Personal Views

Men v women v animals in drug advertisements

BMJ 1997; 315 doi: (Published 06 December 1997) Cite this as: BMJ 1997;315:1550
  1. Lars Breimer, is a pharmaceutical physician

    The advertising of prescription drugs is a specialised activity in Europe because unlike usual marketing it is aimed at the prescriber and not the consumer. A letter in the BMJ in 1996 pointed out that advertisements in the journal for drugs used to treat disorders with a negative image used women and rarely featured men. To investigate whether sexist stereotyping was universal I inspected the advertisements in several medical publications of Europe, the United States, Australia, and New Zealand.

    In Sweden the advertisement for sertraline (Zoloft, in Britain Lustral) showed birds soaring away, with one left behind looking sadly through a window. The Danes used a cheerful picture of a flower. In the Netherlands there was a stylised drawing of the outline of a man wearing a hat filled with blue sky and clouds in front of a brick wall. The journal in Norway carried a full page, frontal photograph of a young woman; another showed an older lady in a two page spread; and a third version (20% usage) had half a page of an older man photographed from above. American advertisements varied: one showed a young woman in a humorous pose with a cat; another a middle aged woman; another a black (probably male) hand over a child's; yet another version had an ambiguous picture of a family, although the man was probably the sufferer. In another version (also used in Portugal) nine photographs filled the spaces in the title of the drug: five were of women, all large; two were of men, one small and one large; and two small ones were of men and women. The pictures of women were the major impact ones. Another Portuguese version has a young woman cheerfully washing her hair. The BMJ advertisement showed a middle aged woman.

    Fluoxetine (Prozac) is available under other names in continental Europe. In Sweden Fontex is promoted by a young ballerina. The Danish journal shows a ballerina lying dead, then dancing. In Denmark the advertisement is a picture of apples, stones, abacus, and coins (representing financial savings) for Flutin, and for Fondur a picture of storm clouds with fresh light behind stating that it is “30% cheaper for patients.” The Finnish advertisement has light streaming into a dark room through a partly open door and an owl perched on the “L” of Seronil. In Germany it is sold as Fluctin with a picture of an older woman. The advertisements for Prozac in American journals predominantly use women and, occasionally, three stylised balls (an obscure link to pawning?). In Australia photographs feature either a woman or a man.

    Advertisements for fluvoxamine (Fevarin) in the BMJ, American, and Portuguese journals use the same stylised black and white drawing of a young woman, with some of the lines coloured in versions in the United States. German advertisements have a different stylised drawing of a woman superimposed with images of neurons. The Norwegian advertisement shows a woman. In the Netherlands there are five advertisements: a man mountain biking uphill; a man painting a wall; a dancing ballerina; a one armed gambling machine; and a young woman running cheerfully.

    Paroxetin is sold as Seroxat in Europe. The Danish, Dutch, and German journals feature advertisements without people. The Swedish journal used pictures of either a woman or a man. About 10% of advertisements used a man but in soft focus. The Finnish and New Zealand journals show women. In the United States the drug is sold as Paxil. Advertisements show a photograph of a woman with four stark impacting lines: “she's anxious; she's agitated; she can't sleep; she is depressed.”

    The Danish, Dutch, and Swedish journals use stylised shapes for venflaxin (Effexor). A German advertisement shows an older sea captain sitting by his beached boat. American advertisements have a graph, a picture of an Afro-American man and a woman with the text “I got my brother back,” a white couple where it is unclear who has been ill with “I got my marriage back,” or a boy and a mother with “I got my mummy back.”

    Advertisements for certain drugs used in psychiatric disorders predominantly use images of women in Anglo-Saxon countries. In the United States racial minorities feature in the advertisements, but the white male is kept unblemished. When men are involved the male image is less prominent. In northern European countries this trend is less marked. Instead abstract or animal images are used. The Netherlands forms a major contrast in using identifiable men.

    One reason for featuring women in these advertisements is that depression, especially mild depression, presents more often in women than men. Also, drug and advertising company executives are mostly men, and might not like their sex associated with the general stigma associated with psychiatric disorders. There is a similar sex bias in antiepileptic drug advertisements Surprisingly, I found that there was a divide between the Anglo-Saxon countries and continental northern (Protestant?) European countries. In Anglo-Saxon countries, the aim apparently was to keep the image of the white male untainted, while the Europeans sidestepped the problem with neutral images. Norway seemed the exception that proved the rule. The Norwegian national soccer team seems modelled on Wimbledon rather than Brazil, and Norway has stayed outside the European Union, where some Britons seem to want to join them.

    Somewhat amusingly, the original advertisement in the BMJ for “Dutonin—living life to the full” had a picture of the legs of a couple in night dress with the catchy text “with Dutonin depressed people can still rise to the occasion,” which, perversely refers to the sex life of the woman and not the man. The later advertisements in the issue of 7 December 1996 feature cartoon drawings of rabbits and squirrels. Likewise, the autumn 1996 advertisements for risperidone (Risperdal) and olanzapine (Zyprexa) in the BMJ have a boy as the case, and sertindole (Serdolect) is advertised with a graph. Perhaps the climate has changed?

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