ABSTRACT
As pharmaceuticals are moving from private patient–doctor conversations to public television and print advertisements, best-selling books, and top TV shows, as well as into everyday conversations around risk and illness, how people understand health, sickness, and their own identity is also changing. This paper explores some of these changes by unpacking some of the social, political, and personal layers that are complicating the production and marketing of prescription drugs, and that are transforming the identity practices around contested illness. I focus on Sarafem and premenstrual dysphoric disorder (the illness Sarafem was marketed for) as a case study.
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Notes
This phrase comes from Kopytoff (1988).
Kramer called this “diagnostic bracket creep.”
Scottsdale physician Joshua Holland, quoted in The Phoenix Business Journal (http://phoenix.bizjournals.com/phoenix/stories/2001/05/28/newscolumn2.html; accessed October 2001).
Viagra is manufactured by Pfizer.
“Drug products evaluated as ‘therapeutically equivalent’ can be expected to have equal effect and no difference when substituted for the brand name product. The FDA considers drug products to be substitutable if they meet the criteria of therapeutic equivalence, even though the generic drug may differ in certain other characteristics (e.g., shape, flavor, or preservatives)” (http://www.fda.gov/cder/about/faq/default.htm#3; accessed March 2002).
For example, Aetna's coverage policy will only cover Sarafem if patients can document contraindications for the generic equivalent (http://www.aetna.com/products/rx/data/sarafemcpb.html). Likewise, Blue Cross/ Blue Shield does not cover Sarafem (http://www.bcbsma.com/pharmacy/en_US/pharmacyIndex.jsp; accessed March 2002).
DTC is the fastest-growing area of pharmaceutical advertising. Between 1994 and 2000, DTC expenditures have increased ninefold, from $266 million to $2.5 billion (Frank et al. 2002).
“U.K. Consumers Reject Direct Advertising to Patients by Drug Industry” (British Medical Journal 324:1416, 2002). “Providing Prescription Medicine Information to Consumers: Is There a Role for Direct-to-Consumer Promotion?” (Health Action International Europe symposium report, 2002). The full proceedings are available at http://www.haiweb.org/campaign/DTCA/symposium_reports.html.
From the Pharmaceutical Manufacturers of America's web page: http://www.phrma.org/publications/documents/backgrounders/2000-11-05.189.phtml (accessed March 2002).
Hailing women simultaneously as sufferers of PMDD and as an empowered consumer demographic has important implications for the evolving relationships between medicine and marketing. For one thing, the kinds of mental illness that the public comes to learn about through DTC in part turn on the kinds of audiences that are expected to engage in consumerist behavior. There is a large market for antipsychotic drugs, for example, but to date there have been no DTC ads for them. The effectiveness of DTC as a medium for disseminating neuroscientific understandings of mental illness depends in part on the kinds of people pharmaceutical companies expect to be watching their ads. Mental illness turns out to have a demographic complexity too.
The entire letter is available at http://www.fda.gov/cder/warn/nov2000/dd9523.pdf.
Lilly complied with the FDA's request, immediately pulling the contested Sarafem commercials.
This metaphor is taken from Women and the Ownership of PMS (Figert 1996).
Judith Gold, chair of the APA's PMDD Work Group, quoted in Figert 1996: 161.
In fact, about a third of the pharmaceutical industry's research and development budget goes toward such “line extensions” (Frank et al. 2002).
For instance, from a zine on sexuality: http://www.theposition.com/cov-erstories/cover1/00/11/27/pmdd/default.shtm. The American Psychological Association has adopted this language as well: http://www.apa.org/monitor/oct02/pmdd.html (accessed October 2002).
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ACKNOWLEDGMENTS
Thanks go especially to Joe Dumit, who saw this paper through from idea to end. Thanks are also due to “Rx-ID” (Joe Dumit, Paula Gardner, Jeremy Greene, Ginger Hoffman, Andy Lakoff, Sherry Turkle) for feedback on the conference material that parts of this paper came from. In addition, thanks go to the MIT STS writing workshop (Sandy Brown, Candis Callison, Anne Pollock, Rachel Prentice, Esra Ozkan, Peter Shulman, Susan Silbey, Rebecca Slayton, Anya Zilberstein), which gave me helpful advice for organizing this paper. Finally, I would like to thank the anonymous readers that Culture, Medicine and Psychiatry chose for my paper; their feedback gave me fresh eyes and rejuvenated interest in the topics I address here.
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Greenslit, N. DEP®ESSION AND CONSUM♀TION: PSYCHOPHARMACEUTICALS, BRANDING, AND NEW IDENTITY PRACTICES. Cult Med Psychiatry 29, 477–502 (2005). https://doi.org/10.1007/s11013-006-9005-3
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DOI: https://doi.org/10.1007/s11013-006-9005-3