Cochrane HPV vaccination review – what about the CDC’s Lauri Markowitz’ undisclosed conflicts of interest?

Elizabeth Hart

Why is the focus only on Marc Arbyn’s conflicts of interest?

What about the conflicts of interest of the CDC’s Lauri Markowitz, who has been a very influential contributor to the Cochrane HPV vaccination review, as outlined in my previous rapid responses on this matter on Nigel Hawkes’ article HPV vaccine safety: Cochrane launches urgent investigation into review after criticisms: https://www.bmj.com/content/362/bmj.k3472/rapid-responses

Lauri Markowitz’ conflicts of interest are not disclosed on the Cochrane HPV vaccination review.

I have asked David Tovey, Editor in Chief of Cochrane, how and why was Lauri Markowitz ‘ original participation in the Cochrane HPV vaccination review approved by Cochrane?

I have also asked who initiated the Cochrane HPV vaccination review protocol?

David Tovey has so far not answered these questions. Can The BMJ please follow up on these matters?

It’s important to examine Lauri Markowitz’ involvement in the Cochrane HPV vaccination review because, as noted in my previous rapid responses, she has undisclosed conflicts of interest, and her input may have biased this review.

As another example demonstrating Markowitz’ conflict of interest, see the video CDC Grand Rounds Beyond the Data: Reducing the Burden of HPV which features Lauri Markowitz and her CDC colleague John Iskander promoting HPV vaccination. The video was published on YouTube on 27 February 2013: https://www.youtube.com/watch?v=bnd_iCOR7-w

How can Lauri Markowitz be an impartial contributor to the Cochrane review of HPV vaccination, when she has obviously been an avid promoter of HPV vaccination, as illustrated in the transcript of the CDC video below?

TRANSCRIPT:

John Iskander: I’m John Iskander, welcome to Beyond the Data. I’m here with Dr Lauri Markowitz. So Lauri we had a lot of great information at today’s public health grand rounds about the HPV vaccine. But there seemed to be some issues with getting teens in to complete the vaccination series, so what’s going on with that, and what are some of the things we can to do improve that?

Lauri Markowitz: Well kids of this age are busy. They have schedules, extra-curricular activities, it’s hard to get them in for the three visits that are needed to complete the vaccination series. I think that providers can do a variety of things. The first thing is when they get their first dose to be sure to remind them that they need two additional doses to complete the series. And then I think doing reminders, reminder calls, reminders of any sort, are really going to be helpful to get the second and third doses in. And also providers can remember to use every visit that the adolescents come in to immunise. I think all those things can be helpful. The other thing I should mention is quick visits, so when they come in to get their second and third dose they don’t have to wait and have a full visit, they can just come in for their vaccination.

John Iskander: OK. Those sound like very good practical strategies. You know we also saw data that suggests there’s a significant minority of kids that haven’t yet started the vaccine series. So, what are the issues there, are these some different strategies that need to happen to get more kids started on this protection?

Lauri Markowitz: Well, we know there’s some fairly strong data that one of the most important things is a strong provider recommendation. Having a recommendation from a provider for any vaccination is one of the most important predictors of getting vaccinated, so that’s very important. There can also be things like standing orders, so that if an adolescent comes in in the age group where the vaccine is recommended, they can, there can be some indication on the chart they can be offered the vaccine. And again, eliminating lost opportunities, if an adolescent is coming in, and gets another vaccination that’s recommended at that age, they can also get the HPV vaccine.

John Iskander: OK, so it sounds like we really do have a lot of tools to be able to address these problems with, but providers are under a lot of time pressure, they might have 15 minutes for some of these visits, and you know, they need to communicate some key information about this vaccine and its importance. So, what are the, you know, in that short amount of time, what are the most important things they should be talking about?

Lauri Markowitz: The most important thing, this is an anti-cancer vaccine, we know it’s a very effective vaccine, it’s actually one of our most effective vaccines, and those are very important things. It’s recommended for both boys and girls, at 11 or 12 years, and this is a great age to give the vaccine, we know the immune response to the vaccination is very good at this age, and it can be delivered before any potential exposure to the virus.

The BMJ has also published another rapid response by me on Peter Doshi’s Pandemrix article, i.e.
Vaccination is political – citizens are entitled to transparency and accountability:
Interesting now that Fiona Godlee has followed up with another article, see A tale of two vaccineshttps://www.bmj.com/content/363/bmj.k4152
Is this progress?  At least we’re getting the opportunity to put this point of view on The BMJ.  Also a varied group of rapid responses on Doshi’s article, including from GSK and the EMA.
Elizabeth

Source: https://www.bmj.com/content/363/bmj.k4163/rr

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