Semiprofessional Microcelebrities
Not the Best Source of Birth Control Information After All
The Australian Open starts this week. It’s a little hard to catch live matches given the time difference, but tennis is the one sporting event that everyone in my family enjoys watching.
I remember the first time I went to a tennis match in person. I was in junior high school. My grandmother had bought tickets for me and a friend to see the Virginia Slim tournament at Madison Square Garden. He was a tennis player/fan, but he had to go and get mono, and so I attended with my mother who was as clueless as I was. We spent the first match trying to figure out the scoring (love is silly bit fun, deuce gets complicated). The second match of the day was Martina Navratilova at the top of her game trouncing a poor 15-year-old girl. We felt terrible for little Steffi Graf who lost very badly. (For those of you who don’t know, Graf didn’t really need our sympathy, she went on to win 22 majors, become the only person to win all four majors and an Olympic medal in the same year, and marry fellow tennis champ Andre Agassi.)
Navratilova had her own impressive record. She spent 332 total weeks as world women’s singles number one (second only to Graf), 237 weeks as number one doubles, won 18 majors, made it to the finals in Wimbledon for nine consecutive years between 1982 and 1990, and won the mixed doubles title at the US Open in 2006 a little bit before she turned 50. In the years since, she’s been a constant presence on TV as a tennis commentator.
Just after New Year’s Navratilova announced that she is battling two separate forms of cancer—breast cancer (which has recurred after being initially diagnosed and treated in 2010) and stage one throat cancer caused by HPV.
We have discussed this many times before, but here’s a recap: HPV is a highly contagious sexually transmitted infection (STI) that the CDC describes as “so common most sexually active men and women get the virus at some point in their lives.” HPV is really a group of more than 150 related viruses that can infect various parts of the body including the genitals, neck, mouth, and throat. Most types of HPV do not cause any long-term health issues or require any treatment—the body is able to clear the virus on its own. There are two types of HPV that cause most genital warts and at least seven known to cause cancer. In this country it is estimated that HPV causes 91% of all cervical cancer, 91% of anal cancer, 75% of vaginal cancer, 69% of vulva cancer, 63% of penis cancer, and 75% of oropharynx cancer (which include throat and tongue cancer).
The good news is that we have a way to prevent this—the HPV vaccine (sold under the name Gardasil) currently protects against these nine high risk types of HPV. The vaccine is recommended as part of standard vaccinations for all young people regardless of sex/gender at age 11 or 12 but is now approved for use in those up to 46. Analyses have suggested that widespread use of this vaccine could eliminate cervical cancer. Unfortunately, in this country Gardasil has gotten caught in both anti-vaccine and anti-sex rhetoric with people arguing that it causes harm and encourages young people to be promiscuous. Neither are true, but as a result HPV vaccination rates lag behind other routine childhood vaccines and may be following the overall downward trend.
At 66, Navratilova is in an age group that has never been eligible for the vaccine which wasn’t approved until 2006 and didn’t expand to people older than 26 until 2018. The good news for her is that HPV-associated cancers of the throat are easier to treat than throat cancers caused by smoking or other factors. Dr. Marshall Posner, co-leader of the Cancer Clinical Investigation Program at The Tisch Cancer Institute at Mount Sinai, told Today.com that 90-95% of cases caught early can be cured using a combination of surgery and low-dose radiation. Later stage cancers can also be cured, but the treatments are more intense and may have side effects including loss of taste.
I’ve never understood the opposition to the HPV vaccine (granted, I stick my arm and my children’s arms out for every vaccine that the CDC recommends). This isn’t about sex it’s about cancer. The Big C. The thing that adults stay up nights fearing. The diagnosis they only discuss in a stage whisper. The disease that kills people every day (4,000 women die of cervical cancer each year, alone). Science figured out how to prevent some kinds of it. We should be celebrating with our arms out for the shot and our fingers crossed that researchers figure out how to prevent even more kinds. And since January is Cervical Health Awareness Month, now is the perfect time to do it.
Martina will not be at the Australian this year as she is getting treatments in New York, but she appeared on the Tennis Channel this weekend via Zoom with her dog sitting on the bed behind her. I wish her a full and easy recovery.
Republican House Starts with Bogus Abortion Bill
After cannibalizing Kevin McCarthy and then voting for the empty shell of a man that was left to become Speaker of the House, the GOP decided to make a statement on abortion. (Hint: that statement was “we don’t care that the issue may have caused us embarrassing losses, we’re going to keep playing to our base.”)
On Wednesday, the House passed the “Born-Alive Abortion Survivors Protection Act” which requires health care providers to try to preserve the life of an infant if that baby is born alive during or after an attempted abortion. Providers who fail to comply could face fines and up to five years in prison.
This bill is as bullsh*t as it sounds. “Babies” aren’t born alive after abortions. For one thing, most abortions (93%) take place during the first 13-weeks of pregnancy. We’re not talking about an infant, for most of that time we’re not even talking about a fetus as the developmental change from embryo to fetus happens at 11 weeks. Less than 1% of abortions happen after 21 weeks. These procedures are intensive (treatment happens over a few days), expensive (over $1,000), hard to find, and often done because of fetal anomalies or maternal health issues. Some of them take place before viability—the point at which the fetus can survive outside the womb with or without medical interventions. All pregnancies are different but this usually happens around 23 or 24 weeks.
Not only is that not how it f**king works, actual infants who are born alive are already protected by homicide laws and standards of practice that encourage doctors to use available interventions.
Surprise, surprise, this is not about the babies. It’s about intimidating doctors and looking tough on an issue important to the base. Though with the recent Supreme Court decision, which was basically the ultimate victory, “tough on abortion” seems unnecessary.
One House Republican agrees that this bill was a waste of time (though she voted for it anyhow). Rep. Nancy Mace of South Carolina believes her party is getting it wrong on abortion. She said: “This is an issue that we lost on. We buried our heads in the sand after Roe v. Wade, and we lost seats because of this issue.” Mace—who has been open about being a survivor of rape herself—says she’s worried about that the GOP might try to pass a federal abortion ban that includes language requiring women to report their rape or punishing doctors who perform abortions after rape.
With a Democratic-held Senate and the Biden Administration in the White House, there is no chance that this bill goes any further. Still, 220 Republicans thought this was the best use of their time.
Breaking News: YouTube Influencers Not Best Source of Contraception Information
This week’s entry into the “we needed a study for that?” file is a review of what YouTube influencers have to say about contraception. Not surprisingly, their information is not always accurate and unbiased. Also not surprisingly, influencers are reinforcing the anti-hormone, “be natural” messages that have become increasingly popular in recent years.
Researchers at the University of Delaware identified of 50 YouTube videos from influencers with 21,000+ subscribers using the search terms “birth control experience” and “Daysy.” (Daysy is a fertility tracking app that claims to be non-hormonal birth control, more on that later.) In analyzing the videos, they were looking for whether influencers focused on discontinuation of hormonal birth control and how they framed that decision.
As anticipated, most videos (74%) focused on the decision to discontinue hormonal birth control methods like the pill, patch, or ring as this is a growing trend that seems to echo the overall movement toward labels like “natural,” “holistic,” “wellness,” and “organic.” A little more than half of the influencers framed their decision positively, reporting improved mood (18%), increased energy (14%), increased libido (10%), improved acne (6%), better hair growth (6%), improved sleep (4%), and weight loss (4%). Overall, fewer influencers mentioned negative effects of going off hormones but, the potential consequences like worsened acne (22%), cycle irregularities (14%), stomach pain (12%), mood swings (8%), fatigue (4%), and hair loss (4%) were also mentioned.
Among those influencers who stopped using their highly effective hormonal contraceptives, 44% mentioned a desire to be more natural, 32% said they wanted to improve/protect their mental health, 20% said they did it because of weight gain, and 14% said the side effects had gotten too burdensome. Only 20% of those who stopped taking their hormonal methods mentioned starting/using a new method.
Those videos that did talk about non-hormonal methods tended to focus on cycle tracking apps. Study co-author Emily Pfender told news outlets that she was concerned about these discussions because she felt that they did not accurately explain how much effort goes into to using a natural family planning method (hi, Cecily). For example, some influencers mentioned having a thermometer by their bed but didn’t discuss how often or when they needed to take their temperature. The influencers also didn’t mention that research has found natural family methods—including cycle tracking apps—don’t work as well for people with longer or unpredictable cycles. Those who talked about using Daysy also didn’t mention that the study on which its effectiveness rates were based has been retracted because the company was said to have cherry-picked data and undercounted unintended pregnancies. (Umm, I’m not a researcher but if you have to knock people out of your study for having too long a cycle and pretend other people didn’t get knocked up, I think you may be doing it wrong.)
I’m going to retract my earlier statement: we did need this study if for no other reason than I now know that the academic definition of social media influencers is “semiprofessional microcelebrities on social media platforms such as YouTube, often sponsored by brands to promote lifestyle products to followers.” (The authors cite this to a 2021 study by Johnson et al.)
The study also confirms that hormonal methods of contraception—which are the most effective—are often disparaged on social media for being dangerous or unnatural. Recent stories from celebrities (like Hailey Bieber and Aubrey Plaza) who suffered serious but rare side effects from birth control pills have helped contribute to this narrative. The narrative itself dovetails with the “all things must be natural” movement that has struck all things from laundry detergent to tampons and often relies on misinformation about existing products.
The study also points out that the overall motif of influencer videos—which co-author Emily Pfender pinpoints as “If this works for them, it must work for me…”—may leave viewers, especially young viewers, with the wrong impression about what contraceptive methods are best for them. For example, most of the influencers in this study were married, which may change both how worried they are about an unintended pregnancy and their risk level for STIs. The same might not be true of their viewers.
I’m not opposed to influencers talking about birth control or other sexual health topics on social media. I’ve learned some things from TikTok. We just have to be careful that young people understand that the experience of one person isn’t universal no matter how many followers they have. And we have to make sure that young people have access to other sources of information that come with less personal bias (or, you know, paid sponsorship).