Tuesday, September 13, 2011

The HPV vaccine, my bread and butter, and why Rick Perry should have known better

From the moment Rick Perry announced his 2012 Presidential candidacy, I knew there would be trouble. Michelle Bachmann's critique that Perry was in the pocket of big pharma (Merck), back in 2007, may or may not have legitimacy, but Perry's attempt to require the HPV vaccine in Texas played perfectly into Merck's marketing strategy for its new (and potentially controversial) vaccine.

In February 2007, Rick Perry, then governor of Texas, overrode the state legislature to require the human papillomavirus (HPV) vaccine for school entry. At the time, the HPV vaccine, Gardasil, was only available for girls, making it a touchy subject for parents who didn't like to think about their adolescent girls' risks for STIs. Concurrent with Perry's gubenatorial power grab, Merck was quietly lobbying state legislatures around the country, mostly through a questionable organization Women in Government, trying to get states to include the HPV vaccine as part of school entry vaccines.

On one hand, school entry vaccines have a long history in the U.S. Though there are increasing numbers of parents who opt out of the school requirements, this topic is more or less a non-issue for most parents when they enroll their kids in kindergarten. What makes the HPV vaccine different is its requirements were for sixth or seventh graders, and at the time only for girls, heightening the emphasis on its possible tacit acceptance of adolescent sexual activity. Interestingly, the parents who resisted the HPV vaccine requirements tended to emphasize not its association with sexual behavior, but rather these parents focused on a libertarian/Tea Party (though this was not yet a widespread movement in the States at the time) position: we don't want government deciding what's "right" for our children. No one seemed upset about other government public health measures, such as water fluoridation or even other school entry vaccines. Yet few of the opponents to an HPV vaccine requirement voiced explicit resistance to its association with the most common sexually transmitted infection (STI).

Rick Perry, at the time of his infamous mandate, framed his decision especially oddly. He argued that this measure was a pro-life one, stating:
Never before have we had an opportunity to prevent cancer with a simple vaccine. While I understand the concerns expressed by some, I stand firmly on the side of protecting life. The HPV vaccine does not promote sex, it protects women's health. In the past, young women who have abstained from sex until marriage have contracted HPV from their husbands and faced the difficult task of defeating cervical cancer. This vaccine prevents that from happening (emphasis mine, La Prensa, February 14, 2007).
The succession of events were fast and furious, with multiple parents suing Perry for overstepping his executive office and the state legislature promptly overturning his inititative. He had also been accused of accepting Merck campaign funds and that his former aide was now a lobbyist for Merck. Simultaneously with Perry's undone executive order, the New York Times published a couple of articles identifying Merck as the lobbying force around many of the state legislature initiatives. Almost all of the state laws failed.

Now that Perry is trying to win the Republican nomination, it's no surprise that he's being resoundedly attacked by his competitors. Though Bachmann's unrelenting insistence that the vaccine could have "very dangerous" side effects is unfounded (especially her endorsement that one girl suffered mental retardation as a result), I'm fascinated by the unfolding of this more than 4-year old discussion.

Bachmann's decision to attack Perry on the HPV vaccine does not seem to address his willingness to override the legislature's role nor his explicit indifference to the preferences of his constituents. Instead Bachmann wants to drag him down for his exposing girls to a purportedly harmful vaccine, which she herself admits she is not knowledgeable enough to determine whether its safety should in fact be called into question.

What's most interesting to me about the rehashing of the HPV vaccine debates (and I have to say, having written my dissertation on the topic, it's a little boring to me), is how perfectly it fits into the Tea Party agenda and how well it reveals the logical inconsistencies of this movement. Further, I have long argued that in order to avoid the conservative backlash against the HPV vaccine, Merck marketed the vaccine as a vaccine against cancer, not as an STI preventive. Even during the FDA hearing to approve the vaccine, the conservative organizations emphasized that they would never be against a vaccine that protected against cancer. All of Merck's ads for the vaccine have promoted it as a cervical cancer preventive, avoiding the controversy associated with sex in the U.S. It's ironic, then that the conservative movement, especially the Tea Party, has still been distrustful and critical of the vaccine and any of its proponents. Ultimately, this suggests that the debates are tacitly about sex, even as other cultural zeitgeist topics such as government regulation are invoked as the reasons for the groups' objections.

Thursday, September 8, 2011

The virtue of the outsider

One of the reasons I think being an anthropologist in the tech world is essential is that it offers a critical eye that often gets lost in the tech world bubble. As a researcher at a health tech startup, I saw firsthand how easily the Bay Area and those within the tech sector presume a lot about the role of technology in everyday lives. For example, the iPad 2 had just been released, and the company's leaders were convinced that all the doctors were wondering what they were going to do with their new gadget. A day or two at a specialty conference made patently clear to me that most doctors in the U.S. were not fretting about the newest Apple gadget. Some Bay Area (and elsewhere) physicians were excited to be on the cutting-edge of mobile devices, but for most MDs, the iPad (1 or 2) was not a core element of their daily concerns. This doesn't mean that the technology won't become well-integrated into physicians' practices, and it is important to have an eye to future technology engagement when building a new product. But hyper-familiarity with certain practices and processes can lead to the inability to understand how and why users might engage with a new product. Some naysayers point to Steve Jobs' unwillingness to do user research, but I think this misses the point. It's not that we need more focus groups or direct market research to understand users' interpretation of technology or a new tool, but rather we need a more nuanced and complex understanding of users' behaviors to anticipate and to improve on existing tools.

Intel is a company that understands that broader research questions can be amazingly informative. Dr. Genevieve Bell, Intel's director of User Experience, is one of the lead anthropologists in the private sector. Her role at Intel and Intel's willingness to include an anthropologist as a key leader in their company demonstrate the company's foresight. Bell's work contributes to the very dynamic that I think is far too absent in the tech world. It's not that every company needs their staff anthropologists, but rather that the interdisciplinary nature of Intel's User Experience department is a sign of creative thinking and the willingness to imagine the world as radically different than just an American-centric world. It's easy to forget that mobile tools outside of the U.S. may have different meanings and utility for their users. The Intel approach has pushed its developers to think about technology in Western China or among the aging population, reminding the people who design and build the products that not everyone uses technology in the same ways. The first four minutes of this video-cast is worth skipping, but here's a chance to hear what Dr. Bell does at Intel and why it matters. If this episode has been updated (I can't find a direct link to the show), it's episode 41.