A book review for “Broadcast Pharmaceutical Advertising in the United States: Primetime Pill Pushers” by Janelle Applequist

Exposure to drug advertisements across media channels has become commonplace for direct consumers in the USA. With the growing concept of shared (patient-provider) decision-making, patients have a more active role in setting treatment plans and deciding on prescribed medications. Thus, pharmaceutical companies have been targeting direct consumers with direct-to-consumer advertisements (DTCA) to promote the use, and therefore promote the sales, of their products. Additionally, with easy access to a large population of direct consumers through different media channels, pharmaceutical companies are slowly but steadily adopting innovative marketing principles and going beyond traditional physician-based marketing approach. Broadcast Pharmaceutical Advertising in the United States: Primetime Pill Pushers critically analyzes the content of DTCA by using a mixed qualitative–quantitative approach. Additionally, the book takes one step further by analyzing not just the drug-related content but the advertisement context in terms of portrayed patients’ gender, race, socio-economic status and lifestyle, along with visual effects, sounds and backgrounds, elements which pharmaceutical companies carefully choose to further promote their products.

Examining pharmaceutical advertisements is a vital issue in today’s life. Nowadays, drugs are no longer negative goods that are used only for the purpose of treating illnesses but basic well-being elements for preventing disease and promoting health. In fact, continuous exposure to drug advertisements, especially through visual media channels (e.g. TV), may alter the way consumers think of drugs and treatment. Instead of perceiving advertised drugs as mere medications, DTCA rather direct people to think of pharmaceutical products as key interventions to improve quality of life from personal, social and emotional perspectives. Actually, the book argues that DTCA can sometimes provide little educational information about drugs, but much emotional depictions that may potentially mislead consumers.

This 168-page book includes 6 chapters that cover a number of different aspects of DTCA. The book introduces the merit of critically examining DTCA. In addition, the author describes how patients might be increasingly eyed by pharmaceutical companies as influential decision-makers with regard to use of prescription medications. After presenting a historical overview of pharmaceutical advertising in the USA and describing how it adapted to (and sometimes how it lobbied for) legal changes in the USA, Chapter 1 explores the industry of pharmaceutical advertisements and strategies that pharmaceutical companies, especially brand name companies, use in DTCA to promote the use of their products. One of these strategies, according to Chapter 1, is having ties with decision-makers such as US Food and Drug Administration, boards of directors for market financial indices (e.g. Dow Jones) and administrators of news media (e.g. New York Times). Additionally, Chapter 1 describes the tactics that pharmaceutical companies use to dominate the market with their brand-name drugs and to influence consumer’s views and prescribers’ decisions to the extent that money spent on promotion and advertising tremendously exceeds money dedicated for research and development. Finally, Chapter 1 describes the content of DTCA indicating that the element of emotional appeals, rather than facts on clinical effects and adverse reactions, is the single most prevalent component in DTCA. For example, use of healthy, active and smiling models appearing in pleasant social context is another way pharmaceutical companies promote sales of their products.

Chapter 2 discusses the theoretical foundations of DTCA. The chapter begins by exploring how advertisements may change consumers’ cultural identity and influence their thinking process by repeated depiction of alleged idealities, which consumers are urged to seek. As such, advertised drugs are portrayed as a wonder solution to a health problem. Additionally, the book argues that advertising may have become a key component of the media system, as the system financially relies on advertising revenues to continue to exist. Chapter 2 also describes how viewers (or potential consumers of advertised products) are compensated for their time watching advertisements by non-advertisements media content, making viewers not very different from laborers. Further, Chapter 2 describes how consumers are led (or mislead) to anticipate not just a product but fame, attention, love, self-fulfillment or autonomy through evocative advertisements. Finally, the book cites mixed (qualitative and quantitative) methods analysis as a mean for more profound and critical understanding of DTCA, especially regarding how health, drugs and treatment are portrayed by advertisers.

Chapter 3 investigates a sample of DTCA from prime-time TV broadcasting from 2010 to 2013 to understand the content, including length of advertisements, story structure, factual claims, animation (e.g. mascots), logo, and financing offers such as free trials. The book demonstrates that the content (i.e. information) and the message (i.e. persuasion) of DTCA may overlap sometimes. In addition, the book describes how DTCA may rely on emotional appeals to direct consumers to focus more on expected benefits and less on potential adverse reactions, contraindications, prevalence, drug interactions and alternate treatment options. Additionally, through modeling and behavioral incentives, Chapter 3 describes how individual attitudes and behaviors can be changed or adjusted by DTCA. Finally, the chapter concludes by describing medication portrayals that DTCA rely on to promote their products. Such portrayals include social approval, gaining control, increasing endurance and preventing future complications, which are the benefits gained allegedly after taking the medication.

Chapter 4 highlights the textual themes of DTCA to show how health is conceptualized to consumers by pharmaceutical companies. This includes examining the portrayal of healthy appearing individuals with identity-rewarding levels of activity, smiles, carefully chosen age and gender of characters and views of patient versus physician (whether they are paid actors of testimonial). Chapter 5 presents a textual analysis of a specific brand-name birth control drug. The chapter demonstrates how the advertisement prompts consumers to expect more benefits beyond the drug’s intended use through depiction of women self-empowerment and autonomy. Chapter 6 presents the potential implications of DTCA on society in general, and on consumers in particular. The chapter presents the views of DTCA proponents and opponents as well as suggestions on how to protect consumers from inaccurate and misleading DTCA.

In summary, the book is a rich source of information to researchers and consumer rights activists interested in gaining more in-depth knowledge about DTCA. The book remarkably contains a number of relevant studies that lay the foundation for future research on this topic. However, the book focuses much on TV advertisements and pays little attention to advertisements disseminated using other media channels. Additionally, the author did a great job identifying problems associated with DTCA but did not provide clearly articulated solutions to decision-makers regarding how to rectify the situation to protect consumers in the future. Moreover, the book is not visually appealing because the author did not use any visual aids such as pictures, graphs, tables and charts.

Overall, this book is a great reference on DTCA, and an indispensable source of learning to individuals interested in learning about DTCA. This book will serve as an important resource for the Master of Business Administration (MBA) with a concentration in pharmaceutical marketing (Alkhateeb et al., 2012), Bachelor of Science in pharmaceutical business and management students (Attarabeen et al., 2014) and any pharmacy or business major student who wants to work in the pharmaceutical marketing and sales field.