One in 4 Teen Girls Has a Sexually Transmitted Disease

(HealthDay News) -- More than 3 million teenaged girls have at least one sexually transmitted disease (STD), a new government study suggests.

The most severely affected are African-American teens. In fact, 48 percent of African-American teenaged girls have an STD, compared with 20 percent of white teenaged girls.

"What we found is alarming," Dr. Sara Forhan, from the U.S. Centers for Disease Control and Prevention, said during a teleconference Tuesday. "One in four female adolescents in the U.S. has at least one of the four most common STDs that affects women."

"These numbers translate into 3.2 million young women nationwide who are infected with an STD," Forhan said. "This means that far too many young women are at risk of the serious health effects of untreated STDs, including infertility and cervical cancer."

These common STDs include human papillomavirus (HPV), chlamydia, herpes simplex virus and trichomoniasis, Forhan said.

Forhan announced the results as part of the CDC's 2008 National STD Prevention Conference, in Chicago.

"These findings are really giving us a lot of pause about how we provide care to adolescent girls who are sexually active," said Dr. Elizabeth Alderman, an adolescent medicine specialist at Children's Hospital at Montefiore in New York City and chairperson of the Executive Committee of the Section of Adolescent Health of the American Academy of Pediatrics. "The numbers are really astonishing."

Forhan noted that most of the burden of STDs falls on young African-American women. "Among African-American teenagers, about one in two were affected compared to one in five white teens," she said.

In terms of the racial disparity, "it's what we've always seen, which is very unfortunate," Alderman said.

In the study, Forhan's team collected data on 838 girls aged 14 to 19 who took part in the 2003-2004 National Health and Nutrition Examination Survey. The study did not include syphilis, gonorrhea or HIV, as earlier studies found very low prevalence of these diseases in this age group.

HPV and chlamydia are the most common STDs found among teenage girls, Forhan said. "Almost one in five overall had a strain of HPV associated with cervical cancer or genital warts," she said.

"We need to be screening adolescent girls who are sexually active and providing them with HPV vaccine," Alderman said. "The recommendations are to screen sexually active girls, but many girls don't disclose to their health-care provider that they are sexually active, even when asked," she said.

As for chlamydia, 4 percent of teenaged girls had this STD, Forhan said. "The majority of chlamydia infections do not have symptoms. If left untreated, it can lead to pelvic inflammatory disease, which leaves these young women at risk for atopic pregnancy, chronic pelvic pain or infertility," she said.

In addition, the study found that 2.9 percent of young women had trichomoniasis, and 2 percent were infected with genital herpes, Forhan said.

According to Forhan, about 50 percent of the teens reported having sex, and the prevalence of STDs in this group was 40 percent. "Even for young women with only one reported lifetime sexual partner, one in five had an STD," she noted.

"If you choose to be sexually active, you need to protect yourself and be screened for these infections," Alderman said. "And all girls between the ages of 11 and 26 should get vaccinated for HPV."

Among women with an STD, 15 percent had more than one infection, Forhan added.
"These data provide a clearest picture to date of the overall burden of STDs in adolescent women in the United States," Forhan said. "The study also underscores the importance of addressing racial disparities in STD rates among young women."

Race itself is not a risk factor for STDs, Forhan said. However, factors such as limited access to health care, poverty, community prevalence of STDs, and misperceptions about individual risk are some of the reasons that STD rates are particularly high among African-Americans, she said.
More information
For more on STDs, visit the U.S. Centers for Disease Control and Prevention.

Cancer Killed Almost 8 Million Worldwide in 2007

(HealthDay News) -- Cancer continues to cut a deadly swath across the globe, with the American Cancer Society reporting 12 million new cases of malignancy diagnosed worldwide in 2007, with 7.6 million people dying from the disease.

The report, Global Cancer Facts & Figures, finds that 5.4 million of those cancers and 2.9 million deaths are in more affluent, developed nations, while 6.7 million new cancer cases and 4.7 million deaths hit people in developing countries.

"The point of the report is to promote cancer control worldwide, and increase awareness worldwide," said report co-author Dr. Ahmedin Jemal, director of the society's Cancer Occurrence Office.

The number of cancers and cancer deaths around the world is on the rise, Jemal said, mostly due to an aging population. "There is increasing life expectancy, and cancer occurs more frequently in older age groups," he noted.

Lifestyle may be another reason for the rise in malignancies in developing countries, Jemal said, as people adopt Western behaviors such as smoking, high-fat diets and less physical activity.

The best way to stem the increasing number of cancer cases and deaths is prevention, especially in poorer countries, the expert said. In many developing nations, the health-care infrastructure simply isn't there to offer cancer screening and treatment for most people, Jemal added.

In developed countries, the most common cancers among men are prostate, lung and colorectal cancer. Among women, the most common cancers are breast, colorectal and lung cancer, according to the report.

However, in developing countries the three most common cancers among men are lung, stomach and liver, and among women, breast, cervix uteri and stomach.

Worldwide, some 15 percent of all cancers are thought to be related to infections, including hepatitis (liver cancer) and human papilloma virus (cervical cancer). But the incidence of infection-related cancers remains three times higher in developing countries compared with developed countries (26 percent vs. 8 percent), according to the report.

In addition, cancer survival rates in many developing countries are far below those in developed countries. This is mostly due to the lack of early detection and treatment services. For example, in North America five-year childhood cancer survival rates are about 75 percent compared with three-year survival rates of 48 percent to 62 percent in Central America, the report notes. The report estimates that 60 percent of the world's children who develop cancer have little or no access to treatment.

The report also includes a section on the toll tobacco use takes around the world. In 2000, some 5 million people worldwide died from tobacco use. Of these, about 30 percent (1.42 million) died from cancer -- 850,000 from lung cancer alone.

Jemal believes smoking is a key culprit.

"Smoking prevalence is decreasing in developed countries. So, as tobacco companies are losing market in developed countries they are trying to expand their market in developing countries," he said.

In China alone, more than 350 million people smoke. "That's more than the entire population of the United States," Jemal said. "If these current patterns continue, there will be 2 billion smokers worldwide by the year 2030, half of whom will die of smoking-related diseases if they do not quit," he added.

In the 20th century, tobacco use caused about 100 million deaths around the world. In this century, that figure is expected to rise to over 1 billion people. Most of these will occur in developing countries.

One expert agreed that many cancer deaths can be avoided through lifestyle changes.
"What is most provocative here is not the total global burden of suffering and death cancer causes, dramatic though that may be, but the variations in cancer occurrence around the world, and the insights provided about how much of the cancer burden need not occur at all," said Dr. David Katz, director of the Prevention Research Center at Yale University School of Medicine.

In developing countries, cancer of the uterine cervix is a leading cause of death in women, Katz noted.

"Yet this infection-related cancer is now preventable by vaccine, and long treatable when detected early using the Pap smear. As a result, death from cervical cancer in developed countries is dramatically lower. Its toll in the developing world is testimony to missed opportunities to apply our resources effectively, and equitably," he said.

Cancer of the liver, often related to hepatitis infection, is a leading cause of death in developing countries, but not so in developed countries. "Again, an infection preventable with vaccine is causing death because of inequities in the distribution and use of existing resources," Katz said.

Prostate and colon cancers are more common in wealthier countries, where they are likely related to poor diet and obesity, Katz said. "Unnecessary suffering and death are occurring in affluent countries due to dietary excesses," he said.

Katz also noted that tobacco-related cancer is largely preventable. "The toll of tobacco-related disease, including lung cancer, is an appalling example of a global willingness to tolerate preventable suffering and death for the sake of profit," he said.

These data show both developed and developing countries how to move toward the lower rates of specific cancers, Katz said.

"It will be a tragic failure for public health if instead of applying these lessons developed countries continue to export tobacco and dietary transgressions so that the developing world adds to its current cancer burden ours as well," he said.

More information
For more information on cancer, visit the American Cancer Society.

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Pill Poses Little Cervical Cancer Risk

(HealthDay News) -- Women taking oral contraceptives are at a slightly increased risk for developing cervical cancer, but a decade after stopping the pill even this very small risk disappears, a new British study suggests.

However, that finding doesn't change the recommendation for women to continue getting screened for cervical cancer, experts say.

"This is good news," said lead researcher Dr. Jane Green, an epidemiologist in the Cancer Epidemiology Unit at the University of Oxford. "We have been able to estimate the lifetime risk of cervical cancer for women on the pill and find it's really quite small," she said.

"The small increase in cervical cancer we see in women who are taking oral contraceptives starts to fall once pill use stops and has really gone away by 10 years after stopping use," Green said.

"The pill has many other benefits, including reducing the risk of other cancers, such as ovarian cancer and womb cancer," Green added.

The report is published in the Nov.10 issue of The Lancet.

In the study, Green and her colleagues from the International Collaboration of Epidemiological Studies of Cervical Cancer collected data on almost 16,600 women with cervical cancer and more than 35,500 women without cervical cancer. These women had participated in a total of 24 studies.

Green's team confirmed that the risk of cervical cancer among women who use oral contraceptives does increase over time. But this increase in risk is very small -- women who take contraceptives for five years or more have only about twice the risk compared with women who never took the pill.

In absolute terms, that means that a 20-year-old woman living in a developed country who uses an oral contraceptive for 10 years increases her odds of developing cervical cancer by age 50 from 3.8 cases per 1,000 women (without Pill use) to 4.5 per 1,000 women after using oral contraception. In less developed countries, where access to cervical cancer screening is more limited, that risk rises from 7.3 to 8.3 cases per 1,000 women, the researchers estimated.

Similar risk was seen for invasive and localized cancer and in women who have the human papillomavirus (HPV), which causes about 70 percent of all cervical cancers, Green noted.
Although the risk for cervical cancer associated with the Pill is small, Green advised women to still be screened for the disease. "Screening for cervical cancer is effective," she said. "The advice is to go for regular screenings."

Eventually, Green hopes that the vaccination against the human papillomavirus will go a long way to preventing many cases of cervical cancer.

One expert agreed that the findings showed the risk for cervical cancer from oral contraceptives was very small.

"This is reassuring news for women," said Dr. Peter Sasieni, from the Wolfson Institute of Preventive Medicine at Queen Mary University of London and author of an accompanying journal comment. "There is really a minimal risk from oral contraceptives, and that risk disappears fairly soon when you stop taking them," he said.

"When making a decision about what from of contraception to use, women shouldn't worry about cervical cancer," Sasieni concluded. "It's not an issue," he said.

However, he believes that taking oral contraceptives is another good reason to get screened regularly for the disease. "By going for regular screenings, a women can reduce her risk by 80 percent," Sasieni said.

Another expert agreed that women shouldn't worry about the Pill and cervical cancer risk.
"I don't think women are basing their decision of which form of contraception to use on the risk for cervical cancer," said Debbie Saslow, director of breast and gynecologic cancer at the American Cancer Society. "People who want to use oral contraceptives should not be alarmed over the slight increase in cervical cancer risk," she said.

However, women -- whether they take oral contraceptives or not -- should be getting regular cervical cancer screening, Saslow said.

More information
For more on cervical cancer, visit the American Cancer Society.
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Precancerous Lesions Raise Cervical Cancer Risk

(HealthDay News) -- Women who have had advanced precancerous lesions of the cervix are still at risk for invasive cancers up to 25 years later, Swedish researchers report.

Currently, the American Cancer Society recommends that women who have had precancerous lesions called severe dysplasia/carcinoma in situ (CIS) continue getting Pap tests for 10 years after treatment. But, based on this study, these guidelines may need to be changed, said Debbie Saslow, the society's director of breast and gynecologic cancer, who was not involved with the research.

Saslow added, however, that even though these women continue to be at risk for developing cervical or vaginal cancer, the risk is low. "Women who have been treated for advanced precancer do need to remain vigilant," she said.

"This paper is going in my file for when we update our guidelines in the next two years," Saslow added. "We will see if we want to stick with 10 years or go to a much wider interval."

The study was led by Dr. Bjorn Strander, a senior consultant with the Department of Obstetrics and Gynecology at Sahlgren's Academy at the University of Gothenburg. The researchers collected data on 132,493 women who had a diagnosis of severe dysplasia/CIS between 1958 and 2002. The statistics came from the National Swedish Cancer Register.

The researchers found 881 women had developed cervical cancer, and 111 had developed vaginal cancer more than one year after the initial diagnosis. This was almost seven times higher than expected, the researchers said.

Women with a diagnosis of severe dysplasia/CIS were more than twice as likely to develop cancer compared with the general female population. The women were also twice as likely to develop invasive cervical cancer after diagnosis of CIS if that diagnosis was made between 1991 and 2000, compared with the same diagnosis made from 1958 to 1970. This increased risk might be due to changes in treatment over that period, particularly because fewer hysterectomies are being done as part of treatment for CIS, the study authors said.

Strander's team also found a particularly high risk for women over age 50, and this risk continued to increase with age. "The risk after treatment hardly decreases at all after treatment and is still sustained after more than 25 years," he said.

"While well-screened women after 50 to 60 years of age are very well protected from cervical cancer and have little, if any, further use of screening, this does not apply to women who have been treated for grade 3 CIS," Strander said. "They need, and should have, long-term follow-up, perhaps lifelong," he said.

The results are published in the Oct. 26 edition of the British Medical Journal.

More information
For more on cervical cancer, visit the American Cancer Society.
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Cervical Cancer Vaccines Won't Fight Existing HPV Infection

(HealthDay News) -- Cervical cancer vaccines that prevent infection with the human papillomavirus (HPV) do not reduce or eliminate preexisting infections, a new study suggests.

That means that shots such as Gardasil, or a similar, yet-to-be-FDA-approved vaccine, Cervarix, should not be viewed as a treatment for women who've most likely contracted the highly common, sexually transmitted virus through their partners.

"From a public health perspective, a population-wide perspective, the best approach is to vaccinate girls and women before they initiate sexual activity," said study researcher Allan Hildesheim, senior investigator in the division of cancer epidemiology and genetics at the U.S. National Cancer Institute.

"You can then protect individuals prior to their being exposed, since the vaccine doesn't have any effect after infection has happened," he said.

The findings, reported in the Aug. 15 issue of the Journal of the American Medical Association, support a recommendation in June from the U.S. Centers for Disease Control and Prevention that vaccination focus on girls 11 and 12 years of age, most of whom would not have already become sexually active.

Gardasil, which targets four cancer-causing strains of the virus -- 6, 11, 16 and 18 -- should be added to the list of routine school vaccinations, experts say.

On the other hand, "for women who have initiated sexual activity, cervical cancer screening is probably a better preventive measure than vaccination," Hildesheim said.

His team's NCI-funded study, which focused on the Cervarix vaccine, was conducted in Costa Rica and included almost 2,200 women aged 18 to 25. Cervarix has not yet been approved by the U.S. Food and Drug Administration, but its maker, GlaxoSmithKline, has said it believes the shot will gain approval sometime in 2008.

According to Hildesheim, prior studies had already strongly suggested that both Gardasil and Cervarix would be ineffective against preexisting viral infections.

"However, we noticed shortly after the initial licensure of the [Gardasil] vaccine that there was tremendous confusion -- both in the clinical and the lay community, regarding the use of this vaccine among women who were already infected," he said.

Other specialists have noticed similar confusion among their peers.

"Each of us has received anecdotal reports of doctors thinking that you can benefit [an infected] woman by vaccinating her," said Dr. Howard Strickler, professor of epidemiology and population health at the Albert Einstein College of Medicine, in New York City. "There are misconceptions in the field," he said.

Even though HPV occurs in a wide variety of strains, Cervarix targets the two strains thought to cause 70 percent of cervical malignancies -- strains 16 and 18.

In the study, the researchers gave the vaccine to about 1,100 young women, all of whom had tested positive for genetic traces of HPV at the beginning of the study. Another group of infected young women received a hepatitis A shot as a "control."

By the end of 12 months, rates of HPV 16 and/or 18 "clearance" -- or absence -- from the body was 48.8 percent in the HPV vaccine group and 49.8 percent among the controls -- a statistical dead heat.

As the experience of the control group showed, the human immune system naturally clears many HPV infections over time. Giving women the vaccine appeared to provide no added benefit, the researchers said.

The investigators also observed no differences between the two groups in terms of the extent of HPV-linked disease, viral antibody load or the results of cervical cell tests conducted in the lab.

"Our results reinforce the notion that this vaccine is meant to protect against infections when they occur, but it isn't effective at helping clear the infection once it has established itself," Hildesheim said.

Still, given the array of HPV viral strains, wouldn't vaccination help protect against viral types a woman had perhaps not yet encountered? Theoretically, that's true, the experts said, and it is for exactly that reason that the CDC recommends the vaccine for women up to age 26.

However, there's currently no test that can determine a woman's HPV history.

"If you are sexually active, there is no way for you to know for sure whether or not you have been exposed to these particular [carcinogenic] strains," explained Hildesheim. They "are very common, and, typically, exposure happens fairly shortly after the initiation of sexual activity," he said. "That's why the best policy is to try and get the vaccine administered prior to sexual debut."

So, for both girls and women, vaccinated or not, the expert advice on avoiding cervical cancer remains the same: Get regular Pap smears.

"Remember, even [Gardasil] is just working against four strains," noted Dr. Stephanie Blank, a gynecologic oncologist and assistant professor of gynecologic oncology at New York University School of Medicine. "There are many more strains than that. So, the Pap smear recommendations have remained unchanged."

More information
There's more on cervical cancer at the American Cancer Society.

Suicide Risk Rises for Cancer Patients, Especially Advanced Stage

By Judith GrochReviewed by Zalman S. Agus, MD; Emeritus Professor at the University of Pennsylvania School of Medicine. Oct 19, 2006

Physicians and other health-care professionals are urged to be aware of the potential suicide risk for cancer patients and to offer support to high-risk patients and their families.

Be aware that the suicide risk for male cancer patients far exceeds that of female patients.

OTTAWA, Ontario, Oct. 19 -- Cancer patients in the U.S. are more than twice as likely to commit suicide as the general population, with the rate for men nearly five times that for women.

The composite picture for suicide risk was that of a white man, with a new diagnosis of either head-and-neck cancer or myeloma, widowed, with widely disseminated and perhaps high-grade disease, limited treatment options, or maybe a history of other cancers.

So revealed an analysis of 1.3 million U.S. cancer cases diagnosed from 1973 to 2001 and recorded in the Surveillance, Epidemiology, and End Results (SEER) registry, Wayne Kendal, M.D., of the Ottawa Hospital Regional Cancer Center here. reported online in the Oct. 19 issue of Annals of Oncology.

The analysis found that 19 of every 1,000 male cancer patients and four of every 1,000 female patients took their own lives.

This amounted to 265 women and 1,307 men, reflecting 0.04% for women and 0.19% for men, he said. The overall hazard ratio (HR) for male suicide was 6.2 (95% confidence interval 5.4-7.1).

At around 24 suicides per 100,000 cancer patients a year, the rate was two to 2.5 times that of the general American population (10.6 per 100,000 per year, including the cancer population), This almost fivefold greater rate for men parallels the male-female ratio for suicide in the general population, Dr. Kendal added.

However, the smaller number of women in this cohort and the resulting lower statistical power could account for the findings, Dr. Kendal said. It is also possible that women, as in the general population, were less likely to react with self-directed violence.

The risk of suicide varied according to gender, prognosis, disease stage, type of cancer, ethnicity, and family status, Dr. Kendal said. Of all the risks, not surprisingly, advanced-stage cancer was a major suicide risk factor, with a higher risk for men even with intermediate-stage disease, Dr. Kendal added.

Analyzed according to sex, the women fared better. The suicide rates were similar for most cancer sites, except for colorectal (P = 0.01) and cervical cancer; depression played a role in many of the suicides in this study.

Using the SEER data, Dr. Kendal said, it was not possible to differentiate between suicides associated with affective illness or substance abuse and those motivated by a desire for relief from terminal illness or the avoidance of being a burden to others.

This high-risk picture, he said, might be associated with substance abuse, poor quality of life, or psychological issues in the context of poor family and cultural support, as well as a poor cancer prognosis, he added.

In contrast, for decreased risk, one might envision a woman of African-American heritage, with colorectal or cervical cancer, localized disease, and living with her spouse.

In the general population, mental illness and substance abuse figure prominently as high risk factors, noted Dr. Kendal. However, in this study, it was not possible to differentiate, on the basis of the SEER data, between suicides associated with affective illness or substance abuse and those motivated by the desire for relief from terminal illness or the avoidance of being a burden to others.

To help people cope with their cancer, Dr. Kendal concluded, oncologists and allied health-care workers should be alert to the risk of suicide in cancer patients, particularly those with high-risk factors such as poor social support, substance abuse, and a history of mental health problems.
(C) 2006 MedPage Today LLC. All Rights Reserved.

Do You Need These Tests?

Q: Do You Need These Tests?
Can you tell me what tests we all should have as we get older? Which ones do you recommend?

A: As we get older, a variety of medical tests can warn of impending problems, with hearts, bones and other chronic disorders. As long as you're in good health and have no unusual symptoms, I don't necessarily recommend an annual physical exam. But here's a list of the tests I do think everyone should have periodically as they age:

Cholesterol: This simple blood test can give you an idea of your heart disease risk. Have your cholesterol tested every five years beginning at age 20 and have your HDL ("good") cholesterol and LDL ("bad" cholesterol) checked if your total cholesterol is over 200. You should also request measurement of serum homocysteine and C-reactive protein, other indicators of heart disease risk.

Bone density: Any woman at high risk of osteoporosis (because her mother had it or because she is light boned and fair-skinned) should have this DEXA scan to determine her bone mineral density and keep track of how it is declining over time.

All women age 65 and older should have at least one DEXA scan to gauge the condition of their bones. We have good drugs to halt and reverse osteoporosis and reduce risk of hip fractures in old age. You should know, however, that DEXA tests also identify bone weakness (osteopenia) that is nowhere near the range of osteoporosis.

As a result of these findings, women may be put on the same strong drugs used to treat osteoporosis - not a wise move, in my judgment.

PSA: This test for prostate specific antigen, a protein produced by prostate cells, can warn men of prostate cancer.

However, false positives are common, and even when the test does detect cancer, it provides no information about how aggressive it is or how likely it is to spread. Until we have a reliable follow-up test to show whether or not a tumor is aggressive, I doubt the wisdom of using PSA as a screening tool, except for men at high risk of prostate cancer on the basis of family history or lifestyle. A newer test, the pro-PSA, may do better.

Discuss prostate screening with your physician.

Mammogram: Every one to two years for all women over 40 to detect early (and curable) breast cancer. Women with a positive family history of breast cancer may want to start screening earlier.

Colonoscopy: A test for early signs of colon cancer; every 10 years starting at age 50, earlier if there is a positive family history.

Blood pressure: Every two years after the age of 18 as long as your blood pressure is normal.
Eye exams: Every two to four years between ages 40 and 65; every one to two years after age 65. If you wear glasses or contacts, you should have your eyes checked annually, regardless of age.

Dental exams: Everyone, regardless of age, should have a dental check-up once or twice a year.
Full body skin exams: Check yourself monthly for moles; an annual skin exam by a physician regardless of age; follow your doctor's recommendations for more frequent exams if you've had any type of skin cancer.

Thyroid tests: All adults, particularly women, should be screened for thyroid disorders at the age of 35 and every five years thereafter.

Pap smears: Women need Pap smears to detect abnormalities that may precede cervical cancer every one to three years.

Diabetes screening: Fasting blood sugar and insulin levels should be checked if you are overweight or have a positive family history.


Weil, M.D.

Feds Approve Unnecessary Cervical Cancer Vaccine That Will Make Drug Company Billions

I warned you the Advisory Committee on Immunization Practices (AICP) would formally rule on the human papillomavirus (HPV) vaccine, that claims to protect women from infections that cause cervical cancer and other infections.

No great surprise, the committee officially and unanimously approved a recommendation yesterday that urges young female patients (ages 11-26) to be vaccinated.

What's more, the decision will force American health officials to shell out up to $2 billion to treat the poor. Eager to distance themselves from the ongoing Vioxx debacle, Merck says its Gardasil vaccine will be ready in a few days.

According to the CDC, HPV is the most common sexually transmitted disease in America (more than 6 million women contract it annually), yet the immune systems of many women are strong enough to clear up these infections on their own.


Also, a New England Journal of Medicine study found the use of condoms reduces the incidence of HPV by 70 percent. By comparison, Gardasil counteracts four varieties of HPV that cause 70 percent of the cases of cervical cancer and 90 percent of genital warts.

So, does your daughter or wife really need it? Before you make that choice, please review some of the pieces I've posted regarding the dangers of relying on vaccines to protect the health of your loved ones.

New York Times June 30, 2006 Registration Required
USA Today June 30, 2006

Merck Turns To Vaccines To Save The Day

An interesting piece in the Chicago Tribune unveiled Merck's latest plans for turning the embattled drugmaker's fiscal fortunes around with the help of three new vaccines in the FDA regulatory pipeline:

Gardasil, a drug intended to protect women from four kinds of human papillomavirus,
that accounts for the lion's share of cervical cancer cases.
Zostavax, a vaccine for shingles.
Rotateq, an oral remedy for common gastrointestinal illnesses in children.

The company is certainly looking for a home run, considering its well-publicized legal wrangling with patients over the health-harming Vioxx, and Zocor running out of patent protection.

However, what you and many other consumers may not recall -- and what Merck is probably betting on -- is news of a scandal I posted earlier this year involving the mislabeling of hepatitis B vaccines for babies that weren't thimerosal-free.

Chicago Tribune December 14, 2005 Registration Required

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