Intended for healthcare professionals

Images Of Health

Accepting what we can learn from advertising's mirror of desire

BMJ 2004; 329 doi: (Published 16 December 2004) Cite this as: BMJ 2004;329:1487
  1. Peter Mansfield, director (peter{at}
  1. 1 Healthy Skepticism, 34 Methodist Street, Willunga, 5172 SA, Australia

    ‘Now can you think what the Mirror of Erised shows us all?’…

    Harry thought. Then he said slowly, ‘It shows us what we want… whatever we want…’

    ‘Yes and no,’ said Dumbledore quietly. ‘It shows us nothing more or less than the deepest, most desperate desire of our hearts.’

    J K Rowling, Harry Potter and the Philosopher's Stone

    The commercial success of the Harry Potter books, despite literary limitations, shows both the power of promotion and the power of imagery that taps deeper meanings from metaphors and ancient myths. Readers of the first Harry Potter book are challenged to decode the inscription on the magical Mirror of Erised to reveal the meaning: “I show not your face but your heart's desire.”2 Drug advertising is also a mirror to our souls that can teach us much about ourselves.2 Competition among drug companies to increase sales creates selective pressure for the evolution of advertising that accurately reflects how healthcare professionals really make decisions. Scott and colleagues have decoded advertising's mirror of desire.1 3 We may not want to believe what the mirror shows us, nor agree with the details of their decoding, but acceptance of their main messages may lead to major improvements in medical decision making by reducing our vulnerability to adverse influence.

    Many healthcare professionals deny that we are influenced by drug promotion because to admit otherwise would insult our intelligence3 and hurt our self esteem. Some of us concede that some of our peers are vulnerable, but not ourselves. By contrast, drug companies know that combinations of promotional techniques, including carefully chosen images that appeal to our desires, are effective for increasing sales.4 Images influence even the cleverest people by sneaking in under the radar of our verbal intelligence.2 The first step to overcoming this vulnerability is to dispel our illusion of invulnerability by accepting that we all have human limitations.5

    Many of us have been misled into overconfidence about drugs such as cyclo-oxygenase-2 inhibitors, antidepressants, and misnamed “hormone replacement therapy.” To avoid being misled again and again, we need a better understanding of how promotional techniques work as a foundation both for better regulation of promotion and for better training for healthcare professionals.6 Harnessing promotional techniques may also enable more effective dissemination of evidence based medicine. My informal marketing research suggests that the metaphors in this commentary will work like magic for many readers but not for all.

    Scott et al's article helps us by studying how symbols and signs in advertising images can create powerful meanings by tapping into the myths we use to understand our world, our lives, and ourselves. Images have different meanings for different people, depending on many factors, including culture and roles. Because images are rarely examined carefully with verbal thought, we are seldom fully aware of the meanings that are generated. The various meanings received by healthcare professionals may differ from the meanings intended by the advertisers. Advertisers hardly ever tell us what messages they intend to send because doing so can break the spell they are casting. However, Ogilvy (founder of the famous advertising agency) disclosed that some of his most powerful images came from his dreams and asserted that “Good ideas come from the unconscious.”7 He did not claim to fully understand what his images meant. What mattered to him was that they were effective for increasing sales.

    Research on the range of meanings that healthcare professionals receive from superficial but repeated exposure to drug advertisements and the influence on prescribing deserves priority. Meanwhile this article shows what meanings can be decoded by a small team thinking about images in great depth. We may not all follow them that far, but medical decision making is likely to improve if we accept the desirability of becoming more thoughtful about advertising. Now, can you think what advertising's mirror of desire shows you?


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