From Lydia Pinkham to Queen Levitra: direct‐to‐consumer advertising and medicalisation

Abstract

The medicalisation of life problems has been occurring for well over a century and has increased over the past 30 years, with the engines of medicalisation shifting to biotechnology, managed care, and consumers. This paper examines one strand of medicalisation during the last century: direct-to-consumer advertising (DTCA) of pharmaceuticals. In particular, it examines the roles that physicians and the Food and Drug Administration (FDA) have played in regulating DTCA in the US. Two advertising exemplars, the late 19 th century Lydia E. Pinkham's Vegetable Compound (for 'women's complaints') and contemporary Levitra (for erectile dysfunction) are used to examine the parallels between the patent medicine era and the DTCA era. DTCA re-establishes the direct and independent relationship between drug companies and consumers that existed in the late 19 th century, encouraging self-diagnosis and requests for specific drugs. The extravagant claims of Lydia Pinkham's day are constrained by laws, but modern-day advertising is more subtle and sophisticated. DTCA has facilitated the impact of the pharmaceutical industry and consumers in becoming more important forces in medicalisation.

Unhealthy Pharmaceutical Regulation

“…However, the US regulations on 'fair balance' and 'brief summary' made DTCA cumbersome for the broadcast media. In 1997, by which time the pharmaceutical industry had become firm supporters of DTCA, even those restrictions were relaxed so that broadcasting product advertisements merely had to provide consumers with access to the drug's official labelling via a telephone number, a webpage, a concurrent advertisement, or additional information from pharmacists, physicians or other healthcare providers (Conrad and Leiter 2008). The consequence of these deregulatory measures in 1985 and 1997 was that expenditure on broadcast DTCA, a form of prescription-drug promotion which bypassed doctors, grew almost 80-fold in the US, from US$55 million in 1991 to US$4.2 billion in 2005(UG GAO 2006.…”

Peering into the pharmaceutical “pipeline”: Investigational drugs, clinical trials, and industry priorities

“…In addition, the pharmaceutical industry places understandably more emphasis on promoting information about marketed products than those unable to meet FDA safety and efficacy benchmarks. Within social science and biomedical communities, scholarship has also centered on marketed pharmaceuticals, analyzing physicians’ relationships with industry, direct-to-consumer advertising, and industry constructions of illness (e.g., Conrad & Leiter, 2008; Dumit, 2012; Greene, 2007; Kassirer, 2005). This literature often mobilizes the concept of “pharmaceuticalization” to signal the increasing power of the pharmaceutical industry to shape physicians’ and patients’ engagement with health and illness (Abraham, 2010; Bell & Figert, 2012; Busfield, 2010; Williams, Gabe, and Davis, 2008; Williams et al, 2011).…”

Prediction model for penile prosthesis implantation for erectile dysfunction management

“…Salonia et al 22 reported on 619 patients seeking medical help for new-onset ED in the PDE5i era, where the mean delay prior to presentation was 30.2 months (median 12.0; range 5-300). This delay seems surprising given the likely waning of the taboo associated with openly discussing ED, as well as the explosion of direct-to-consumer advertising for ED treatments in both electronic and print media 25 . In another study comprising a cohort of men who underwent PPI, the mean duration of ED prior to surgery was 60 months 23 .…”