Challenging Dogma

...Using social sciences to improve the practice of public health

Saturday, April 21, 2007

"Tell Someone" The Whole Truth – Emily Littlejohn

The recent hype around the new Human Papillomavirus (HPV) vaccine is well deserved—a vaccine that can help prevent cancer is a huge step for science, medicine and public health. However, the development of this vaccine has brought with it public health messages that convey and don’t convey certain information to the general public about the risks and behaviors surrounding HPV. One campaign, called the “ Tell Someone" campaign, put forth by Merck pharmaceuticals in releasing their HPV vaccine, Guardisil, is of particular interest.

The "Tell Someone" Public Health initiative utilizes concepts from Self-Efficacy and Agenda Setting theories and has been successful in drawing awareness to HPV, cervical cancer, and how women can protect themselves. However, these models and this initiative have deliberately left out information on HPV transmission creating an illusion of just "how easy" it is for women to protect themselves from cervical cancer.

Self-efficacy is a perception based on the perceived ability to do something and behave a certain way (1). According the online encyclopedia Wikipedia, self-efficacy is “an impression that one is capable of performing in a certain manner or attaining certain goals” (1). If people can perceive and believe they can accomplish something, then they are more likely to change their behavior and do it. Conversely, if a person perceives they are not able, or cannot do something, they are less likely to attempt to change their behavior. An example can be illustrated in smoking; If a person perceives quitting smoking is something they can really do and stick with, they are likely to try to quit. If the person has low self-efficacy, or does not believe they can truly quit, they are unlikely to change their behavior.

This model is applicable to the “Tell Someone” campaign for a number of reasons. The crux of the campaign is that it gets the word out that cervical cancer can be caused by HPV (2). Additionally, the campaign explains that getting the HPV vaccine can protect women from this virus, and ultimately cervical cancer. The commercials for the campaign show clips of women surprised at how easy it is to protect themselves by getting the vaccine, and encourages the viewer to “tell someone” they know and love to help protect them, too. In fact, the website slogan states, “Help protect your future, and the futures of those you love. Ask your doctor about ways to help prevent HPV and its consequences.” (2). In this way the advertisement is showing people what they can do, and just “ how easy “ it is—a token feature to the self-efficacy model.

The first, most important facet left out of this model is the fact that HPV is a sexually transmitted infection, and that there are other ways to avoid HPV (besides getting the vaccine) – by staying sexually healthy and visiting a gynecologist regularly. Nowhere in the ads or ad campaign does Merck mention the behaviors involved in the acquisition of HPV. As the Pharmaceutical Business Review-Online states, “What is strangely missing from the otherwise informative and influential "Tell Someone" television ads is the key fact that HPV is a sexually transmitted infection” (3). This creates a huge problem, as women don’t perceive how their behavior applies and can translate to getting the virus. Marcelle Pick, founder of the Women to Women Medical Health Clinic, has also noticed the important information left out of this campaign, “What the commercials don’t make clear is that the vaccine is meant for very young women who have had no prior sexual contact […] reliance on a vaccine for HPV may lead women to ignore the underlying causes” (4).

At an online women’s forum, an angry blogger came forth,
“There isn't a single reference to sex in the entire commercial, even though HPV is sexually transmitted. […] Any mention of sex would be read in popular culture as an assertion that women who get cervical cancer are [promiscuous] […] What will really help prevent the spread of HPV is frank discussion of how it is transmitted, how it can be prevented, how precancerous cells are detected, and how any woman who has any genital contact with anyone is potentially at risk. It's not a scare tactic, it's the truth” (5).

Here, the public is responding to the ad campaigns in stating that they realize something is missing. They want the whole truth to be told, not a twisted version that avoids dealing with the issue of a sexually transmitted infection and responsible sexual behavior.

Because the behavioral cause of HPV is intentionally left out of the picture, women falsely believe “how easy” it is to avoid HPV and cervical cancer. They think it is simply a matter of getting the “quick fix” of the vaccine, rather than changing risky behavior. Even the vaccine name, “Guardisil”, reinforces this idea in women’s heads; they think they are “guarded” against HPV and cancer, no strings attached. “The drug company behind the vaccine is already promoting it as a cure-all solution. The ad campaign, titled ‘Tell Someone”, has created false hope among women that this new vaccine will make the HPV problem go away” (4), says Marcy Holmes, a practitioner at the Women to Women Health Clinic. Merck may think that women are more likely to inquire about getting a vaccine from their doctor knowing “how easy it is” and knowing that they may avoid the topic of sexual behavior, which is a great advertising ploy. However, withholding the truth from people creates an illusion and a false sense of immunity from STIs, and is not responsible advertising. As illustrated above, many people would rather know the whole truth and be aware of the causes of a virus that can potentially cause cervical cancer than be left in the dark and think a quick fix vaccine is a cure all.

Another Health Behavior model employed in the “Tell Someone” campaign is Agenda Setting theory. Agenda Setting theory is based on the media creating awareness around an issue and deciding what topics are important and thus setting the public agenda (6). If an issue gets a lot of hype in the media, it then becomes an important issue to the public. The theory explains the correlation between media coverage of an issue and the extent that people think that this story is important (6).

Using Agenda Setting theory, the media has hyped up the public over the new vaccine. Almost everyone has heard or seen the commercials and news coverage can be found in magazines, newspapers and online ads. In fact, in reading the newspaper, it is rare to not find an article somehow related to the issue, its implications or its implementation. Consequently, the HPV vaccine has become a hot topic and a critical issue in the public eye.

As momentous and important the development of this vaccine may be, Merck is misleading women into believing that the Guardisil vaccine is a foolproof cure-all. Although very effective, the lab-to-marketing phase of the vaccine has happened very quickly. There are still possibilities that more strains of HPV, that the vaccine does not protect against, will be proven to cause cervical cancer. “Many vaccines can have negative effects on health and this new vaccine has not been studied in sufficient depth or over sufficient time to ascertain its long-term safety. The truth is we just do not know enough yet to be generating this kind of hype,” (4) says Holmes. Since there is a distinct lack of information surrounding this vaccine, it is extremely important for people to understand the cause (here, risky behavior), which leads to the acquisition and spread of HPV. We cannot rely on the “quick fix” solution, if in truth it may not be a “fix” at all. “The fact that a number of articles have called Guardisil a vaccine against cancer is either sloppy journalism or pure propaganda, because reporters are in a position to know better--and should be doing better research” (7). Although the development and distribution of this vaccine is a very important medical advancement, the media is hyperbolizing the extent of how safe and effective the vaccine is before sound, well-researched scientific confirmation.

It is so important for women to thoroughly understand HPV; what it is, how it is acquired, how it affects the body and can cause cancerous cells. Most importantly, women need to know how to be protected from it. As sexual health gains greater attention amidst the media and in the public, we should take this opportunity to broach topics that have previously been seen as too private or inappropriate for public discussion. Namely, that risky, irresponsible sexual behavior can lead to HPV and consequentially cervical cancer. By being sexually responsible, visiting the gynecologist regularly and in general taking one’s health seriously, one can avoid HPV. That is the whole truth. Tell Someone.

1.Wikipedia, free online dictionary. Self-efficacy.
2. The Society of Obstetricians and Gynaecologists of Canada (SOGC) HPV info: Tell Someone. Ottawa, ON.
3. O’Malley, Kimberly (2006, June 13) Merck & Co: the marketing machine behind Gardasil. Pharmaceutical Business Review online.
4. Women to Women (2006, June 20). Hype about new HPV vaccine is more good marketing than good medicine: Yarmouth, Maine: Women to Women.
5. Sexual Evolution (2006, October 22). HPV Politics: Tell Someone.
6. University of Twente. Agenda Setting Theory. The Netherlands.
7. Dakota Voice Blog (2007, March 14). HPV Researcher Blasts HPV Vaccine Marketing.

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  • At April 26, 2007 at 7:35 AM , Blogger Emily said...

    Just recently Merck has released its new commercial for Guardisil presented as the "One Less" Campaign, where women encourage other women to get informed and become "one less" affected by HPV. Fortunately, sexual behavior is actually mentioned in the ad. Maybe after public criticism on the "Tell Someone" effort, Merck is trying a different, more responsible approach.

  • At April 26, 2007 at 7:51 AM , Blogger christine peloquin said...

    loved your ending. very well-written twist on the campaign's slogan.

    good point that we need to be cautious about how successful the vaccine will be. while the vaccine's efficacy was proven in the clinical trials, its effectiveness in the uncontrolled, real world remains to be seen.


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