Friday, December 08, 2006

A Social Science Critique of Merck’s “Tell Someone” Campaign – Ann Perrin

“There’s a common virus that can cause cancer? I didn’t know that!” Merck’s Tell Someone television campaign is reaching millions of women to inform them about cervical cancer and its causes. I find several problems with this campaign, including how Merck “defines” human papillomavirus, the missing content, and the use of fear messages.

Merck defines HPV as a common virus with over 100 strands. In the commercial Merck does not come out and say that HPV is a sexually transmitted disease. This is pertinent information because by possessing the information that HPV is a sexually transmitted disease, one knows exactly how it is transmitted and can assume certain precautions against getting it. By defining HPV as a virus and not an STD, people are not only misinformed about what HPV is but also about the progression of HPV.

As discussed in the first class, how we frame an argument or the facts can lead people to believe certain things. The article “Actual Causes of Death in the United States” by McGinnis and Foege frames the most prominent causes of death as individual behaviors whereas Link and Phelan frame the most prominent causes of death as social factors in “Social Conditions as Fundamental Causes of Disease.” Neither duo is completely right nor completely wrong, it just depends on what type of question you ask and who your audience is. Here Merck is trying to market a vaccine for HPV. Their advertisements frame HPV as leading to cancer not as a sexually transmitted disease even though most forms of HPV never lead to cervical cancer. Although this is not wrong information, it misinforms the public to thinking HPV is not a sexually transmitted disease since it is not mentioned and therefore can be detrimental to the public’s understanding of the virus.

These ads are missing key information in order to be an informative piece of material. Although HPV is the most common STD in the United States, with approximately 20 million people in the U.S. infected at anytime (Mahdavi and Monk), fewer than one-third of men and women have heard of it (Anhang, Goodman, and Goldie p.250). Of those who have heard of HPV, very few know what the symptoms are, what it can lead to, and how it is transmitted. The Tell Someone television ads do make people aware of HPV and that some strands lead to cervical cancer, but they do not let people know what the symptoms are and how HPV is transmitted. With less than one-third of the common population having previous knowledge about HPV, this ad leaves much room for confusion. Studies have shown that “women’s basic areas of desired information are: transmission, prevention and detection, treatment and progression without treatment, and risk of cervical cancer” (Anhang et al p.252). “A content analysis of HPV news stories from 1995 to 2002 found that many stories failed to provide complete information about HPV’s link to cervical cancer” (Anhang et al p.254). Although the Tell Someone campaign has clearly linked HPV to cervical cancer, like many previous news stories it is “missing vital information regarding HPV prevention, transmission, and symptoms” (Anhang et al p.254). “Thus far the media have not adequately conveyed appropriate levels of HPV risk perception or the distinction between low- and high-risk types of HPV” (Anhang et al p.255).

Six points have been recommended to “be emphasized when providing patients technical information about HPV and HPV testing: (1) HPV is sexually transmitted; (2) HPV is very common; (3) most women with HPV will not develop cervical cancer; (4) HPV’s most common prognosis is clearance without treatment; (5) the purpose of a Pap test is to detect HPV-related lesions in the cervix suggestive of precancerous or cancerous conditions; and (6) most women who test positive for high-risk HPV will not be diagnosed with cervical cancer or a precursor on further evaluation” (Anhang et al p.256). The Merck campaign makes number two—HPV is very common—apparent, but only glosses over or completely ignores the other five points. This leaves many women confused and wanting more information. If they turn to Merck’s website on HPV, http://www.tellsomeone.com/, they can find some more information. However, this information should be expressed in the commercials because by only having it available on the internet Merck is excluding a specific type of population from receiving all the correct information. Those who do not have access to a computer or the internet, or those who are illiterate are already at greater risk of not seeking needed treatment for HPV. By not providing these people with all the facts, Merck adds to the differences between the “haves” and “have nots.” This undermines the effectiveness of Merck’s message. As good as a message’s content may be, if that content is not communicated adequately, its effectiveness is lost.

An article in A Cancer Journal for Clinicians entitled “HPV Communication: Review of Existing Research and Recommendation for Patient Education” states that, in order to combat health illiteracy, the communication style of clinicians is as important as the content of their message (Anhang et al p.257). This can be applied to the HPV campaign by Merck. I have previously established that there is vital missing information. If we pretend that all the information needed to make an informed decision is present for a minute, we can concentrate on the communication style of the clinician, or in this case, the women delivering the message in the commercial.
The writers of the commercial were very insightful to use women and mothers with adolescent daughters to deliver their message. Their persuasive communication technique catches the attention of the intended audience. Women are more likely to relate to women. Furthermore, the way the women communicate the message with an element of concern was an important style choice. However, there are other elements of style that Merck did not grasp.

One such element is Merck’s use of fear messages to get people’s attention. “There’s a common virus that can cause cancer? I didn’t know that!” When the phrase “common virus” is mentioned most people think of something simple like the common cold. Then to say there are over 100 strands of HPV does not increase someone’s confidence, although it might get their attention. This use of fear arousal to increase health seeking behaviors has actually been proven to backfire. It has been shown that extreme emotions interfere and turn people off (O’Malley).
We can see examples of failed fear messages in the HIV prevention literature. The safe sex campaign targeted toward gay men where the message was “people must use a condom every time they have sex for the rest of their lives” so they will not contract HIV/AIDS created “a sense of hopelessness and complete lack of control” among the gay community (Siegel p.67). Like the “condom every time” campaign, the HPV campaign by Merck gives people a sense of hopelessness while trying to get them to increase their health seeking behaviors. By only knowing that millions of women have HPV, there are over 100 strands, and it leads to cervical cancer, there are many questions left unanswered. As stated in “The Importance of Formative Research in Public Health Campaigns: An Example from the Area of HIV Prevention among Gay Men,” “people must feel that their decisions are being left to them, that they are being given all the options and all the information, but that the final decision, and therefore the control of their future, is in their own hands” (Siegel p.68). In the campaign among the gay community this would mean your risk of contracting HIV during unprotected sex, not just the blanket statement, “you will get HIV if you do not use a condom even once,” which leaves people feeling hopeless. In the Merck campaign this would start with how HPV is contracted and safer sexual practices to avoid it, as well as the knowledge that a very low percentage of HPV cases actually lead to cervical cancer.

Another study titled “AIDS prevention: Application of health education principles to different subcultures” further addresses this issue. Here, the authors state that instead of saying the blanket statement that unsafe sex leads to death, a more thoughtful and personal approach should be taken in order to change people’s health behavior. First, the stimulus used, whether fear or something else, should not be too great. Next, a way to shape safer behavior should be offered. Instead of saying that people should change their behavior, ways they can accomplish this need to be offered. Finally, there should be immediate reinforcement for health seeking behaviors.

The Tell Someone television campaign does use fear, but between the concern of the actresses and the missing information the fear angle is too intense. The commercials do mention pap tests and recommend talking to a doctor, but without stating how HPV is contracted, people are not able to learn safer health behaviors. Lastly, there is no immediate reinforcement for health seeking behaviors.

Merck’s Tell Someone television campaign paved the way for the appearance of Merck’s HPV vaccine hitting the market. In the end it’s about making a profit and selling a product. How the ads “define” HPV, the missing content, and the communication style/use of fear messages frame HPV in a way that will sell Merck’s “cancer prevention product” and not completely educate the public on this sexually transmitted disease.

References:
Anhang, Rebecca, Annekathryn Goodman and Sue J. Goldie. “HPV Communication: Review of Existing Research and Recommendation for Patient Education.” A Cancer Journal for Clinicians. 2004; 54; 248-259.
Link, Bruce G. and Jo Phelan. “Social Conditions as Fundamental Causes of Disease.” Journal of Health and Social Behavior. 1995, (Extra Issue): 80-94.
Mahdavi, Ali and Bradles J. Monk. “Vaccines Against Human Papillomavirus and Cervical Cancer: Promises and Challenges.” The Oncologist. 2005; 10; 528-538.
McGinnis, Michael, MD, MPP and William H. Foege, MD, MPH. “Actual Causes of Death in the United States.” JAMA. November 10, 1993; Vol. 270, No.18; 31-36.
O’Malley, Kimerly. Merck & Co: the marketing machine behind Gardasil. Pharmaceutical Business review online. June 13, 2006. http://www.pharmaceutical-business-review.com/ accessed October 8, 2006.
Plymptn, Tia J. and Judith H. Hibbard. “AIDS prevention: Application of health education principle to different subcultures.” International Quarterly of Community Health Education. Vol (12)1, 1991-1992. pp.51-58.
Siegel, Michael. “The Importance of Formative Research in Public Health Campaigns: An Example from the Area of HIV Prevention among Gay Men.” Marketing Public Health: Strategies to Promote Social Change. p.66-69.
Stall, Ron. “How to lose the fight against AIDS among gay men: Declare victory and leave the field.” BMJ1. Vol 1. 17 September 1994; p.685-686.

254 Comments:

Blogger Michael Siegel said...

This is a fantastic critique of a pharmaceutical company marketing campaign. You do a great job of demonstrating how the goals of this marketing campaign run counter to basic public health goals. You also make a fine use of basic communication theory to show why the campaign may not be effective. While sometimes the goals of pharamaceutical companies and public health can be in line, you show that this is one example where they are not. And public health practitioners who are working in the area of STD and/or cervical cancer prevention must be aware of it. It would behoove them to read your article and consider it seriously.

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Anonymous Anonymous said...

I recently learned about a proposal to administer the HPV vaccination to all adolescent girls at age 13 to prevent cervical cancer. I wonder if the exclusion of the "STD" label is related to its acceptance has a preventative measure for young girls as well? -either way brings up the need to consider a pharmaceutical company's intentions.

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Anonymous Anonymous said...

I enjoyed reading your critique; it tackled the key topics of framing and communication theory and how they both affect public perception of an issue -- I thought you incorporated class topics very well into your critique.

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