This week, the journal club met to discuss the articles “For and against: Direct to consumer advertising is medicalising normal human experience” (For: Mintzes, Against: Bonaccorso and Sturchio, 2006).
“Abstract: In direct to consumer advertising, drug companies target advertisements for prescription drugs directly at the public. Barbara Mintzes argues that this type of advertising risks medicalising normal human conditions, with the drug companies raking in increasingly healthy profits. Silvia N Bonaccorso and Jeffrey L Sturchio argue that, through advertising, drug companies can enable patients to make better informed choices about their health and treatment.”
Although the article’s structure was a rigid “For” and “Against” dichotomy, the positions represented at our round table blended into a rich spectrum. The token capitalist took a firm “pro” direct to consumer (DTC) marketing position, several defended the opposite ground with emphasis on public education campaigns, one member agreed with DTC advertising with the provision of external regulation, and one member disagreed with DTC marketing but offered different arguments for his position than the article’s. One or two individuals even enjoyed the exercise of playing both sides.
The first argument put forth against DTC marketing was perhaps the weakest – that money as a motivator was somehow problematic. An immediate rebuttal pointed out that many dubious motivators enter into research and development in all sectors, such as academic prestige, career advancement, publication, etc. At least there is no mistaking what motivates the private sector. Despite a shaky start, several strong arguments against the practice of DTC marketing were put forth or reiterated from the article. Perhaps the most provocative of these arguments involved the following metaphor (paraphrased):
If my car were performing poorly and needed repairs – say, for example, new spark plugs – then I would go to the mechanic, describe the problem, and ask for his advice because he is the professional. He has training in automotive repair that I do not. If I see an advertisement for spark plugs on television and walk in and ask for that brand of spark plugs without understanding why, it is of no benefit to me or my car. So it should be with medicine. Doctors have medical training that many do not, so patients should therefore present themselves to the clinic, describe their symptoms as accurately as possible, and then accept the diagnosis and treatment options presented by their physician (within reason). If funny noises or fumes persist, take your body back into the shop.
But then consider an eloquent counter-argument – the big pharma perspective – also in metaphor form (paraphrased):
You could argue that the situation is actually this: a spark plug manufacturer has developed a spark plug that reduces emissions by 25%. Mechanics know of its benefit, but they can only affect change in the cars that “get sick” and are brought into the shop. The manufacturer knows that there would be wide interest but is not allowed to advertise to car owners at large. Thus, only a fraction of the cars are optimized each year that are eligible.
In our discussion, these creative spark plug metaphors had the potential to drive home either point.
One sticking point for the token capitalist was on the opposition’s insistence that there is something “special” about health and – because it is somehow more precious than t-shirts or tacos – DTC advertisements that could influence decision-making should be disallowed. It was never fleshed out why health was attributed a special status, however (although it might have been if given enough time). Even if special status was conceded, the argument unfolded like so: (a) a person’s health is especially important; (b) a person might be manipulated by advertisements; (c) someone else should control what that person sees (whether on a regulatory, do-not-DTC advertise level, or a leave-it-all-to-the-physician level). The token capitalist pointed out a potential regression to paternalism, if the physician was the only player in the relationship with access to and understanding of treatment information. (Note: While the first website listed in an impromptu Google search on “depression” was maintained by a drug company, it nevertheless did provide information about depression and medication that was more comprehensible than, for example, a drug label.) She also pursued the following series of questions:
“To clarify: by DTC advertising, we are talking about both television and Internet advertisements?” Yes. “Then where are patients getting information about treatments?” Their doctors. “Then where are their doctors getting their information?” Oh.
The group contended, however, that the problem of drug advertisements to physicians was less problematic and more easily regulated than widespread DTC marketing. Advertisements, it was pointed out, are crafted to undermine rational decision-making, short-circuiting it with appeals to deep and powerful biases, insecurities, and desires. To whatever extent it is true that advertisements modify product-seeking behavior (to the detriment, presumably, of best interest-seeking behavior), it becomes an argument against DTC drug advertising “mind control” when coupled with a stance on the special status of health. Such influence on human behavior would be too pervasive if allowed to permeate the market and should – the anti-DTCs argued – be contained (to physicians) if not eliminated.
Many at the table were championing public health education campaigns, and even the token capitalist could not deny their merit. (She was, however, befuddled by (1) the idea that public health education and DTC advertisements could not coexist, and (2) the round table’s remarkable trust in the manufacturers of public education campaigns.)
Points that were mentioned as significant for consideration but, in the interest of time, were set aside for another day include: pharmaceutical advertisement to physicians, budget management of pharmaceutical companies (i.e., will removing the need for a massive marketing budget redirect those funds to developing cures? or will the subsequent drop in profit and actually yield fewer resources for R & D?), limitations on the concept of autonomy, and the “specialness” of health.