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Opinion related to HPV vaccination “against cervical cancer”
Prof. dr h.c. Rudolf Klimek
The Human Papilloma Virus is a sufficient factor not only to induce inflammation and eventually infectious disease, but also one of the necessary events in neogenesis. Cervical cancer is not an infectious disease. The legitimacy of this statement is confirmed, among others, by the common conditioning of premature birth and cervical cancer, e.g.: commence of the sexual life and first pregnancy and labor in an early age, poor socio-economic status, smoking, infections of the genital tract, as well as some neurohormonal disorders. There are many factors that contribute to cancer disease, among them viruses and infections, accounting only for 10-15% of all cancers (e.g. tobacco smoking and diet ca 60%).. Different kinds of neoplasm may be developed for the same factor, and inversely the same neoplasm may be called for different oncogenic reason. The new cancer cell is a natural alternative to a cell’s death, and according to the thermodynamics rules, for its existence and progress it has to increase chaos (entropy) in the organism through greater material and energetic dissipation. This is a universal phenomenon, and the self-organizations of the physical, chemical and even social dissipative structures were described in 1967 by I.Prigogine, honored with Nobel Prize (1977).
Cancer is a natural stochastic phenomenon in which psychosocial variables interact with biological ones. There are ca. 200 phenotypically different cells in the human being, nevertheless, all of them have an identical genome. The self-organization of the body’s cells existing at lethal risk prolongs only the cellular form of living matter with a new genome to protect life itself. According to the 2nd thermodynamic law the new cancer cell has to dissipate more matter and energy in the whole human organism. The cellular heterogenicity of neoplasms has been known since the last century, when histologic studies first identified morphologic differences among cells within the same tumor. Normal cells can be transformed by a variety of agents, such as chemicals, RNA and DNA viruses, radiation, and even as transformation of a single gene produced protein, very similar or equal to normal cell components, but present in too large amounts in transformed cells. Cancer cells can grow under some thermodynamic conditions, it means only in a far-from-equlibrium internal state of multicellular organism and exclusively in the organism of their origin.
Cancer can develop only in the host’s organism, and owing to that they perish together, because the sum of entropy production in both of them must always grow according to the 2nd thermodynamic law. It explains the cause-effect relationship between unrepeatable cancer and cancer disease which is exactly opposed to such a relation between any repeatable microbe and infectious diseases. Therefore, there is no such thing as a “cancer virus”. The viruses on their own don’t cause the cancers, but they affect the body’s cells in such a way that they make the cells more open to self-organization.
My master Prof.Bolesław Skarżyński, co-author with Nobel Prize winner (1929) Prof.Hans v. Euler-Chelpin of “Biochemie der Tumoren” (F.Enke Verlag, Stuttgart-W, 1942) – has reported in late 50-ties of past century that the critical factor in cancerogenesis is a specific protein overproduction. This was experimentally repeated by biochemical teams (R.Baserga ed. Cell proliferation, cancer and cancer therapy. An NY Academy of Sciences, vol 397, 1982). Thus, more copies of the protein’s structural gene per cell, bordering high-activity promotores and/or autoproduction of growth factors – could lead to neoplasia. In 1977 I.Prigogine received the Nobel Prize in chemistry for the discovery of the self-organizing dissipative structure which I used to explain at the biophysical level the mystery of thermodynamic origin of cancer cell and caused by it the neoplastic disease. This new theory unifies all so far existing theories of cancerogenesis and clearly identifies a cause of cancer as dissipatogenic internal state of cell. It was confirmed in 1980 by our studies using magnetic resonance imaging and spectroscopy together with Paul Lauterbur, a creator of the nucleomagnetic imaging and Nobel Prize winner (2003). Recently it was found that cells are able to undergo DNA self-organization and cell division in the absence of a coincident cellular enlargement. Thus cervical cancer, as any other cancer, is not related only to one virus or to neuroendocrine and metabolic internal state of women, but also to the presence and activity of symbiotic flora, as well as host’s lifestyle.
Clinic-epidemiological studies did not support the hypothesis that only infection with HPV is a sufficient factor for inducing precancerous lesions of cervix. Today in Vienna we have an opportunity to celebrate the 160th anniversary of Semmelwies’ discovery of the mystery of puerperal fever instead of discrediting EBCOG by supporting HPV as “cancer virus”. I.P.Semmelwies in his historic publication described “The etiology, the concept and the prophylaxis of childbed fever” remarked about the lack of medical students washing their hands (1847). It was not until the late nineteenth century that the introduction of his discovery to obstetrics led to a steep fall in deaths from puerperal fever. Nowadays, 160 years later, it is time to transform pure morphological and biochemical views into a more thermodynamic interpretation of cause-effect relationships, and not only in oncology.
Often media reports give a misleading impression of research because busy journalists don’t have the time to study the papers on which their reports and their sensational headlines such as “HPV vaccine prevents cervical cancer” are based. It is moreover unethical to publicize statements which do not give the full information needed by both patients and doctors, and may are seriously misleading. Patients can only make their own assessments of harm versus benefits it that they are given the truthful facts. They need doctors who can distinguish between fact and spin, and help them make genuinely informed decisions. A high incidence of cervical cancer and high mortality rate is caused by law prevention, detection and therapy of precancerous lesions with neuroendocrinal and obstetrical origins. Cervical cancer can be promoted by many non-specific factors, including such gynecological ones as: faulty prediction and determination of birth date, instrumental instead of possible natural labor, reduction of lactation, early sexual life, wrong hormonal therapy, long lasting prescription of pills, infrequent diagnosis and wrong therapy of hypothalamic conditioned abortions and premature deliveries, eradication of neoplastic lesion without normalization of its environment.
Sexually transmitted infections include, for example: chlamydial infections, gonorrhoea, trichomoniasis, syphilis, chancroid, genital herpes, genital warts (caused by the human papilloma virus) and HIV. Endogenous infections include bacterial vaginosis and candidiasis, which result from an overgrowth of organisms normally present in the vagina. On the other hands iatrogenic infections are caused by the introduction of microorganisms into the reproductive tract through a medical procedure i.e. unhygienic delivery conditions and other procedures such as pregnancy termination, menstrual regulation, IUD insertion, sterilization procedures and circumcision carried out under unhygienic conditions.
In medical thermodynamics the inflammation is perceived as a phenomenon proving local and/or general states far from physiological hemostasis. The inflammation is always evidence that there is a local and/or general insufficiency of the organisms independent of the causes and reasons leading to such unstable states. Infections with bacteria or viruses may, but do not have to lead to the diseases generally referred to as “infections” in which an intensity of the symptoms and affections depends on the internal state of the organisms. Clinical course of these events proves that if the states far from equilibrium are maintained, this is potentially a dangerous situation, and even a quite weak negative stimulus may shift them into a dissipathogenic original reason of a tumor.
It has taken me twenty years to achieve recognition of neurohormonal background of cervical cancer and thirty years to understand the thermodynamic cause of cancerogenesis. Twenty years ago, I have introduced Immunotherapy of cervical intraepithelial neoplasia during the 2nd EAGO Meeting in Paris after it first presentation during Jubilee Congress of Polish Gynecologists (1985). My treatment consists of three injections every second week of 0.5 ml Gynatren (Solco-Trichovac) containing ca 7.108 lyophilized coccoid forms of Lactobacillus acidophilus. The lactobacilli vaccine has an immunogenic effect in serum and locally in the vagina as a natural protection against many foreign pathogenic microorganisms by restoration of normal Doderlein flora and transfer of surface antigens by plasmids. Table 1 presents the results of two Gynatren vaccinations in women with CIN and infections changes. CIN was cytologically diagnosed and proved by colposcopy and in questionable cases diagnosis was confirmed by biopsy. This effect is apparently stronger in women without CIN as well as two weeks after the third injection. Therefore, the very aggressively promoted HPV vaccine at last is not the first one in immunoprophylaxis of cervical cancer as well as sexual transmitted infections are not related only to one virus.
Tab 1. Results (%) of two Gynatren vaccinations in women with CIN and infections
Klimek R. Cervical cancer as a natural phenomenon. Presented at 4th Meeting EAGO, Cracow 1989; Eur J Obstet Gynecol Reprod Biol, 1990, 36, 221-238
Klimek R. Conquering cancer ourselves. New trends in gynecology and obstetrics. J.Libbey CIC s.r.l., Roma 1990, vol VI no 2, 53-117
Klimek R. Biology of Cancer: Thermodynamic Answers to Some Questions. Neuroendocrinology Letters, 2001, 22, 413-416
Klimek M, Klimek R, Mazanek-Mościcka M. Preterm birth as an indicator of cancer risk for the mother. It J Gynacol Ibstet 2002, 3, 73-77
Klimek R, Dembowska J, Bałajewicz M, Plechanow J. Effect of immunopotentialization on rate of vaginal smear normalization according to appearance of cervical intraepithelial neoplasia. Int J Gynecol Obstet, 1989, 28, 41-44
Conclusion
The role of research ethics committees is to essentially protect the rights and the welfare of any human participants by collectively considering the ethical implications of a research proposal rather than scientific issues. One should not forget that from medical and ethical reasons HPV vaccines should not be advertised and marketed as an anticancer product. ESGO has to reconsider its position to produce a mutual European statement aiming for the wellbeing of our patients against the too aggressive marketing of HPV vaccination by the industry. Some WHO Committees recognized cervical cancer as a sexually transmitted disease disregarding e.g. hormonal contraception, obstetrical hemorrhages, premature and instrumental deliveries and lack or insufficient breast-feeding as the main risk groups of cervical cancer developments not taking into account such life-style factors as tobacco smoking, narcotic substances, etc. Therefore some gynecologists reckon that HPV vaccines should be advertised and marketed as an anticancer and not a STD, preventing a product which could result in a misleading opinion that vaccinated women are entirely protected from cervical cancer. Zur Hausen and Gissman clearly established that an infection induced by HPV is the cause of some cervical cancers (see ESGO Statement - reference 4: zur Haunsen. Infections causing human cancer), but HPV is not in a direct cause-effect relationship with cervical cancer. If the vaccine prevents only certain HPV subtypes from infecting individual, it is possible that other subtypes or even other viruses will quickly fill the void. HPV is only one of many, including infectious causes of dissipatogenic (precancerous) cellular state which is in a direct cause–effect relation as an origin of cell self-organization into cancer cell as newly formed dissipative structure with its unique genetic identity.
I am not in opposition to HPV vaccination which has to be used not only before the onset of sexual activity, but also e.g. before the beginning of hormonal contraception owing a strong positive relationship between cervical cancer incidence and duration of oral contraceptive use. Why not introduce such information into discussed statement. What more, the ESGO Statement on Cervical Cancer Vaccination connotes to advise all women with Pap test abnormalities or after treatment of already established dysplasia that HPV vaccine has no known therapeutic effect. Again, first of all, it has to be advised that in such cases there exists an effective immunotherapy using Lactobacillus vaccine since twenty years, regrettably without industrial support. I therefore cordially ask you to consider my proposal on the progress from Semmelweis’ idea of clean hands to our clear conscience, free from the accusation of the industry’s convenient statements.
»2 weeks - not only assess the current maturity, mass, length and gestational age of the child but also predict those values in the perinatal period. It brings measurable medical, social and financial profits and - most importantly – discards the ethics of reticence on the dangerous dominance of technology over general knowledge. It also reminds the doctors that their first obligation remains the tenet “primum non nocere”. There was a time when improper use of cardiotocographs resulted in too much irreversible medical and social damage. The time has come to point one’s finger at manufacturers and users who bear the responsibility for similar effects in obstetrical ultrasonography. This is the best way to bring the percentage of prematurity down to the natural limit of 2.5% of all deliveries. Currently, 10-18% of labors are induced prematurely only because the calendar time of pregnancy duration has exceeded 287 or 294 days from the date of the last menstrual period, which additionally is given by the mothers accurate to several days, anyway.
The reduction of perinatal mortality – sometimes wrongly ascribed mainly to obstetricians – is primarily an effect of the amazing progress in neonatology. Low birth weight, perinatal mortality and prematurity rate have been even adopted as general social and economic indices of development of entire countries or at least selected territories. Therefore, to bring out the role of obstetricians there in, one should permanently introduce two other clinical criteria: distribution of birth in the range of six-week norm of occurrence in humans and ratio of premature infants to the mature ones at the gestational age <37 weeks counting from the last menstrual period.
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Enzymatyczna diagnostyka ginekologiczno- położnicza
Pociążowe neuroendokrynne
zespoły chorobowe i nowotwory
O programie prognozującym
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