Wednesday 5 June 2013

Social Costs and HPV

I've seen the light.*

Here's the New York Times on recent findings about HPV.
In the 1980s, only a small number of throat cancers were linked to HPV infection. Historically, patients who developed the disease were in their 70s and were heavy smokers and drinkers.
Now, about 70 percent of all throat cancers are caused by HPV, up from roughly 15 percent three decades ago. Patients are now more frequently middle-aged husbands and fathers who are economically well off, nonsmokers and not particularly heavy drinkers. Men are three times more likely to be diagnosed than women with HPV-related throat cancer.
In short, 70% of throat cancer is caused by HPV transmitted during oral sex. And we know that when private actions impose costs on others through the public health system, there's a prima facie case for government intervention.

Let's run the drill. What are the social costs of risky sex? And why haven't we taxed it yet?

First, any risky act undertaken with imperfect knowledge about possible consequences cannot, by assumption, yield any benefit for the person bearing the risk. It's all market failure. We will consequently assume that hazardous oral sex of this sort is not pleasurable for anyone involved, so there are no offsetting benefits that must be counted when we go about regulating and taxing. Recall that sex addiction is very real and that there is no known safe level of sex; every sex addict began with a single sex act. There's no possible reason that anybody could be engaging in risky sex other than irrationality or addiction, given that we've assumed that there's zero benefit from doing it. Why else would somebody do something that has zero benefit?

And we also know that oral sex is like a gateway drug: I'm sure that the Dunedin Longitudinal Survey people could really easily show that teenagers engaging in oral sex were more likely to go on to try other sex acts at younger ages and with more partners than those who showed more restraint. I bet they're also more likely to try marijuana.**

So what then are the costs? Well, let's apply sex attributable fractions to a whole host of disorders. 70% of throat cancers are due to HPV, which is by definition a consequence of undertaking a risky sex act. And there's all the other STD costs. Add up all the treatment costs, add up all the costs of premature mortality, double-count the costs of productivity losses, add in some estimates of intangible costs falling on friends and families of those suffering. Then add in all of the costs that men and women incur in finding partners for engaging in sexual activity: all the costs of attractive clothing, the opportunity costs of time spent trying to attract a partner, the direct costs of buying drinks for a potential partner, subscription fees at dating websites... it's all pure loss because dangerous sex has no offsetting benefit by our assumption at page 173 in the appendix to the report. Pretty clearly, the social costs of oral sex exceed the excise tax revenues. And that by itself of evidence of market failure.***

So why haven't we taxed oral sex? Well, it would be almost impossible to enforce. In a perfect world, the panopticon would see and tax all. But we're not there. Instead, we have only imperfect regulatory instruments. What should we then do?

For starters, we need studies by the University of Otago's School of Public Health demonstrating how not only movies and television glorify oral sex, but also how social media affects things. Doesn't Durex have a Twitter account? It's also worth noting the timing on the HPV rise here. I blame Desperate Housewives:
Bree: Excuse me. Did you lose something?
Orson: No. I just thought... for you.
Bree: Oh, um. I don't do that.
Orson: Why not?
Bree: I'm a republican.
Orson: I'm a libertarian. I believe in minimizing the role of the state and maximizing individual rights.
Bree: But Orson?!
Orson: Trust me. I know what I'm doing.
Is it any surprise that the libertarians would be the ones again to blame? 

Otago could also recruit a dozen people via Facebook and interview them about whether drinking makes them more likely to consider oral sex. If it does, then anti-alcohol and anti-oral-sex policies could be complementary. And if people are more likely to smoke after sex, then that also increases the benefits of anti-sex policies. We also need to think about how alcohol advertising also promotes sex: Woodstock commercials could lead young men to have sex with their friends' mothers. It's so obvious that we need a trifecta of policies to simultaneously address alcohol, tobacco and oral sex because of their costs to the public health system. Actually, that misses one: I'm pretty sure that this all somehow makes fat taxes even more important, I just haven't figured out how yet. But I'm sure that Otago's public health people will figure it out.

Now a couple of people on Twitter last night, likely secretly in the pockets of Big Sex, suggested that all of this might be misguided. There's a vaccine for HPV that removes the HPV-risk of oral sex while maintaining the supposed benefits. But, that's cheating. Just like it is cheating to use e-cigarettes to get a nicotine hit while avoiding lung cancer. If we cannot use e-cigarettes as part of anti-smoking policy, we can't use the HPV vaccine a way of avoiding the social costs of oral sex. Deep down, it's the sin that's the problem. If people could enjoy sinful hedons without consequence, where would we be? We have to teach them to avoid the sin, not to mitigate sin's consequence.

* No I haven't. Everything in this post, except for **** below, is simply applying consistently the methods used in the bogus shonky cost of illness studies used to justify alcohol and tobacco regulation.

** And if Ole Rogeborg wants to claim that they haven't proven causality and that much of it is due to underlying type, remember that because Dunedin refuses to share their data with anybody, we just have to take Dunedin at their word even if Ole has some fancy simulations.

*** Especially as there is no excise tax that here applies. Note that we shouldn't count GST revenues from professional transactions of this sort as offsetting things because the money would be spent on other GST-applicable transactions in the alternative.****

**** This is about the only part that isn't tongue-in-cheek. GST really wouldn't and shouldn't count in this case. Everything else here is rubbish.


  1. I thought this was just a sneaky way of Douglas reminding us all that he has been muffing Zeta-Jones. I think we're all supposed to be jealous.

  2. "I'm sure that the Dunedin Longitudinal Survey people could really easily show that teenagers engaging in oral sex were more likely to go on to try other sex acts at younger ages and with more partners than those who showed more restraint. I bet they're also more likely to try marijuana."

    Meh. It is well known that teenagers who start sex early are overrepresented in all kinds of delinquency, not just marijuana smoking. You will want to count that properly, Professor!

  3. You're right. We need to assume that that is 100% caused by the sex and attribute all of those crime costs as social costs of oral sex.

  4. The obsessive pursuit of oral sex, which is not safe sex, is an iatrogenic consequence of the American obsession with making all penises bald 24/7. It is boring to give a handjob to a man whose foreskin is AWOL for ever. Or, as a sign carried by a defiant sex positive woman at SF's 2013 Gay Pride march read, "Circumcision Ruined the Handjob". Leave the scalpel in the drawer, the handjob makes a comeback, no need for furtive dirty blowjobs, and problem solved.