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Exclusive to CounterPunch Newsletter Subscribers!

PAUL CRAIG ROBERTS ON HOW THE 'FREE TRADE' CASE
FOR OFFSHORING AMERICA'S JOBS HAS COME UNGLUED

Roberts on the sensational exposure of the faked "gains" and phantom stats of the free traders. Who was America's most anti-imperialist president? Try Grover Cleveland! JoAnn Wypijewski on the unlikely hero of Hawai'i's restoration movement. Alexander Cockburn reports on evangelical Christians in crisis amid fresh onslaughts by forces of darkness. The Warbler's Parable: Rosa Miriam Elizalde on the black-masked visitors to Cuba defying the US economic blockade.

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"Imperial Crusades: a Diary of Three Wars" by Cockburn and St. Clair

CounterPunch Jazz and Blues: Danny Cassidy in the Bay Area; David Vest in Portland

Today's Stories

June 30 / July 1, 2007

Robert Fisk
Abu Henry and the Mysterious Silence

June 29, 2007

St. Clair / Frank
Toward a New Environmental Movement

Brian Cloughley
Losing the War in Afghanistan: One Civilian Massacre at a Time

Patrick Cockburn
End the Occupation: an Open Letter to Gordon Brown

Gilad Atzmon
The Peace Envoy: Tony Blair on Work Release

Dave Lindorff
Subpoenas, Executive Privilege and Liberal Pipedreams

Jennifer Matsui /
Carl Kandutsch

Electric Larryland

Kevin Zeese
A Different Kind of Peace Candidate

Daniel Klimek
Fasting for Justice at DePaul

David Michael Green
The Founding Fathers Never Met Dick Cheney

John Chuckman
The London Car Bomb

Website of the Day
BAM!

 

June 28, 2007

Bill Quigley
How to Destroy an African American City in 33 Steps

Vijay Prashad
Once More on the New York Times

Margaret Kimberley
The Whitening of Marianne Pearl: When White Actors Play Black Characters

Winslow T. Wheeler
House of Pork: Changing Lightbulbs in the Democrats' Bordello

Philip Rizk
The Failing of Gaza

D. K. Wilson
The Black Villains Club

Bill Williams
Strange Calculus at DePaul

Mahmoud El-Yousseph
The Deportation of Yardlin Jimenez

Richard Rhames
The Liberation of Paris

Paul Krassner
Bong Hits for Repression: the Giant Sucking Sound of the Supreme Court

Website of the Day
Free Lightnin' Hopkins

 


June 27, 2007

Marjorie Cohn
Targeting Dissent: FBI Spying on the National Lawyers Guild

Dr. Susan Rosenthal, MD
Sick and Sicker: Two Models of Health Care Rationing

Alan Farago
Bush and the Everglades: Rebranding Failure as Success

Carla Blank
"America, the Beautiful": the Queen, Jamestown and the Eye of the Beholder

Matthew Abraham
The Smearing of Robert Trivers, Dershowitz-Style

Sunsara Taylor
The Deadly Consequences of Compromise: Abortion Rights Under Assault, Where's the Women's Movement?

Russell D. Hoffman
16 Dirty Secrets About Nuclear Power

Robert Weissman
Blackstone and Capital's Grand Scam

Sen. Russ Feingold
Secrecy and the Federal Death Penalty

Paul Buchheit
The Footprints of Democracies

Website of the Day
Anarchy for the USA: an Interview with Josh Wolf

 

June 26, 2007

Jonathan Cook
Divide and Rule, Israeli-Style

Ralph Nader
Sicko and the Politics of Health Care

Corporate Crime Reporter
Which Side Are You On, Michael Moore?

Ron Jacobs
Are the Neocons Really Going?

Martha Rosenberg
Mad Cow in God's Country

John Chuckman
China's New Weapons

Denny Haldeman
Ethanolics Anonymous

Anthony DiMaggio
Free Speech Hypocrisy at the Supreme Court

Stephen Fleischman
The Tightrope Economy

William S. Lind
Legitimacy, Toujours Legitimacy

Website of the Day
The CIA's Family Jewels

 


June 25, 2007

Paul Craig Roberts
Goodbye to the City on the Hill

Jennifer Loewenstein
The Triumph of US / Israeli Policy in Palestine

Bob Anderson
The Grooming of Bill Richardson: New Mexico's Nuclear Governor

Robert Pollin
The Realities of Microlending

Patrick Cockburn
Chemical Ali Faces the Hangman: the Life and Crimes of al-Majid

Eva Liddell
Why They Want to Fire Ward Churchill

Dan Bacher
Democrats and the School of the Americas: 42 House Democrats Back Torture Academy

Larry Atkins
The Case of the Judge and the $54 Million Pair of Pants: an Embarrassment, Not an Argument for Tort Reform

Mark Brenner
SEIU Ends Nursing Home Partnership

James Rothenberg
Hillary Does Iraq

Website of the Day
"A Long Train of Abuses"

June 23 / 24, 2007

Alexander Cockburn
Zyklon B on the US Border

Jeff Taylor
The Foreign Policy of Barack Obama

Oren Ben-Dor
Israeli Apartheid is the Core of the Crisis in Gaza

Gary Leupp
In Defense of Academic Freedom: the Ward Churchill Case

Robert Fisk
The Bumbling Envoy

David Rosen
The Hidden Cost of War: Genital Injuries, Prosthetic Devices and the War on Terror

Russell Mokhiber
Ins and Outs for 2008: Up with Spoilers!

Alison Weir
USA Today and the USS Liberty

Robert Fantina
The Floundering Congress

D. K. Wilson
Of Gangstas and Spearchuckers, Sex and Zulus

Nicole Colson
Litigating Gitmo

Stephen Soldz, Steven Reisner and Brad Olson
Torture, Psychologists and Colonel James

Dave Lindorff
Exodus of the Puppets: Bush's Incredible Shrinking Coalition

Benjamin Dangl
Cerámica de Cuyo: a Profile of Worker Control in Argentina

Michael Dickinson
The Catholicization of Tony

Poets' Basement
Davies, Engel, Gerard and Orloski

Website of the Weekend
Incarcerex: a Drug War Video

 

June 22, 2007

Andy Worthington
A Tunisian in Gitmo: the Story of Prisoner 660

Sherwood Ross
Corporate America's Deadliest Secret: the Big Profits in Biowarfare Research

Eliana Monteforte
The Torture Academy

Robert Weissman
Things Can Be Different

Richard Rhames
Farmer Preservation

Christopher Brauchli
Bush and the Uighurs: an Encounter in Albania

Ramzy Baroud
Chronicle of a Chaos Foretold

Ehud Krinis, David Shulman and Neve Gordon
Facing an Imminent Threat of Expulsion: Palestinians in S. Hebron Hills Need Your Help!

David Michael Green
If Reid Were Rove

Kathryn Webber
Boycotting DePaul

Website of the Day
Stop Me Before I Vote Again!

 

June 21, 2007

Peter Linebaugh
The Day of the Rope

Natsu Saito
The Regents and Ward Churchill: Now is the Time to Speak Out

Ron Jacobs
The Intimidation of a Vet

Saree Makdisi
The West Chooses Fatah, But Palestinians Don't

John Stauber
Blessed Unrest: an Interview with Paul Hawken

Scott Liebertz
Fox News and Venezuela: an Analysis of How the Network Deliberately Misinforms Its Viewers

Tom Clifford
The Ghost Prisoners

Robert Jensen
The Last Sunday?

Michael J. Smith
Who Among Us Will Step Up to Destroy the Democratic Party?

Jeb Sprague
Pain at the Pump in Haiti

Website of the Day
Dion: Hey Paris


June 20, 2007

Omar Barghouti
A Secular-Democratic State Solution

Andy Worthington
Repatriated to Torture

Margaret Kimberley
Supreme Injustices: the Bush Court

Robert Weissman
Sicko, Part One: the Human Tragedy

Russell D. Hoffman
Time to Choose: Meltdowns or Solar Power?

Rannie Amiri
Mideast Alight

Stephen Lendman
The New York Times vs. Hugo Chavez

Dave Lindorff
Democratic Disconnect

David Swanson
Booing Hillary: Platitudes from the Drone Machine

Anne Dachel
Autism & Vaccines: Why are They Afraid to Look?

Website of the Day
Revolution By the Book

 

June 19, 2007

Ralph Nader
Hillary's Stock and Trade: the NAFTA Two-Step

Dr. Shepherd Bliss
Torture's Long Reach

Bill and Kathleen Christison
Demostrating Against the Catholic Church in Santa Fe

Jeff Leys
Swarming Congress: Building a Resistance to the 2008 Iraq War Supplemental Funding Bill

Dave Zirin
The Unforgiven: Barry Bonds and Jack Johnson

Chris Floyd
Hitchens Takes a Roll in the Hay

Ben Terrall
Iraq Union Leaders Speak Out Against the Occupation

Anthony Papa
Veronica's Story: a Dying Wish to Governor Spitzer

VIPS
Countering Terrorism: How Not to Do It

Linda Flores
Criminalizing the Classroom

Website of the Day
Sign On to the Iraq Moratorium


June 18, 2007

John Ross
The Annexation of Mexico

Paul Craig Roberts
The Reign of the Tyrants is at Hand

Martha Rosenberg
Let Cheney at Him: Richardson the Oryx Hunter

Norman Solomon
War at the Remote

Don Santina
Memo to the Queen: Bobby Sands Died for Your Sins

Isabella Kenfield
Landless Rural Workers Confront Lula

James Brooks
America's Guilty Silence

Eva Liddell
Planning to Lose: Democratic Stratagems

Sam Husseini
Clinton Health Care Scam Revisited

Akiva Eldar
Ariel Sharon's Dream

Website of the Day
Frank Zappa: the Cop Interview

 


June 16 / 17, 2007

Alexander Cockburn
The Psychopathology of Shrinks

John Halle
Finkelstein and "The Progressive"

Robert Fisk
Welcome to "Palestine"

Andy Worthington
Return to Torture?

Uri Avnery
The Gaza Cage

Fred Gardner
Paris Hilton's Punishment: a False Parable

Saul Landau
Our Gang of Thugs: The 1970s as a Context for Terrorist Violence

P. Sainath
Heaven Can Wait: Creditors and the Widows of Vidharbha

Missy Comley Beattie
Calling Evil Its Name

Alan Gregory
When ADM Comes to Town: Killer Tax Breaks for Wildlife Destruction

Walter Brasch
Bush and the Philosophy of Swiss Cheese

Website of the Weekend
Obama Girl

 

June 15, 2007

Alan Farago
View from the Construction Crane: Sex, Taxes and Real Estate Scams in Miami

Andy Worthington
The Ordeal of Ali al--Marri

Michael Simmons
Terrorizing Artists in the USA

Franklin Lamb
Blowback Across Lebanon: The Failed Sunni Army Solution

Gary Leupp
The Day After We Attack Iran

John Ross
Ballot Burning Time in Ol' Mexico

Website of the Day
The American Rationalist

 

June 14, 2007

Michael Donnelly
Charred SUVs and the End of Citizen Eco--Activism

Faisal Kutty
Scare Canada: The No--Fly List's False Sense of Security

Harry Browne
Ireland's Green Party Sells Out

Charles Jonkel
From the Arctic to Yellowstone: Bears in a World of Indifference

Steven Higgs
Murder in a Small Town: "Gay Panic" in Indiana?

Bruce Dixon
Black Power Through Low Power Radio

Bruce K. Gagnon
What Do We Do Now? A 10--Step Plan for Antiwar Activists

Website of the Day
Finkelgate

June 13, 2007

Glen Ford
Obama's Siren Song

Marjorie Cohn
Repression in Oaxaca

Bill Christison
A Grave Injustice at DePaul University

Charles Jonkel
Bears in a World of Indifference

Silvia Cattori
"I Was Not Prepared for the Horrors I Saw": an Interview with Hedy Epstein

Richard Gott
Racism and TV in Venezuela

Firmin DeBrabander
How the Neocons Misread Machiavelli

William S. Lind
The Perfect (Sine) Wave: Bombing Railroad Stations in Iraq

Keith Rosenthal
Workers Score a Victory at Harvard

Website of the Day
GOP and Monty Python Explain: "Enhanced Interrogation Techniques"

June 12, 2007

Jeffrey St. Clair
How to Sell a War

Paul Craig Roberts
The Neocon Threat to American Freedom

P. Sainath
India's Plutocrats and the Press

Ralph Nader
The Biggest Scam in the World

Omar Waraich
A Black Day for Pakistan's Press

Dave Lindorff
Things Your Media Momma Didn't Tell You

Harvey Wasserman
Confessions of an Anti-Nuke Jerk

Malini Johar Schueller
It Takes a Bomb

Ramzy Baroud
War Foretold: Mark Twain and the Sins of Empire

Website of the Day
Palestinian Chronicle Needs Our Help!

 

June 11, 2007

Patrick Cockburn
The War on Journalists

Paul Craig Roberts
Losing the Economy to Mythology

Uri Avnery
40 Bad Years: the Rot of Occupation

Norman Solomon
The Silence of the Bombs

Eva Liddell
Paris Hilton Doesn't Do Dishes: How Barbie Stood Up to Allen Ginsberg

Rannie Amiri
Groundhog Day in Pakistan

Rachel Voss
Poetry and Politics in Nassau County

Christopher Brauchli
A Wild West Tale, Starring Rev. Dobson and Bill O'Reilly

D. K. Wilson
Untangling Michael Vick from the Dogs

Website of the Day
Paris, Mixed Up


June 9 / 10, 2007

Alexander Cockburn
Dissidents Against Dogma

George Ciccariello-Maher
Behind Venezuela's "Student Rebellion": Who's Pulling the Strings?

Saul Landau
An Interview with Ricardo Alarcon, Vice President of Cuba

Robert Fisk
Believe It or Not in the Middle East

Brian Cloughley
Troop Support: Deceptions and Insipid Sentiments

Ron Jacobs
Condoleezza Rice Names the System

Ward Boston
Searching for the Truth About the USS Liberty

Conn Hallinan
Dark Plots in Byzantine Beirut

Leonard Peltier
The Ongoing War on Native American Religious Practices

Lawrence Davidson
Israel's New Anti-Boycott Task Force

John Ross
Mass Nude-In Complicates Church-State Scuffling in Mexico

Kate Allan
Some People Think the Internet is a Bad Thing

Fred Gardner
Ignorance Marches On

Stephen Fleischman
Little Boy, Fat Man and Iran

Monica Benderman
Reading Tom Paine in a Time of Crisis

Geoff Bailey
A Real Oil Conspiracy: Gouged at the Pump

Missy Beattie
Faith and War

Patrick Dyer
A Democrat Revs Up Ohio's Death Machine

Tim Lengerich
Dispelling the Cowboy Myth: an Interview with George Wuerthner

James Irani
and David Rahni

Perspectives on the Arrests of Iran-Americans in Tehran

Gary Leupp
The Unfair Treatment of Paris Hilton

Michael Tillery
The Heart of a Sportswriter: an Interview with David Aldridge

Michael Simmons
Beating Off the Squares: the Hipness of Anton Rosenberg

Poets' Basement
Laymon, Davies and Ford

Website of the Weekend
This is Sea Shepherd!

 

June 8, 2007

Serge Halimi
What Sarkozy Learned About Politics from the US

Patrick Cockburn
The Turkish Incursion

Jeffrey St. Clair
Israel's Attack on the USS Liberty, Revisited

 

Paul Craig Roberts
The Secret War

William Blum
What If NBC Cheered on a Military Coup Against Bush?

Joshua Frank
Swing-State Strategy: Looking for a Spoiler

Lance Selfa
How the Six Day War Changed the Middle East

Dave Lindorff
A "Criminal Conspiracy" in the White House

Lawrence Ferlinghetti
The Summer of Love: Flashbacks of a Human Be-In

Website of the Day
Robert Pollin: "Making the Federal Minimum Wage a Living Wage"


June 7, 2007

Marjorie Cohn
The Prison is the War Crime

Soldz, Reisner and Olson:
A Q & A on Psychologists and Torture

Soldz, Reisner
and Olson, et al:
An Open Letter to Sharon Brehm, President of the American Psychological Association

Paul Craig Roberts
Losing Iraq, Nuking Iran

Bill Quigley
"How Long Must We Support a Mistake?"

Silvia Cattori
Sailing to Gaza

Carl G. Estabrook
What the June Bug Is: Politics in the Dismal Season

Ellen Taylor
Free the Tweakers!: The Good News About Meth

Corporate Crime Reporter
BAE Systems, Prince Bandar and the $2 Billion Account at the Riggs Bank

Brenda Norrell
Torture Training at Ft. Huachuca: Two Priests Face Prison for Exposing Torture in Arizona

D. K. Wilson
What Gary Sheffield Really Said

Kevin Zeese
Iraq Occupation Coming to a Head Over Oil

Website of the Day
How the Press Expired


June 6, 2007

Alain Gresh
Countdown to War on Iran

Gary Leupp
Poddy's Crazy Prayer: Bomb Iran, For Israel and America!

Steven Sherman
The Perils of Humanitarian Intervention

Bruce Dixon
Is Bill Gates Trying to Hijack Africa's Food Supply?

Corporate Crime Reporter
The Professor and the Nukes

Brian M. Downing
The Iraq War and Presidential Politics

Ron Jacobs
Luv n' Hate: a Different Take on the Summer of Love

George Bisharat
The Mirage of the Two State Solution

Nicole Colson
Over to You, Dante: Falwell's Ministry of Hate

Bruce K. Gagnon
From Italy to Guam: A Global Peace Movement is Taking Shape

Website of the Day
How the Democrats Should Treat Bush

 

June 5, 2007

Michael Neumann
Canada in Afghanistan

Jonathan Cook
The Shin Bet and the Persecution of Azmi Bishara

David Vest
The Democrats' War

Robert Fantina
America's Cuba Policy

Hoffman, Parsneau and Chowdhury
CounterTerrorism as International Healthcare

John V. Walsh
Shaming the Official Antiwar Movement

Richard Cretan
Yellow Dog: The Strange Love of Martin Amis and Tony Blair

Adam Engel
Days of Dread: an American Tale

William S. Lind
The News from Anbar: Has Al Qaeda Over-Reached?

Myles Hoenig
Free the Oaks! Cut Down Those Yellow Ribbons!

Jim Minick
Lead-Foot Nation

Website of the Day
Punk Rock Soap Opera


June 4, 2007

Nizar Latif
An Interview with Moqtada al-Sadr

Diana Johnstone
Sarko and the Ghosts of May, 1968

Gregory Wilpert
RCTV and Freedom of Speech in Venezuela

Paul Watson
The Anchorage Whale Killing Bureaucrats Summit

Susan Rosenthal, MD
How Cindy Sheehan Unmasked the Democrats

Richard Ward
The Right of Return to New Orleans

Eva Liddell
Don't Support the Troops

Zahi Khouri
Four Decades of Occupation

Evelyn Pringle
The FDA, GlaxoSmithKline and the Avandia Disaster

China Hand
About Those North Korean Benjamin Franklins ...

Karyn Strickler
George W. Bush: a "Ficeist" Leader

Website of the Day
The Guantanamo Files

 

June 2 / 3, 2007

Alexander Cockburn
The Last of the Texas Outsiders

Marc Levy
Iraq Dead Ahead: a Brief Military History and Civilian Guide to Arlington National Cemetery

Martin Smith
Camilo Mejía's War: From Foot Soldier for Empire to Rebel for Peace

Diana Johnstone
Great Power Meddling in Kosovo

John Ross
The Oaxaca Volcano Stews

Uri Avnery
On Generals and Admirals

Sunsara Taylor
This is Not a Story About Cindy Sheehan

Richard Neville
Were the Hippies Right?

P. Sainath
The Farm Crisis and 100,000 Indian Widows

Missy Comley Beattie
Let's Roar

Nisrine Abiad
and Victor Kattan
The Hariri Tribunal: a Fait Accompli?

Rannie Amiri
Lebanon, Bush and the Three Stooges

Margot Pepper
Deconstructing "Return to Sender"

Eric Stewart
Censorship and Cop Brutality in the New Bison Wars

Ralph Nader
The Halberstam Camp

Dan Bacher
A Victory for the Fish

Shaun Harkin
and Sandy Boyer
Irish War Protesters on Trial

Richard Rhames
Selling Five Acres in Crawford

Frederick Hudson
The Rediscovery of Ella Fitzgerald

Poets' Basement
Lindorff, Landau and Buknatski

Website of the Weekend
Gimme Shelter


June 1, 2007

Dave Marsh
The FBI and the Godfather (of Soul): James Brown's FBI Files

Saul Landau
Return to Cuba: 47 Years Later in Havana

David Phinney
How the Baghdad Embassy Was Built: Forced Labor and Worker Abuse

Robert Jensen
The Bigot and the Boycott

Stanley Heller
Arrest Robert McNamara

Yifat Susskind
Indigenous Women Fight Back

Robert Weissman
Corporate Power Since 1980

Paul Buchheit
Africa and Its Discontents

William S. Lind
The Folly of Maximalist Objectives

Sherwood Ross
78,000 Iraqis Have Been Killed by Coalition Airstrikes

Stephen Lendman
Terrorism Defined

Website of the Day
Desert Autonomous Zone


May 31, 2007

Robert Bryce
The Language Barrier

Patrick Cockburn
Killing with Impunity: Iraq's Militias Under the Surge

Gary Leupp
Appropriate Disillusionment: the Despair of Cindy Sheehan and Andrew Bacevich

Kathy Kelly
Being Hope

Marjorie Cohn
The Unitary King George

Chris Kutalik
and Tiffany Ten Eyck

Fallout from the Sale of Chrysler: Jobs, Health Care, Pensions, All in Jeopardy

Corporate Crime Reporter
Zheng Xiaoyu Meet Lester Crawford

Dave Lindorff
Our Monica: a Hero of the Constitution

Website of the Day
Know Your Rights!

 

May 30, 2007

James Ridgeway
The Bi-Partisan Con on Synthetic Fuels

Franklin Lamb
Lebanon and the Planned US Airbase at Kaleiaat

Terrence E. Paupp
Withdrawal Symptoms

Uri Avnery
To the Shores of Tripoli

Alan Maass
and Jeffrey St. Clair
The Green Masquerade: Corporate America's Latest Counter-Attack

Rock and Rap Confidential
Watching the Detectives: the Political Censorship of Hip Hop

Ralph Nader
Taming the Giant Corporation

Nirmal Ghosh
China, CITES and the Fate of the Tiger

Jean Daniels
Dealing Democrats: Folding to Mr. 28%

Tom Barry
Meet Robert Zoellick: Bush's Pick to Head World Bank

Website of the Day
Petuuche Gilbert on the Rights of Indigenous People


May 29, 2007

Stephen Soldz
Shrinks and the SERE Technique at Guantanamo

Eliza Ernshire
Refugees Forever: Inside Bedawi Camp

Ron Jacobs
The Exit of Cindy Sheehan

Dave Lindorff
Whatever Happened to Signing Statements?

Evelyn Pringle
What Qualifies Bush to Lead Iraq War

Mike Whitney
Bush's New Middle East

David Swanson
How We Got Here: The Democrats and the Antiwar Movement

John Holt
Gating Montana, Part Two: the Feedback Loop

Cynthia McKinney
Dreaming of a True Memorial Day

Martha Rosenberg
Mad Cows, Mad Pigs and the Horse Slaughter Lobby

Website of the Day
The Ruminant


May 28, 2007

Bill Quigley
Katrina Activists: "Less Meeting, More Fighting"

Col. Dan Smith
The Paranoid and the Dead

Cindy Sheehan
Why I Am Leaving the Democratic Party

Dr. Susan Block
Dr. Laura's Little Monster

Jeeni Criscenzo
What I Learned About Being a Dickhead

Douglas Valentine
Memorial Day: a Poem

Website of the Day
Peace TV

 

 

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Weekend Edition
June 30 / July 1, 2007

Part One: Setting the Stage

The Politics and PR of Cervical Cancer

By JUDITH SIERS-POISSON

Many women, myself included, have been affected by cervical cancer or Human Papillomavirus (HPV) at some point in their lives. In this series of four articles, I will examine HPV and Gardasil -- the facts, the hype, and what Merck stands to gain; the marketing campaigns promoting Gardasil in the U.S. and the media's lack of attention to concerns about the rush to mandate vaccination; the role of the non-profit group Women In Government in promoting mandatory vaccination against HPV; and what is going on outside of the U.S. on this issue.

HPV is rampant throughout the world, and the U.S. is no exception. It is estimated [1] that up to 20 million people in the U.S. are currently infected with HPV -- men as well as women. It is not surprising, therefore, that Gardasil [2] has burst onto the national stage as the latest 'wonder' vaccine. Manufactured by Merck [3], Gardasil is the first vaccine available that can prevent 4 strains of HPV, which is a leading cause of cervical cancer and pre-cancerous cervical conditions.

In nearly every state in the U.S. there is a legislative push to make the HPV vaccine mandatory for middle school aged girls, with catch-up clauses to cover girls that have passed that age but are not yet sexually active. Given the anxiety of most people about cancer and the number of people infected with HPV, it is not surprising that what is touted as the first vaccine against cancer has been largely greeted with acclaim. But despite having been affected personally, I became concerned by the headlong rush to not only approve the vaccine, but to mandate it for middle-school aged girls. It is also worrisome that a vaccine may give a false sense of security, which could lead to a decline in the very reliable and proven diagnostic tools available, including Pap tests. Decisions affecting millions of young women should not be made lightly, and certainly not without examining the marketing, PR, and profit motives of a corporation like Merck.


HPV and Cervical Cancer: Just the facts, Ma'am

According to the Centers for Disease Control and Prevention [4], as many as 50 percent of sexually active men and women become infected with Human Papillomavirus (HPV) at some point in their lives. Because the virus is so pervasive, by age 50, at least 80 percent of women will have acquired genital HPV infection. It is estimated that each year an additional 6.2 million Americans becomes infected by one of the strains of HPV. It is important to note, however, that only a few strains of HPV actually cause cervical cancer.

Despite how ubiquitous the virus is, basic knowledge about HPV and its link to cervical cancer is sadly lacking in the U.S. population. According to the 2005 National Cancer Institute [5]'s Health Information National Trends survey, only 38.3% of U.S. women surveyed said that they had heard of Human Papillomavirus or HPV. In addition, less than 50% thought that HPV caused cervical cancer [6].

HPV is significant not only because of the high infection rates among the population. HPV infection can affect fertility, can cause the sexually transmitted disease (STD) genital warts, and some strains can lead, in rare cases according to the Centers for Disease Control and Prevention [7], to cervical cancer. The CDC goes on to say that "Most people who become infected with HPV will not have any symptoms and will clear the infection on their own." That is to say, without any treatment, many infections are addressed by the body's own immune system. (The National Cancer Institute's survey noted that nearly 80% of women mistakenly believed that the body could not resolve the infection without treatment [8].)

Pap smears can detect early pre-cancerous conditions and have drastically improved survival rates. For those whose bodies are unable to counter the infection without assistance, a Pap test [9] provides a reliable method of detection, which, coupled with appropriate treatment, has drastically reduced the mortality rate of cervical cancer patients. The National Institutes of Health points out that [10] HPV does not lead directly to cervical cancer but causes cell abnormalities, or dysplasia, which can over time develop into cancer. It is a slow progression, and "this pre-cancerous condition can be detected by a Pap smear and is 100% treatable." In addition, 92% of women are alive 5 years after a cervical cancer diagnosis if the cancer was kept from spreading outside of the cervical area.

So why is cervical cancer still an issue for women? In the developing world, lack of access to healthcare and routine tests like the Pap smear means that infections and early pre-cancerous conditions are not detected, and if and when women are diagnosed, it is with advanced, invasive cervical cancer that may have metastasized to other parts of the body. In addition, other cervical cancer risk factors, such as becoming sexually active at an early age and giving birth to several children, are more common for women in developing countries.

Globally, cervical cancer is the third most common type of cancer in women. It is much less common in the United States because of routine use of Pap smears for early detection, at least if you are white and economically privileged. In the U.S., tremendous racial and economic disparities exist in the general rates of cancer diagnosis, and cervical cancer is even worse than most. The Centers for Disease Control and Prevention [11] have found that African American women still die from both cervical and breast cancer at much higher rates than white women. Perhaps due to cultural beliefs that talking about diseases can bring bad luck, Vietnamese women in the U.S. are 5 times more likely to develop cervical cancer than their white counterparts. Limited access to health care services and language and cultural barriers contribute to low rates of screening and treatment for other minority groups, such as Latinas, American Indian or Alaska Natives, Asian-American, and Pacific Islander women. This leads to later diagnosis and more invasive cancerous conditions that decrease the likelihood of survival for women in these groups.

Invasive cervical cancer is also more common in women middle aged and older, who are less likely to receive regular screening and early treatment, often due to lack of medical coverage, but also because of the misconception that it is a disease of younger women and that Pap tests are not as important as women age. Smoking also doubles the rate of cervical cancer. Not only do higher smoking rates correlate with lower levels of education and membership in a lower economic class, racial minorities have been consistently targeted by Big Tobacco marketing and so have had their cancer risk increased as well.

It can be informative to examine from what U.S. women are dying statistically. According to the American Heart Association [12], coronary heart disease, which causes heart attacks, is the leading cause of death for American women. "Many women believe that cancer is more of a threat, but they're wrong. Nearly twice as many women in the United States die of heart disease and stroke as from all forms of cancer, including breast cancer." Even so, a recent Washington Post article [13] states that more than 200,000 US women are diagnosed with breast cancer each year and 40,000 die annually as a result -- a mortality rate almost ten times higher than that of cervical cancer.

None of this is meant to minimize the tragedy of cervical cancer, with which more than 11,000 U.S. women are diagnosed each year and which, according to the American Cancer Society [14], is expected to claim 3,700 lives in the U.S. in 2007 alone, and many times more in developing countries. It is instead meant to set the stage and to keep in perspective the risk as we examine the push for mandatory vaccination, especially since not all cases of cervical cancer are caused by HPV infection.


Enter Gardasil, the 'Wonder Drug'

Produced by pharmaceutical mega-corporation Merck [15], Gardasil [16] is a vaccine given in a series of three injections before a girl has become sexually active to guard against HPV infection. Gardasil protects against four of the more than 30 strains of HPV ­ types 6, 11, 16, and 18. According to the Merck product site [17], "HPV Types 16 and 18 cause 70% of cervical cancer cases, and HPV Types 6 and 11 cause 90% of genital warts cases." Gardasil is the first vaccine approved by the U.S. Food and Drug Administration [18] for prevention of HPV.

Gardasil is being touted as a "wonder drug" for women. Might it also be a wonder drug for Merck? In the world of drugs, vaccines for use by the whole population are close to corporate nirvana since they ensure a mass market for prevention instead of having to wait to identify the smaller number of people who actually develop a particular disease. In addition, mandating vaccination helps ensure a mass market and gets the government involved in what would otherwise be left to market forces.

The FDA's approval of Gardasil in June 2006, has allowed Merck to establish a substantial lead over its rival GlaxoSmithKline [20], which has an HPV vaccine, Cervarix, pending approval by the FDA. But by the time Cervarix is approved, which is expected to occur between October 2007 and January 2008, Gardasil will have enjoyed its monopoly status for between 16 and 19 months. Estimates of the global market value [21] for HPV vaccines are that it will be worth $2 billion to $4 billion within three years.

Equally significant is that Merck is still recovering from the Vioxx scandal [22] on 2005, in which Merck's prescription pain reliever was linked to an increase in heart attack risk. Worse still for the company was the assertion that Merck has intentionally kept secret findings of the risks associated with Vioxx while at the same time executing an aggressive direct-to-consumer advertising [23] campaign to increase demand for the drug.

The Vioxx recall is estimated to have cost Merck $2.5 billion in annual revenue. According to Merck [24], As of March 31, 2007, Merck "has been named as a defendant in approximately 27,250 lawsuits, which include approximately 45,700 plaintiff groups alleging personal injuries resulting from the use of VIOXX, and in approximately 266 putative class actions alleging personal injuries and/or economic loss." In May 2007, Merck announced that it would be facing litigation in CA, AL, FL, NV, WV, TX, and IL state courts as well as in federal court in the folllowing nine months.

In March, 2007, MSNBC reported [25] that Merck had a designated legal war chest of $1.64 billion for Vioxx legal costs, but had not set aside a penny for damages,intending to fight each case rather than settle out of court. As of September 2006, Merck had spent $325 million on defense costs during the first nine months of that year alone. MSNBC also reports that in New Jersey, a state Supreme Court panel is considering whether to uphold a lower court decision that would allow health insurers and union health plans to sue Merck jointly to recover money they paid for Vioxx prescriptions. Merck is appealing. If allowed to go forward, that lawsuit alone would potentially be worth more than $15 billion.

The Food and Drug Administration [26] did not escape unscathed either. As the New York Times reported [27] in December 2004,

"The Food and Drug Administration had shifted gears, slashing its laboratories and network of independent drug safety experts in favor of hiring more people to approve drugs, changes that arose under an unusual agreement that has left the agency increasingly reliant on and bound by drug company money. Discovering Vioxx's dangers would take four more years. ... As a result of the agency's shifting its resources, almost everyone, including critics, outside drug safety experts, medical journal editors, some industry executives and even top agency officials, now agrees that its mechanisms for uncovering the dangers of drugs after they have been approved are woefully inadequate."

Merck is pushing hard for a drug that in their ideal world would be given to every middle-school aged girl and would be mandated by each state. The FDA is assuring us that this drug is safe and effective for mass vaccination of young girls. With their combined track record, shouldn't we be concerned?


Access in Theory, and in Practice

Momentarily setting aside valid concerns about the mandating of a new vaccine, there are other issues to consider. Gardasil is not an inexpensive drug. Each vaccine shot will cost $120 through private insurance, or $96 through governmental programs buying at the federal rate. Those that have insurance may only need to pay a co-payment if it is offered by their provider and those on government assistance programs might not pay at all, but those without insurance would have a hefty bill to pay, particularly if it is mandated for school attendance, and if there are several girls in a family. $360 on average for each girl would add up quickly for a family that may fall in the working poor class -- the people that most often do not have health care through their employer but do not qualify for government assistance. These are the same women that are most likely not receiving regular Pap tests to detect early pre-cancerous conditions before they develop into life-threatening cancer.

The idea of mandating HPV vaccination for girls as a requisite for school attendance may seem helpful, or at worst benign, but this isn't the case. Government mandates often create requirements, but not the funding to fulfill them. Even a government recommendation can have far reaching effects on access. On June 8, 2006, the U.S. Food and Drug Administration [28] approved Gardasil as the first vaccine against Human Papillomavirus (HPV). Less than a month later, the Advisory Committee of Immunization Practices (ACIP) unanimously recommended vaccination for 11 and 12 year old girls. According to the Oncology Nursing Society [29], the ACIP also "resolved that the HPV vaccine be included in the Vaccination for Children (VFC) Program, a national effort that provides free immunizations to children who are Medicaid eligible, uninsured, underinsured, or Native American. 'About 40%­45% of the U.S. child population is included in the VFC,' said Lance Rodewald, MD, of the Immunization Services Division.'"

This may sound positive, but Dr. Diane Harper sees it differently. Dr. Harper is a Professor at the Dartmouth Medical School and has been studying HPV for almost 20 years. She was involved with both Merck and GlaxoSmithKline in HPV vaccine trial design and served as a principal investigator at the clinic site for both the phase two and phase three trials for Gardasil and Cervarix.

In our interview, she stated that this federal directive to provide the vaccine free to such a large segment of the U.S. child population falls to the states, and federal funding covers at best 10% of the cost of the program. So the federal government is requiring states to cover the children, and the states themselves might choose to make the vaccine mandatory for school attendance. But 90% of the children who would in theory receive the shots free won't, and so parents will have to pay for the shots out of pocket or risk their daughter being barred from going to school. And those children that are covered by private insurance? Dr. Harper explained further that particularly with a drug as expensive as Gardasil, its inclusion in the Vaccination for Children program provides insurance companies with a perfect reason not to cover the shots for anyone under 18 years old beginning July 1, 2007.

"Insurance companies are saying that VFC program is required by law to purchase this. But the problem is that the states don't have enough money allocated by VFC to purchase enough to cover their whole state's population. So if you make a mandate that your child can't enter sixth grade as a twelve-year old without having the shots, and your state only has enough to give it to 10% of the twelve-year olds, and you're the next kid in line and your family doesn't have $500, then you can't go to school. And that is wrong."

According to the National Center for Children in Poverty [30] at Columbia University, 18% of children in the U.S. live below the federal poverty level ($20,650 a year for a family of four) and 38% of children live in low-income families. There is obviously a huge gap in coverage for those who can't afford the shots on their own. For most families, said Harper, "it would be an onerous amount to pay. And it would be awful to link your further education with your inability to pay for a vaccine."

Merck used its deep pockets to make sure that even before the FDA had approved Gardasil, there was a growing awareness of and concern about HPV and its link to cervical cancer. According to Bloomberg News [31], Merck spent $841,000 for Internet ads alone relating to HPV in the first quarter of 2006 -- months before the FDA had even approved Gardasil.

In the next article, "Research, Develop, and Sell, Sell, Sell," we'll look in detail at the extensive marketing campaigns in the US which were in place before FDA approval and what has happened since.

Judith Siers-Poisson is association director of the Center for Media and Democracy. She can be reached at: judith@prwatch.org

Links:
[1] http://www.cdc.gov/std/HPV/STDFact-HPV.htm#common
[2] http://www.sourcewatch.org/index.php?title=Gardasil
[3] http://www.sourcewatch.org/index.php?title=Merck
[4] http://www.cdc.gov/std/HPV/STDFact-HPV.htm#common
[5] http://www.sourcewatch.org/index.php?title=National_Cancer_Institute
[6] http://hints.cancer.gov/questions/
[7] http://www.cdc.gov/std/HPV/STDFact-HPV.htm#cancer
[8] http://hints.cancer.gov/questions/
[9] http://en.wikipedia.org/wiki/Pap_test
[10] http://www.nlm.nih.gov/medlineplus/
[11] http://www.cdc.gov/omh/AMH/factsheets/cancer.htm
[12] http://www.americanheart.org/presenter.jhtml?identifier=4786
[13] http://www.washingtonpost.com/wp-dyn/content/article/l
[14] http://www.cancer.org/docroot/CRI/content/
[15] http://www.sourcewatch.org/index.php?title=Merck
[16] http://www.sourcewatch.org/index.php?title=Gardasil
[17] http://www.gardasil.com/
[18] http://www.sourcewatch.org/
[19] http://bendib.com
[20] http://www.sourcewatch.org/index.php?title=GlaxoSmithKline
[21] http://www.philly.com/inquirer/business/
[22] http://www.sourcewatch.org/index.php?title=Merck
[23] http://www.sourcewatch.org/
[24] http://www.merck.com/newsroom/
[25] http://www.msnbc.msn.com/id/17814905/page/2/
[26] http://www.sourcewatch.org/
[27] http://www.nytimes.com/
[28] http://www.sourcewatch.org/
[29] http://www.ons.org/publications/journals/
[30] http://www.nccp.org/topics/childpoverty.html
[31] http://www.bloomberg.com/apps/


 

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