A Disease for Every Pill
For specialists in pharmaceutical marketing like Vince Parry, the story of PMDD and Sarafem is a great example of a company "fostering the creation of a condition and aligning it with a product." He worked for Lilly on the campaign, which he describes as helping to "build awareness for both the condition and the drug." To kick it off, he says, the company sponsored a "pre-launch initiative" to raise awareness of the condition. "By changing the brand name from Prozac to Sarafem--packaged in a lavender-colored pill and promoted with images of sunflowers and smart women--Lilly created a brand that better aligned with the personality of the condition for a hand-in-glove fit." Lilly's market research investigated how best to brand both the drug and the condition to come up with language women felt most comfortable with.
Lilly's shopping-cart commercial duly followed and provoked a complaint from the FDA alleging that the ad was "lacking in fair balance" because it minimized information about the drug's side effects. In the end, the FDA simply asked Lilly to withdraw the offending ad. This is typical. Despite repeated violations across the industry, and tens of millions of Americans being regularly exposed to misleading information about the risks and benefits of widely prescribed drugs, companies are rarely fined and executives are not held accountable.
Another theme has recently emerged in pharmaceutical industry advertising. Researchers are finding more and more ads helping to sell the idea that everyday human experiences are symptoms of medical conditions requiring treatment with drugs. Together with colleagues, two doctors from Dartmouth Medical School, Steven Woloshin and Lisa Schwartz, recently analyzed some seventy drug company ads in ten popular magazines. They found that almost half tried to encourage consumers to consider medical causes for their common experiences, most often urging them to consult a physician. The ads targeted aspects of ordinary life including sneezing, hair loss and being overweight--things many people could clearly manage without seeing a doctor--and portrayed them as though they were part of a medical condition. The researchers speculated that advertising was increasingly medicalizing ordinary experience, and pushing the boundaries of medical influence far too wide.
Watching these trends closely is Canadian researcher Barbara Mintzes, who included in her PhD thesis at the University of British Columbia in Vancouver a rigorous examination of drug company advertising. She also discovered that many ads now promote medical conditions, rather than just drugs, and are helping to medicalize life, as she puts it. "To an unprecedented degree they portray the educational message of a pill for every ill--and increasingly an ill for every pill. It's a shift from a drug that's approved to treat people who are actually suffering from an illness to the idea that you just take a pill to deal with normal life situations."
Mintzes is particularly outraged by the promotion of PMDD, which has been aggressively advertised in magazines read by teenagers, as well as in TV commercials. In her view it seems designed to make younger women feel there is something wrong with the normal emotional fluctuations they experience in the lead-up to their monthly period. While accepting that for some people the problem can be severe, Mintzes worries that the ads paint a shallow picture of what it means to be a young woman. "There is pressure on people to be someone other than who they are."
With all treatments there is a balance between benefits and harms. For someone who is very sick, the chances of a great improvement may easily outweigh the risks of side effects from a drug. The antidepressants like Prozac that are being prescribed for PMDD carry many side effects, including serious sexual difficulties, and for teenagers an apparent increase in the risk of suicidal behavior. Such risks might be worth taking for someone severely debilitated by chronic clinical depression, but for a woman arguing with a boyfriend or frustrated by a shopping cart?
"When you're giving drugs to healthy people you're shifting the balance," says Mintzes. "If you're already healthy, the likelihood of benefit becomes much, much smaller, and then there's a concern that what we are actually doing at a population level is causing much more harm than benefit through drug treatment."