Traditional drug advertisements involve drug ads and promotional material targeted at healthcare professionals to increase clinician knowledge of advancement in treatment options. On the other hand, direct-to-consumer advertising (DTCA) is pharmaceutical advertising directed at patients to increase their awareness of available drugs and treatment options.
There has been renewed interest in the value of DTCA in recent years, which makes it seem like a modern phenomenon, but the practice dates back to early medical training. The argument in support of DTCA is that targeting consumers instead of healthcare providers gives patients power and agency over their drug consumption (Schwartz & Woloshin, 2016). While this argument has some merits, it is vital that we know the history of drug advertisements in the United States to understand how DTCA has shaped public perception of drugs, drug use, and public health. Only with this understanding can we make a sound judgment on the need for DTCA in present times and the future of healthcare.
Lucas Richert introduces a new ‘Points’ feature for 2022: Pharmaceutical Inequalities. Contributing Authors for the series will explore 4 emerging themes within pharmaceuticals through a range of content shared on the blog.
Editor’s Note: Today’s post comes from contributing editor Sarah Brady Siff, avisiting assistant professor at the Moritz College of Law at The Ohio State University, in affiliation with the Drug Enforcement and Policy Center (DEPC).
The superb historian of medicine Keith Wailoo has just written Pushing Cool: Big Tobacco, Racial Marketing, and the Untold Story of the Menthol Cigarette (online book talk here). With this fifth monograph, Wailoo places a capacious 20th-century frame around a culturally and economically significant drug—just as he did around opiates in Pain: A Political History (2015). For those of us in the subfield of alcohol & drugs history, both books offer unique insights from a gifted researcher with deep experience writing about the impact of race on health by way of institutions. In Pain, those institutions mostly are public and federal, from the camera-ready 1980s “Just Say No”-style prohibition campaigns to quieter efforts to deny opiates to Medicaid patients—including combat-injured veterans—with chronic pain.
But in Pushing Cool, the institutions are tobacco companies, along with the Madison Avenue firms they hire to pry open particular demographic segments and make them smokers. Wailoo identifies 1964 as the start of an aggressive campaign to attract urban Black consumers to menthol cigarettes, a charge led by Brown & Williamson’s Kool but soon attracting dozens of other menthol brands.
Editor’s Note: From the Collections highlights articles, artifacts, images, and other items of interest from publications and historical collections of the American Institute of the History of Pharmacy (AIHP). Points Managing Editor and AIHP Head Archivist Greg Bond writes about a recent AIHP online historical exhibit.
Burroughs, Wellcome, and Company Exhibit at the 1893 Columbian Exhibition in Chicago featuring several Native Americans. Henry Wellcome stands at the left wearing a hat. Image courtesy of the Wellcome Library.
At the 1893 Columbian Exposition in Chicago, British multinational pharmaceutical firm Burroughs, Wellcome, and Company constructed an elaborate exhibit featuring the company’s drugs, medicines, and pharmaceutical products. Company co-founder Henry Wellcome was on site for the Exposition, and, during the event, he posed for a picture at his company’s exhibit along with several unnamed and unidentified Native Americans.
There might not seem to be an obvious connection between Indigenous North Americans and a European pharmaceutical company, but Wellcome strategically utilized the imagery—and the bodies—of Native Americans to exploit a longstanding Euro-American association between Indigenous peoples and the healing power of natural medicinal plants. By arranging for the presence of the uncredited Native Americans at his company’s exhibit space, Wellcome hoped that fair goers would thereby associate his company’s manufactured pharmaceuticals with the therapeutic healing power of traditional medicinal plants.
Indigenous peoples in North America have long used medicinal plants and botanicals to treat illnesses and diseases. White Americans and Europeans quickly adopted some native plants for therapeutic purposes after arriving in North America, and they also came to strongly associate medicinal plants and natural medicines with Indigenous cultures.
Drug companies and pharmaceutical manufacturers—like Burroughs, Wellcome—in turn, capitalized on these beliefs and co-opted Native and Indigenous imagery and iconography to market drugs and medicines containing plants and natural products. Particularly during the nineteenth and twentieth centuries, drug companies often relied on these misrepresentations and misappropriations of Native Americans and Indigenous cultures to brand their products as “natural” and safe for therapeutic purposes.
The American Institute of the History of pharmacy recently unveiled an online exhibit titled, “The Misappropriation of Native/Indigenous Imagery in Pharmaceutical Advertising” that explores some of this complicated history. Drawn mostly from the historical collections of AIHP and the University of Wisconsin–Madison School of Pharmacy, the exhibit interrogates how drug companies and pharmaceutical manufacturers have misappropriated Native and Indigenous imagery, customs, and beliefs to market their products.
Alcohol marketing is big business, but what is it for? If the drinks industry is to be believed, advertising doesn’t make people drink more: it just encourages them to choose one brand over another. If health campaigners are to be believed, alcohol marketing causes people to both start drinking earlier, to drink more frequently and to have more positive expectations about alcohol. Meanwhile, social researchers point out that advertising operates within a complex range of cultural and economic drivers and that it is extremely difficult to bracket off the impact of marketing from the other contextual influences that shape people’s beliefs and behaviours around drink.
In the last few weeks, a number of reports have been published calling for the stricter regulation – or outlawing – of alcohol marketing (see here, here and here). For health lobbyists, alcohol marketing is fundamentally problematic precisely because alcohol is not an ‘ordinary commodity’. If, as they would argue, the goal of public policy should be to reduce consumption then all marketing is detrimental. For drinks producers, such calls ignore the social value of alcohol, impinge unjustly on individual freedom, and overlook the fact that marketing is designed to promote brand awareness and loyalty, not increase overall consumption. To many people the last claim may sound like equivocation, for what is the point of advertising if not to make people consume more? However, the question of value is critical: do the potential social harms of alcohol outweigh our individual rights as consumers, or the corporate right of businesses to advertise their products?
Describe your book in terms your mother (or the average mother-in-the-street) could understand.
Happy Pills is a cultural history of Miltown, Valium, and Prozac—three of the best known, most widely used, and controversial medicines in the postwar era. It tells their medical and commercial stories, but also asks why they became so faddish and contentious, and how their fame (and infamy) influenced medical and popular ideas about consciousness and identity.
The book begins in the 1950s, when Miltown became the first “blockbuster” tranquilizer and an early icon of biological psychiatry. The drug’s celebrity was the product of several developments: intensified popular marketing of prescription drugs; increased medical and public attention to anxiety as an illness, led in part by Freudian psychiatry; and a burgeoning consumer culture primed to deliver technological wonders in the name of comfort and convenience for the middle classes.
But Miltown’s popularity didn’t sit well with everyone; in fact the prospect of eradicating anxiety made some people quite nervous. The tranquilizer and its successors quickly became embroiled in postwar gender battles and the explosive politics of the “war against drugs,” and Happy Pills traces these stories to their combined conclusion in a feminist campaign against Valium addiction in the 1970s. This was a most unusual anti-drug campaign, targeting sexism in drug companies and the medical system rather than stoking fear of addicts. It capped off a decade of challenges to the pharmaceutical industry, and was part of a broader effort by reformers to rethink the boundaries between “drugs” and “medicines.”
Happy Pills ends with a look at the emergence of Prozac and other antidepressants in the late 1980s and 1990s, and the accompanying revival of popular belief in wonder drugs. Why was this resurgence so successful when the drugs themselves turned out to be far from revolutionary? Prozac’s boosters, I argue, took new findings in brain science and used them to create a story that was as much political as it was scientific: miraculous new consumer goods now made it possible to pick and choose personalities—identities—in a utopian free market of accessorizable selfhood. However exaggerated such promises may have been, they proved a powerful cultural vehicle for pushback against feminist-era drug critics, and a fitting vision of identity and personal change for an increasingly conservative era.
