Using the “carrot and stick” of sex and fear is the most widely used tool of the trade in modern advertising; except in the most gratuitous ads, they are so ubiquitous as to be almost completely taken for granted by the viewing public. Some Viagra ads, for example, openly and directly address one of the most compelling male insecurities - sexual impotence. Ads for Axe Body Spray are notoriously over-the-top in their lascivious and fantastical depictions of otherwise hopelessly socially-challenged young men instantaneously becoming the objects of beautiful, statuesque women immediately upon anointing themselves with Axe products. Though eschewing the sex component of the equation, an ad for Effexor nevertheless uses emotionally exploitative language and pictures to prey on human anxieties, pushing the drug on vulnerable people. Commercials for cars, breakfast cereals, body sprays, and other products may employ psychologically manipulative words and imagery as well, but those employed by television ads for prescription drugs have the nasty distinction of increasing the incidence of iatrogenic death. ("Iatrogenesis" being the term used for inadvertently induced adverse side effects or complications, including death, which result from medical treatment or diagnostic procedures performed by a physician or surgeon.)
Every successful ad campaign requires effective “branding.” Branding works by creating an association in the mind of consumers between the particular product being sold and its intended use, the image it projects, or feeling it produces – an association so strong that, in the case of some brands, such as Kleenex, Jacuzzi, Q-Tip, Google, etc., the name actually becomes synonymous with an entire class of products. This phenomenon was well demonstrated by a British study that used four different treatment groups to determine the effectiveness of a popular painkiller. Each group received one of four pills: a widely advertised, or “branded,” aspirin; the same drug in plain packaging; a branded placebo; or an unbranded placebo tablet. The study found that aspirin worked better than placebo, but even more interesting was that branding was more effective in pain relief for both the real drug and the placebo (Greider 112).
In a commercial for Axe Body Spray, a buxom woman in a skimpy, red string-bikini seems to be on the prowl, hunting for some as-yet unseen prey, while an epic and vaguely operatic score sets the mood. Running in slow motion through the woods, breasts bobbing, she is gradually joined by hundreds of attractive, similarly endowed and ravenous, bikini-clad young women. The hundreds become thousands, streaming over hills and scrambling down craggy outcroppings of rock. From the sea, still more thousands surge toward the shore, swimming through the surf. As the music crescendos, the horde begins converging on the beach where a scrawny, twenty-something male is shown spraying cans of Axe body spray, double-fisted and gleefully, all over his torso. The shot pans out before we can see what fate befalls the women's quarry, as a seductive, Australian-accented, female voice admonishes the viewer, “Spray more, Get more” – these words appear on the screen with “The Axe Effect” underneath (Axe Body Spray Ad).
Implying that the women were whipped into a feral frenzy of insatiable desire by the scent of the young man's Axe body spray, it is somewhat obvious that the ad is self-consciously intended to be over-the-top. No one but the most immature or mentally delayed person could rationally expect to achieve similar results from using this product. Yet the ad is effective precisely because the seductive quality of the imagery largely affects the subconscious, sub-rational parts of the consumer's psyche, which is the driving force behind many purchases. Thus, the product becomes linked, or branded, with the promise of sexual fulfillment and gratification. If the ad were to be taken at face value and the product delivered the results depicted, perhaps Axe body spray would be responsible for even more deaths than prescription medications.
An ad for Effexor is much more subdued. The scene is set by the opening shot of the turbulent surface of a lake in the fading light of dusk, while melancholy piano music plunks along. The metered, tenor voice of the narrator asks the viewer, “Do you feel alone?” As the view switches to a forest scene and an out-of-focus person walks away from the camera, the narrator continues, “Do you feel like everyone is far away from you?” Switch to a profile shot of a solitary, white daisy, waving in front of a watery background. “You could be depressed,” the voice offers as the scene changes to an empty picnic table. “Ask your doctor about the all new Effexor, because feeling alone,” switch to the out-of-focus back of someone sitting alone by the water, “might not be normal.” Product face and logo appear, “Effexor, the feel better solution” (Effexor Ad).
While the allure of this ad is definitely not sex, it is using specific language, tone, and imagery to create a depressive resonance, even among those who are not clinically depressed - so much so that many people may ask their doctors to prescribe an unnecessary drug for treatment of experiential phenomena that are not the results of disease states. Apart from being used for the very real conditions of clinical depression and anxiety for which it is approved, this ad for Effexor seems to suggest that even these relatively mild range of emotions are actually symptoms we should seek to mitigate with a powerful, and potentially dangerous, prescription drug.
Television advertising reaches the widest consumer audience of any medium, and sales of the prescription drugs most heavily marketed on television have seen the most dramatic rise. Now factor in that, more often than not, patients get the prescriptions for which they ask, and it is easy to see why spending on direct-to-consumer advertising, or DTC, increased almost tenfold from $266 million in 1994 to $2.6 billion in 2001 (Greider 88). The majority of that increase took place in the area of television ads (More Prescription Drug par 5). The dramatic rise in spending is reflected in the record profits being raked in by big pharmaceutical companies. The pharmaceutical industry argues that consumers of their products, and the public in general, have profited also with increased well-being and quality of life. Yet when the numbers are tallied, this becomes a rather dubious assertion.
As fantastic and unlikely as it sounds, a conservative estimate of how many people die every year from biomedical intervention in the United States is equivalent to six jumbo-jets full of passengers, crashing with no survivors, every day for a year (Null 3). At 783,936 a year, iatrogenic death nosed out heart disease at 699,697, and cancer at 553,251, to make it the number one killer in America in 2001 (Null 2). Of those deaths, 106,000 were the result of “reactions to properly prescribed and administered medications” that occurred after being hospitalized. When the 80,000 deaths caused by “improperly prescribed or administered medication” are added, “adverse drug events become the number-three leading cause of death in this country” (Strand 8). Only a fraction of iatrogenic events are ever reported and these numbers are conservative estimates. The actual numbers for iatrogenic deaths are probably much higher and on the rise (Null 3). Thanks to ads for prescription drugs like Effexor, more and more people are “asking their doctors” about them.
In the words of Larry D. Sasich of Public Citizen, a non-profit health research group, pharmaceutical ads have one purpose: "to drive patients into doctors' offices and ask for drugs by brand name”(Belkin par 14). An FDA survey found that patients asking for a specific brand name got the prescription they asked for 75 percent of the time (Aikin 17). One consequence of branding in pharmaceuticals is that the branded drugs get associated with feeling better, looking better, performing better, in the same way as do cars, clothes, or body sprays. A major difference is that drugs, even when properly prescribed, have a significantly higher chance of killing you.
Pharmaceutical companies often argue that DTC ads for prescription drugs educate the public, creating a more informed and therefore empowered consumer. They point out that millions of Americans go undiagnosed for a whole host of diseases and serious health conditions like depression and high blood pressure – estimating that for every million men who asked for a Viagra prescription, their doctors found that 30,000 had untreated diabetes, 140,000 had untreated high blood pressure, and 50,000 had untreated heart disease (Belkin par 9). Still more people, however, are visiting their doctor because a television commercial has convinced them that they may need medications when they actually do not. There is sufficient evidence to prove that the ads are working – both to educate consumers, and to persuade an increasingly neurotic public that there is something wrong with them. Proponents argue the ads are a public service; detractors see DTC ads as unethical, dangerous and a practice we should ban like the rest of the world (except for New Zealand, an ignominious distinction).
Yet the figures for iatrogenic deaths quoted above linger like a host of specters, imploring us to re-examine the way we practice medicine in this country, as well as why and how we commercialize it. Some radical public interest groups have suggested that all emotionally manipulative television advertisements, not just those for prescription drugs, should be outlawed for many of the same reasons already listed. Though there may be compelling arguments for this point of view, clearly some ads are more dangerous to public health than others. Vioxx, after all, is estimated by some to have killed over 60,000 people – as many as the number of US service men that died in the Vietnam War (Herper par 4). Though the Axe ads may be repugnant to some, and also have far-reaching and serious negative social implications - sexual and physical violence against women, body image issues, to name just a few - it is doubtful that anyone could claim that body sprays are equally lethal.
Yes, television commercials can educate the public, and responsibly administered pharmaceuticals help millions, but at what cost? When biomedical intervention is the leading cause of death, and ads for prescription medications invite consumers to take powerful drugs for practically any reason at all, it is time to accept that our health care system is broken and the commercial culture that drives it is steering us towards a very steep precipice. No doubt we shall soon see marketing for Effexe, the prescription pill that changes body chemistry such that pores emit cologne, or Axfexxor, the anti-depressant medicated body spray, which yields mood elevating effects for everyone within range of its odor. At that point, all bets are off for the future of our species.
Many people - usually those inhabiting the so-called "first-world" countries - are experiencing a downward spiral of neurosis, hypochondria and declining health. To move away from such a trend towards something more healthy and sustainable, we need to understand that making good choices is seldom just an issue of discerning right form wrong but is more often than not a matter of choosing between what is right and what's easy.
Perhaps if we begin to disengage from the cannibalistic consumerism that is slowly turning us into a race of zombie-sheep – we might be more able to take care of ourselves and each other, as both a means of preventative medicine, and as a recognition that we as individuals are solely responsible for our health. Then we might have more time, energy, and peace of mind to actually be able to enjoy life, medication-free.
I'm not suggesting that the answer to our collective and individual problems will simply disappear overnight because we start thinking positively and hugging each other more often (though that wouldn't hurt). Rather I am asserting that the decision remains open for each of us to abdicate responsibility for our well-being to the multifarious commercial-industrial interests of our consumerist society, or take it back into our own hands, seeking the help of physicians when necessary, but also by consuming wholesome foods in place of unnecessary products, exercising our bodies instead of our credit cards, and caring for one another – as if our lives depended on it.
Works Cited
Aikin, Kathryn, PhD J. United States of America. Division of Drug Marketing, Advertising and Communications. Food and Drug Administration. 13 Jan. 2003. 29 July 2006
Axe Body Spray Ad. http://www.youtube.com/watch?v=NnmDhr_ZnSI.
Belkin, Lisa. "Prime Time Pushers." Mother Jones Magazine Mar.-Apr. 2001. 28 July 2006
Effexor Ad. http://www.youtube.com/watch?v=6gSD5bK1Zgo
Greider, Katharine. The Big Fix: How the Pharmaceutical Industry Rips Off American Consumers. 1st ed. New York: Public Affairs, 2003.
Herper, Mathew. “David Graham On The Vioxx Verdict.” Forbes Online. Aug. 18, 2008.
"More Prescription Drug Ads on TV." Harvard Gazette 21 Feb. 2002. 29 July 2006
Null, Gary, PhD, Dean, Carolyn, Md Nd, Feldman, Martin, Md, Rasio, Debora, Md and Smith, Dorothy, PhD. Death by Medicine. Nutrition Institute of America. 2003. 28 July 2006
Strand, Ray, Md D. Death by Prescription: the Shocking Truth Behind an Overmedicated Nation. 1st ed. Nashville: Thomas Nelson, 2003.
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