NEJM 10 May 2007 Vol 356

In the USA, there is much debate about compulsory vaccination of girls at the age of 11 or 12 against the most oncogenic strains of human papillomavirus (HPV). Opposition comes from the religious right who believe that this undermines the message of chastity before marriage and faithfulness thereafter. Indeed, if only people would behave, we could say goodbye to every sexually transmitted disease. Maybe there is a group somewhere mad enough to refuse cervical screening too, on the basis that their purity of life makes it unnecessary and those who get cervical cancer deserve God’s punishment. The studies in this week’s NEJM show that the quadrivalent vaccine against HPV offers some – but not complete – protection against the diseases associated with HPV infection. In this study it produces modest reductions in high-grade cervical neoplasia.

Another study in the same series (FUTURE) shows a similar protective effect against a wider range of anogenital disease – including warts – in vaccinated young women. And what does the acronym stand for? Females United To Unilaterally Reduce Endo/Ectocervical Disease. I might have guessed.

By means we can only guess at, HPV also reaches the oropharynx. This case-control study shows that this is associated with an increased risk of oropharyngeal cancer. In fact the epidemiologists had already discovered an added risk of these cancers and a lifetime number of sexual partners in excess of 25.

It seems that whenever the topic of physician-assisted death is mentioned in the UK, a torrent of passionate objection will follow (the Independent illustrated that last week). The arguments usually raise the spectre of a slippery slope, the prospect that vulnerable individuals will be coerced, that progress in palliative care will cease, and that we will lose our respect for the sanctity of life. None of these notions has any basis in fact, as illustrated by this study of end-of-life practices in the Netherlands under the Euthanasia Act, which shows a slight decline in physician-assisted death. For further evidence-based discussion, including figures from Oregon, see the introductory article.

Having sprung to the defence of salt a couple of weeks ago, I was interested to read this paper on sodium and potassium in the pathogenesis of hypertension. We know that our ancestors who were inland hunter-gatherers would have eaten very little sodium in relation potassium (the ratio would have been about 2 in favour of potassium), but it is unlikely that this was true of those who were shoreline scavengers. Anyway, modern human communities generally consume much more than the 50mmol of sodium daily which is the recognised threshold for the occurrence – in a minority of individuals – of salt-related hypertension. It would take an extreme effort of health fascism to reduce the whole-population intake below this threshold, but that is probably unnecessary. Just get people to eat more fruit and vegetables, which are high in potassium, and avoid all processed food, which accounts for about 80% of most people’s sodium load. Only 8% comes from salt used in home cooking. It’s tipping the balance in favour of potassium that counts, according to this paper.