A specific example of the culture of commerce is television advertising for prescription drugs targeted at the general population. Television viewers represent members of all cultures (except perhaps the Amish). Viewers cannot buy any of these products without a prescription from their doctor. These drug ads are regulated by the Federal Trade Commission and not the Food and Drug Administration (FDA, 2012). The FDA Division of Drug Marketing, Advertising and Communication (DMAC) is responsible for regulating direct-to-consumer ads. Drug companies are required to submit copies of their ads at the same time that they are disseminated, but no preclearance is yet required. If a direct-to-consumer ad is found to be in violation of FDA regulations, the FDA can issue warning letters for serious violations, which may lead to regulatory action by the FDA.
However, if a company refuses to comply, the FDA cannot impose fines, except through administrative hearings. The United States is only one of two countries that allows direct-to-consumer ads (U.S. House of Representatives,2008).In a physician survey, the FDA found that 8% of physicians felt very pressured and 20% felt somewhat pressured to prescribe the specific brand name drug when the patient asked the physician to do so. Most physicians suggested alternative courses of action (Woodcock, 2003). Direct-to-consumer television advertising fell 11.5% to $3.47 billion in 2012. Even so, Nielsen, the television monitoring organization, estimates that an average of 80 drug ads air every hour ofevery day on American television (Palmer, 2013).Most ads (82%) made some factual claims and made rational arguments (86%) for product use, but few described condition causes (26%), risk factors (26%), or prevalence (25%). Emotional appeals were almost universal (95%).
No ads mentioned lifestyle change as an alternative to products, though some (19%) portrayed it as an adjunct to medication. Some ads (18%) portrayed lifestyle changes as insufficient for controlling a condition. The ads often framed medication use in terms of losing (58%) and regaining control (85%) over some aspect of life and as engendering social approval (78%). Products were frequently (58%) portrayed as a medical breakthrough. Despite claims that ads have educational value, the study found ads provide little information about the causes of a disease or who may be at risk. Ads illustrate characters who have lost control over their social, emotional, or physical lives without the medication; and they minimize the value of health promotion through lifestyle changes (Frosch et al., 2007).
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