Direct‐to‐consumer advertising for bleeding disorders: a content analysis and expert evaluation of advertising claims

Summary. Objective: In the United States, the Food and Drug Administration (FDA) requires that all direct‐to‐consumer advertising (DTCA) contain both an accurate statement of a medication’s effects (‘truth’) and an even‐handed discussion of its benefits and risks/adverse effects (‘fair balance’). DTCA for medications to treat rare diseases such as bleeding disorders is unlikely to be given high priority for FDA review. Methods: We reviewed all DTCA for bleeding disorder products appearing in the patient‐directed magazine HemeAware from January 2004 to June 2006. We categorized the information presented in each advertisement as benefit, risk/adverse effect, or neither, and assessed the amount of text and type size devoted to each. We also assessed the readability of each type of text using the Flesch Reading Ease Score (FRES, where a score of ≥65 is considered of average readability), and assessed the accuracy of the advertising claims utilizing a panel of five bleeding disorder experts. Results: A total of 39 unique advertisements for 12 products were found. On average, approximately twice the amount of text was devoted to benefits as compared with risks/adverse effects, and the latter was more difficult to read [FRES of 32.0 for benefits vs. 20.5 for risks/adverse effects, a difference of 11.5 (95% CI: 4.5–18.5)]. Only about two‐thirds of the advertising claims were considered by a majority of the experts to be based on at least low‐quality evidence. Conclusion: As measured by our methods, print DTCA for bleeding disorders may not reach the FDA’s standards of truth and fair balance.     

Effects of a Media Literacy Program in the US on Children's Critical Evaluation of Unhealthy Media Messages about Violence,Smoking, and Food

This study evaluates the effectiveness of the Media Power Youth health-focused media literacy program. Using a susceptibility reduction strategy, this program seeks to develop participants' media-literacy beliefs and skills to enhance their ability to critically evaluate portrayals of violence, substance use, and non-nutritional eating. It was implemented in fifth-grade classes at two elementary schools in the Northeastern United States. A third school served as a nontreatment control group. Evaluation results indicated significant increases in students' understanding that (1) media violence is often glorified, unrealistic, and can make children act more violently, and (2) advertising can make smoking and fast foods look healthy and can affect children's desires and behaviors. Students' ability to apply media-literacy skills to new media portrayals was also enhanced. Findings are discussed in terms of the Habits of Thought and the Health Beliefs Models, and benefits of integrating such programs into existing courses of study are described.     

Adolescent gambling: Temperament,sense of coherence and exposure to advertising

This study examines the relationships between gambling behaviour and temperament, sense of coherence (SOC) and exposure to advertising among adolescents, and the interactions between these three independent variables in relation to problem gambling (PG). One thousand and sixty-nine Israeli adolescents (males = 539, females = 530), aged 16–19, were sampled from 19 high schools. The following instruments were used: a gambling behaviour scale; a PG scale; an advertising exposure scale; Buss and Plomin's emotionality, activity and sociability (EAS) questionnaire measuring temperament; and a short version of Antonovsky's SOC scale. The findings indicated a relationship between recall of exposure to advertising and gambling behaviour and PG among adolescents. No correlations were found between SOC and gambling behaviour and PG, and no correlation was found between temperament and gambling behaviour. However, the effect of temperament on PG was significant for girls only. In addition, no interaction was found between the three independent variables relating to PG. The findings of this study underline the social role of advertisements in the process of developing gambling behaviour among adolescents and its effect on problem gambling.     

Dynamic advertising with spillovers: Cartel vs competitive fringe

A differential oligopoly game with advertising is investigated, where different dynamics occur between two groups of agents, the former playing a competitive Nash game and the latter cooperating as a cartel. Sufficient conditions for stability and a qualitative analysis of the profit ratio and social welfare at equilibrium are provided. A threshold value for the size of the competitive fringe is pointed out by a suitable numerical simulation. Copyright © 2009 John Wiley & Sons, Ltd.     

The Origins and Consequences of Patient Autonomy: A 25-Year Retrospective

This essay explores the evolution of the tension between the principles of autonomy and beneficence in American health care over the past several decades. In retrospect it is clear that the social movements of the 1960s and 70s set the tone and the goals for the emergence of a new emphasis on patient autonomy. Indeed, the impact of civil liberties-minded lawyers on the promotion of a commitment to autonomy is far more vital than the term “bioethics” commonly suggests. Tracing the impact of this principle on clinical encounters over the past 25 years makes apparent that consumers have extended their influence over a wide range of treatment decisions. This influence is now being reinforced by an extraordinary information revolution, which includes the computer, the web, the dot.coms, the search engines, and such novel practices as Direct-to-Consumer advertising by pharmaceutical companies. The impact of these developments may be seen in such diverse issues as physician-assisted suicide and the failure of national health insurance initiatives. This revised version was published online in July 2006 with corrections to the Cover Date.     

Food advertising targeted at school-age children: a content analysis

OBJECTIVE: To determine whether the contents of food and beverage advertisements are associated with physical activity and athletic ability more often than those for toys and games, and to describe persuasive techniques used in advertising food and beverages to children. DESIGN: A content analysis of advertisements during 31 hours of school-age children's television programming. ANALYSIS: Chi-square tests were used to examine differences in depictions of physical activity. Types of persuasive techniques were tabulated and, within each advertisement, categorized as implicit or explicit. RESULTS: Food and beverage ads depicted children engaged in physical activity and associated the advertised product with athletic ability significantly more than toy and game ads. Food was most often associated with fun and good times (75%), pleasant taste (54.1%), being hip or cool (43.2%), and feelings of happiness (43.2%). IMPLICATIONS FOR RESEARCH AND PRACTICE: These findings raise concern that greater levels of physical activity and athletic ability in food advertising, in which the product is frequently associated with fun, may promote overconsumption, especially of calorie-dense, nutrient-poor foods. Further research would elucidate whether this concern is warranted. On the other hand, since food advertisements are presumably effective, health educators can use these techniques to formulate messages for nutritious foods. This concept should be tested with well-designed interventions.     

Impact of cigarette advertising on smoking behaviour in Spanish adolescents as measured using recognition of billboard advertising

BACKGROUND: Cross-sectional studies provide empirical support for associations between advertising and adolescent smoking. The aim of this study was to investigate the relationship between Spanish adolescent smoking behaviour and prior awareness of cigarette advertisements on billboards, using a prospective design. METHODS: 3,664 Spanish children aged 13 and 14 years filled in self-completion questionnaires at baseline, and 6, 12, and 18 months later (cohort study). Slides of three advertisements were projected at baseline. A multivariate logistic regression analysis was carried out to detect possible association between number of identified tobacco advertisements brands at baseline and smoking status along time, controlling ASE Model smoking determinants, smoking prevention interventions, age, gender and socio-economic status. RESULTS: The more advertisements identified at baseline, the greater was the risk of being a smoker (p<0.0001). Final percentages of smokers were 15.8%, 16.3%, 19.3%, and 32.6%, respectively, for zero, one, two and three advertisements recognized. When confounders were controlled, the probability of being a smoker increased with the number of advertisements identified [OR 1.26 (95% CI: 1.09-1.46) after 6 months, OR 1.18 (95% CI: 1.03-1.35) after 12 months and 1.15 (95% CI: 1.02-1.30)] after 18 months. It is possible the association would have been even greater if there had not been a differential loss of smokers from the sample. CONCLUSION: Increased awareness of cigarette advertising was associated with a higher smoking incidence and an increased risk of Spanish children becoming smokers. It is, therefore, imperative that cigarette advertising should be banned as a matter of urgency.     

Unsafe driving in North American automobile commercials

BACKGROUND: Motor-vehicle crashes (MVCs) are a leading cause of death of young Americans and Canadians. Aggressive driving and driving at high speed are frequently cited as contributing to crashes. Consumer and safety associations have raised concern that driving behaviour portrayed in automobile commercials may influence consumer-driving behaviour. However, the prevalence of aggressive driving in automobile commercials has not been systematically evaluated. OBJECTIVES: To identify the prevalence and types of unsafe driving that are portrayed in United States and Canadian televised automobile commercials as well as the use of safety promotion and disclaimers. DESIGN: All English language automobile and truck commercials (>or=30 seconds in length), airing nationally on major broadcast and cable networks in either the United States or Canada during January or July between 1998 and 2002 were assessed by three independent raters for the presence and type of unsafe driving activity, presence of safety promotion and the use of written disclaimers in each commercial. RESULTS: Of 250 total commercials, 113 (45 per cent) contained an unsafe driving sequence as determined by at least two of three raters. Unanimous agreement as to the presence of an unsafe driving sequence was found in 63 (25 per cent) commercials. Aggressive driving accounted for 85 per cent of the unsafe driving sequences, including 56 per cent with speed violations. Safety promotion was present in 30 (12 per cent) commercials. Of 141 commercials in which the gender /sex of the driver was shown, 115 (81 per cent) displayed a male driver. CONCLUSION: Unsafe driving is prevalent in North American automobile commercials. Given the extent to which MVCs are a public health and economic concern, this finding seems in conflict with responsible advertising. The degree to which the portrayal of driving in automobile commercials affects consumer-driving behaviour should be an area of further investigation.     

The quantity and quality of scientific graphs in pharmaceutical advertisements

We characterized the quantity and quality of graphs in all pharmaceutical advertisements, in the 10 U.S. medical journals. Four hundred eighty-four unique advertisements (of 3,185 total advertisements) contained 836 glossy and 455 small-print pages. Forty-nine percent of glossy page area was nonscientific figures/images, 0.4% tables, and 1.6% scientific graphs (74 graphs in 64 advertisements). All 74 graphs were univariate displays, 4% were distributions, and 4% contained confidence intervals for summary measures. Extraneous decoration (66%) and redundancy (46%) were common. Fifty-eight percent of graphs presented an outcome relevant to the drug's indication. Numeric distortion, specifically prohibited by FDA regulations, occurred in 36% of graphs.