Category Archives: Pharma

Vaccine Promotion in the Hands of a Corporation: The Missed Opportunity of Merck’s Marketing of Gardasil

Over the last several years, human papillomavirus (HPV), one of the most common sexually transmitted infections in the United States, has gone from relative obscurity to a source of heated debate and, for some, a new cause for fear. Casting a new spin on an old infection, Merck Pharmaceuticals single-handedly produced more widespread familiarity with the virus and manufactured the catalyst for conversations about HPV and cervical cancer. In June 2006, Merck received FDA approval for a new vaccine that protects against four of the more than thirty types of sexually transmitted HPV, Gardasil. Even before its approval, Merck advertised the coming vaccine indirectly with the teaser “Tell Someone.” In doing so, Merck began the process of using marketing to position a vaccine that protects primarily against a common sexually transmitted infection instead as a powerful vaccine against cancer.

The HPV vaccine debuted on the market with an advertisement campaign explicitly acknowledging women’s lack of familiarity with the virus and its consequences. The television ads featured women talking directly to the camera, exclaiming, “Cancer caused by a virus…I didn’t know that!”

As the “Tell someone” campaign encouraged its viewers, sharing this knowledge with other women was critical. Concurrent with its direct-to-consumer advertising, Merck also launched an “Educate the educators” session to inform physicians about the new vaccine, anticipating a fair amount of public resistance to vaccinating girls (ages 9-26) with a vaccine that might minimize the consequences of sexual activity. The importance of this education also stemmed from the fact that HPV is not well understood even among many physicians, likely as a result of the many types of HPV that exist. In a physician education session targeting gynecologists that I attended, the majority of the session focused on the epidemiology of the virus, and session leaders failed to discuss any of the existing treatment options, which most attendees would be using in their everyday practice. In other words, Merck seemed to expect that even physicians had vague knowledge about one of the most common STIs.

At its FDA hearing, Merck explicitly focused on the vaccine as a response to a variety of working groups that sought to reduce mortality due to cervical cancer. The promotion of the vaccine and the management of the trial data stressed that the “need” was for a cancer vaccine, not for a vaccine to prevent a highly transmissible and very prevalent STI. Some of this focus may reflect the company’s desire to minimize parental resistance to the vaccine. In the months leading up to the vaccine’s distribution, a variety of popular press articles questioned whether a vaccine for an STI could really gain acceptance in the United States, with its recent history of abstinence only programs in lieu of sexual health education. The reactions from a number of conservative family organizations, like Focus on the Family, and these groups’ public acceptance of the vaccine also suggest that Merck packaged its campaign to address their concerns. Once the FDA approved the vaccine, these groups acknowledged that they were not against a vaccine that protected against cancer, but they were against government requirements of the vaccine. This carefully worded response played into Merck’s own positioning perfectly. While the vaccine does prevent the infection with some types of HPV that can cause cancer, cancer is not, in fact, an inevitable outcome of an HPV infection. This point, though small, is rather critical. Merck’s entire advertising campaign has focused on HPV’s cancer potential; a recent advertisement that leads the viewer to visit Merck-owned HPV.com portrayed a young woman’s (heteronormative) life dreams (college, travel, boyfriend, marriage) as pre-empted by her health decline into a cancer that could be prevented. HPV.com directs the viewer to learn more about preventing the STI by sending her to the Gardasil website. The tagline for this promotion is quite simple: HPV. Why risk it?

Once Merck received its FDA approval, the campaign progressed from the vague and non-specific “Tell Someone,” into “One Less” (woman/girl with cervical cancer) and then to “I Chose.”

In addition to its advertisements, Merck created a program initially called “Make the Connection,” which was renamed “Make the Commitment,” that offered make your own bracelet kits for free that would donate money to a cancer research organization. A number of celebrities participated in the purported “public service announcement” promotions, which have since been discontinued.

The Gardasil campaign, which included non-transparent lobbying of state legislatures to require the vaccine for school-entry, revealed that the pharmaceutical company’s message and the everyday experience of/practice around HPV infection were not completely coherent with each other. Merck’s education campaign pushed the vaccine as an unquestionable necessity, neglecting to mention how highly effective other technologies of gynecological care can be to reduce cervical cancer. The Pap smear, for example, has been used in the U.S. since the 1940s, and while it is an imperfect science, its institutionalization through gynecological guidelines have reduced American women’s deaths from cervical cancer to about 3,400 a year from more than 70,000 annually in the 1970s. Still, the consequences of HPV morbidity are not insignificant and reducing the spread of the disease is not inconsequential. What causes concern, however, is Merck’s positioning of Gardasil as a cervical cancer vaccine (not an STI vaccine), which in fact complicates how women may understand the benefits and limitations of the vaccine. What remains problematic about Merck’s campaign is that even with the HPV vaccine, women will need to have the same gynecological screening and treatment that women experienced before the vaccine. Women’s experiences with gynecological care may not change radically.

Merck’s vaccine (and now GlaxoSmithKline’s recently approved vaccine) is not intrinsically bad; such a position is uncomplicated and fails to take into account the fact that HPV can be a serious infection, regardless of whether it develops into cancer or not. However, the company’s willingness to use fear to incite parents and young women to vaccinate casts doubt on the insistent message that the vaccine will liberate women from traumatic health care experiences. Gynecological care is not without its limitations. Technicians read hundreds and hundreds of Pap smear slides in a day. Human errors can contribute to the progression of HPV to cervical cancer, and clinicians’ and patients’ continued uncertainty about the most appropriate interventions and even prevention make the vaccine a very powerful prophylactic.

Merck invested a lot of time and money in “educating” people — public health officials and providers in particular — about HPV and cervical cancer as the vaccine became available and widely disseminated. Tracking exactly how and where the money has gone is difficult because, like the program for Make the Connection/Commitment, Merck’s strategies appear to have included supporting a number of non-profits, such as Women in Government, an organization that lobbied in various states for the vaccine requirements in schools. But all its investment in education stressed the necessity of the vaccine, rather than focusing on preventive health as a more comprehensive strategy. Because a more comprehensive cervical health education focus might obviate the urgency of the vaccine, the emphasis in all the educational materials was on the ubiquity of HPV and the challenges of preventing its spread.

Throughout Merck’s HPV and Gardasil advertisements, little has been said about the treatability of cervical cancer or the success at preventing HPV from progressing to cancer. Much like other pharmaceutical interventions designed to make life easier, when available solutions exist to address the same problem, Gardasil offered an alternative but is not a panacea. Many of the screening techniques and preventive health services are less expensive (per use) than the high cost (and incomplete levels of protection) that the vaccine presents. Though Merck has set up programs to allow low-income women (and presumably now men, since its FDA approval in boys and men in September 2009) to receive financial assistance to get the vaccine, Gardasil debuted on the market as the most expensive vaccine. Costing nearly $350 for the three shot series, the vaccine initially was a big money maker for Merck with $1.4 billion sales worldwide in 2007. Its first quarter report in 2010, however, showed an 11% decrease in sales from the same time last year. Sales of the vaccine, however, are harder to track than other treatments, because governments fuel much of the purchasing, with programs like the United States’ Vaccines for Children program and county public health programs’ acquisition of the vaccine. Current research suggests that there are still significant disparities between women/girls who receive the vaccine and those who don’t. Much like the disparities in cervical cancer rates (and deaths), class and race seem to be the distinguishing factors in terms of who gets the vaccine. With further approval to market the vaccine to older women, Merck is capturing a large market share of people who may not benefit from the vaccine.

Because Gardasil only protects against some and not all types of HPV, promoting a more comprehensive education scheme would have not compromised Merck’s campaign. Merck’s rush to lobby state legislatures to require the vaccine for school entry, for example, seriously undermined the public’s trust in their motives. Instead of transparently lobbying (though perhaps an unrealistic expectation in American government), Merck used a number of indirect channels to promote state laws (for instance, Women in Government) that subsequently failed almost nationwide. Merck publicly announced it would no longer lobby state legislatures after the Texas governor overrode the state legislature debate. This sort of aggressive push devalues the real potential benefits the vaccine might offer young women.

It seems clear that there was an incredible opportunity available at the moment of Gardasil’s debut. A vaccine that protects against an STI that can slowly progress into cancer is a significant accomplishment. Offering women the opportunity to reduce their health risks and preempt an often painful and stressful set of morbidities associated with HPV infection was also a significant coup. Raising awareness about HPV, the difficulty in preventing it, and reducing cervical cancer mortality globally are all meaningful developments. But Merck did not manage any of these well and used its advertising campaign to manipulate women by playing on their ignorance or confusion about their health care. While the campaigns framed the decision to use the HPV vaccine as women’s own proactive involvement in their health care, the messages have been frightening and unsettling unnecessarily. Merck has handled its campaign irresponsibly, choosing not to frame the message simply and with straightforward information, perpetuating the notion that HPV and cervical cancer are a mysterious threat that can only be stemmed through vaccination. Since this is not true, and women will still get HPV and may still get cervical cancer, the message remains deeply problematic and even paternalistic.

By S.D. Gottlieb, MHS, PhD, anthropologist and author of the recent dissertation entitled, “Manufactured Uncertainty: the Human Papillomavirus and the Object Multiple.”

Photo Credit:

  1. neofedex

Healthy Skepticism: Countering misleading drug promotion advertising and promoting healthy skepticism about pharmaceutical marketing practices

Healthy Skepticism is an international non-profit organization with headquarters in Adelaide, Australia. Its website www.healthyskepticism.org offers a collection of journal articles focusing mainly on the problems that arise when pharmaceutical companies advertise directly to physicians and publishes a monthly newsletter for its member subscribers.

Healthy Skepticism is an international non-profit organization with headquarters in Adelaide, Australia.  Its website, www.healthyskepticism.org, offers a collection of journal articles focusing mainly on the problems that arise when pharmaceutical companies advertise directly to physicians.  Other articles deal with problems arising from Direct to Consumer (DTC) advertising, misleading and unethical advertisements, and issues such as government policies on pharmaceuticals. In a fact sheet, the organization offers seven reasons why we should all be concerned about the harmful effects of drug promotion.

This extensive collection includes references for over 16,000 articles and is updated regularly.  In addition, the organization publishes a monthly newsletter for its member subscribers, most of whom are physicians and pharmacists.  You may become a free subscriber by using this link http://www.healthyskepticism.org/lists/?p=subscribe.

Selected Bibliography on Retail Practices and Health by Industry

Selected Bibliography on Retail Practices and Health in the Alcohol, Automobile, Firearms, Food and Beverage, Pharmaceutical, and Tobacco industries.

 

Alcohol Industry

  • Cohen DA, GhoshDastidar B, Scribner R, Miu A, Scott M, Robinson P, et al. Alcohol outlets, gonorrhea, and the Los Angeles civil unrest: A longitudinal analysis. Soc Sci Med. 2006;62(12):3062-3071.
  • Gruenewald PJ, Freisthler B, Remer L, Lascala EA, Treno A. Ecological models of alcohol outlets and violent assaults: Crime potentials and geospatial analysis. Addiction. 2006;101(5):666-677.
  • Gruenewald PJ, Johnson FW, Treno AJ. Outlets, drinking and driving: A multilevel analysis of availability. Stud Alcoho. 2002;63(4):460-468.
  • Gruenewald PJ, Millar AB, Treno AJ, Yang Z, Ponicki WR, Roeper P. The geography of availability and driving after drinking. Addiction. 1996;91(7):967-983.
  • Kotecki JE, Fowler JB, German TC, Stephenson SL, Warnick T. Kentucky pharmacists’ opinions and practices related to the sale of cigarettes and alcohol in pharmacies. J Community Health. 2000;25(4):343-355.
  • Lapham SC, Gruenwald PJ, Remer L, Layne L. New Mexico’s 1998 driveup liquor window closure. Study I: Effect on alcohol involved crashes. Addiction. 2004;99(5):598-606.
  • Miller T, Snowden C, Birckmayer J, Hendrie D. Retail alcohol monopolies, underage drinking, and youth impaired driving deaths. Accid Anal Prev. 2006;38(6):1162-1167.
  • Montgomery JM, Foley KL, Wolfson M. Enforcing the minimum drinking age: State, local and agency characteristics associated with compliance checks and Cops in Shops programs. Addiction. 2006;101(2):223-231.
  • Reynolds RI, Holder HD, Gruenewald PJ. Community prevention and alcohol retail access. Addiction. 1997;92 Suppl 2:S261-S272.
  • Treno AJ, Gruenewald PJ, Johnson FW. Alcohol availability and injury: The role of local outlet densities.  Alcohol Clin Exp Res. 2001;25(10):1467-1471.
  • Treno AJ, Gruenewald PJ, Wood DS, Ponicki WR. The price of alcohol: A consideration of contextual factors. Alcohol Clin Exp Res. 2006;30(10):1734-1742.
  • Treno AJ, Grube JW, Martin SE. Alcohol availability as a predictor of youth drinking and driving: A hierarchical analysis of survey and archival data. Alcohol Clin Exp Res. 2003;27(5):835-840.

 

Automobile Industry

  • Devaraj S, Matta KF, Conlon E.  Product and Service Quality: The Antecedents of Customer Loyalty in the Automotive Industry. Production and Operations Management.  2001; 10(4): 424-439.
  • Hellinga LA, McCartt AT, Haire ER. Choice of teenagers’ vehicles and views on vehicle safety: Survey of parents of novice teenage drivers. J Safety Res.2007;38(6):707-713.
  • Joetan E, Kleiner BH. Incentive practices in the US automobile industry. Management Research News. 2004;27(7):49–62.
  • Koppel S, Charlton J, Fildes B, Fitzharris M. How important is vehicle safety in the new vehicle purchase process? Accid Anal Prev. 2008;40(3):994-1004.
  • Koppel S, Charlton J, Fildes B. How important is vehicle safety in the new vehicle purchase/lease process for fleet vehicles? Traffic Inj Prev. 2007;8(2):130-136.
  • Van Alst JW.  Fueling Fair Practices: A Road Map to Improved Public Policy for Used Car Sales and Financing, National Consumer Law Center, (March 5, 2008), Available at http://www.nclc.org/issues/auto/content/report-fuelingfairpractices0309.pdf.

 

Firearms Industry

  • Cook, PJ, Molliconi S, Cole, TB.Regulating gun markets. The Journal of Criminal Law and Criminology. 1995;86(1):59-92.
  • Lewin NL, Vernick JS, Beilenson PL, Mair JS, Lindamood MM, Teret SP, Webster DW. The Baltimore Youth Ammunition Initiative: A model application of local public health authority in preventing gun violence. Am J Public Health. 2005;95(5):762-765.
  • Miller M, Azrael D, Hemenway D. Firearm availability and unintentional deaths, suicide, and homicide among 5-14 year olds. The Journal of Trauma. 2002;52(2):267-275.
  • Miller M, Azrael D, Hemenway D. Firearm availability and unintentional deaths. Accident Analysis and Prevention. 2001;33:477-484.
  • Miller M, Azrael D, Hemenway D. Firearm availability and unintentional deaths, suicide, and homicide among women. Journal of Urban Health. 2002; 79(1):26-38.
  • Sorenson SB, Berk RA. Handgun sales, beer sales, and youth homicide, California 1972-1993. Journal of Public Health Policy. 2001;22(2):182-197.
  • Vernick JS, Mair JS. How the law affects gun policy in the United States: Law as intervention or obstacle to prevention. J Law Med Ethics. 2002;30(4):692-704.
  • Vernick JS, Webster DW, Bulzacchelli MT, Mair JS. Regulation of firearm dealers in the United States: An analysis of state law and opportunities for improvement. J Law Med Ethics. 2006;34(4):765-775.
  • Webster DW, Vernick JS, Buzacchelli MT. Effects of a gun dealer’s change in sales practices on the supply of guns to criminals. The Journal of Urban Health. 2006; 83(5):778-787.
  • Webster DW, Bulzacchelli MT, Zeoli AM, Vernick JS. Effects of undercover police stings of gun dealers on the supply of new guns to criminals. Inj Prev. 2006;12(4):225-230.
  • Webster DW, Vernick JS, Bulzacchelli MT. Effects of state-level firearm seller accountability policies on firearm trafficking. J Urban Health. 2009;86(4):525-537.
  • Webster DW, Vernick JS, Hepburn LM. Relationship between licensing, registration, and other gun sales laws and the source state of crime guns. Inj Prev. 2001;7(3):184-189.
  • Wintemute GJ. Where the guns come from: The gun industry and gun commerce. The Future of Children. 2003;12(2):55-71.

 

Food and Beverage Industry

  • Altekruse SF, Yang S, Timbo BB, Angulo FJ. A multi-state survey of consumer food-handling and food-consumption practices. Am J Prev Med. 1999;16(3):216-221.
  • Angell SY, Silver LD, Goldstein GP, Johnson CM, Deitcher DR, Frieden TR, Bassett MT. Cholesterol control beyond the clinic: New York City’s trans fat restriction. Ann Intern Med. 2009;151(2):129-134.
  • Austin SB, Melly SJ, Sanchez BN, Patel A, Buka S, Gortmaker SL. Clustering of fast food restaurants around schools: A novel application of spatial statistics to the study of food environments. Am J Public Health. 2005;95(9):1575-1581.
  • Baker EA, Schootman M, Barnidge E, Kelly C. The role of race and poverty in access to foods that enable individuals to adhere to dietary guidelines. Prev Chronic Dis. 2006;3(3):A76.
  • Borgmeier I, Westenhoefer J. Impact of different food label formats on healthiness evaluation and food choice of consumers: A randomized-controlled study. BMC Public Health. 2009;12(9):184.
  • Burton S, Creyer EH, Kees J, Huggins K. Attacking the obesity epidemic: the potential health benefits of providing nutrition information in restaurants. Am J Public Health.2006;96(9):1669-1675.
  • Cassady D, Housemann R, Dagher C. Measuring cues for healthy choices on restaurant menus: Development and testing of a measurement instrument. Am J Health Promot. 2004;18(6):444-449.
  • Creel JS, Sharkey JR, McIntosh A, Anding J, Huber JC Jr. Availability of healthier options in traditional and nontraditional rural fast-food outlets. BMC Public Health. 2008;8:395.
  • Dumanovsky T, Nonas CA, Huang CY, Silver LD, Bassett MT. What people buy from fast-food restaurants: Caloric content and menu item selection, New York City 2007. Obesity (Silver Spring). 2009; 17(7):1369-1374.
  • Dwyer JJ, Macaskill LA, Uetrecht CL, Dombrow C. Eat Smart! Ontario’s Healthy Restaurant Program: Focus groups with non-participating restaurant operators. Can J Diet Pract Res. 2004.;65(1):6-9.
  • Economos CD, Folta SC, Goldberg J, Hudson D, Collins J, Baker Z, Lawson E, Nelson M. A community-based restaurant initiative to increase availability of healthy menu options in Somerville, Massachusetts: Shape Up Somerville. Prev Chronic Dis. 2009.;6(3):A102
  • Fielding JE, Aguirre A, Palaiologos E. Effectiveness of altered incentives in a food safety inspection program. Prev Med. 2001;32(3):239-244.
  • Ford PB, Dzewaltowski DA. Disparities in obesity prevalence due to variation in the retail food environment: Three testable hypotheses. Nutr Rev. 2008 Apr;66(4):216-228.
  • French SA, Harnack L, Jeffery RW. Fast food restaurant use among women in the Pound of Prevention study: Dietary, behavioral and demographic correlates. International Journal of Obesity & Related Metabolic Disorders. 2000;24(1):1353.
  • French SA. Pricing effects on food choices. J.Nutr. 2003;133(3):841S-843S.
  • French SA, Jeffery RW, Story M, Breitlow KK, Baxter JS, Hannan P, et al. Pricing and promotion effects on lowfat vending snack purchases: The CHIPS Study. Am J Public Health. 2001 ;91(1):112-117.
  • French SA, Story M, Neumark Sztainer D, Fulkerson JA, Hannan P. Fast food restaurant use among adolescents: Associations with nutrient intake, food choices and behavioral and psychosocial variables. Int J Obes Relat Metab Disord. 2001;25(12):1823-1833.
  • Fried EJ, Nestle M. The growing political movement against soft drinks in schools. JAMA.2002 ;288(1):2181-2181.
  • Gerend MA. Does calorie information promote lower calorie fast food choices among college students? J Adolesc Health. 2009;44(1):84-86.
  • Glanz K, Resnicow K, Seymour J, Hoy K, Stewart H, Lyons M, Goldberg J. How major restaurant chains plan their menus: The role of profit, demand, and health. Am J Prev Med. 2007;32(5):383-388.
  • Hannan P, French SA, Story M, Fulkerson JA. A pricing strategy to promote sales of lower fat foods in high school cafeterias: Acceptability and sensitivity analysis. Am.J.Health Promot. 2002 ;17(1):16,ii.
  • Hanni KD, Garcia E, Ellemberg C, Winkleby M. Targeting the taqueria: Implementing healthy food options at Mexican American restaurants. Health Promot Pract. 2009;10(2 Suppl):91S-99S.
  • Harnack LJ, French SA. Effect of point-of-purchase calorie labeling on restaurant and cafeteria food choices: A review of the literature. Int J Behav Nutr Phys Act. 2008 Oct 26;5:51.
  • Harnack LJ, French SA, Oakes JM, Story MT, Jeffery RW, Rydell SA. Effects of calorie labeling and value size pricing on fast food meal choices: Results from an experimental trial. Int J Behav Nutr Phys Act. 2008 ;5:63.
  • Jacobson MF, Brownell KD. Small taxes on soft drinks and snack foods to promote health. Am J Public Health 2000;90:854-857.
  • Jetter KM, Cassady DL. Increasing fresh fruit and vegetable availability in a low-income neighborhood convenience store: A pilot study. Health Promot Pract. 2009 Feb 12. [Epub ahead of print]
  • Kim D, Kawachi I. Food taxation and pricing strategies to “thin out” the obesity epidemic.  Am. J. Prev. Med. 2006;30(5):430-437.
  • Kimathi AN, Gregoire MB, Dowling RA, Stone MK. A healthful options food station can improve satisfaction and generate gross profit in a worksite cafeteria. J Am Diet Assoc. 2009;109(5):914-917.
  • Kuo T, Jarosz CJ, Simon P, Fielding JE. Menu labeling as a potential strategy for combating the obesity epidemic: A health impact assessment. Am J Public Health. 2009;99(9):1680-1686.
  • Kwate N O A. Fried chicken and fresh apples: Racial segregation as a fundamental cause of fast food density in black neighborhoods. Health and Place. 2008;14:32-44.
  • Kwate NO, Yau CY, Loh JM, Williams D. Inequality in obesigenic environments: Fast food density in New York City. Healthand Place. 2009;15(1):364-73
  • Lang T, Rayner G, Kaelin E. The Food Industry, Diet, Physical Activity and Health: A Review Of Reported Commitments And Practice Of 25 Of The World’s Largest Food Companies. 2006.
  • Larson NI, Story MT, Nelson MC. Neighborhood environments: Disparities in access to healthy foods in the U.S. Am J Prev Med. 2009;36(1):74-81.
  • Ludwig DS, Brownell KD. Public health action amid scientific uncertainty: The case of restaurant calorie labeling regulations. JAMA. 2009;302(4):434-435.
  • Lynch RA, Elledge BL, Griffith CC, Boatright DT. A comparison of food safety knowledge among restaurant managers, by source of training and experience, in Oklahoma County, Oklahoma. J Environ Health. 2003;66(2):9-14, 26.
  • Macdonald L, Cummins S, Macintyre S. Neighbourhood fast food environment and area deprivation-substitution or concentration? Appetite. 2007l;49(1):251-254.
  • Maddock J. The relationship between obesity and the prevalence of fast food restaurants: State level analysis. Am J Health Promot. 2004;19(2):137-143.
  • Mashta O. UK firms sign up to display calories on menus. BMJ. 2009;338:b182.
  • Morland KB, Evenson KR. Obesity prevalence and the local food environment.  Health and Place. 2009; 15(2):491-495
  • Nielsen SJ, Siega Riz AM, Popkin BM. Trends in food locations and sources among adolescents and young adults. Prev Med. 2002;35(2):107-113.
  • O’Dougherty M, Harnack LJ, French SA, Story M, Oakes JM, Jeffery RW. Nutrition labeling and value size pricing at fast-food restaurants: A consumer perspective. Am J Health Promot. 2006;20(4):247-250.
  • Phillips ML, Elledge BL, Basara HG, Lynch RA, Boatright DT. Recurrent critical violations of the food code in retail food service establishments. J Environ Health. 2006;68(10):24-30, 55.
  • Pomeranz JL, Brownell KD. Legal and public health considerations affecting  the success, reach, and impact of menu-labeling laws. Am J Public Health. 2008;98(9):1578-1583.
  • Roberto CA, Agnew H, Brownell KD. An observational study of consumers’ accessing of nutrition information in chain restaurants. Am J Public Health. 2009;99(5):820-821.
  • Rose D, Hutchinson PL, Bodor JN, Swalm CM, Farley TA, Cohen DA, Rice JC. Neighborhood food environments and Body Mass Index: The importance of in-store contents. Am J Prev Med. 2009;37(3):214-219.
  • Rydell SA, Harnack LJ, Oakes JM, Story M, Jeffery RW, French SA. Why eat at fast-food restaurants: reported reasons among frequent consumers. J Am Diet Assoc. 2008;108(12):2066-2070.
  • Sharkey JR, Horel S, Han D, Huber JC Jr. Association between neighborhood need and spatial access to food stores and fast food restaurants in neighborhoods of colonias. Int J Health Geogr. 2009;8:9.
  • Song HJ, Gittelsohn J, Kim M, Suratkar S, Sharma S, Anliker J. A corner store intervention in a low-income urban community is associated with increased availability and sales of some healthy foods. Public Health Nutr. 2009:1-8.
  • Spencer EH, Frank E, McIntosh NF. Potential effects of the next 100 billion hamburgers sold by McDonald’s. Am.J.Prev.Med. 2005 ;28(4):379-381.
  • Story M, Kaphingst KM, Robinson-O’Brien R, Glanz K. Creating healthy food and eating environments: Policy and environmental approaches. Annu Rev Public Health. 2008;29:253-72.

 

Pharmaceutical Industry

  • Brooks JM, Doucette WR, Wan S, Klepser DG. Retail pharmacy market structure and performance. Inquiry. 2008;45(1):75-88.
  • Carroll NV. Estimating the impact of Medicare part D on the profitability of independent community pharmacies. J Manag Care Pharm. 2008;14(8):768-779.
  • Fincham JE. An unfortunate and avoidable component of American pharmacy: Tobacco. Am J Pharm Educ. 2008;72(3):57
  • Garattini L, Motterlini N, Cornago D. Prices and distribution margins of in-patent drugs in pharmacy: A comparison in seven European countries. Health Policy. 2008;85(3):305-313.
  • Gellad WF, Choudhry NK, Friedberg MW, Brookhart MA, Haas JS, Shrank WH. Variation in drug prices at pharmacies: Are prices higher in poorer areas? Health Serv Res. 2009;44(2 Pt 1):606-617.
  • Gitlin M, Wilson L. Repackaged pharmaceuticals in the California workers’ compensation system: From distribution and pricing options to physician and retail dispensing. Am J Ind Med. 2007;50(4):303-315.
  • Montoya ID, Jano E. Online pharmacies: Safety and regulatory considerations. Int J Health Serv. 2007;37(2):279-289.
  • Retail and mail copayments on the rise. Manag Care. 2009;18(6):50.
  • Rudholm N. Entry of new pharmacies in the deregulated Norwegian pharmaceuticals market– consequences for costs and availability. Health Policy.2008;87(2):258-263
  • Stafford E. Pharmacy initiatives target prescription drug costs. J Mich Dent Assoc. 2008;90(9):22.
  • Stevenson FA, Leontowitsch M, Duggan C. Over-the-counter medicines: Professional expertise and consumer discourses. Sociol Health Illn. 2008;30(6):913-928.

 

Tobacco Industry

  • Andersen BS, Begay ME, Lawson CB. Breaking the alliance: Defeating the tobacco industry’s allies and enacting youth access restrictions in Massachusetts. Am J Public Health. 2003;93(11):1922-1928.
  • Celebucki CC, Diskin K. A longitudinal study of externally visible cigarette advertising on retail storefronts in Massachusetts before and after the Master Settlement Agreement. Tob Control. 2002;11 Suppl 2:ii47-53.
  • Chriqui JF, Ribisl KM, Wallace RM, Williams RS, O’Connor JC, el Arculli R. A comprehensive review of state laws governing Internet and other delivery sales of cigarettes in the United States. Nicotine Tob Res. 2008;10(2):253-265.
  • Feighery EC, Ribisl KM, Achabal DD, Tyebjee T. Retail trade incentives: How tobacco industry practices compare with those of other industries. Am J Public Health. 1999;89(10):1564-1566.
  • Feighery EC, Ribisl KM, Clark PI, Haladjian HH. How tobacco companies ensure prime placement of their advertising and products in stores: Interviews with retailers about tobacco company incentive programmes. Tob Control. 2003;12(2):184-188.
  • Feighery EC, Ribisl KM, Schleicher N, Lee RE, Halvorson S. Cigarette advertising and promotional strategies in retail outlets: results of a statewide survey in California. Tob Control. 2001;10(2):184-188.
  • Feighery EC, Ribisl KM, Schleicher NC, Clark PI. Retailer participation in cigarette company incentive programs is related to increased levels of cigarette advertising and cheaper cigarette prices in stores. Prev Med. 2004;38(6):876-884.
  • Gilbertson T. Retail point-of-sale guardianship and juvenile tobacco purchases: assessing the prevention capabilities of undergraduate college students. J Drug Educ. 2007;37(1):1-30.
  • Gilpin EA, White VM, Pierce JP. How effective are tobacco industry bar and club marketing efforts in reaching young adults? Tob Control. 2005;14(3):186-192.
  • Glanz K, Sutton NM, Jacob Arriola KR. Operation storefront Hawaii: Tobacco advertising and promotion in Hawaii stores. J Health Commun. 2006;11(7):699-707.
  • Henriksen L, Feighery EC, Schleicher NC, Cowling DW, Kline RS, Fortmann SP. Is adolescent smoking related to the density and proximity of tobacco outlets and retail cigarette advertising near schools? Prev Med. 2008;47(2):210-4.
  • Henriksen L, Feighery EC, Schleicher NC, Haladjian HH, Fortmann SP. Reaching youth at the point of sale: cigarette marketing is more prevalent in stores where adolescents shop frequently. Tob Control. 2004;13(3):315-318.
  • Henriksen L, Feighery EC, Wang Y, Fortmann SP. Association of retail tobacco marketing with adolescent smoking. Am J Public Health. 2004;94(12):2081-2083.
  • Lavack AM, Toth G. Tobacco point-of-purchase promotion: Examining tobacco industry documents. Tob Control. 2006;15(5):377-384.
  • Loomis BR, Farrelly MC, Mann NH. The association of retail promotions for cigarettes with the Master Settlement Agreement, tobacco control programmes and cigarette excise taxes. Tob Control. 2006;15(6):458-463.
  • Loomis BR, Farrelly MC, Nonnemaker JM, Mann NH. Point of purchase cigarette promotions before and after the Master Settlement Agreement: exploring retail scanner data. Tob Control. 2006;15(2):140-
  • Pollay RW. More than meets the eye: on the importance of retail cigarette merchandising. Tob Control. 2007;16(4):270-274.
  • Sepe E, Ling PM, Glantz SA. Smooth moves: bar and nightclub tobacco promotions that target young adults. Am J Public Health. 2002;92(3):414-419.
  • Slater S, Chaloupka FJ, Wakefield M. State variation in retail promotions and advertising for Marlboro cigarettes. Tob Control. 2001;10(4):337-339.
  • Slater S, Giovino G, Chaloupka F. Surveillance of tobacco industry retail marketing activities of reduced harm products. Nicotine Tob Res. 2008;10(1):187-193.
  • Slater SJ, Chaloupka FJ, Wakefield M, Johnston LD, O’malley PM. The impact of retail cigarette marketing practices on youth smoking uptake. Arch Pediatr Adolesc. Med. 2007;161(5):440-445.
  • Slater SJ, Chaloupka FJ, Wakefield M, Johnston LD, O’Malley PM. The impact of retail cigarette marketing practices on youth smoking uptake. Arch Pediatr Adolesc Med. 2007;161(5):440-445.
  • Smith EA, Blackman VS, Malone RE. Death at a discount: how the tobacco industry thwarted tobacco control policies in US military commissaries. Tob Control. 2007;16(1):38-46.

 

Studies of Multiple Industries

  • Ashe M, Jernigan D, Kline R, Galaz R. Land use planning and the control of alcohol, tobacco, firearms, and fast food restaurants. Am J Public Health. 2003;93(9):1404-1408.
  • Feighery EC, Ribisl KM, Achabal DD, Tyebjee T. Retail trade incentives: how tobacco industry practices compare with those of other industries. Am J Public Health. 1999;89(10):1564-1566.
  • Freudenberg N, Galea S, Fahs M. Changing corporate practices to reduce cancer disparities. J Health Care Poor Underserved. 2008; 19(1):26-40.
  • Hemenway D. The public health approach to motor vehicles, tobacco, and alcohol, with applications to firearms policy. J Public Health Policy. 2001;22(4):381-402.
  • Kotecki JE. Sale of alcohol in pharmacies: results and implications of an empirical study. J Community Health. 2003;28(1):65-77.

Selected Bibliography on Retail Practices and Health by Industry

Selected Bibliography on Retail Practices and Health in the Alcohol, Automobile, Firearms, Food and Beverage, Pharmaceutical, and Tobacco industries.

Alcohol Industry

Cohen DA, GhoshDastidar B, Scribner R, Miu A, Scott M, Robinson P, et al. Alcohol outlets, gonorrhea, and the Los Angeles civil unrest: A longitudinal analysis. Soc Sci Med. 2006;62(12):3062-3071.

Gruenewald PJ, Freisthler B, Remer L, Lascala EA, Treno A. Ecological models of alcohol outlets and violent assaults: Crime potentials and geospatial analysis. Addiction. 2006;101(5):666-677.

Gruenewald PJ, Johnson FW, Treno AJ. Outlets, drinking and driving: A multilevel analysis of availability. Stud Alcoho. 2002;63(4):460-468.

Gruenewald PJ, Millar AB, Treno AJ, Yang Z, Ponicki WR, Roeper P. The geography of availability and driving after drinking.Addiction. 1996;91(7):967-983.

Kotecki JE, Fowler JB, German TC, Stephenson SL, Warnick T. Kentucky pharmacists’ opinions and practices related to the sale of cigarettes and alcohol in pharmacies. J Community Health. 2000;25(4):343-355.

Lapham SC, Gruenwald PJ, Remer L, Layne L. New Mexico’s 1998 driveup liquor window closure. Study I: Effect on alcohol involved crashes. Addiction. 2004;99(5):598-606.

Miller T, Snowden C, Birckmayer J, Hendrie D. Retail alcohol monopolies, underage drinking, and youth impaired driving deaths. Accid Anal Prev. 2006;38(6):1162-1167.

Montgomery JM, Foley KL, Wolfson M. Enforcing the minimum drinking age: State, local and agency characteristics associated with compliance checks and Cops in Shops programs. Addiction. 2006;101(2):223-231.

Reynolds RI, Holder HD, Gruenewald PJ. Community prevention and alcohol retail access. Addiction. 1997;92 Suppl 2:S261-S272.

Treno AJ, Gruenewald PJ, Johnson FW. Alcohol availability and injury: The role of local outlet densities.  Alcohol Clin Exp Res. 2001;25(10):1467-1471.

Treno AJ, Gruenewald PJ, Wood DS, Ponicki WR. The price of alcohol: A consideration of contextual factors. Alcohol Clin Exp Res. 2006;30(10):1734-1742.

Treno AJ, Grube JW, Martin SE. Alcohol availability as a predictor of youth drinking and driving: A hierarchical analysis of survey and archival data. Alcohol Clin Exp Res. 2003;27(5):835-840.

 

Automobile Industry

Devaraj S, Matta KF, Conlon E.  Product and Service Quality: The Antecedents of Customer Loyalty in the Automotive Industry.Production and Operations Management.  2001; 10(4): 424-439.

Hellinga LA, McCartt AT, Haire ER. Choice of teenagers’ vehicles and views on vehicle safety: Survey of parents of novice teenage drivers. J Safety Res.2007;38(6):707-713.

Joetan E, Kleiner BH. Incentive practices in the US automobile industry. Management Research News. 2004;27(7):49–62.

Koppel S, Charlton J, Fildes B, Fitzharris M. How important is vehicle safety in the new vehicle purchase process? Accid Anal Prev. 2008;40(3):994-1004.

Koppel S, Charlton J, Fildes B. How important is vehicle safety in the new vehicle purchase/lease process for fleet vehicles?Traffic Inj Prev. 2007;8(2):130-136.

Van Alst JW.  Fueling Fair Practices: A Road Map to Improved Public Policy for Used Car Sales and Financing, National Consumer Law Center, (March 5, 2008), Available at http://www.nclc.org/issues/auto/content/report-fuelingfairpractices0309.pdf.

 

Firearms Industry

Cook, PJ, Molliconi S, Cole, TB.Regulating gun markets. The Journal of Criminal Law and Criminology. 1995;86(1):59-92.

Lewin NL, Vernick JS, Beilenson PL, Mair JS, Lindamood MM, Teret SP, Webster DW. The Baltimore Youth Ammunition Initiative: A model application of local public health authority in preventing gun violence. Am J Public Health. 2005;95(5):762-765.

Miller M, Azrael D, Hemenway D. Firearm availability and unintentional deaths, suicide, and homicide among 5-14 year olds. The Journal of Trauma. 2002;52(2):267-275.

Miller M, Azrael D, Hemenway D. Firearm availability and unintentional deaths. Accident Analysis and Prevention. 2001;33:477-484.

Miller M, Azrael D, Hemenway D. Firearm availability and unintentional deaths, suicide, and homicide among women.Journal of Urban Health. 2002; 79(1):26-38.

Sorenson SB, Berk RA. Handgun sales, beer sales, and youth homicide, California 1972-1993. Journal of Public Health Policy. 2001;22(2):182-197.

Vernick JS, Mair JS. How the law affects gun policy in the United States: Law as intervention or obstacle to prevention. J Law Med Ethics. 2002;30(4):692-704.

Vernick JS, Webster DW, Bulzacchelli MT, Mair JS. Regulation of firearm dealers in the United States: An analysis of state law and opportunities for improvement. J Law Med Ethics. 2006;34(4):765-775.

Webster DW, Vernick JS, Buzacchelli MT. Effects of a gun dealer’s change in sales practices on the supply of guns to criminals. The Journal of Urban Health. 2006; 83(5):778-787.

Webster DW, Bulzacchelli MT, Zeoli AM, Vernick JS. Effects of undercover police stings of gun dealers on the supply of new guns to criminals. Inj Prev. 2006;12(4):225-230.

Webster DW, Vernick JS, Bulzacchelli MT. Effects of state-level firearm seller accountability policies on firearm trafficking. J Urban Health. 2009;86(4):525-537.

Webster DW, Vernick JS, Hepburn LM. Relationship between licensing, registration, and other gun sales laws and the source state of crime guns. Inj Prev. 2001;7(3):184-189.

Wintemute GJ. Where the guns come from: The gun industry and gun commerce. The Future of Children. 2003;12(2):55-71.

 

Food and Beverage Industry

Altekruse SF, Yang S, Timbo BB, Angulo FJ. A multi-state survey of consumer food-handling and food-consumption practices.Am J Prev Med. 1999;16(3):216-221.

Angell SY, Silver LD, Goldstein GP, Johnson CM, Deitcher DR, Frieden TR, Bassett MT. Cholesterol control beyond the clinic: New York City’s trans fat restriction. Ann Intern Med. 2009;151(2):129-134.

Austin SB, Melly SJ, Sanchez BN, Patel A, Buka S, Gortmaker SL. Clustering of fast food restaurants around schools: A novel application of spatial statistics to the study of food environments. Am J Public Health. 2005;95(9):1575-1581.

Baker EA, Schootman M, Barnidge E, Kelly C. The role of race and poverty in access to foods that enable individuals to adhere to dietary guidelines. Prev Chronic Dis. 2006;3(3):A76.

Borgmeier I, Westenhoefer J. Impact of different food label formats on healthiness evaluation and food choice of consumers: A randomized-controlled study. BMC Public Health. 2009;12(9):184.

Burton S, Creyer EH, Kees J, Huggins K. Attacking the obesity epidemic: the potential health benefits of providing nutrition information in restaurants. Am J Public Health.2006;96(9):1669-1675.

Cassady D, Housemann R, Dagher C. Measuring cues for healthy choices on restaurant menus: Development and testing of a measurement instrument. Am J Health Promot. 2004;18(6):444-449.

Creel JS, Sharkey JR, McIntosh A, Anding J, Huber JC Jr. Availability of healthier options in traditional and nontraditional rural fast-food outlets. BMC Public Health. 2008;8:395.

Dumanovsky T, Nonas CA, Huang CY, Silver LD, Bassett MT. What people buy from fast-food restaurants: Caloric content and menu item selection, New York City 2007. Obesity (Silver Spring). 2009; 17(7):1369-1374.

Dwyer JJ, Macaskill LA, Uetrecht CL, Dombrow C. Eat Smart! Ontario’s Healthy Restaurant Program: Focus groups with non-participating restaurant operators. Can J Diet Pract Res. 2004.;65(1):6-9.

Economos CD, Folta SC, Goldberg J, Hudson D, Collins J, Baker Z, Lawson E, Nelson M. A community-based restaurant initiative to increase availability of healthy menu options in Somerville, Massachusetts: Shape Up Somerville. Prev Chronic Dis. 2009.;6(3):A102

Fielding JE, Aguirre A, Palaiologos E. Effectiveness of altered incentives in a food safety inspection program. Prev Med. 2001;32(3):239-244.

Ford PB, Dzewaltowski DA. Disparities in obesity prevalence due to variation in the retail food environment: Three testable hypotheses. Nutr Rev. 2008 Apr;66(4):216-228.

French SA, Harnack L, Jeffery RW. Fast food restaurant use among women in the Pound of Prevention study: Dietary, behavioral and demographic correlates. International Journal of Obesity & Related Metabolic Disorders. 2000;24(1):1353.

French SA. Pricing effects on food choices. J.Nutr. 2003;133(3):841S-843S.

French SA, Jeffery RW, Story M, Breitlow KK, Baxter JS, Hannan P, et al. Pricing and promotion effects on lowfat vending snack purchases: The CHIPS Study. Am J Public Health. 2001 ;91(1):112-117.

French SA, Story M, Neumark Sztainer D, Fulkerson JA, Hannan P. Fast food restaurant use among adolescents: Associations with nutrient intake, food choices and behavioral and psychosocial variables. Int J Obes Relat Metab Disord.2001;25(12):1823-1833.

Fried EJ, Nestle M. The growing political movement against soft drinks in schools. JAMA.2002 ;288(1):2181-2181.

Gerend MA. Does calorie information promote lower calorie fast food choices among college students? J Adolesc Health. 2009;44(1):84-86.

Glanz K, Resnicow K, Seymour J, Hoy K, Stewart H, Lyons M, Goldberg J. How major restaurant chains plan their menus: The role of profit, demand, and health. Am J Prev Med. 2007;32(5):383-388.

Hannan P, French SA, Story M, Fulkerson JA. A pricing strategy to promote sales of lower fat foods in high school cafeterias: Acceptability and sensitivity analysis. Am.J.Health Promot. 2002 ;17(1):16,ii.

Hanni KD, Garcia E, Ellemberg C, Winkleby M. Targeting the taqueria: Implementing healthy food options at Mexican American restaurants. Health Promot Pract. 2009;10(2 Suppl):91S-99S.

Harnack LJ, French SA. Effect of point-of-purchase calorie labeling on restaurant and cafeteria food choices: A review of the literature. Int J Behav Nutr Phys Act. 2008 Oct 26;5:51.

Harnack LJ, French SA, Oakes JM, Story MT, Jeffery RW, Rydell SA. Effects of calorie labeling and value size pricing on fast food meal choices: Results from an experimental trial. Int J Behav Nutr Phys Act. 2008 ;5:63.

Jacobson MF, Brownell KD. Small taxes on soft drinks and snack foods to promote health. Am J Public Health 2000;90:854-857.

Jetter KM, Cassady DL. Increasing fresh fruit and vegetable availability in a low-income neighborhood convenience store: A pilot study. Health Promot Pract. 2009 Feb 12. [Epub ahead of print]

Kim D, Kawachi I. Food taxation and pricing strategies to “thin out” the obesity epidemic.  Am. J. Prev. Med.2006;30(5):430-437.

Kimathi AN, Gregoire MB, Dowling RA, Stone MK. A healthful options food station can improve satisfaction and generate gross profit in a worksite cafeteria. J Am Diet Assoc. 2009;109(5):914-917.

Kuo T, Jarosz CJ, Simon P, Fielding JE. Menu labeling as a potential strategy for combating the obesity epidemic: A health impact assessment. Am J Public Health. 2009;99(9):1680-1686.

Kwate N O A. Fried chicken and fresh apples: Racial segregation as a fundamental cause of fast food density in black neighborhoods. Health and Place. 2008;14:32-44.

Kwate NO, Yau CY, Loh JM, Williams D. Inequality in obesigenic environments: Fast food density in New York City.Healthand Place. 2009;15(1):364-73

Lang T, Rayner G, Kaelin E. The Food Industry, Diet, Physical Activity and Health: A Review Of Reported Commitments And Practice Of 25 Of The World’s Largest Food Companies. 2006.

Larson NI, Story MT, Nelson MC. Neighborhood environments: Disparities in access to healthy foods in the U.S. Am J Prev Med. 2009;36(1):74-81.

Ludwig DS, Brownell KD. Public health action amid scientific uncertainty: The case of restaurant calorie labeling regulations.JAMA. 2009;302(4):434-435.

Lynch RA, Elledge BL, Griffith CC, Boatright DT. A comparison of food safety knowledge among restaurant managers, by source of training and experience, in Oklahoma County, Oklahoma. J Environ Health. 2003;66(2):9-14, 26.

Macdonald L, Cummins S, Macintyre S. Neighbourhood fast food environment and area deprivation-substitution or concentration? Appetite. 2007l;49(1):251-254.

Maddock J. The relationship between obesity and the prevalence of fast food restaurants: State level analysis. Am J Health Promot. 2004;19(2):137-143.

Mashta O. UK firms sign up to display calories on menus. BMJ. 2009;338:b182.

Morland KB, Evenson KR. Obesity prevalence and the local food environment.  Health and Place. 2009; 15(2):491-495

Nielsen SJ, Siega Riz AM, Popkin BM. Trends in food locations and sources among adolescents and young adults. Prev Med.2002;35(2):107-113.

O’Dougherty M, Harnack LJ, French SA, Story M, Oakes JM, Jeffery RW. Nutrition labeling and value size pricing at fast-food restaurants: A consumer perspective. Am J Health Promot. 2006;20(4):247-250.

Phillips ML, Elledge BL, Basara HG, Lynch RA, Boatright DT. Recurrent critical violations of the food code in retail food service establishments. J Environ Health. 2006;68(10):24-30, 55.

Pomeranz JL, Brownell KD. Legal and public health considerations affecting  the success, reach, and impact of menu-labeling laws. Am J Public Health. 2008;98(9):1578-1583.

Roberto CA, Agnew H, Brownell KD. An observational study of consumers’ accessing of nutrition information in chain restaurants. Am J Public Health. 2009;99(5):820-821.

Rose D, Hutchinson PL, Bodor JN, Swalm CM, Farley TA, Cohen DA, Rice JC. Neighborhood food environments and Body Mass Index: The importance of in-store contents. Am J Prev Med. 2009;37(3):214-219.

Rydell SA, Harnack LJ, Oakes JM, Story M, Jeffery RW, French SA. Why eat at fast-food restaurants: reported reasons among frequent consumers. J Am Diet Assoc. 2008;108(12):2066-2070.

Sharkey JR, Horel S, Han D, Huber JC Jr. Association between neighborhood need and spatial access to food stores and fast food restaurants in neighborhoods of colonias. Int J Health Geogr. 2009;8:9.

Song HJ, Gittelsohn J, Kim M, Suratkar S, Sharma S, Anliker J. A corner store intervention in a low-income urban community is associated with increased availability and sales of some healthy foods. Public Health Nutr. 2009:1-8.

Spencer EH, Frank E, McIntosh NF. Potential effects of the next 100 billion hamburgers sold by McDonald’s.Am.J.Prev.Med. 2005 ;28(4):379-381.

Story M, Kaphingst KM, Robinson-O’Brien R, Glanz K. Creating healthy food and eating environments: Policy and environmental approaches. Annu Rev Public Health. 2008;29:253-72.

 

Pharmaceutical Industry

Brooks JM, Doucette WR, Wan S, Klepser DG. Retail pharmacy market structure and performance. Inquiry. 2008;45(1):75-88.

Carroll NV. Estimating the impact of Medicare part D on the profitability of independent community pharmacies. J Manag Care Pharm. 2008;14(8):768-779.

Fincham JE. An unfortunate and avoidable component of American pharmacy: Tobacco. Am J Pharm Educ. 2008;72(3):57

Garattini L, Motterlini N, Cornago D. Prices and distribution margins of in-patent drugs in pharmacy: A comparison in seven European countries. Health Policy. 2008;85(3):305-313.

Gellad WF, Choudhry NK, Friedberg MW, Brookhart MA, Haas JS, Shrank WH. Variation in drug prices at pharmacies: Are prices higher in poorer areas? Health Serv Res. 2009;44(2 Pt 1):606-617.

Gitlin M, Wilson L. Repackaged pharmaceuticals in the California workers’ compensation system: From distribution and pricing options to physician and retail dispensing. Am J Ind Med. 2007;50(4):303-315.

Montoya ID, Jano E. Online pharmacies: Safety and regulatory considerations. Int J Health Serv. 2007;37(2):279-289.

Retail and mail copayments on the rise. Manag Care. 2009;18(6):50.

Rudholm N. Entry of new pharmacies in the deregulated Norwegian pharmaceuticals market– consequences for costs and availability. Health Policy.2008;87(2):258-263

Stafford E. Pharmacy initiatives target prescription drug costs. J Mich Dent Assoc. 2008;90(9):22.

Stevenson FA, Leontowitsch M, Duggan C. Over-the-counter medicines: Professional expertise and consumer discourses.Sociol Health Illn. 2008;30(6):913-928.

Tobacco Industry

Andersen BS, Begay ME, Lawson CB. Breaking the alliance: Defeating the tobacco industry’s allies and enacting youth access restrictions in Massachusetts. Am J Public Health. 2003;93(11):1922-1928.

Celebucki CC, Diskin K. A longitudinal study of externally visible cigarette advertising on retail storefronts in Massachusetts before and after the Master Settlement Agreement. Tob Control. 2002;11 Suppl 2:ii47-53.

Chriqui JF, Ribisl KM, Wallace RM, Williams RS, O’Connor JC, el Arculli R. A comprehensive review of state laws governing Internet and other delivery sales of cigarettes in the United States. Nicotine Tob Res. 2008;10(2):253-265.

Feighery EC, Ribisl KM, Achabal DD, Tyebjee T. Retail trade incentives: How tobacco industry practices compare with those of other industries. Am J Public Health. 1999;89(10):1564-1566.

Feighery EC, Ribisl KM, Clark PI, Haladjian HH. How tobacco companies ensure prime placement of their advertising and products in stores: Interviews with retailers about tobacco company incentive programmes. Tob Control. 2003;12(2):184-188.

Feighery EC, Ribisl KM, Schleicher N, Lee RE, Halvorson S. Cigarette advertising and promotional strategies in retail outlets: results of a statewide survey in California. Tob Control. 2001;10(2):184-188.

Feighery EC, Ribisl KM, Schleicher NC, Clark PI. Retailer participation in cigarette company incentive programs is related to increased levels of cigarette advertising and cheaper cigarette prices in stores. Prev Med. 2004;38(6):876-884.

Gilbertson T. Retail point-of-sale guardianship and juvenile tobacco purchases: assessing the prevention capabilities of undergraduate college students. J Drug Educ. 2007;37(1):1-30.

Gilpin EA, White VM, Pierce JP. How effective are tobacco industry bar and club marketing efforts in reaching young adults?Tob Control. 2005;14(3):186-192.

Glanz K, Sutton NM, Jacob Arriola KR. Operation storefront Hawaii: Tobacco advertising and promotion in Hawaii stores. J Health Commun. 2006;11(7):699-707.

Henriksen L, Feighery EC, Schleicher NC, Cowling DW, Kline RS, Fortmann SP. Is adolescent smoking related to the density and proximity of tobacco outlets and retail cigarette advertising near schools? Prev Med. 2008;47(2):210-4.

Henriksen L, Feighery EC, Schleicher NC, Haladjian HH, Fortmann SP. Reaching youth at the point of sale: cigarette marketing is more prevalent in stores where adolescents shop frequently. Tob Control. 2004;13(3):315-318.

Henriksen L, Feighery EC, Wang Y, Fortmann SP. Association of retail tobacco marketing with adolescent smoking. Am J Public Health. 2004;94(12):2081-2083.

Lavack AM, Toth G. Tobacco point-of-purchase promotion: Examining tobacco industry documents. Tob Control. 2006;15(5):377-384.

Loomis BR, Farrelly MC, Mann NH. The association of retail promotions for cigarettes with the Master Settlement Agreement, tobacco control programmes and cigarette excise taxes. Tob Control. 2006;15(6):458-463.

Loomis BR, Farrelly MC, Nonnemaker JM, Mann NH. Point of purchase cigarette promotions before and after the Master Settlement Agreement: exploring retail scanner data. Tob Control. 2006;15(2):140-

Pollay RW. More than meets the eye: on the importance of retail cigarette merchandising. Tob Control. 2007;16(4):270-274.

Sepe E, Ling PM, Glantz SA. Smooth moves: bar and nightclub tobacco promotions that target young adults. Am J Public Health. 2002;92(3):414-419.

Slater S, Chaloupka FJ, Wakefield M. State variation in retail promotions and advertising for Marlboro cigarettes. Tob Control. 2001;10(4):337-339.

Slater S, Giovino G, Chaloupka F. Surveillance of tobacco industry retail marketing activities of reduced harm products.Nicotine Tob Res. 2008;10(1):187-193.

Slater SJ, Chaloupka FJ, Wakefield M, Johnston LD, O’malley PM. The impact of retail cigarette marketing practices on youth smoking uptake. Arch Pediatr Adolesc. Med. 2007;161(5):440-445.

Slater SJ, Chaloupka FJ, Wakefield M, Johnston LD, O’Malley PM. The impact of retail cigarette marketing practices on youth smoking uptake. Arch Pediatr Adolesc Med. 2007;161(5):440-445.

Smith EA, Blackman VS, Malone RE. Death at a discount: how the tobacco industry thwarted tobacco control policies in US military commissaries. Tob Control. 2007;16(1):38-46.

 

Studies of Multiple Industries

Ashe M, Jernigan D, Kline R, Galaz R. Land use planning and the control of alcohol, tobacco, firearms, and fast food restaurants. Am J Public Health. 2003;93(9):1404-1408.

Feighery EC, Ribisl KM, Achabal DD, Tyebjee T. Retail trade incentives: how tobacco industry practices compare with those of other industries. Am J Public Health. 1999;89(10):1564-1566.

Freudenberg N, Galea S, Fahs M. Changing corporate practices to reduce cancer disparities. J Health Care Poor Underserved.2008; 19(1):26-40.

Hemenway D. The public health approach to motor vehicles, tobacco, and alcohol, with applications to firearms policy. J Public Health Policy. 2001;22(4):381-402.

Kotecki JE. Sale of alcohol in pharmacies: results and implications of an empirical study. J Community Health. 2003;28(1):65-77.

 
 

Pharma Goes Online; Feds Fail to Follow

While the fiercest opposition to direct-to-consumer (DTC) advertisements has been to television advertisements, pharmaceutical companies have increasingly turned their attention to online marketing and social media, such as Facebook and YouTube with very little opposition or regulation by the Food and Drug Administration. In this report, CHW explores the reasons for this increased use of online marketing and social media, profiles a few recent examples where online DTC advertisements have raised concerns, and suggest possible future directions for consumer advocates.

Since the Food and Drug Administration (FDA) first relaxed guidelines governing direct-to-consumer (DTC) pharmaceutical advertising in 1997, DTC advertising has increased dramatically, from approximately $1 billion per year in 19971 to $5.4 billion in 2006.2 As a result, physician and advocacy groups and some elected officials have begun to raise questions about the ethics of DTC advertising.3 While the fiercest opposition to DTC advertisements has been to television advertisements, with less opposition, pharmaceutical companies have increasingly turned their attention to online marketing and social media, such as Facebook, YouTube, Sermo (for physicians), and iVillage (for women’s health).4 A recent article in Advertising Age notes that “what might be considered a yawn-worthy move into new and social media is nothing short of a revolution” for the pharmaceutical industry.5 In this report, Corporations and Health Watch explores the reasons for this increased use of online marketing and social media, profiles a few recent examples where online DTC advertisements have raised concerns, and suggest possible future directions for consumer advocates.

Online advertisements and social media challenge our conceptions of DTC advertisements

Some of the largest pharmaceutical companies have challenged common conceptions of DTC communication through the launch of popular blogs, YouTube channels and other forms of online media. For example, Johnson & Johnson’s McNeil Pediatrics unit sponsors an attention-deficit hyperactivity disorder group called “ADHD Moms” on the social media site Facebook,6 where the number of participants has grown to more than 8,200 without any expenditure by the company.1 Johnson & Johnson also hosts a popular blog called “JNJ BTW” where the company seeks to create a space for a “three-dimensional view” of the company and a “conversation” with consumers. Novartis, Boehringer Ingelheim and AstraZeneca all use Twitter to deliver news about their companies, and several firms have launched controversial channels on YouTube to promote their drugs. Pharmaceutical companies also bid for key words such as “cholesterol” in Google and other search engines so that advertisements for their drugs will appear in the sponsored search results, for which the search engine company collects a fee each time someone clicks on the advertisement.7 In addition, contextual advertising on websites offers pharmaceutical companies the opportunity to place banners on websites targeted to visitors to certain websites or to visitors in certain geographic locations.7

Reasons for industry’s increased use of social media and online advertisements

At a time when print advertisements for pharmaceuticals are down 18% and television advertisements are down 4% to $4.4 billion in 2008 (compared to the $4.8 billion spent in 2007),1 online marketing efforts have soared.1, 5 One reason drug makers have turned to online advertising is because it is a relatively inexpensive way to reach targeted audiences. But in addition to being cost-effective, online media communications are less likely to mobilize patient advocates who are critical of DTC advertising.4, 7

Some observers have suggested that the “lower profile” yet highly effective online DTC advertisements might be “simply smart politics” on the part of pharmaceutical companies wishing to avoid attention by members of congress who wish to regulate DTC advertisements.2 Pharmaceutical marketers have taken advantage of the fact that greater numbers of Americans are now seeking health information and support online instead of consulting their physicians.4, 5, 8 Patients are now seeking more interactive communications, and, in an interview with Advertising Age, a relationship-marketing agency CEO said that social media offers the pharmaceutical industry an opportunity to rebuild trust between the consumer and an industry that is often unpopular.5

Recent DTC “success stories”

Several pharmaceutical companies have launched highly successful online marketing communications, and in some ways these companies serve as industry forerunners.5 Here are some examples:

MULTIPLE SCLEROSIS: Patients with chronic conditions often turn to the internet for the support of others with similar concerns and for help in managing chronic conditions.4 Acorda Therapeutics, working with a division of global advertising agency Saatchi & Saatchi launched a community website called iwalkbecause.org in advance of the release of its drug for multiple sclerosis which will not be available until next year.5 According to a Saatchi executive, the community of people with multiple sclerosis is a group that searches for online information “ferociously.” 5

AMBIEN CR: Saatchi also worked on an integrated TV-web campaign for Sanofi-Aventis’ sleep drug Ambien CR.5 The 15-second commercial directed viewers to go to a “microsite” called silenceyourrooster.com with games, videos, and other social-media elements.5 In the first three days, the site received 1 million “hits” and a 2% “clickthrough rate” to the branded site www.ambiencr.com.5

ASTHMA: AstraZeneca launched a YouTube channel called “My Asthma Story” for its asthma drug Symbicort where they invite patients to submit videos about their positive experiences with Symbicort to their website, where consumers “essentially create their own advertisements for the drug.”5

RESTLESS LEGS: In late 2006, GlaxoSmithKline introduced an unbranded and very creative video on YouTube that received over 200,000 views, which led the company to establish its own YouTube channel, GSK Vision.5

Future Issues for advocates and regulators to consider

Overall, the FDA has, until recently, been weak in its response to pharmaceutical companies’ online DTC advertisements. In fact, there are no published guidelines for online pharmaceutical advertising by the FDA Division of Drug Marketing, Advertising, and Communications Research, the organization typically responsible for providing such oversight.5 As noted by a senior VP at the public relations and marketing communications firm Fleishman Hillard, “People are still figuring out how we employ new media, whish is such a completely new paradigm. What [pharmaceutical companies] are doing now is experimenting.” 5 Similarly, Symbicort brand manager for AstraZeneca notes, “The social-media space is still very much a gray area.” 5 Without oversight, controversy has begun to erupt as it did this past January, when a banner ad went online for the emergency contraceptive Plan B. Plan B is marketed by Duramed, a subsidiary of Barr Pharmaceuticals, which was recently acquired by Teva Pharmaceuticals USA.9 The company advertised on the MTV website which is very popular among girls 17 and younger, directing viewers to go to the Plan B website with the tagline “Because the unexpected happens.” 9

Last April, the FDA began to take action with regard to DTC advertising in new media by sending major pharmaceutical companies untitled letters in April asking them to not place misleading ads on search engines such as Google and Yahoo,5 as well as taking action regarding several YouTube videos with misleading pharmaceutical advertising content. For example, the FDA requested that UK drugmaker Shire Pharmaceuticals remove its YouTube video for Adderall XR, which the agency argued was overstating the hyperactivity drug’s effectiveness while omitting relevant information about risks.10 The FDA also began requiring pharmaceutical companies to embed safety and risk information in the videos themselves, rather than providing a link alongside the video advertisements they post.10

As pharmaceutical companies increasingly turn to online media and social marketing to reach consumers, regulatory guidance from the FDA on this “gray area” will be increasingly necessary, as will increased vigilance on the part of consumer advocates and Congressional leaders.

References

1 US DTC Rx advertising falls 8% to $4.4 billion. Pharma Marketletter. April 21, 2009.

2 US Pharma DTC “recession” started in 2006. Pharma Marketletter. December 5, 2008.

3 Douglas J. Wood Reed Smith LLP. Legal issues to watch in 2009. Advertising Age. December 15, 2009.

4 US drugmakers switch marketing approach. Pharma Marketletter. April 25, 2008.

5 Miley M, Thomaselli R. Big Pharma finally taking steps to reach patients with digital media: highly regulated industry slowly mobilizes with blogs, Twitter, YouTube. Advertising Age. May 11, 2009.

6 McNeil Pediatrics, ADHD Moms A Place for Moms of Children with ADHD. Press Release dated July 9, 2008. Available at: http://www.mcneilpediatrics.net/mcneilpediatrics/assets/
60CON08453A_ADHD_Moms_Press_Release_FINAL_FOR_DIST.pdf

7 US drug DTC cuts in 1st half 2008: TV ad effectiveness low, regulatory risk high? Pharma Marketletter. October 17, 2008.

8 California HealthCare Foundation. Social Media’s Challenge to Traditional Health Care Patients, Providers, Researchers, and Advocates Forge Online Connections. April 22, 2008. Accessed June 7, 2009 at: http://www.chcf.org/press/view.cfm?itemID=133633.

9 Thomaselli R. “Morning-After Pill” catches flak for MTV.com ad: site’s under-18 visitors will see banner for emergency contraceptive Plan B. Advertising Age. January 8, 2009.

10 US FDA swoops on YouTube “DTC Abuse.” Pharma Marketletter. December 4, 2008.

Image Credit:

1. tomsaint

Book Reviews: Global Politics & Pharmaceutical Industry Practices

Two books on the ethics, politics and practices of the global pharmaceutical trade. Reviewed are: The Global Politics of Pharmaceutical Monopoly, Power, Drug Patents, Access, Innovation and the application of the WTO Doha Declaration on TRIPS and Public Health by Ellen F.M. ‘t Hoen (AMB Diemen, 2009) and Global Pharmaceuticals: Ethics, Markets, Practices, edited by Adriana Petryna, Andrew Lakoff, & Arthur Kleinman (Duke University Press, 2006).

The Global Politics of Pharmaceutical Monopoly, Power, Drug Patents, Access, Innovation and the application of the WTO Doha Declaration on TRIPS and Public Health by Ellen F.M. ‘t Hoen (AMB Diemen, 2009. ISBN 97890-79700-06-6)

In her new book, The Global Politics of Pharmaceutical Monopoly, Power, Drug Patents, Access, Innovation and the application of the WTO Doha Declaration on TRIPS and Public Health, Ellen ‘t Hoen, former Director of Policy Advocacy for the Medecins Sans Frontieres (Doctors Without Borders) Access Campaign, outlines progress made in increasing access to medication and medical innovation. She also identifies critical unresolved issues in development and distribution of new medical technologies for the treatment and prevention of disease in the developing world. Specifically, this book describes how access to medication in the developing world is affected by the current global rules for pharmaceutical patents. The book highlights recent alternative mechanisms to encourage medical research and development in a way that also ensures access to the product—by separating the cost of research and development from the price of diagnostics, medicines, and vaccines.

Link to reviews of this book:

Knowledge Ecology Studies
European AIDS Treatment Group

Link to this book:

AMB Press (where you will find link to an on-line version of this book)

 

Global Pharmaceuticals: Ethics, Markets, Practices by Adriana Petryna, Andrew Lakoff, & Arthur Kleinman (eds.) (Duke University Press, 2006. 312pp. ISBN 082233741X)

This edited volume, a collection of ethnographies, tackles a timely topic- the inequalities produced by the current global pharmaceutical system that of the anthropologist. This collection provides insights into the burgeoning international pharmaceutical trade and the global inequalities reinforced by market-driven medicine. From an examination of how popular and professional understandings of psychiatric illness in the Western world to the experience of African families faced with the financial burden of AIDS treatment for its members, this book brings together experiences of individuals and communities and the roles they play along with organizations, corporations, and governments in the market-driven game of global pharma. This work is an important step in bringing the moral and ethical issues inherent in every phase of pharmaceutical production to the forefront of the social science research agenda.

Link to review of this book:

British Journal of Psychiatry

Link to this book:

Amazon.com

The Depression Epidemic: The “Medication-alization” of Sadness

Is there really an epidemic of depression or is it, as some have suggested, forces of medicalization at work? This article looks at pharma’s direct-to-consumer advertising practices of marketing antidepressants and the health insurance industry’s influence on the perception of depression prevalence.

Surviving America’s Depression Epidemic, “Depression: Epidemic for a Postmodern Age,” “Depression: The Hidden Epidemic.” These kinds of titles lamenting or questioning the popular lay and professional conception of depression as increasingly widespread have become more and more common in recent years. It is true that depression is understood by many as a major public health problem of epidemic proportions. The United States Surgeon General’s 1999 report, “Mental Health: A Report of the Surgeon General,” stresses the widespread nature of mental illness, with one in five Americans affected by mental illness each year. The World Health Organization describes depression as an epidemic that will, within the next 20 years, be second only to cardiovascular disease in terms of disease burden worldwide.1

But what is an epidemic? And for that matter, what exactly do we mean when we say “depression?” The U.S. Centers for Disease Control defines an epidemic as: “the occurrence of disease within a specific geographical area or population that is in excess of what is normally expected.” The term depression is used regularly in our everyday lexicon to refer to a variety of concepts relating to weather patterns to the state of our economy. We also use the word depression to describe a fleeting mood state—the disappointment after failing a test or a feeling resulting from a particularly sad or “depressing” movie. However, increasingly over the last few decades, the general public uses depression as physicians and mental health researchers do—to refer to a mental illness called “major depressive disorder (MDD),” which, as described above, seems to be affecting more and more of us each year.

If depression is an epidemic then, according to the CDC definition, depression is a disease. It also means that depression is occurring “in excess of what is normally expected.” But what is a “normal” amount of depression? Is the number of people found to be depressed in U.S. higher than what should be expected? Are those diagnosed in epidemiologic studies as depressed experiencing disease or just plain old sadness resulting from the normal ups and downs of life?

There is no doubt that depression is a serious, debilitating condition for sufferers, who can be helped immensely by professional interventions, including medication. But it remains the case that there is no definitive test—no blood test or x-ray—to confirm or deny someone has MDD. This uncertainty about cause and the widespread nature of depression “symptoms” makes depression diagnosis malleable and suggestible—offering opportunity to the pharmaceutical industry to expand sales by expanding what is considered treatable “illness.”

Medications work on our biology and therefore pharmaceutical companies depend on biological definition of depression to sell their products. Because of the difficulty in identifying clear cut biological mechanisms for the diagnosis of various mental disorders, the degree to which the mental is medical remains contested.

Medicationalization—DTCA

The medicalization of “sadness,” as it is called by critics of the depression as epidemic perspective, points to direct to consumer (DTC) advertising of antidepressants by pharmaceutical companies as a major vehicle in the expansion of depression diagnoses.2,3 “Medication-alization” seems more like it. In 1997, The Food and Drug Administration approved the use of DTC drug advertisements in broadcast media (TV and radio); before that, advertising was relegated to publications targeted at physicians.4 By 2000, the pharmaceutical industry was spending more than $2 billion on DTC advertisements.

DTC ads for antidepressants typically feature the DSM defined symptoms of major depressive disorder in conjunction with explicit reference to biological etiology, defining depression as a “chemical imbalance” or lack of normal levels of the neurotransmitter serotonin in the brain. While this was once a promising theory, science has not borne out the truth of the “chemical imbalance” theory.5 Today’s science increasingly depicts depression as resulting from a highly complex interaction of human biology, genetics, psychology, and social and physical environments. But even though psychiatry shies away from direct claims about cause, the pharmaceutical industry is sticking with what works—and the result is continued sales. SSRIs have come to be some of the best selling drugs of all time, and the success of these drugs has lead to a proliferation of new antidepressants on the market for depression and a variety of other mental health problems.

Managed care and mental health treatment

Around the time that SSRI antidepressants came on the market in the late 1980’s to early 1990’s, managed care was expanding. Managed care prefers the quickest, least expensive treatment alternatives. In the case of depression treatment that means medication over psychotherapy. The result—patients seeking care for depressive symptoms were more than four times more likely to receive medication for depression in 1997 than in 1987.6

What doctors can diagnose and prescribe as treatment is subject to the approval of a patient’s health insurance companies and what it defines as acceptable diagnosis and treatment. To the degree that patients are unable or unwilling to pay for service out of pocket, they must seek the services covered by their health insurance carrier, all of whom employ at least some managed care practices these days. With recent mental health parity legislation, insurance companies being forced to provide increased psychotherapy benefits, but most still have strict limits on coverage, ironically requiring a mental health problem to be deemed “biologically-based” by the provider to get reimbursed for psychotherapy treatment services.

Protecting the healthy

The number of people experiencing the “symptoms” of Major Depressive Disorder may be plenty. No doubt, the symptoms of depression are common and widespread human experiences. We may have a lot of depression going on, but that there’s “disease” in excess of what’s normally expected in this case is less certain.

Contrary to popular sentiment, while lots of people may be experiencing symptoms of depression, it’s not clear that this is occurring at higher rates than in the past, nor is it the case that everybody who goes to their doctor is clamoring for medication. But with Pharma, physicians and health insurance industries telling us that yes, our experience is very common, but no, it is not normal, and that medication is our best option for feeling better, it’s no wonder that we’ve got a society ripe for viewing depression as an epidemic.

No question society needs to make the protection of the rights and interests of persons with mental illness a priority since they have in the past often been ignored and trampled on. But convincing people who are sad or live in difficult circumstances that the only way they can get better is to take a powerful drug carries its own dangers. Only by critically analyzing the social forces that have created the “epidemic” of depression can we chart effective policies to recues its burdens.

 

References

1 Summerfield D. Depression: epidemic or pseudo-epidemic? Journal of the Royal Society of Medicine. 2005: 99: 161-1.

2 Horwitz A, Wakefield J. The loss of sadness: How psychiatry transformed normal sorrow into depressive disorder. Oxford: Oxford University Press; 2007.

3 Conrad P. The shifting engines of medicalization. Journal of Health and Social Behavior. 2005: 46(1): 3-14.

4 Conrad P, Leiter V. From Lydia Pinkham to Queen Levitra: DTCA and medicalization. Sociology of Health and Illness. 2008: 30: 825-838.

5 Lacasse JR, Leo J. Serotonin and depression: A disconnect between the advertisements and the scientific literature. PLoS Medicine. 2005: 2(12): 1211-1216.

6 Olfson M, Marcus SC, Druss B, Elinson L, Tanielian T, Pincus HA. National trends in the outpatient treatment of depression. JAMA. 2002;287:203-209.

 

Photo Credits:
1. angelinawb 

Sara Kuppin, DrPH, is a postodoctoral fellow in Urban Public Health at Hunter College.