Women will get cancer: visual and verbal presence (and absence) in a pharmaceutical advertising campaign about HPV.

• Author: Landau, Jamie
• Position: Report

At the start of a video that aired repeatedly in the spring of 2006 across major U.S. television channels and online, a woman exclaims, "I don't know why people don't know about this. I don't know why I didn't know." A minute later the video ends by featuring the same woman, only now she smiles at the camera and asserts, "Tell someone." Simultaneously, she points to a white T-shirt that she now wears and that reads across the front, "Tell Someone." This video was part of a national print, television, and online "Tell Someone" direct-to-consumer advertising campaign funded by Merck & Co., Inc., a global pharmaceutical company, to "educate" about the human papillomavirus (HPV) (Merck, 2006c). For example, Merck bought 1,083 television spots in April and May of 2006 for this campaign that, as of the first quarter of that year, totaled about $107 million in spending (Zimm & Blum, 2006). Merck spokeswoman Kelley Dougherty reported that the "Tell Someone" campaign was "part of a broad and longstanding Merck public health commitment to encourage education about the disease" (as cited in Zimm & Blum, 2006). Merck again emphasized the educational mission of the "Tell Someone" campaign in a press release for its subsequent "One Less" direct-to-consumer advertising campaign for Gardasih

In addition to One Less, Merck will continue to separately support HPV disease education including the Tell Someone ... awareness programs to ensure an understanding about the important link between cervical cancer and HPV and the need to continue regular screening. (Merck, 2006d)

On June 8, 2006, only a couple of months after the "Tell Someone" campaign broadcasted over national television and posted online, the U.S. Food and Drug Administration (FDA) approved Gardasil, a vaccine distributed by Merck, for females ages nine to 26 that protects against four HPV types that cause 70 percent of cervical cancers and 90 percent of genital warts (U.S. Food and Drug Administration, 2006). Gardasil is the world's first and only cervical cancer drug for women. By November 1, 2006, Gardasil was approved in 50 countries and was added to the U.S. Centers for Disease Control and Prevention's (CDC) Vaccines for Children contract for girls and women aged nine to 18 (Centers for Disease Control and Prevention, 2006c). In October of 2009, the FDA approved Gardasil for use by males ages nine to 26 (U.S. Food and Drug Administration, 2009).

Merck's "Tell Someone" direct-to-consumer advertising campaign is a rich site for studying visual and verbal arguments about women's health in the early 21st century United States for a number of reasons. As a direct-to-consumer advertising campaign, it had widespread circulation through mainstream mass media outlets and new media technologies such as the Internet, thereby reaching an expansive lay U.S. audience. In addition, the campaign preceded FDA approval of Gardasil and the CDC recommendations for Gardasil vaccination. Although U.S. government agencies ensure the safety and efficacy of vaccinations through comprehensive research and reviews before approving them for public use, it is highly likely that Merck's "Tell Someone" campaign was seen by, and perhaps persuaded, government officials prior to their approval of Gardasil. (1) Furthermore, it is significant to the purported educational mission of the "Tell Someone" campaign that it circulated before Merck's "One Less" direct-to-consumer advertising campaign for Gardasil that launched in November of 2006 across national print, television, and online media and explicitly pitched the vaccination. By launching the "Tell Someone" campaign first and separating it from its "One Less" advertising campaign for Gardasil, I suggest that Merck presented "Tell Someone" as a public health campaign rather than as an advertisement.

In this essay, I apply a visual and verbal analysis of presence and absence to demonstrate how Merck's "Tell Someone" campaign makes the argument that women will get cancer. Specifically, by closely analyzing two representative videos from Merck's "Tell Someone" direct-to-consumer pharmaceutical advertising campaign, I illustrate how the videos make present middle-to-upper-middle class adult women as the only people who contract HPV, how they amplify the equation that HPV equals cancer, and how they present a limited course of health prevention under the guise of a public health campaign that has a mission of education. Increasing public awareness about the health risks of HPV and vaccinations that can prevent its contraction are necessary steps for improving the lives of women and men. However, I suggest that Merck's "Tell Someone" campaign, which reportedly educates about the public health problem of HPV, problematically suppresses the presence of a number of other significant health factors. For example, HPV can be a sexually transmitted disease that also involves men in the case of heterosexual relationships, yet this is absent in the videos. These techniques of presence make Merck's argument stand out among the proliferation and plethora of images circulating through current U.S. mass media but at the cost of accentuating women's bodies as inherently diseased.

In this essay, I first describe the theoretical concept of presence initially developed by foundational argumentation scholars Chaim Perelman and Lucie Olbrechts-Tyteca (1969). This literature review also explores extensions of Perelman and Olbrechts-Tyteca's concept to justify a combined visual and verbal analysis of presence and absence and its utility for studying our currently crowded media matrix. I then turn to an analysis of presence and absence in two representative "Tell Someone" videos. I conclude with implications for women's health, pharmaceutical advertising, and the growing conversation in the field of visual argumentation about the attention and distraction of audiences. My conclusion also includes the rhetorical creation of an improved video for a public health campaign about HPV.

PRESENCE (AND ABSENCE) OF VISUAL ARGUMENTS

In Perelman and Olbrechts-Tyteca's (1969) canonical text, The New Rhetoric: A Treatise on Argumentation, they assert that "presence" is an "essential factor in argumentation" because presentation is the act of choosing or selecting among data, the "starting point of the argument" (pp. 115-116). Perelman and Olbrechts-Tyteca (1969) also indicate that the "deliberate suppression of presence is an equally noteworthy phenomenon" (p. 118). When reviewing Perelman and Olbrechts-Tyteca's initial conceptualization and the work of scholars who later critique and extend their scholarship (e.g. Atkinson, Kaufer & Ishizaki, 2008; Gross, 2005; Gross & Dearin, 2003; Karon, 1976; Kauffman & Parson, 1990; Murphy, 1994; Tucker, 2001), presence and its suppression (also known as absence) are understood as verbal and/or visual strategies for making arguments that can be persuasive, both on the level of individual psychology and on the larger level of society.

Specifically, presence is a technique of verbal and/or visual argumentation where some object or idea that is real or abstract is amplified, foregrounded, or made significant. Robert Tucker (2001) defines presence as "a property of 'standing-out-hess' that rhetors give to particular meanings at the expense of the available others" (p. 406). Another apt way that Tucker describes presence is with the word "figural," in the sense of a figure-ground relationship (p. 397). Nathan Atkinson, David Kaufer, and Suguru Ishizaki (2008) more recently explain presence as a theory of "amplitude" and "frequency" (p. 360). Because the bestowing of presence is a process of selection, the suppression of presence, or absence, is a corresponding technique of argumentation. Perelman and Olbrechts-Tyteca (1969) note how presence involves selection and works in conjunction with absence:

one of the preoccupations of a speaker is to make present, by verbal magic alone, what is actually absent but what he [s] considers important to his argument or, by making them more present, to enhance the value of some of the elements of which one has actually been made conscious. (p. 117)

Furthermore, Perelman and Olbrechts-Tyteca (1969) claim that if presence is effectively impressed on the consciousness of audiences, then they can be oriented toward a certain agreement with the speaker and moved toward immediate action (p. 142). As John Murphy (1994) summarizes, "An argument that is present is one that we remember, and one that we feel compelled to act on" (p. 5).

Perelman and Olbrechts-Tyteca (1969) write that presence is made by "verbal magic alone" (p. 117) and they provide a number of examples that convey the feeling of presence in speaking and writing, including repetition, using present tense, and incorporating rhetorical figures such as synecdoche (pp. 144-183). However, visual argumentation scholars should note that Perelman and Olbrechts-Tyteca (1969) also cite Piaget to explain presence as "the thing on which the eye dwells, that which is best or most often seen" (p. 116). And, on that same page, Perelman and Olbrechts-Tyteca (1969) reference the following Chinese story that is centered on a visual kind of presence:

What we have in mind is illustrated by this lovely Chinese story: A king sees an ox on its way to sacrifice. He is moved to pity for it and orders that a sheep be used in its place. He confesses he did so because he could see the ox, but not the sheep. (p. 116)

In fact, Diane Hope (2006) reports in the introduction to her edited collection on visual communication, "the concept [of presence] has been revived in studies of visual rhetoric" (p. 13). Tucker's (2001) phenomenological read of presence in two-dimensional figures and phrases demonstrates this valuing of the visual, as does Alan Gross and Ray Dearin's (2003) analysis of how the pictures and words in a paper on avian taxonomy gave a hummingbird in Peru a...