Killing me softly: myth in pharmaceutical advertising
BMJ 2004; 329 doi: https://doi.org/10.1136/bmj.329.7480.1484 (Published 16 December 2004) Cite this as: BMJ 2004;329:1484
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Prof. Sheridan's identification of a reference to Roberta Flack in
"Killing Me Softly: Myth in Pharmaceutical Advertising" is correct and I
think our title's patholological twist closer to the song lyric than he
suspects. The meaning concerns subtle and fatal seduction.
I differ from his reading on two other points. We do not "lament the
use of rhetorical rather than rational argument in scientific media". We
merely attempt to describe how ad images function as rhetorical devices in
that context.
By the phrase “Words are precise and accountable in Law and Science”
we only invoke normal expectations. To imply that these discourses occupy
"a higher ethical ground" than rhetoric might be contradictory.
As for his dictum, "Let the reader beware", I agree absolutely.
Competing interests:
None declared
Competing interests: No competing interests
Prof Sheridan is surely stretching a point. He demolishes the title
of the article alone. A strange message to be on your guard against being
on your guard against advertising copy, if that is what he is saying.
Perhaps we are all safer these days believing everything.
Competing interests:
None declared
Competing interests: No competing interests
Scott et al discuss the use of symbolism in images in drug
advertising, indicating that mythology may be used to mislead doctors
about therapeutic efficacy. They suggest that doctors need support to
resist drug advertising; they recommend regulation of journals'
advertising to clinicians and lament the use of rhetorical rather than
rational argument in scientific media. However it is evident that the
authors use the very techniques they warn about to influence the reader to
their point of view. The article entitled "Killing me softly: myth in
pharmaceutical advertising” borrows from the title of Fox and Gimbel’s hit
song recorded by Roberta Flack in 1973 to capture the reader’s attention.
Juxtaposing the word “Killing” with “pharmaceutical advertising” conveys
an unhealthy and negative sense and transforms the metaphor from a
romantic to an aggressive one. The word “myth” in this context is also
ambiguous, carrying a sense of deception as well as its classical meaning.
Capturing the attention of readers is challenging for advertisers and
writers alike. Scott et al argue “words are precise and accountable in Law
and Science” and imply that these occupy a higher ethical ground; however
these authors themselves exemplify the fact that symbolism is frequently
used to reinforce messages, whether in linguistic or image form and not
only in advertising. Let the reader beware.
Competing interests:
None declared
Competing interests: No competing interests
Nice piece! I published a similar paper in 1979 that may interest
readers: Chapman S. Advertising and psychotropic drugs:the place of myth
in ideological reproduction. Social Science and Medicine 1979;13A:751-64.
Then, as today, virtually the entire debate about regulating
pharmaceutical advertising is bogged down in considerations of the wording
and fine print in the ads, almost all of which is never read. The in-your-
face visual copy is seen as an irrelevant, inconsequential distraction
that could never hope to sway cerebral doctors. Yes sure, sure ....
Competing interests:
None declared
Competing interests: No competing interests
More Mythologies in Advertising
The semiotic approach to advertising discussed in Scott et al (BMJ
2004 Dec
18) is a useful one for understanding the power of the images used in
advertising. One aspect of this privileged and uncensored method of visual
communication has particularly interested me over the last few years: it
seems that pharmaceutical companies have developed new ways of
publicizing features of their medications that have not yet been proven. I
have had the experience of detail men and women hinting at new uses that
are being discovered or off-label ways that medications are being used,
but it
is not legal for the companies to say things in their advertisements that
are
not features of the FDA approval.
The first example of this that I noticed was when Parke-Davis was
conducting
its push to get people to prescribe Neurontin. At a time when its only
FDA
approved use was as an adjunctive anticonvulsant, there was a belief that
it
might be a good mood stabilizer. Obviously Parke-Davis could not
advertise
this directly so instead there was an advertising campaign that was based
on
bicycles. Neurontin patients were smiling on bicycles in advertisements
for
this adjunctive anticonvulsant in psychiatric journals everywhere. First
of all,
it was odd to be advertising an adjunctive anticonvulsant in psychiatric
journals. Secondly, it was not clear what the reason for the ads was
except
that all those cycling people were happy. It is my belief that this was a
subliminal campaign to impress on psychiatrists that Neurontin was good
for
“cycling” even though they could not come out and say that. Of course in
the
same journals there were lots of case reports and open trials discussing
the
possibility that Neurontin might be a mood stabilizer. The articles asked
the
questions and the ads subliminally provided the answers.
A second example is the campaign for Cymbalta. It has not been shown
that
antidepressants that affect two neurotransmitters are more effective that
those that affect one neurotransmitter system. This question will not be
answered until there are more head-to-head studies. However the Cymbalta
advertising campaign takes this on in a subliminal way. The ad for
Cymbalta
centers again on bicycles. The ad shows one bicycle missing a wheel and
one
with both wheels. The implications is that two wheels are better than one
and
that similarly two neurotransmitters are better than one. Again this is
not
stated explicitly, but cleverly implied. After all, who would give their
patient a
bicycle with only one wheel to ride?
Physician prescribing practices have been shown to be affected by
advertising, (Goodman, 2001) I think that it is very important that we
notice
the messages that are being covertly sent in the advertising: both to be
aware
of the accuracy of the information and also of the implications that may
be
conveyed, without proof, by the images.
References
Scott, Stanford, and Thompson. Killing me softly: myth in
pharmaceutical
advertising. BMJ. 2004 December 18;329(7480): 1484-1487
Goodman B. Do drug company promotions influence physician behavior?
Western Journal of Medicine; Apr 2001; 174,4; Health Module pg. 232
Competing interests:
None declared
Competing interests: No competing interests