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  • BIOETHICS FORUM ESSAY

Let’s Talk About Sex, Baby

Most 20-somethings can readily recall Salt ’n Peppa’s 1992 hit rap song, the chorus of which declared: “Let’s talk about sex, baby/Let’s talk about you and me/Let’s talk about all the good things and the bad things that may be/Let’s talk about sex, let’s talk about sex.” In the decade and a half since the release of the song, American culture has become ever less prudish (if that seems possible), regularly alluding to sex on primetime TV and overtly featuring sex on cable networks and in pop music.

Nonetheless, there are some areas in which talk of sex is overlooked, downplayed, or outright suppressed. In the formats in which we least need it (TV, radio, the internet), sex is abundant, but in the areas where it ought to be given attention, sex is shushed. I have in mind the marketing of Merck’s two year-old vaccine, Gardasil. The vaccine inoculates girls and women, ages 9 to 26, against four common strands of the human papillomavirus (HPV), which together are responsible for causing 70% of cervical cancer cases. Advertisements for Gardasil, now common on network television, use a full minute of air time to communicate this message. Unfortunately, this is all they communicate. The Merck ads talk rather cryptically of HPV’s relation to cervical cancer, and all the while studiously avoid mentioning that HPV is a sexually transmitted disease, is easily communicable, and can be passed between partners even without their actually having had intercourse. The virus is so common, in fact, that the CDC estimates that 80% of adults will contract at least one strand of HPV in their lifetimes. For most people, the body’s immune system rids itself of the virus without incident, but for some women, HPV leads to the growth of irregular cells in the cervix which, left untreated, can lead to cervical cancer.

These facts are straightforward enough. Why, then, Merck’s exclusion of the fact that HPV is a sexually transmitted disease? The outcry from conservative religious factions when the vaccine was released seems a likely contributing factor. Members of the religious right denounced Gardasil at the time of its release, predicting that immunizations in preteens would encourage otherwise abstinent girls to engage in sexual activity. Although even the most conservative organizations eventually recognized the vaccine as a potentially lifesaving health measure (they remain staunchly opposed, however, to mandated vaccination), their initial protests almost certainly affected Merck’s marketing campaign. Whatever the factors that shaped the campaign, Merck’s decision to dissociate sexual intimacy from HPV and cervical cancer propagates a woefully incomplete account of a pressing public health issue.

Admittedly, conservative groups’ ideological opposition to the vaccine has received plenty of criticism. Nearly all of the criticism, however, has focused on the ways in which certain factions have hindered the passage of state legislation that would mandate that middle school girls receive the vaccine. What critics do not seem to have picked up on is that the abstinence-only agendas of these groups, in their ability to affect what is said (or, rather, not said) in ads for Gardasil, also negatively affect women in their late teens and 20s. Let me explain briefly what I mean.

As a woman approaching the outer age limits of qualifying for the vaccine, my not having the full story about why Gardasil is important has delayed my getting the three-shot series far longer than if I had been presented the whole picture. The same, I think, can be said for most of my friends. Because I spend my days researching issues in health and health care, I have been able to piece together for myself all of the details about the interrelationship of HPV, sex, cervical cancer, and Gardasil. But this took a good bit of digging online, and no single site – not even the CDC’s – makes all of the statistics and details readily available. For teens and young women whose only exposure to information on Gardasil comes from Merck’s TV ads, I fear that the omission of the role that sexual intimacy plays in the spread of HPV minimizes the likelihood that women in their late teens and early 20s will get vaccinated. For women who do not have the time or resources to research health measures that would impact them, Merck’s ads may be one of the few channels through which information about HPV is communicated. Although minor girls may receive the complete story about HPV through public school health classes, there remains a large population of women in their 20s for whom this information has never been made clear.

Merck needs to reconceptualize its marketing of Gardasil to include the fact that HPV is an easily acquirable sexually transmitted disease. Ideally, this information would be communicated in all of their marketing materials, television ads especially. Some will contend that eleven and twelve year old girls are too young to receive information about sex and HPV through advertisements. Perhaps, although it’s debatable. One compromise might be for targeted ads to air on late-night television (after “family viewing” hours are over) and on cable channels with a younger viewership, like MTV and VH1.

Merck would do well to get behind so many pharmaceuticals’ claims that their products are for the benefit of the public’s health and that for-profit motives are secondary. If the American public can handle sitcoms in which sexual antics drive the storyline, they can handle public health ads with crucial sexual health information. Let’s talk about sex, baby – let’s talk about HPV.

 

Readers respond

Thank you for raising this issue. I am not convinced, however, that your analysis is accurate. The issue of HPV being a common, if not the most common, sexually transmitted infection is not a well-kept secret. Every pamphlet, book, or lecture about safe sex practices mentions HPV as a sexually transmitted infection whose transmission may be reduced by the appropriate use of a barrier device. Leaving aside, for the moment, the validity of this teaching, it is common practice, in the public health arena to discuss HPV and it’s relation to sex.

The manufacturer of another drug that purports to reduce the risk of transmitting another common viral sexually transmitted infection has taken the approach of directly tackling the sexual transmission of Herpes Simplex in its advertising. They use adult actors and seem to stress that the issue of transmission to a non-infected partner arises within a committed relationship. There is no question of shying away from the discussion of sex in this context.

One wonders whether the reticence to engage in sex talk, in the context of the HPV vaccine debate is related to the fact that this vaccine is being targeted to our early adolescent and, in the case of nine year olds, our pre-pubescent daughters. There is a difference between a 20- or 25-year-old woman seeking out the information about HPV and the impact of vaccination on her risk of developing cervical cancer, should she be infected, and the state-mandated vaccination of an 11-year-old girl before she has the capacity to understand what she is having done to her. This vaccine is not in the same league as the vaccines that are currently given to children, in that it is targeted against an infection that is sexually transmitted and not transmitted, as are the others, by casual contact. We, as parents, should rightly be concerned about the implication that the state knows best with regards to the sexual health of our children.

Perhaps, as a company, Merck knows that it would be treading in murky waters should it make its advertisements explicit with regards to the sexually transmitted nature of HPV infection. There are other ways of helping our children reduce the risk of infection and improve their health and these include discussion of the proper role that sex plays in our lives and that the ‘hypersexualized’ culture that is targeting our teens is not the only forum for talk about sex.

– Harry D. Mueller

 

This comment isn’t meant to defend the Merck ads, because I agree that they, like most of the information regarding HPV and Gardasil, leave much to be desired. However, I would raise a couple of questions/points. First, the ads are meant to get young women and parents (consumers) to get the vaccine- for Merck to make a profit. If pharmaceutical companies are claiming that profit is a “secondary” interest, they are telling (at best) a half-truth.

Second, the ads do discuss the relationship between HPV and cervical cancer, so one needs to demonstrate why the risk of cancer is not a sufficiently compelling reason for young women to request the vaccine. In other words, while I agree that better and more information is needed, I’m not sure why, in a TV ad, disseminating information regarding the sexual transmission of HPV would encourage more women to get the vaccine than informing them that the vaccine could protect them from a dangerous cancer.

– Priya P. Curtis

Published on: February 28, 2008
Published in: Public Health

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