Pharmaceutical Marketing and the Invention of the Medical Consumer

I t is often said that leading drug companies now spend more on marketing than on research and development [1]. While such contemporary pharmaceutical marketing practices are sometimes believed to be a modern phenomenon, they are in fact a direct continuation of 19th-century patent medicine advertising. " Nostrum-mongers, " as the novelist Henry James dubbed them, are noted in the history of advertising as having been the leading spenders on, and foremost originators of, advertising technique [2,3]. Nostrum sellers pioneered print advertising, use of trademarks and distinctive packaging, " pull " or demand-stimulation strategies, and even the design and commissioning of medical almanacs that functioned as vehicles for promotion of disease awareness. Henry James's psychologist brother, William James, was so exasperated by " the medical advertisement abomination " that in 1894 he declared that " the authors of these advertisements should be treated as public enemies and have no mercy shown " (see page 235 in [4]). There is no doubt that drug company discoveries have profoundly improved upon our capacity to treat illness. But pharmaceutical marketing is more closely aligned with consumer marketing in other industries than with medicine, for which the consequences are not trivial. Once we view pharmaceutical industry activities in this light, we can disentangle industry's infl uence on contemporary medicine. Because we believe that we owe corporations our wealth and well-being, we tend not to question corporations' fundamental practices, and they become invisible to us. What follows is an attempt to demystify some of the assumptions at work in the " culture of marketing, " toward the goal of explaining contemporary disease mongering. There are three beliefs commonly associated with the " free market. " The fi rst is that human beings are creatures of limitless but insatiable needs, wants, and discomforts. The second is that the free market is a place where these needs might be satisfi ed through the exercise of free choice. The last of these beliefs is that the surest avenue to innovation in all industries is unfettered competition in the market. Insatiable needs. The anthropologist Marshall Sahlins theorizes that the belief in unlimited wants is unique in the West, and stems from the Christian notion of " fallen man " as sufferer. This results, says Sahlins, in a peculiar idea of the person " as an imperfect creature of need and desire, whose whole earthly existence can be reduced to …