done having kids and it doesn't put you into early

01:14:47.360 menopause. So I'm, the guy took, took out the cyst. He took out the left ovary and he took out my

01:14:53.160 fallopian tubes. I was, I was done having kids. So it wasn't an issue for me with one time. You can't

01:14:58.000 even tell there's not even an incision mark anymore. It's, it's like, it never happened. And it's not

01:15:03.900 to say you don't have to worry about that at all. Cause you know, you had cells in you, God forbid

01:15:08.160 they'd been cancerous. It's not to say he got every single one and he got the other ovary, but what,

01:15:11.980 it's such an easy way of reducing risk. Yeah. Well, and one thing, you know, we were talking

01:15:18.480 before about like Vinay Prasad and, and, you know, I, I follow him too. And I think he's made some

01:15:23.840 great points. And I mean, just to tie together a couple of things, like for me, this is part,

01:15:28.760 partly gets to why I do support the HPV vaccine. Like we talked about before, I don't want these

01:15:34.040 young girls to have to go through these painful excisions and, you know, various things done to 0.80

01:15:39.540 their cervix, but it also speaks to things Allie was talking about. Like we really need to make clear

01:15:44.000 that, you know, certain people don't need these procedures. If you don't have a uterus, you don't 0.99

01:15:49.140 have a cervix. And, um, also, you know, it's, it's just one of these things about pap smears that

01:15:56.000 we should be addressing. You know, that's, that's something that we could use HPV testing for. I've

01:16:00.360 found, and, and Dr. Prasad talks about this too, just sort of like at some point saying, no, I think

01:16:05.520 for me, you know, I had never had an abnormal pap smear. I had been married for many years. I didn't

01:16:10.900 have a great reason to go to the OBGYN. I just stopped going, you're not supposed to do that. But that was

01:16:15.240 sort of my way of opting out of all these things. I was like, I think I'm good for right now. And when

01:16:19.380 I, when I finally did go back, of course they were horrified and they yelled at me and doctors are the

01:16:23.000 worst patients and everything else. But I do think we do too much of, of a lot of things in this country.

01:16:28.620 And, um, but, but that's part of the reason, like this, I think this is a good vaccine because

01:16:34.100 hopefully we can prevent some of these painful, you know, invasive sort of unpleasant

01:16:39.260 procedures in, in young girls.

01:16:41.760 Hmm. All right. Now the question is, do we give it to boys? And also I just want to spend

01:16:47.640 a little time on the most severe side effects because, you know, they are alarming and you

01:16:51.980 know, you, you're use the D word death and it has a way of just shutting down the whole,

01:16:56.780 like, forget it. It's not worth it. Well, I'll get annual pap smears. I'm not doing that.

01:17:00.540 So we'll spend some time on that right after this.

01:17:02.800 So, uh, what about boys? Uh, I've got two in addition to my girl doctor, did the boys need it?

01:17:12.600 And if so, why I have a fun story about that actually. Um, so I was, I was already a pediatrician

01:17:18.660 for several years when the HPV vaccine came out and, um, my aunt who was also a physician, but, but

01:17:24.560 not a pediatrician called me at the time. So if you remember HPV was only licensed for women and

01:17:30.480 girls initially, and later boys were added on. And so she called me sort of in between time

01:17:35.080 when her two boys were, I think around your boy's age. And she was like, should I give this to my

01:17:41.440 sons off label? And I was like, I think you should. Cause I'd already seen a lot of the data,

01:17:47.380 you know, on the, on the safety and efficacy in men from the trials. And I was like, you know,

01:17:52.720 I knew already that men got HPV related cancers and that the vaccine looked safe and effective for them.

01:17:57.620 So, um, I told her to do it. I, she ended up being very happy. She did. I vaccinated my boys when they

01:18:04.120 were 12 actually. And, you know, these days, um, men are account for 42% of the HPV related cancers

01:18:13.420 that are diagnosed. So it's like 92% of anal cancer, 63% of penile cancer. That's that's that these are

01:18:21.480 HPV related. So there's other causes of penile cancer. Um, 89% of oral, 89% of oral and oropharyngeal

01:18:28.740 cancers are, are HPV related now. Hmm. My gosh. I mean, that's, that's pretty persuasive, but

01:18:34.360 is, is the response to that alley that the overall numbers are low?

01:18:40.440 Well, that gets into absolute risk reduction versus relative risk reduction. So yes, that's one

01:18:45.040 concern. The other one that I have, um, as a mother of boys is who vaccinated her boys because I was back

01:18:50.900 in my pre COVID trust, you know, trust the FDA and the CDC. And that's a place, frankly, I'd like us

01:18:57.000 to get back to Dr. Walsh and I were just talking about, you know, how that is probably the biggest

01:19:00.980 problem, um, that we have is, is loss of trust. Um, but I don't think that there's enough data out

01:19:06.780 there for us to really understand what the risks are for boys. Um, because most understandably, most of

01:19:11.720 the emphasis has been on girls in the trials. So I, I would have to say I I'm undecided there.

01:19:18.300 Um, I want to take a call. We've, uh, let's see, hold on a second. We've got Amanda calling in from 1.00

01:19:24.040 Oklahoma and she's got a question for you. Amanda. Hi, what's on your mind?

01:19:29.320 Hi, thanks for taking my call. And honestly, I can't even believe I'm calling in to spare,

01:19:33.800 uh, share my health on national radio, but we're all doing it. I know, right. Just kind of listening

01:19:40.920 to this conversation. I want to add a different angle. So, um, I was married for 22 years. My husband

01:19:46.700 was my high school sweetheart. I'd never been with anybody else. And I went through a divorce

01:19:51.480 and lo and behold, at my very next, uh, pap smear, I had HPV and, um, clearly it was either

01:19:59.220 given to me during my marriage or maybe my husband, I know he had another partner before me and maybe

01:20:05.040 the stress of the divorce, you know, caused it to be active, whatever the case, it was the most

01:20:09.920 aggressive kind. And, um, I had to have a hysterectomy. Uh, it actually did not take it

01:20:15.920 all away. I still had vaginal HPV. Thank goodness. After about a year that cleared up. I mean, I was

01:20:21.000 like, gosh, we can't take my vagina out, you know, um, any, anyway, um, when I see, so I have the HPV 1.00

01:20:29.780 vaccine. I was, um, nearing my 44th birthday. She crammed that third dose in. Cause I believe as an 0.96

01:20:35.880 adult, you get three doses and, um, I'm grateful to have had it. I had zero issues. And when I see

01:20:41.700 moms on Facebook posts that they don't want their daughters to have it, I have to tell you, I cringe

01:20:45.860 because I thought I would be with one person my entire life. And if that had happened to me at a

01:20:51.120 younger age and I had to have a hysterectomy, I wouldn't be able to have kids. And I'm just kind

01:20:54.700 of curious the doctor's thoughts and what she's seen. Like, is this a trend? You know, um, again,

01:21:00.240 something I never thought I'd have to deal with. Well, thank you for telling us that story and, uh,

01:21:05.160 and raising the question. These are, these are good points from somebody who's lived it.

01:21:08.060 Uh, Dr. Walsh, what do you think? Yeah. So a lot of times, you know, by the time we are diagnosed

01:21:13.160 with HPV, we have no idea when we were exposed. Cause as you pointed out, it can kind of come out,

01:21:18.020 you know, many years later. And, um, and the, and the other thing is, like I said before, you can

01:21:23.660 really lead a very conservative life and, and still be exposed because you're, you know, you're sort of at

01:21:29.200 the mercy of anyone your partner was with before you and, um, things take years and years to emerge.

01:21:34.960 And so that's why, like having given this vaccine for, you know, 17 or whatever years now. And I

01:21:41.700 mean, my patients, I feel like my patients are very communicative with me, even like the babies who get 0.99

01:21:46.840 fevers after their routine childhood vaccines. I hear about it. My patients tell me what's up. And

01:21:51.720 so I definitely, I mean, yes, one day in the office is anecdotal, but 20 years of experience,

01:21:57.500 you know, giving this vaccine has given me really great confidence in the safety. Um,

01:22:02.360 being totally honest with people. Yes. The syncope is an issue, a minor one, you know,

01:22:07.520 pretty much solvable by having the patient lie down when they get the vaccine. But that's why in my

01:22:13.160 mind, I view this vaccine as a home run, because if we can catch kids before they're exposed boys and

01:22:18.800 girls, we can really prevent a lot of problems. I think. Hmm. Let me, let me thank you so much,

01:22:24.100 Amanda, for calling. And I hope you stay well. Love that you listen to the show. Let's go,

01:22:27.980 let's get Jane in Wisconsin. And she's got some interesting thoughts. Hi, Jane, what's on your

01:22:31.100 mind? Hi, thank you so much for taking my call, Megan. Um, I'm a board certified orthodontist

01:22:36.480 and mother of five kids. And I just wanted to readdress, um, the importance from an oral health

01:22:43.660 perspective. There's definitely been an uptick in oral cancers amongst young people, like in their

01:22:48.860 forties, people that normally wouldn't get throat and mouth cancer. And it has been attributed to

01:22:54.100 HPV, the virus. And these are people that, you know, historically it was drinkers, smokers, heavy,

01:23:01.060 um, you know, heavy drinkers and smokers that would get throat and neck cancer. And, um, Michael

01:23:07.360 Douglas is a great example. I think Val Kilmer is another one, but there are all of the unnamed

01:23:11.980 people that are also going through throat and neck cancer, which is even more miserable than probably

01:23:18.320 cervical cancer. Because I mean, you're on a feeding tube. Um, it really, you know, I've seen

01:23:23.860 tongue resections. It's really, it's really devastating. So you're giving us some perspective

01:23:29.940 there on, yes, these are risks, you know, I mean, if the, if the real risk is fainting, like who cares

01:23:35.420 and some pain from the needle, cause it, the injection hurts more or too bad, right? It's like

01:23:39.660 the, you, the, the things you're outlining, outlining would, would far outweigh those other

01:23:45.640 things. It's these other reports, right? Of like, I'm, I'm going to give you a couple of

01:23:50.860 examples from the lawsuits. And I want the audience to remember, these are people making

01:23:55.020 allegations. It doesn't mean that they've been proven or that it will happen to your child.

01:24:00.520 If this were happening on a mass scale, we would know, we would know, but you hear, for example,

01:24:05.800 um, the case of, hold on, let me get a Noah Foley now deceased, part of whose parents are part of

01:24:12.920 this lawsuit. Two days after his 11th birthday, uh, he was totally fine. They say before the

01:24:17.340 Gardasil shot, no autoimmune diseases, nothing extremely healthy. Roughly two weeks after the

01:24:22.720 Gardasil shot, they say experienced fevers that reaches high as 102.9. Uh, his mother recalled the

01:24:29.260 35 days between the discovery of swollen lymph node, and then a report that ruled out cancer,

01:24:33.940 uh, as long and tortuous, but then things went South. His left leg went numb, his face and tongue went

01:24:40.000 numb. He started vomiting and then he was completely non-responsive, almost completely brain dead.

01:24:45.440 And eventually he passed away, um, some, sometime later. Now they say he died of encephalitis caused

01:24:52.860 by an autoimmune auto-inflammatory dysregulation process, which was caused in fact, according to

01:24:57.600 the plaintiffs by the Gardasil vaccination. Um, they say Merck never told us this was even possible

01:25:03.380 again. I guess I'll give that to you doctor, because I hesitate to even read it. Right. Cause

01:25:10.580 I think that's, I don't want that to be everybody's takeaway. Like my kid's going to die. It hasn't

01:25:14.840 been proven, but it is. That's the stuff that really gets a parent's attention. Yeah. I think

01:25:19.880 those are outlier risks. And it's just like the cases where you hear of a child dropping down on the

01:25:24.540 basketball court, playing basketball. Are we all stopping our kids from playing youth sports? No.

01:25:29.140 So if that was a real legitimate risk, um, they wouldn't be offering this vaccine. So I think,

01:25:36.060 you know, I agree with the pediatrician that you have on. Um, I really, really believe that the

01:25:40.380 benefits outweigh the risks and I intend on vaccinating my five children. Jane, thank you. 0.53

01:25:46.480 Thanks for calling. What? Yeah, go ahead. I definitely agree with all those points. Um, I would add

01:25:50.960 also that, I mean, at first I'm going to preface this by saying like regarding autoimmune disease,

01:25:55.880 you know, there've been some large population based studies that compare vaccinated and unvaccinated

01:26:02.180 patients for HPV, and they find no difference in the rate of autoimmune diseases. However,

01:26:08.260 you know, it is important. And I, this is one of the things that really hit home for me during COVID.

01:26:13.080 I think it's very important to be honest with people about risks and, and a vaccine is a medical

01:26:18.600 intervention. You know, it's like a medication and every once in a while, somebody has a severe fatal

01:26:24.520 allergic reaction to medication. It's why, for example, I'm pretty stingy about doing, I'm only

01:26:29.700 going to do a strep test on a kid. If I think they actually have strep not to make, make the parent feel

01:26:34.120 better. Cause I don't want to give a kid antibiotics who doesn't really need it. Cause I don't want them

01:26:37.420 to have an allergic reaction that could be fatal. So I think the same way about vaccines. And as we

01:26:42.880 were discussing before vaccines do stimulate the immune system. So I think that there's a medical

01:26:48.500 premise there for both vaccines and viral infections to trigger autoimmune conditions. And,

01:26:53.180 you know, some kids with severe autoimmune conditions, like they can't get live virus

01:26:57.480 vaccines, for example. And, um, I think that, you know, we do need to be honest about those

01:27:02.780 things. I do not see a special risk here regarding the HPV vaccine versus other vaccine, but I do think

01:27:09.360 it's important to say any vaccine could trigger an autoimmune disease, just like any viral infection

01:27:14.680 could, you know, it's much more often viruses. Number one, I want to remind the audience about your

01:27:19.660 point about maybe one, maybe one shot, one shot. And we kind of got to that with COVID with children

01:27:24.500 too. And I know Vinay Prasad, uh, who you work with doctor was, he was somebody who said on myocarditis,

01:27:30.220 if you're in the risk group, one shot, uh, could be the one for you. Um, so that's a possibility,

01:27:35.240 but also when Jane said, you know, I trust the officials, you know, I like my spidey census went

01:27:41.720 out because I too trusted the officials. And I remember when the, when the COVID vaccines first came out,

01:27:45.240 I said, I trust in Pfizer and I trust these brilliant doctors who came up with this vaccine.

01:27:49.500 If there are massive side effects, they'll come up with the cure for those. And like,

01:27:53.660 that's not what happened. People started getting myocarditis and they started denying it.

01:27:57.800 They broke the public trust. And so now I like millions of others no longer trust these officials.

01:28:02.700 I trust you too. You know, like I trust data, real data, but you're, you've been talking all show

01:28:07.500 about how hard it is to get. So your thoughts on all that. Yeah. I mean, my spidey sense went off too,

01:28:13.860 because I, like you, I trusted people implicitly who has the time to spend hundreds of hours digging

01:28:18.400 into every vaccine, right? I mean, that's why we have the experts do this. And this is why we have

01:28:22.680 trusted agencies to run the trials and to ensure that, um, vaccines are safe. That's what they are

01:28:28.380 charged to do. Unfortunately, I don't really feel like we're in that place anymore. And, um, I do think

01:28:35.280 that it is reasonable to ask questions. I think that the atmosphere in which we are now, where it's,

01:28:41.080 where I am painted as an anti-vaxxer for asking questions and ending a Twitter thread with,

01:28:46.300 I think maybe one shot is justifiable. Um, it got me just absolutely annihilated. I think that's

01:28:51.740 a difficult atmosphere to have reasonable conversations and that's not where we should

01:28:55.640 be. I think it might be possible to mitigate potential harms, however rare they are by considering

01:29:02.480 a person's history before vaccination. You know, do they have a history of autoimmune issues? Do they

01:29:07.200 have a history of reactions to prior vaccines and what is, you know, their, their risk likelihood

01:29:13.680 going forward? Um, are you catching them before they've been exposed to, um, these HPV viruses?

01:29:20.020 So I do think that that's difficult. And I just want to also reiterate that it's not like annual

01:29:24.920 screenings. Um, it really is a lifetime seven pap smears that we're talking about potentially being

01:29:30.740 reduced to three. So it's, we've all been getting too many clearly. Um, and I think maybe too many

01:29:37.540 doses of vaccines, you know, can I, can I ask you, can you just hit a couple of the things

01:29:42.080 because all we've been talking about is syncope passing, passing out and like the shot will hurt.

01:29:47.140 And then I went to the more extreme allegations of a kid dying, but what, what are, what is your

01:29:52.260 research show are the risks? I mean, nobody wants autoimmune. You kind of touched on that one.

01:29:57.460 What are the other ones? Yeah, well, I did speak to an expert who works in a very, very interesting

01:30:02.700 area and he's working on autonomic, um, issues like POTS, postural orthostatic tachycardia

01:30:08.900 syndrome. You've probably heard of POTS. It's something that affects people with long COVID as

01:30:12.180 well. Um, and he's in New Jersey. So I had a really great hour long chat with him, um, because he

01:30:17.400 actually does try to treat people who have this. And that is one of the potential adverse events that's

01:30:22.520 been noted, um, chronic regional pain syndrome as well. And, you know, it's very interesting.

01:30:27.260 I think as we understand long COVID, the potential is that we could understand who's at risk for

01:30:31.500 having an adverse event, um, related to autonomic dysfunction. Um, so I do, I do think that

01:30:37.320 there's a lot that we can do. Um, no, I, I do think that actually we, we could predict better

01:30:43.740 based on what he told me about lifestyle, uh, not lifestyle, um, PTSD, like traumas and other

01:30:50.620 things that cause our sympathetic and parasympathetic nervous systems to be constantly at war with each

01:30:55.680 other. He described it as like driving with the brake on. So, you know, those two are trying to

01:30:59.440 keep you in stasis and trying to keep you in equilibrium. Well, if you have a lot of stressors

01:31:04.320 in your life, then your parasympathetic system is always on and always trying to help regulate. And

01:31:09.760 there's only so much he was describing that your body can really take over time and then vaccine or a

01:31:14.840 virus could potentially be one more insult to that. So I think that the time for strategic

01:31:20.040 vaccination is here. I think it's long since passed. I'm not the first asking for that. Um,

01:31:25.700 back in 2018, there was a study saying, Hey, we really need to think about, you know,

01:31:29.440 minimizing harms of vaccination. Vaccine harms are there. They are real. They are rare,

01:31:33.380 but if we are more strategic in our thinking and personalize our vaccine recommendations,

01:31:38.020 we, I think we can minimize the harms and maximize the benefits of vaccination. And I think that's

01:31:42.540 really what I think is, you know, the ultimate goal from where I stand as an epidemiologist

01:31:46.320 concerned about population health. So we got one minute left, so I'll give you 30, 30 seconds,

01:31:52.240 closing argument on, uh, on your positions. Uh, I'll start with you, Dr. Walsh. Go ahead.

01:31:57.560 Yeah. I mean, I, I do think we do have to regain trust in public health by being honest. Um, but I

01:32:04.300 am being honest when I say I have long experience giving this vaccine. I've really reviewed all the

01:32:09.060 safety data and I still think in terms of risks and benefits, it is a home run. I gave it to my two boys.

01:32:14.580 I, I can't think of too many patients who I would counsel not to get it. So, so that that's my

01:32:19.280 take on it. Okay. Allie, how about you? Yeah, I started thinking it was a home run actually.

01:32:25.180 And now I think possibly I could justify one dose. So I'm, I wouldn't say I'm all the way on the other

01:32:30.320 side of the continuum, but I am much more circumspect. Um, my coauthor in the Epoch Times,

01:32:36.180 Dr. Yuhong Dong feels very strongly. She's an MD PhD. She feels very strongly that it's a hard no.

01:32:41.620 So on any doses, any doses. Yeah. Okay. Wow. I don't know if we've answered the questions for

01:32:49.680 people, but we've given them the questions to think about. And that's, that's our mission.

01:32:53.820 Kristen Allie, thank you both so much. Really appreciate this fair debate. You guys were both

01:32:57.860 awesome. Thanks for having us. Yeah. Thank you very much. And, uh, I guess we'll figure out what

01:33:05.080 we're going to decide all you moms and dads out there. Um, in it with you, uh, and stay tuned.

01:33:10.260 We'll see you for more tomorrow. Thanks for listening to the Megan Kelly show. No BS, 0.85

01:33:17.180 no agenda, and no fear.

The Megyn Kelly Show - June 05, 2023

Truth About the HPV Vaccine： A Megyn Kelly Show Debate and Discussion, with Dr. Kristen Walsh and Allison Krug ｜ Ep. 565

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