Women, the media, and heart disease. For better or for worse?

OBJECTIVE: To analyze the nature and presentation of print media messages regarding cholesterol and heart disease in women. The hypothesis is that print media messages about cholesterol and heart disease may encourage and perpetuate the use of cholesterol-lowering drugs in women. METHODS: A hand-search of the "seven sisters" of American women's magazines and of two Canadian women's magazines. All print material related to cholesterol and heart disease in women was photocopied and the content analyzed qualitatively. The print media content was divided into two categories: magazine articles and drug industry-sponsored advertisements. Themes were identified and were analyzed for the messages they contained about heart disease, cholesterol, and the use of cholesterol-lowering drugs in women. RESULTS: From the magazine articles, three main messages were identified. First, heart disease is the number one killer of women. Second, women must demand recognition of their hig risk of heart disease and demand equal access to prevention and treatment services for heart disease. Third, lifestyles changes are not enough. Cholesterol-lowering drugs should be considered. Drug advertisements also emphasize that postmenopausal women are at high risk of heart disease and that lifestyle changes are inadequate or insufficient to lower this risk. In both cases, high blood cholesterol is considered not as a risk factor for heart disease but as the disease itself. CONCLUSIONS: Magazine articles and drug advertisements act synergistically and may encourage and promote the use of cholesterol-lowering drugs in women. Postmenopausal women not on hormone therapy are particularly targeted.     

Relationships of Physicians with Pharmaceutical Sales Representatives and Pharmaceutical Companies:

Physicians were surveyed in Northwestern Pennsylvania to examine how they viewed their relationships with pharmaceutical sales representatives (PSR) and the pharmaceutical industry. Physicians viewed the PSR as an important source of information, but felt that they could get needed information from other sources without the PSR's assistance. Physicians also had friendly relationships with the PSRs and did not distrust them, but they did not view PSRs as a vital part of their practice. Samples and gifts provided by the pharmaceutical companies were not viewed as vital to gaining access to physicians. However, the financial support the companies provided for continuing medical education was seen as vital. The selling approaches used by PSRs was not considered manipulative, nor were PSRs thought to be perceived negatively by the medical community. A majority of the physicians said they would accept honoraria for delivering lectures to pharmaceutical companies. Twenty-five percent of the responding physicians also owned stock in pharmaceutical companies.     

Relationships of physicians with pharmaceutical sales representatives and pharmaceutical companies: an exploratory study

Physicians were surveyed in Northwestern Pennsylvania to examine how they viewed their relationships with pharmaceutical sales representatives (PSR) and the pharmaceutical industry. Physicians viewed the PSR as an important source of information, but felt that they could get needed information from other sources without the PSR's assistance. Physicians also had friendly relations with PSRs and did not distrust them, but they did not view PSRs as a vital part of their practice. Samples and gifts provided by the pharmaceutical companies were not viewed as vital to gaining access to physicians. However, the financial support the companies provided for continuing medical education was seen as vital. The selling approaches used by PSRs was not considered as manipulative, nor were PSRs thought to be perceived negatively by the medical community. A majority of the physicians said they would accept honoraria for delivering lectures to pharmaceutical companies. Twenty-five percent of the responding physicians also owned stock in pharmaceutical companies.     

Negative effects of individual-based preventive interventions. 2008 SESPAS Report

Because preventive interventions are usually assumed to carry few risks, research on their negative effects is scarce, as revealed by a review of the Spanish literature. The studies retrieved analyze short-term effects (such as false-positive results of screening tests), but do not evaluate the long-term effects of postscreening interventions (for example: preventive drugs) or even less tangible negative effects (such as medicalization). Uncritical spread of preventive medicine is occurring, with continual proposals for new screening tests (for pre-diseases and risk factors) and new vaccines. The risk-benefit ratio of this spread is, at the very least, doubtful. The pharmaceutical industry plays a key role in this process but the role of other stakeholders (health professionals and health authorities, mass media and society) should also be reviewed. The present article highlights the role of the medical profession, since, without it, definition of new diseases and pre-diseases and the creation of guidelines on the use of new preventive interventions would not be possible. The medical profession has sufficient prestige to lead any change. Before any change occurs, however, scientific societies should conduct an internal debate on their current role in the adoption of new preventive interventions, their relationships with the pharmaceutical industry and their conflicts of interest. Some medical associations are already adopting a more critical approach to the evaluation of the benefit-risk trade-off of new interventions and are analyzing the impact of their own preventive recommendations on the medicalization of life. The adverse effects of the preventive measures implemented in health services should be continually assessed and procedures for the critical evaluation of the benefit-risk-cost trade-offs of new preventive interventions should be established before making decisions on their incorporation in the health services' portfolio. Finally, in daily clinical practice, enhancing citizen participation in decisions and adopting the approach of quaternary prevention would be desirable.     

Hype in health reporting: "checkbook science" buys distortion of medical news.

The greatest danger to public health might be "checkbook science": research intended not to expand knowledge or to benefit humanity but to sell products. Much of the media coverage of health news stories is based on public relations efforts on behalf of the companies that sell the products, including pharmaceutical companies, diet clinics, or doctors selling new techniques. The author presents three case studies of how companies selling medical products effectively but invisibly shaped recent news coverage of medical products: fen-phen diet pills, breast implants, and hormone replacement therapy. All involve subtle strategies whereby physicians and other experts paid by corporate interests are influential because they are perceived to be objective medical experts. Articles in prestigious medical journals are sometimes ghostwritten by individuals paid by companies or are based on biased analyses or interpretations shaped by corporate interests. Nonprofit organizations that tout the benefits of specific medical products also may be part of the public relations efforts of the companies making the product. Meanwhile, important newsworthy studies are ignored by the mass media when corporate interests do not publicize or pitch the results to influential reporters and producers.     

The medicalization of female "circumcision": harm reduction or promotion of a dangerous practice?

In recent decades the practice of female "circumcision" has come under intense international scrutiny, often conceptualized as a violation of women's basic right to health. Although the adverse health consequences of female "circumcision" form the basis of opposition to the practice, anti-circumcision activists, as well as many international medical associations, largely oppose measures to improve its safety. The debate over medicalization of female "circumcision" has, up until now, been cast as a moral dilemma: to protect women's health at the expense of legitimating a destructive practice? Or to hasten the elimination of a dangerous practice while allowing women to die from preventable conditions? This paper seeks to re-examine this debate by conceptualizing medicalization of female "circumcision" as a harm-reduction strategy. Harm reduction is a new paradigm in the field of public health that aims to minimize the health hazards associated with risky behaviors, such as intravenous drug use and high-risk sexual behavior, by encouraging safer alternatives, including, but not limited to abstinence. Harm reduction considers a wide range of alternatives, and promotes the alternative that is culturally acceptable and bears the least amount of harm. This paper evaluates the applicability of harm reduction principles to medical interventions for female "circumcision," and draws parallels to other harm reduction programs. In this light, arguments for opposing medicalization of female "circumcision", including the assertion that it counteracts efforts to eliminate the practice, are critically evaluated, revealing that there is not sufficient evidence to support staunch opposition to medicalization. Rather, it appears that medicalization, if implemented as a harm-reduction strategy, may be a sound and compassionate approach to improving women's health in settings where abandonment of the practice of "circumcision" is not immediately attainable.     

An analysis of the pharmaceuticals market in Vietnam

This article sheds a light on the Vietnamese pharmaceutical market. The progress that has been made in the recent years following the opening of the Vietnamese regime to the western world, although not easy, brought a certain number of opportunities for domestic firms and foreign investors. The pharmaceutical Vietnamese industry started to emerge at the beginning of the 1990s. Although, the consumption of drugs is low, it does reach the sum of $ 5.5 per capita. As the majority of these products are imported, foreign companies tend to dominate the market both in volume and in diversity. The state has always played an important role with the implementation of a strict price control strategy and most national drug companies remain state-owned. The production and consumption of drugs were also largely influenced by state policies as the latter also control hospitals. In the second half of the eighties, the progressive liberalisation of the country allowed private drug pharmacies to appear and advertisement campaigns became legal. Because the lack of specific products like antibiotics was clear, the government increased the flow of imports, including private imports by citizens. Sources of imports have become more diverse, although France remains an important source of supply. Fournier, Lipha and Pierre Fabre are among the French drug manufacturers located in Vietnam. Other foreign companies include from India, South Korea, Thailand and Germany. Joint ventures were also created with French and Japanese companies. The import of medical materials is subjected to authorisations from the Ministry of Health and the Ministry of Foreign Trade as it is necessary to obtain a licence to do so. Licences are issued on the basis of the production of drugs that do not currently exist on the local market. But Vietnam also exports pharmaceutical products to Laos, Cambodia, and Cuba. Local resources constitute an important source of new products and have stirred a strong interest among pharmaceutical researchers. A strong decentralisation process characterises the pharmaceutical sector, with pharmacies in the provinces and districts while wholesalers remain located in Hanoi and Saigon. The presence of many middlemen has contributed to an increase in prices. Today, a concentration of pharmacies is still noted in inner cities while the suburbs and the villages still have difficulties supplying drugs for inhabitants. Solutions have been implemented such as the opening of new pharmacies and additional professional training for pharmacists. Prices were lowered while the quality of the supply chain was improved. Local production is encouraged as hospitals are prompted to prescribe Vietnamese products. The modernisation of the Vietnamese pharmaceutical industry is also visible through the importation of medical materials and an increase in the number of private hospitals financed with both the help of local and foreign investors, mainly through joint-ventures, most often in Saigon and Hanoi. The renovation of local hospitals was also possible with the help of France and Japan. Columbia Gia Dinh International, located in Saigon, is one of the very few US/Vietnamese medical institutions created with a local partner, the Gia Dinh hospital. The recovery of the economy will accelerate the creation of new projects designed to improve local medical infrastructures. Other private companies, some of which are based in Singapore, have been specifically designed to deliver care to expatriates working in Vietnam. Insurance coverage has been provided in Vietnam since in 1992. Other improvements concern the implementation of "Good Manufacturing Practices" (GMP) and "Good Laboratory Practices" and "Good Storage Practices". Most norms were implemented at the end of the 90s in joint companies linking foreign investors and local partners or in independent foreign drug manufacturers based in Vietnam. Special areas were created to receive high tech investments in the medical and pharmaceutical field. Prices should diminish as competition on the market increases and new products are placed on the market to achieve economies of scale. But investment in medical research is still strongly needed.     

Characteristics of Physicians Targeted by the Pharmaceutical Industry to Participate in E-detailing

Electronic detailing (e-detailing) has been introduced in the last few years by the pharmaceutical industry as a new communication channel through which to promote pharmaceutical products to physicians. E-detailing involves using digital technology, such as Internet, video conferencing, and interactive voice response, by which drug companies target their marketing efforts toward specific physicians with pinpoint accuracy. A mail survey of 671 Iowa physicians was used to gather information about the physician characteristics and practice setting characteristics of those who are usually targeted by pharmaceutical companies to participate in e-detailing. A model is developed and tested to explain firms' targeting strategy for targeting physicians for e-detailing.     

Pharmaceutical reform and physician strikes in Korea: separation of drug prescribing and dispensing

Before the recent pharmaceutical reform in Korea that mandates the separation of drug prescribing and dispensing, physicians and pharmacists both prescribed and dispensed drugs, resulting in the overuse and misuse of drugs. The pharmaceutical reform attempts to change the provider's economic incentives by eliminating the providers' profit from drugs that have been a major source of their income. It also influences the pharmaceutical industry that has thrived on offering high margins to physicians rather than on producing high-quality drugs. However, physician strikes forced the government to modify some critical elements of the reform package and to raise medical fees substantially to compensate for the income loss of physicians. Lack of a strategic plan of implementation, failure to appreciate the change in the paradigm of health policy process, and failure to convince consumers of the benefits of the reform, are the major reasons that the historic reform of the separation of drug prescribing and dispensing has resulted in greater social cost than expected.     

Medicalization of psychoactive substance use and the doctor-patient relationship.

Any attempt at medicalization of cocaine, heroin, marijuana, and other psychoactive substances of abuse in the United States is likely to encounter strong opposition by many responsible physicians. Such opposition would be grounded in their perception that medicalization would be contrary to the purposes of medical practice. Most physicians would, however, be willing to consider prescribing such substances for pathological users if such prescribing took place within the context of a fully developed doctor-patient relationship in which the patient recognized the dependency as undesirable and wanted to cooperate with the physician in a mutual effort to end the dependency or, if this were not feasible, to mitigate its destructive effects.     

Pharmaceutical promotion in Canada: convince them or confuse them

Currently, drug companies are spending in excess of $200 million annually on promoting their products to Canadian physicians. Although the industry has adopted a voluntary code of advertising practice, this has not prevented gross excesses in all forms of pharmaceutical promotion: drug-company sponsored continuing medical education, and promotion through the public media, detailers, direct mail, sampling, and journal advertising. Not only does advertising add to the cost of drugs, but physicians' reliance on information conveyed through advertising leads to poor prescribing and consequently to significant adverse health effects for patients. Reforms of promotional practices are possible, but the initiative is unlikely to come from either the medical profession or the government. Pressure applied through an emerging grass-roots movement is the best hope for change.     

Practicing research ethics: private-sector physicians & pharmaceutical clinical trials

This paper focuses on constructions of research ethics by primary care physicians in the USA as they engage in contract research for the pharmaceutical industry. Drawing first on historical studies of physicians as investigators and then on 12 months of qualitative fieldwork in the Southwestern US, this paper analyzes the shifting, contextualized ethics that shape physicians' relationships with patients/subjects and pharmaceutical companies. Just as physicians followed professional codes of ethics prior to the codification of acceptable research conduct in the 1980s, physicians today continue to develop tacit systems of research ethics. This paper argues that private-sector physicians primarily conceptualize their ethical conduct in relation to the pharmaceutical companies hiring them, not to human subjects they enroll in clinical trials. This is not to say that these physicians do not follow the formal U.S. regulation to protect human subjects, but rather that their financial relationships with the pharmaceutical industry have a greater influence on their identities as researchers and on their constructions of their ethical responsibilities.     

Turf battles rock radiology

CEOs tell Hospitals magazine that imaging is a major area of expansion for their hospitals. But radiology is in a state of transition. Technological advances have made it possible to do more radiological procedures in the physician's office. This situation has created competition--and tension--between physicians in the same community, physicians and hospitals, and physicians on the same medical staff. How can you avoid costly turf wars at your hospital? Health care executives and directors of medical affairs say that the answer to this realignment of specialties is to create integrated teams of medical specialists.     

Evaluating direct-to-consumer marketing of race-based pharmacogenomics: a focus group study of public understandings of applied genomic medication

Some medical providers have advocated applied genomics, including the use of genetically linked racial phenotypes in medical practice, raising fear that race-based medication will become justified. As with other emerging medical genetic technologies, pharmaceutical companies may advertise these treatments. Researchers fear that consumers will uncritically accept pharmaceutical messages and demand the product. In this exploratory study, we examined public reactions to advertisements for applied genomic medications. A focus group methodology was employed. Participants tended to resist the message and generated warrants for doing so, indicating critical reception of the messages. Message accepters also provided warrants. Warrants for resistance and acceptance differ between self-identified racial groups. Consumers, health care providers, and pharmaceutical corporations will benefit from a better understanding of direct-to-consumer advertisements as medical communication. Our study concludes that both advocates and opponents of direct-to-consumer advertisements should recognize that potential consumers of pharmacogenomics act as critical consumers of health advertising discourse.     

Mothers Whose Children Have ADD/ADHD Discuss Their Children's Medication Use: An Investigation of Blogs

This article presents the results of a frame and discourse analysis of Internet blog sites where parents (usually mothers) discuss their concerns about medication use by their children with attention deficit disorder or attention deficit hyperactivity disorder (ADD/ADHD). This is a particularly important topic in an era characterized by powerful circulating discourses around the contentious medicalization of, and prevalent pharmaceutical treatments for, ADD/ADHD, as well as the mother blame associated with having a child diagnosed with ADD/ADHD. The findings document that the mothers see ADD/ADHD as legitimate medical diagnoses and view themselves as caretakers of children with brain and neuro-chemical anomalies affecting the behavior of their children. They favor pharmaceutical use and describe themselves as experts in the difficult and complex issues related to pharmaceuticalized parenting. At the same time their adoption of medicalization is contingent as they express specific critiques of some doctors, some types of doctors, and critically evaluate science.     

Struggles for medical legitimacy among women experiencing sexual pain: A qualitative study

ABSTRACT

Given the prominent role of medical institutions in defining what is “healthy” and “normal,” many women turn to medicine when experiencing pain during intercourse (dyspareunia). The medical encounter can become a contest between patients and providers when physicians do not grant legitimacy to patients’ claims of illness. Drawing on interviews conducted from 2007 to 2008 and 2011 to 2012 with 32 women experiencing dyspareunia (ages 18–60 years) and living in New York City and its surrounding areas, this study examined women’s and their physicians’ claims regarding bodily expertise, particularly women’s perceptions of physician invalidation, their understanding of this invalidation as gendered, and the consequences for women’s pursuit of medicalization. Women overwhelmingly sought a medical diagnosis for their dyspareunia, in which they believed that providers would relieve uncertainty about its origin, give treatment alternatives, and permit them to avoid sexual activity. When providers did not give diagnoses, women reported feeling that their bodily self-knowledge was dismissed and their symptoms were attributed to psychosomatic causes. Furthermore, some women linked their perceptions of invalidation to both historical and contemporary forms of gender bias. Exploration of women’s struggles for medical legitimacy may lead to a better understanding of the processes by which medicalization of female sexuality takes place.     

Mothers whose children have ADD/ADHD discuss their children's medication use: an investigation of blogs

This article presents the results of a frame and discourse analysis of Internet blog sites where parents (usually mothers) discuss their concerns about medication use by their children with attention deficit disorder or attention deficit hyperactivity disorder (ADD/ADHD). This is a particularly important topic in an era characterized by powerful circulating discourses around the contentious medicalization of, and prevalent pharmaceutical treatments for, ADD/ADHD, as well as the mother blame associated with having a child diagnosed with ADD/ADHD. The findings document that the mothers see ADD/ADHD as legitimate medical diagnoses and view themselves as caretakers of children with brain and neuro-chemical anomalies affecting the behavior of their children. They favor pharmaceutical use and describe themselves as experts in the difficult and complex issues related to pharmaceuticalized parenting. At the same time their adoption of medicalization is contingent as they express specific critiques of some doctors, some types of doctors, and critically evaluate science.     

Tracking governance: advice to mothers about managing the behaviour of their children in a leading Canadian women’s magazine during two disease regimes

This paper explores how advice to mothers about raising healthy children differs in two distinct disease regimes as portrayed in articles in the pre-eminent Canadian women’s magazine Chatelaine about 50?years apart, 1928–1944 and 1990–2012. The paper compares intensive mothering, medicalization and the perception of risk. It suggests that both intensive mothering and medicalization are continuous from time period to time period (although the content of both mothering and medicalization differ in the two periods). Medicalization focused on the physical well-being and emphasized the importance of the routinized behaviours designed for conformity in the early period. In the latter period, there is a greater focus on individuality of children and their emotional well-being. This is linked to the rise of the discourses of the psy professions. With respect to risk, however, the paper documents an important change in the expansion of the degree to which life is considered risky. The substantive, theoretical and practical consequences of the findings are discussed.