Direct-to-consumer-advertising of prescription medicines: a theoretical approach to understanding

Pharmaceutical companies are writing the script for health consumerism

In this rhetorical analysis based on the Foucaultian constructs of power in medicine, specifically the docile body, the medical gaze, and health consumerism, the authors examine ways the pharmaceutical industry used web-based direct-to-consumer advertising, from 2007-2010, to craft interactions between U.S. consumers and physicians in ways that changed the traditional patient-physician relationship in order to drive sales of brand-name therapeutic drugs. We demonstrate how the pharmaceutical industry uses its websites to script power relationships between patients and physicians in order to undermined physician authority and empower patients to become healthcare consumers. We speculate that this shift minimizes or even erases dialogue, diagnosis, and consideration of medical expertise. We suggest that if it is important to uphold values of the modern version of the hippocratic oath, it may be necessary to provide physicians and patients additional parts in the script so that medical decisions are made based on sound science, knowledge, and experience.

An academic-marketing collaborative to promote depression care: a tale of two cultures

OBJECTIVES

Commercial advertising and patient education have separate theoretical underpinnings, approaches, and practitioners. This paper aims to describe a collaboration between academic researchers and a marketing firm working to produce demographically targeted public service anouncements (PSAs) designed to enhance depression care-seeking in primary care.

METHODS

An interdisciplinary group of academic researchers contracted with a marketing firm in Rochester, NY to produce PSAs that would help patients with depressive symptoms engage more effectively with their primary care physicians (PCPs). The researchers brought perspectives derived from clinical experience and the social sciences and conducted empirical research using focus groups, conjoint analysis, and a population-based survey. Results were shared with the marketing firm, which produced four PSA variants targeted to gender and socioeconomic position.

RESULTS

There was no simple, one-to-one relationship between research results and the form, content, or style of the PSAs. Instead, empirical findings served as a springboard for discussion and kept the creative process tethered to the experiences, attitudes, and opinions of actual patients. Reflecting research findings highlighting patients' struggles to recognize, label, and disclose depressive symptoms, the marketing firm generated communication objectives that emphasized: (a) educating the patient to consider and investigate the possibility of depression; (b) creating the belief that the PCP is interested in discussing depression and capable of offering helpful treatment; and (c) modelling different ways of communicating with physicians about depression. Before production, PSA prototypes were vetted with additional focus groups. The winning prototype, "Faces," involved a multi-ethnic montage of formerly depressed persons talking about how depression affected them and how they improved with treatment, punctuated by a physician who provided clinical information. A member of the academic team was present and consulted closely during production. Challenges included reconciling the marketing tradition of audience segmentation with the overall project goal of reaching as broad an audience as possible; integrating research findings across dimensions of words, images, music, and tone; and dealing with misunderstandings related to project scope and budget.

CONCLUSION

Mixed methods research can usefully inform PSAs that incorporate patient perspectives and are produced to professional standards. However, tensions between the academic and commercial worlds exist and must be addressed.

PRACTICE IMPLICATIONS

While rewarding, academic-marketing collaborations introduce tensions which must be addressed.

Antibiotic identification, use, and self-medication for respiratory illnesses among urban Latinos

PURPOSE

The purpose of this study was to describe the extent to which antibiotic and nonantibiotic medications commonly used for upper respiratory infections (URIs) were correctly identified by a sample of urban dwelling Latinas and the association of medication identification with antibiotic use and self-medication.

DATA SOURCES

One hundred women completed an interview and were asked to identify whether a list of 39 medications (17 antibiotics, 22 nonantibiotics) were antibiotics or not, whether anyone in the household had used the medication, their ages, and the source of the medication.

RESULTS

Overall, participants correctly identified 62% of nonantibiotics and 34% of antibiotics. Seventy three (73%) women in the study reported antibiotic use by at least one member of the household in the past year. Among users, self-medication was reported in 67.2% of antibiotics for adults, but in only 2.4% of children. There was no difference in antibiotic recognition between those who self-medicated and those who did not, but antibiotic self-medication was associated with a significantly lower recognition of nonantibiotics (p= .01).

IMPLICATIONS FOR PRACTICE

Measures to improve antibiotic utilization should address self-medication and consider the cultural and social context in which antibiotic use occurs.