Sot
SC! & Med
Vol 9, pp 23 lo 26 Pergamon Press 1975 PrInted III Great Bntam
SEX DIFFERENCES IN THE CONTENT AND STYLE OF MEDICAL ADVERTISEMENTS JANE PRATHER and LINDA S FIDELL Soaology Department and Psychology Department, Cahforma State Umverslty, Northndge, Cahforma, U S A Abstract-An analysis of drug advertisements from four leachng Amerrcan medical Journals was performed to determme If content and style were related to the sex of the patient portrayed Content differences emerged m that advertisements for psychoactlve drugs tended to show women whale those for nonpsychoactlve drugs showed men Wtthm the psychoactlve drug category alone, women were shown wtth diffuse emotional symptoms while men were shown with anxiety because of pressures from work or from accompanymg orgamc Illness Styhstlc dtfferences were also found The parallel relationship between the advertlsmg, phystcian attitudes and rates of psychoactlve drug usage by women was &scussed Thts study focuses on the relatlonshlp
between sex dlfferences m medical advertisements for drugs and physlclan attitudes as these attitudes are influenced by and/or reflected m drug advertisements The sex of the pattent ISa salient variable because there are sex differences m theextent, type and source of drugs m use Women receive 60 per cent of the prescrlptlons for drugs m all categories, and 67 per cent of the prescnptlons for psychoactlve (mood-modlfymg) drugs [l J A 1971 survey [2] mdlcated that 45 per cent of the women and 33 per cent of the men had taken psychoactive drugs m the preceding year Chambers [3] concluded that women were the maJor users of barblturates, non-barbiturate sedative-hypnotics, relaxants and minor tranqulhzers, antidepressants, pep pills, diet pills, non-controlled narcotics and analgesics, and controlled narcotics (not mcludmg herom) Men were the major users of maquana/hashah, LSD, the mhalants, methedrme and herom Another sex difference m drug taking behavior mvolves the source of the drug Women are much more hkely than men to obtalrpsychoactlve drugs from a physIcIan (pnmanly from their general practltloner or mternnt) while men obtam them from other (less legltlmate) sources [2] Obtammg psychoactive drugs from a physician rather than obtammg them from other sources has been shown to lead to longer term and more consistent usage of the drugs [Z] Because women tend to receive psychoactive drugs by prescription more frequently than men, it 1s relevant to inquire mto the variables which encourage or dlscourage a physlclan from writing such a prescription * Lmn [6] found that physicians’ attitudes about the legltlmacy of prescribed psychoactlve drug usage 111a variety of settings were more strongly related to the social values and moral standards of the physlclans than to their scientific backgrounds Intervention of social values in Judgments by physicians about legltlmate drug use lends plauslblhty to the view that physlclans’ attitudes may be mfluenced by advertlsmg techmques
Physicians, m fact, report that drug advertisements are an Important source of mformatlon In a recent study 171, 73 per cent of physlclans rated advertlsements m medical Journals as either somewhat or very Important to them as sources of mformatlon about drugs This source of mformatlon ranked behind only that of detailmen? (84 per cent) and other physicians (83 per cent) in importance for physlclans. Although the exact extent of this mfluence has not been directly measured, the potential for mfluence IS great Any consistently developed mew shown m the advertisements about charactenstics of patients (male and female) may potentially Influence the attitudes of physlclans who consider this source of mformatlon important The present study mvolved m-depth content analySIS of medical advertisements to determme which, d any, relation&ups exist between the sex of the patient shown m advertisements and the style and content of the advertisements
METHOD The sample of me&Cal advertisements was taken from the New England Journal ofMedmne, Calrfornla Medlczne, the Journal of the Amewan Me&al Asmxatlon and the American Journal of Psychiatry These Journals were selected because of then wide clrculatlon as well as their prestige One issue from each Journal for each year between 1968 and 1972 was selected randomly from the complete set of Issues for that year (see Appendix A for a list of issues sampled) All the advertisements from each issue of each Journal were tabulated Advertisements were mltlally tabulated accdrdmg to whether or not they included a specfic reference to the sex of the patlent for whom the drug was to be prescribed Classlficatlon by sex was most often made according to the sex of the patient shown m accompanymg photographs or sketches, although occaslonally the sex was determined by display of sex-stereotyped paraphernalia (e g a purse or a wallet) or from a verbal descrlptlon which specifically mcluded reference to either a female or a male For advertisements for which the sex of the patient could be ascertained, mformatlon was collected as to the drug name, the drug company, the symptoms or disease for which the drug was advertised the pectoral
* Both Seldenberg [4] and Lennard et al [S] have chscussed the Impact of drug advertlsmg upon the physlclan’s declslon to write a prescrIptIon t DetaIlmen often leave the physicIan reprmts of advertlSements ldentlcal to those that appear m the Journals 23
24
JANEPRATHERand LINDA S FIDELL
accompaniment and the verbal description of the complaint for which the drug was appropriate In addition, the ages of the people displayed m the advertisements were estimated by the coders along with then race and social class For advertisements for which the sex of the patient could not be determmed, mformatlon was collected as to whether the ailment was psychogenic (anxiety, depression or msomma) or non-psychogemc (all other condmons) Although we reahze that certain other 111nesses such as asthma, ulcers, hypertension and so forth, may have psychogenic origins, we felt that once a disease had progressed to the point that it could be ldentlfied by medical crnerla such as X-rays or phystological disturbances, at was no longer strictly an emotlonal, as opposed to an organic illness
Table 1 Analysis of drug advertrsements and nonpsychogemc illnesses by sex expected frequencies calculated under independence Psychogenic Female
101
for psychogemc of patlent with assumptions of
Nonpsvchogemc 103
@2)*
(122) (131)
204 -219 423
* Expected frequency ~2=1422,1df,P
SC! & Med
Vol 9, pp 23 lo 26 Pergamon Press 1975 PrInted III Great Bntam
SEX DIFFERENCES IN THE CONTENT AND STYLE OF MEDICAL ADVERTISEMENTS JANE PRATHER and LINDA S FIDELL Soaology Department and Psychology Department, Cahforma State Umverslty, Northndge, Cahforma, U S A Abstract-An analysis of drug advertisements from four leachng Amerrcan medical Journals was performed to determme If content and style were related to the sex of the patient portrayed Content differences emerged m that advertisements for psychoactlve drugs tended to show women whale those for nonpsychoactlve drugs showed men Wtthm the psychoactlve drug category alone, women were shown wtth diffuse emotional symptoms while men were shown with anxiety because of pressures from work or from accompanymg orgamc Illness Styhstlc dtfferences were also found The parallel relationship between the advertlsmg, phystcian attitudes and rates of psychoactlve drug usage by women was &scussed Thts study focuses on the relatlonshlp
between sex dlfferences m medical advertisements for drugs and physlclan attitudes as these attitudes are influenced by and/or reflected m drug advertisements The sex of the pattent ISa salient variable because there are sex differences m theextent, type and source of drugs m use Women receive 60 per cent of the prescrlptlons for drugs m all categories, and 67 per cent of the prescnptlons for psychoactlve (mood-modlfymg) drugs [l J A 1971 survey [2] mdlcated that 45 per cent of the women and 33 per cent of the men had taken psychoactive drugs m the preceding year Chambers [3] concluded that women were the maJor users of barblturates, non-barbiturate sedative-hypnotics, relaxants and minor tranqulhzers, antidepressants, pep pills, diet pills, non-controlled narcotics and analgesics, and controlled narcotics (not mcludmg herom) Men were the major users of maquana/hashah, LSD, the mhalants, methedrme and herom Another sex difference m drug taking behavior mvolves the source of the drug Women are much more hkely than men to obtalrpsychoactlve drugs from a physIcIan (pnmanly from their general practltloner or mternnt) while men obtam them from other (less legltlmate) sources [2] Obtammg psychoactive drugs from a physician rather than obtammg them from other sources has been shown to lead to longer term and more consistent usage of the drugs [Z] Because women tend to receive psychoactive drugs by prescription more frequently than men, it 1s relevant to inquire mto the variables which encourage or dlscourage a physlclan from writing such a prescription * Lmn [6] found that physicians’ attitudes about the legltlmacy of prescribed psychoactlve drug usage 111a variety of settings were more strongly related to the social values and moral standards of the physlclans than to their scientific backgrounds Intervention of social values in Judgments by physicians about legltlmate drug use lends plauslblhty to the view that physlclans’ attitudes may be mfluenced by advertlsmg techmques
Physicians, m fact, report that drug advertisements are an Important source of mformatlon In a recent study 171, 73 per cent of physlclans rated advertlsements m medical Journals as either somewhat or very Important to them as sources of mformatlon about drugs This source of mformatlon ranked behind only that of detailmen? (84 per cent) and other physicians (83 per cent) in importance for physlclans. Although the exact extent of this mfluence has not been directly measured, the potential for mfluence IS great Any consistently developed mew shown m the advertisements about charactenstics of patients (male and female) may potentially Influence the attitudes of physlclans who consider this source of mformatlon important The present study mvolved m-depth content analySIS of medical advertisements to determme which, d any, relation&ups exist between the sex of the patient shown m advertisements and the style and content of the advertisements
METHOD The sample of me&Cal advertisements was taken from the New England Journal ofMedmne, Calrfornla Medlczne, the Journal of the Amewan Me&al Asmxatlon and the American Journal of Psychiatry These Journals were selected because of then wide clrculatlon as well as their prestige One issue from each Journal for each year between 1968 and 1972 was selected randomly from the complete set of Issues for that year (see Appendix A for a list of issues sampled) All the advertisements from each issue of each Journal were tabulated Advertisements were mltlally tabulated accdrdmg to whether or not they included a specfic reference to the sex of the patlent for whom the drug was to be prescribed Classlficatlon by sex was most often made according to the sex of the patient shown m accompanymg photographs or sketches, although occaslonally the sex was determined by display of sex-stereotyped paraphernalia (e g a purse or a wallet) or from a verbal descrlptlon which specifically mcluded reference to either a female or a male For advertisements for which the sex of the patient could be ascertained, mformatlon was collected as to the drug name, the drug company, the symptoms or disease for which the drug was advertised the pectoral
* Both Seldenberg [4] and Lennard et al [S] have chscussed the Impact of drug advertlsmg upon the physlclan’s declslon to write a prescrIptIon t DetaIlmen often leave the physicIan reprmts of advertlSements ldentlcal to those that appear m the Journals 23
24
JANEPRATHERand LINDA S FIDELL
accompaniment and the verbal description of the complaint for which the drug was appropriate In addition, the ages of the people displayed m the advertisements were estimated by the coders along with then race and social class For advertisements for which the sex of the patient could not be determmed, mformatlon was collected as to whether the ailment was psychogenic (anxiety, depression or msomma) or non-psychogemc (all other condmons) Although we reahze that certain other 111nesses such as asthma, ulcers, hypertension and so forth, may have psychogenic origins, we felt that once a disease had progressed to the point that it could be ldentlfied by medical crnerla such as X-rays or phystological disturbances, at was no longer strictly an emotlonal, as opposed to an organic illness
Table 1 Analysis of drug advertrsements and nonpsychogemc illnesses by sex expected frequencies calculated under independence Psychogenic Female
101
for psychogemc of patlent with assumptions of
Nonpsvchogemc 103
@2)*
(122) (131)
204 -219 423
* Expected frequency ~2=1422,1df,P
