Why Is Preventive Care So Anxiety-Inducing?

Not all preventive care is anxiety-inducing. But there's two kinds of medical care that the hand-wringers who don't understand science very well always denounce at the slightest provocation: Birth control, particularly hormonal birth control, and vaccinations. This came up again this week at the completely unwarranted spate of panicked articles about how birth control will make you go blind, based on a paper that was released without peer review, shows results that other studies haven't found, and whose own researchers are describing as extremely preliminary and shouldn't mean you should reconsider the pill. Indeed, the worst case scenario from the existing information is that gynecologists might start screening for a family history of glaucoma. Hardly a reason to, as one writer for The Week did, suggest that women go off the birth control pill.

Inevitably when you start pushing back against these alarmist, unscientific anti-pill hit pieces, defenders of this practice of sounding the alarm frame it as "education" and imply that the critics are simply dupes of Big Medicine who want to conceal the no doubt nefarious motives behind, uh, making a product women clearly and desperately want. While pill alarmists like to paint themselves as innocent parties whose attempts to add more information---the argument depends on refusing to distinguish between good and bad information---to the discourse, the effects of alarmist disinformation are actually quite serious:

In fact, sensational reporting on such findings can have an actively negative impact on women’s ability to choose the best contraceptive method. For years, women’s magazines reported that birth control pills caused weight gain. Even after numerous studies debunked this claim, concern about putting on a few pounds is one of the main reasons why women stop using the pill, or refuse to take it in the first place. In 1995, after the British Committee on the Safety of Medicines erroneously suggested that certain types of birth control pills dramatically increased women’s risk of blood clots, rates of unintended pregnancy soared.

It's clear that this isn't just a generalized inability to understand issues like cost/benefit analysis or risk assessment. As the writer of the quote above, Amelia Thomson-Deveaux points out, Viagra, coffee, and other drugs with similar or even much higher risk profiles don't get this treatment. OTC painkillers are often much more dangerous than the pill, and that doesn't get nearly the same kind of coverage. Big Pharma has some seriously shady practices, but---and sorry to disappoint---hiding the supposedly ill effects of birth control just isn't one of them. Or vaccines. It's actually quite maddening to see the most paranoia and anger about two kinds of drugs that Big Pharma actually gets largely right.

Obviously, with the birth control pill, a lot of the anxiety that is ready to seize on any anti-pill "evidence", no matter how shoddy, goes right back to fear of female sexuality. But a lot of pill alarmists are feminists who otherwise don't seem to be overly anxious at changing social norms regarding women and sexual freedom. That's why I can't help but think there's a connection to the psychological anxieties underpinning so many left-leaning people's fear of vaccines. (To be very clear, however, anti-pill and anti-vaccine sentiment are more common on the right, but why that would be so is fairly obvious.)

It's clear that there's a fear of contamination that goes on that attaches itself to preventive medicine because the fact that you're not sick makes it harder to grasp, emotionally, why you're adding things to your body. Unsurprisingly, anti-pill feminists frequently tend to lean hard on abortion as a viable alternative for the inevitably higher rates of unintended pregnancy that come with "natural" contraception forms they prefer---once you're in a medical condition, medical intervention seems easier to grasp.

There's also the fetishization of the "natural" and the strong desire to believe that nature knows best and has worked everything out and civilization is a corruption of our perfect state. The problem with this way of thinking is that most of what we think of as civilization is the result of human beings doing what we do best: Seeing problems and fixing them. Birth control pills and vaccines in particular were responses to very real and very serious problems facing our species, namely our inability to express ourselves sexually without major and pointless suffering and widespread death and injury from contagious disease. If these were not problems to begin with, solutions would not have been found.

Of course, some problems have solutions that end up creating more problems. (See: The discovery of oil as an efficient way to power an industrialized world.) But what's funny about the pill and vaccines is that they are two technologies for which this is largely untrue. The pill has some side effects in some women, but on the whole, the cost is extremely low compared to the benefits, to the point where it feels like we, as a species, are getting something for nothing. Same story with vaccines. It defies the "civilization corrupts" narrative profoundly, because that narrative insists that we must pay for our hubris in developing technology, and as far as we can tell, we're not really paying much at all for these preventive medicines. So people, I think, feel the need to look for any evidence that we are, as a form of confirmation bias for their belief that there's always a high cost to development.

Finally, I think vaccines and birth control become the focal point for these anxieties because they are technologies that largely benefit women and children, traditionally disempowered groups who are available for scolding and policing in a way that men are not. (The fact that the HPV vaccine has attracted even more hysteria than most vaccines shows how true this is.)  If there was a similar kind of preventive care for men only, it would be untouchable. If it was something for men and women both, basically the same. But women and children's bodies are eligible for public debate, and so the most is made out of that unfortunate reality.