The male heart and the female mind: a study in the gendering of antidepressants and cardiovascular drugs in advertisements in Irish medical publication

The Rise and Fall of the Neurotic Housewife: Patient Sex in Psychotropic Drug Advertising to Physicians 1946-1990

Previous studies have demonstrated a sex bias when it comes to the portrayal of men and women in medical journal advertisements for prescription drugs for psychiatric conditions. However, these studies have typically looked at ads over a restricted time period and often for a single diagnosis. Here we focus on ads for 3 diagnoses - anxiety, depression, and a combination of anxiety and depression - and cover nearly half a century to examine how the portrayal of patients changed over that time period with respect to sex. We sampled ads for products treating anxiety, depression, and anxiety/depression published in the Journal of the American Medical Association between 1946 and 1990. Our findings confirm other studies showing a marked preponderance of female patient representation during the 1960s in psychotropic drug advertising. However, we also show that from the mid-1970s to the mid-1980s, the proportion of ads for drugs featuring depression and/or anxiety indications depicted male patients significantly more than prior years in which females predominated, demonstrating advertisers' reaction to the critique of gender stereotyping.

Gender bias in clinical research, pharmaceutical marketing, and the prescription of drugs

This thesis is part of the studies of gender bias in health which together with the paradigm of evidence-based medicine shares the empirical assumption that there are inaccuracies in medical practice, in addition to a lack of rigour and transparency. It worked with the distinction between the concepts of sex and gender and between the concepts of sex-related differences and gender inequalities, in terms of applying a gender perspective in the study design and the subsequent analysis. This PhD review presents the research process conducted in Spain, which can provide an example for future research. Study I described a review of 58 clinical trials (CTs) of etoricoxib to assess its compliance with the Recommendations of Evaluation of Gender Differences in the Clinical Evaluation of Drugs. In Study II, key informants from professions related to different areas in drug development and pharmacovigilance held a working meeting to reach a consensus document on recommendations for the study and evaluation of gender differences in CTs in Spain. In Study III, the websites of the eight best-selling hormone replacement therapy drugs in Spain on Google first page of results were analysed. In Study IV, a logistic regression analysis was performed to compare analgesic prescription by sex in regions with a higher or lower Gender Development Index (GDI) than the Spanish average. Gender biases identified in this thesis limited the legitimacy of medicine, which is not based on the best possible evidence. The results also demonstrate the existence of inequalities between men and women that are not due merely to biological differences, but are gender inequalities stemming from the social differences that exist between both sexes.

Quality of pharmaceutical advertising and gender bias in medical journals (1998-2008): a review of the scientific literature

OBJECTIVE

To review the scientific literature on pharmaceutical advertising aimed at health professionals in order to determine whether gender bias has decreased and the quality of information in pharmaceutical advertising has improved over time.

METHODS

We performed a content analysis of original articles dealing with medical drug promotion (1998-2008), according to quality criteria such as (a) the number, validity and accessibility of bibliographic references provided in pharmaceutical advertising and (b) the extent to which gender representations were consistent with the prevalence of the diseases. Databases: PUBMED, Medline, Scopus, Sociological Abstract, Eric and LILACS.

RESULTS

We reviewed 31 articles that analyzed advertising in medical journals from 1975-2005 and were published between 1998 and 2008. We found that the number of references used to support pharmaceutical advertising claims increased from 1975 but that 50% of these references were not valid. There was a tendency to depict men in paid productive roles, while women appeared inside the home or in non-occupational social contexts. Advertisements for psychotropic and cardiovascular drugs overrepresented women and men respectively.

CONCLUSIONS

The use of bibliographic references increased between 1998 and 2008. However, representation of traditional male-female roles was similar in 1975 and 2005. Pharmaceutical advertisements may contribute to reinforcing the perception that certain diseases are associated with the most frequently portrayed sex.

Heart Stories

In this study we explore the views and beliefs of men and women about cardiovascular disease and the emotions and social relations that are involved. Women and men attending a cardiovascular rehabilitation program participated in two in-depth interviews carried out with each individual six months after a first serious cardiac event. The transcribed interviews were analyzed using a narrative-discursive methodology. Although there were numerous differences between the men and women’s stories, an outstanding commonality was that their narrative efforts to negotiate healing and rehabilitation were guided by gendered identities and societal roles.

Evaluation of rationality of promotional drug literature using World Health Organization guidelines

OBJECTIVES

The study was aimed to evaluate collected drug promotional brochures for accuracy, consistency, and validity of the information presented in it, using World Health Organization (WHO) criteria for ethical medicinal drug promotion. Drug promotional brochures were evaluated for the type of claims and pictorial content presented in it and for references cited in support of these claims.

MATERIAL AND METHODS

This observational, cross-sectional study was conducted in the outpatient department of Government Medical College and Hospital, Nagpur, India. In addition to the fulfillment of "WHO criteria, 1988," we examined 513 promotional brochures for the type of claims and pictorial content presented in it and references quoted in support of claims to check their retrievability, type, and authenticity.

RESULTS

None of the promotional literature fulfilled all WHO criteria. Majority (92%) brochures claimed about the efficacy of product, and a few about safety (37.8%). Out of 1003 references given in support of various claims, 84.4% were from journals and only 28.5% were validly presented researches. Brochures presenting irrelevant pictures were 41.3%, whereas brief prescription information (BPI) of the promoted drug was given only by 8.8% brochures.

CONCLUSION

Pharmaceutical industries did not follow the WHO guidelines while promoting their products, thus aiming to satisfying their commercial motive rather than fulfill the educational aspect of promotion.

Women with coronary artery disease and depression: a neglected risk group

Coronary artery disease (CAD) has been held to be a "male" disease due to men's higher absolute risk compared to women, but the relative risk of women for CAD morbidity and mortality is actually higher. The purpose of this article is to review research evidence for gender differences in CAD and depression with special emphasis on women. Current knowledge points to important gender differences in age of onset, symptom presentation, management, outcome as well as traditional and psychosocial risk factors. Compared to men, CAD risk in women is more strongly increased by some traditional factors (diabetes, hypertension, hypercholesterolemia, obesity), and socioeconomic and psychosocial factors seem to have a higher impact on CAD in women as well. With respect to differences in CAD management, a gender-bias in favour of men has to be taken into account in spite of older age and higher comorbidity in women, possibly contributing to a poorer outcome. Depression was shown to be an independent risk factor and consequence of CAD; however, concerning gender differences, the results have been inconsistent. Current evidence suggests that depression causes a greater increase in CAD incidence in women, and that female CAD patients experience higher levels of depression than men. Gender aspects should be more intensively considered both in further research on gender differences in comorbid depression and in cardiac treatment and rehabilitation with the goal of making secondary prevention for women more effective.

Gender and images of heart disease in Scandinavian drug advertising

AIMS

This study examines the construction of the "heart disease candidate" in advertisements for cardiovascular drugs in Scandinavian medical journals.

METHODS

All advertisements for cardiovascular drugs (n = 603) in Scandinavian medical journals (Denmark, Finland, Norway, and Sweden) in 2005 were collected. Only advertisements that portray users (n = 289, 48% of the advertisements) were analyzed.

RESULTS

The results show that coronary candidacy is constructed as a male condition in half of the advertisements for cardiovascular drugs. The advertisements suggest a gendering of heart disease: men are the major victims of heart failure and cardiac insufficiency, and women are in need of cholesterol-lowering drugs. The cardiovascular drug advertisements portray a restoration of men's hyperactive agency, valorized by means of sporty images, by drawing on masculinity as a fixed trait and behavior. Hypercholesterolemia as a woman's disease reproduces the tyranny of slimness for women: Only women's stoutness is medicalized, and there are no pictures of heavy men.

CONCLUSIONS

The findings point to the public health implications of gendered images of coronary candidacy in medical advertising.

A comparison of blogs by depressed men and women

This paper reports on a study comparing Internet blogs written by 45 men and 45 women who self-identified as depressed. Using qualitative and inductive methods, distinct differences among the male and female experiences of depression were documented. Among the most important differences were the distinctions male and female bloggers made in regards to (1) the bio-medicalization of depression; (2) the relative significance of world events as compared to relationships in depression experiences; and (3) violence, including suicide and cutting. Theoretical reasons and explanations for these findings are discussed.

Heart disease and gender in mass print media

Heart disease is a major cause of death, disease and disability in the developed world for both men and women. Nevertheless, the evidence suggests that women are under-diagnosed both because they fail to visit the doctor with relevant symptoms and because doctors tend to dismiss the seriousness of women's symptoms of heart disease. This study examines the way that popular mass print media present the possible links between gender and heart disease. The findings suggest that the 'usual candidates' for heart disease are considered to be high achieving and active men for whom the 'heart attack' is sometimes seen as a 'badge of honour' and a symbol of their success. In contrast, women are less often seen as likely to succumb, but they are portrayed as if they are and ought to be worried about their husbands. Women's own bodies are described as so problematic as to be perhaps useless to diagnose, because they are so difficult to understand and treat.

Gender differences in cardiovascular disease and comorbid depression

Although gender is increasingly perceived as a key determinant in health and illness, systematic gender studies in medicine are still lacking. For a long time, cardiovascular disease (CVD) has been seen as a “male” disease, due to men's higher absolute risk compared with women, but the relative risk in women of CVD morbidity and mortality is actually higher: Current knowledge points to important gender differences in age of onset, symptom presentation, management, and outcome, as well as traditional and psychosocial risk factors. Compared with men, CVD risk in women is increased to a greater extent by some traditional factors (eg, diabetes, hypertension, hypercholesterolemia, obesity,) and socioeconomic and psychosocial factors also seem to have a higher impact on CVD in women. With respect la differences in CVD management, a gender bias in favor of men has to be taken into account, in spite of greater age and higher comorbidity in women, possibly contributing to a poorer outcome. Depression has been shown to be an independent risk factor and consequence of CVD; however, concerning gender differences, The results have been inconsistent. Current evidence suggests that depression causes a greater increase in CVD incidence in women, and that female CVD patients experience higher levels of depression than men. Gensier aspects should be more intensively considered, both in further research on gender differences in comorbid depresion, and in cardiac treatment and rehabilitation, with the goal of making secondary prevention more effective.

How do patients at risk portray candidates for coronary heart disease? A qualitative interview study

OBJECTIVE

To explore how patients at risk of coronary heart disease (CHD) portray candidates for CHD.

DESIGN

Qualitative interview study.

SETTING

Norway.

SUBJECTS

A total of 20 men and 20 women diagnosed with heterozygous familial hypercholesterolemia (FH) recruited through a lipid clinic.

MAIN OUTCOME MEASURES

Participants' beliefs concerning persons who are considered candidates for CHD.

RESULTS

Some participants believed that CHD could happen to anyone, while the majority conveyed detailed notions of persons they considered to be likely victims of CHD. Participants often portrayed the coronary candidate as someone who was different from themselves. Among those who mentioned gender, all presented the candidate as a man. Some women said that they had to reconcile themselves to being at risk of CHD, since they at first had conceived CHD as a man's disease. While some participants considered their notions to be valid for assessing people's risk of CHD, others questioned how valid their notions were.

CONCLUSION

Doctors should recognize that distancing is a way patients cope with risk and that such a strategy may have psychological and moral reasons. When communicating about risk, doctors should take into account that patients' notions of risk may differ from medical notions of risk.