How can a pharmaceutical branding campaign gender a virus and subsequent public health programming? It is not simply that the multi-national pharmaceutical corporation with the most dollars or persuasive lobbyists triumphs. Rather, the situation is more complex – economic power is embedded in, and not above, social, cultural and historical processes (Morrison 1995:320). In this specific case, Merck Frosst
strategically harnessed western hegemonic cultural logics and discourses surrounding risk and gender in order to develop marketing campaigns to sell its vaccine. This was a two-part process which involved: (1) circulating HPV-related information that
leveraged cultural logics surrounding risk and gender in order to brand HPV as a woman-only concern and (2) arranging consumer buy-in through self-regulation. The first step was to disseminate HPV-related “expert knowledge” (Foucault 1989:52). As publicly available government information on the vaccine was limited, Merck Frosst readily filled that void. Merck Frosst used the advertorial, “Make the Connection”, (figure 2) to inform women about HPV. It contains information on cervical cancer, what HPV is and the many different HPV strains. This information is supported by statistics of the global incidence of cervical cancer, an anatomical drawing of a woman’s
reproductive system and endorsements provided by leaders in the field of women’s
health in the United States. While this is a paid advertisement, it reads and looks as though it is a medical information brochure.
Figure 3 provides a transcript and two still shots of a television advertisement for the
“Tell Someone” component of the Gardasil® marketing campaign. This advertisement, like the “Make the Connection” advertorial, also aims to inform women about HPV, particularly the trajectory of the virus, whether it “clears on its own” or turns into cervical cancer. Both examples of Gardasil® marketing urge women to take an active role in preventing HPV. The “Make the Connection” advertorial states: “It’s your health, it’s your life. So take control.” Taking control in the advertorial involves visiting a physician to regularly undergo a Pap test. Taking control in the “Tell
Someone” commercial involves spreading the word about HPV – telling the women you know about it and speaking to a physician about Pap testing. It is important to note that these two advertisements were developed and released prior to the approval of
Gardasil® by the Food and Drug Administration (FDA) in the United States. Because of this Merck Frosst was not able to mention the Gardasil® vaccine by name in its
advertisements. The next wave of Gardasil® advertising, post-FDA approval, is discussed in chapters four and five. Chapter Four features a Gardasil® “mom”
advertisement (figure 5), which depicts a mother and a daughter, and urges the mother to talk to her doctor about her daughter’s vaccination. Chapter Five includes a post-approval Gardasil® advertisement aimed at female university students (figure 7). This advertisement encourages female students to visit their campus health clinics to get
vaccinated. The knowledge of HPV provided in the pre-approval advertisements and the push to get women vaccinated in the post-approval advertisements work together to scare women about HPV and to create a “need” for inoculation against HPV.
The second step involved getting consumer buy-in, literally. Merck Frosst created such a need for the vaccine in its multiple advertising campaigns that consumers asked their doctors for it. This is a common tactic of pharmaceutical companies and is called direct-to-consumer advertising (Mintzes 2010). This tactic is essentially
pharmaceutically directed self-regulation. As such, Gardasil® sales tactics also function as governance strategies. Such a governance approach works to deploy “a mode of power par excellence designed to produce a market-based notion of agency and subjectivity” (Giroux 2010:30). To critique this governance strategy, I am employing Foucault’s concept of governmentality (1991). The governmentality approach to risk focuses on how governments “work together to govern – that is, manage and regulate – populations via risk discourses and strategies” (Lupton, 1999a: 1).9 Governmentality is not necessarily about governmental institutions, though. Instead it is about their ability through “persuasion” to get those they are governing to enact their policies and
directives (Giroux 2010:51-52). Within the current, contemporary climate of “new”10
9 At the beginning of Chapter Three the rationale for utilizing a governmentality approach to risk in the analysis of the archival portion of the research project will be explained.
10 Nettleton (1996) calls this the “rise of a psycho-socio-environmental/epidemiological model” (34), which has replaced the biomedical approach. This shift results in moving away from treating disease to preventing disease. Prevention policy, which is delivered
public health that emphasizes neo-liberal devolution of governmental responsibility (Lupton and Petersen 1996), governing approaches focus more and more on “the art of self-government, connected with morality” (Foucault, 1991:91). As such, preventative strategies, or “technologies of power” (Foucault, 1999:14), center on the promotion of self-regulation, which works to attain and maintain an idealized form of self (Turner 1997). Contemporary health discourse focuses on a version of the self “that is
autonomous, subjective and active” (Nettleton 1997:209). In other words, it is up to you to ensure that you meet the standards of health and to manage any potential health risks.
Thus, if a person falls sick, it is due to their lack of self-restraint. Idealized
conceptualizations of the self are then steeped in the notions of self-discipline and the ability to continually reinforce an identity that promotes one’s health.
All individuals are expected to be “active citizens,” whether or not they are actually part of “targeted populations” (Dean 1997:147), albeit, the lines between those who are targeted and those who are not are porous – all can be at-risk at anytime. This is part and parcel of the “colonization of the future” (Giddens 1991:117, 182) whereby risk has become a foundational tenet of governance strategies. As such, “it seems that we are no longer simply concerned with the governance of risk but we are now in an era of
governance by risk” (Rothstein 2006:216, emphasis in the original). Governance
via health promotion strategies, is predicated upon the tenets of “’risk’, ‘surveillance’, and the ‘rational self’” (Nettleton 1996:34).
through pre-detection, or creating what Rose11 calls “pre-patients” (2007:20) opens up increasingly fertile ground for surveillance (Castel 1991:288).
The expansive surveillance mandate of the new public health functions by “mainly incorporate[ing] voluntary actions on the part of citizens but also [by] us[ing]
legislation, much of which is enshrined in public health acts” (Lupton and Petersen 1996:5). As is seen with the Gardasil® campaigns, women are urged to accept greater responsibility for their health through direct-to-consumer advertising. But Gardasil®
sales are also ensured because of the Ontario province-wide grade eight public school vaccination program for girls. As the Province of Ontario did not initiate a public information campaign alongside the grade eight programming, Merck Frosst’s multi-pronged Gardasil® advertising campaigns worked to ensure that a need for the vaccine was maintained. In the case of Gardasil®, the responsibility for the health of the population was no longer entirely under the purview of the state. While the
responsibility for keeping risk at bay is that of the individuals, what is deemed to be a risk is established through the joint workings of the pharmaceutical company and policy-making processes. Together they create a guaranteed market for the sale of the
11 In his work on risk and governmentality, Rose puts forth the notion of biological citizenship (Rose and Novas 2002). In biological citizenship, governmentality is linked to governance via the body (Rose and Novas 2002:2). Biological citizenship follows the dominant trend in risk theory literature as it does not critically address gender. As is discussed in Chapter Seven, “situated risk” (Boholm 2003:158) provides more fertile ground through which to pursue risk and gender in tandem. Moreover, Giroux posits that in the current neo-liberal landscape, individuals are organized not “as citizens but as consumers” (2010:2).
product. This would not happen, however, if prevailing cultural logics did not support the notion of women being perpetually at-risk.