Our latest Pieces of the Continent interview is with Gretchen LaSalle MD FAAFP is a board certified family physician.
Gretchen completed her medical school training at the Tulane University School of Medicine and her residency at the Oregon Health and Science University. She has practiced at MultiCare Rockwood Clinic in Spokane, Washington for the last 13 years and serves as a Clinical Associate Professor for the WSU Elson S. Floyd College of Medicine. Vaccine advocacy came as a natural extension of her passion for preventive care. She is an active writer and public speaker on the topic. She runs a website (gretchenlasallemd.com) where she offers reliable sources of vaccine-related information (research articles, videos, books, and more) and writes regular blogposts, specifically aimed at providing vaccine education and countering vaccine misconceptions. In October 2019, she published a book with Wolters Kluwer Press titled Let’s Talk Vaccines: A Clinician’s Guide to Addressing Vaccine Hesitancy and Saving Lives. In a growing climate of vaccine hesitancy, her primary mission is to keep patients from falling victim to vaccine misinformation and to decrease the frustrations, while increasing the successes, that clinician’s have in getting patients vaccinated. HPV vaccination is one of her favorite things to discuss with patients and parents, as the extent and severity of HPV-related illness and the success of the vaccine is still not well understood by many.
Q: What are the main responses have you seen to the HPV vaccine in your work as a family physician?
I’ve seen a mixture of responses. Those who know the devastation that HPV-related cancers and pre-cancers can cause are excited that their children and grandchildren may no longer have to suffer from these very preventable conditions. However, there are many more who aren’t very familiar with HPV-related diseases; who still think that it is a virus that only affects individuals with “high risk” sexual activity; that the vaccine will somehow encourage earlier and riskier sexual behavior; who think that they should just wait until their kids are older to get the vaccine; or that the vaccine is still only indicated for girls.
Q: How can we improve parent-physician discussions surrounding the HPV vaccine?
We need to start with an anticipatory approach to the vaccine discussion. We need to be talking about this vaccine at early ages, prepping the parents for the fact that it is one of the routinely recommended childhood/preadolescent vaccines. It is much easier to get parental buy-in that this is a cancer prevention vaccine (which, of course, it is), instead of a STD prevention vaccine, when we are discussing it long before their children are even close to becoming sexually active. If we can’t avoid the discussion of the virus as related to sexual activity, I try to remind parents that it takes NO high risk sexual activity to contract the virus. Skin to skin contact is all that is needed. Even deep kissing is suspected of possibly transmitting this virus. I also help them remember what it was like to be a teenager. I ask them to think back to their own adolescence and consider whether they ever made decisions they regretted or did things that they didn’t tell their parents. I remind them that their kids, our kids, will be no different and that we owe it to them to protect them as much as possible.
Q: What do you see as the greatest obstacle to take up of the HPV vaccine? How can we overcome this?
We’ve got to get past the idea that this vaccine is to protect against a sexually transmitted disease. This adds a stigma to it that isn’t real or fair. We have to focus on it as a cancer prevention vaccine and, as discussed above, I think talking about it early and often is the best way to address this issue in a proactive way.
Q: Do you have any final thoughts or anything you would like to add?
We need all hands on deck when it comes to vaccinating against HPV. It shouldn’t just be the responsibility of the pediatrician or family physician to educate. HPV-related cancers are dealt with by many specialties - Ob/Gyn, ENT, Urology, Colorectal Surgery, Oncology, Dentistry and more. If all of these specialties add their voices of support and education, it will be easier to get our message across loud and clear.