Doc, I need Cialis

We've all been there. Hanging out with your parents or grandparents when an advertisement for Viagra or Cialis comes on the television. Someone scrambles for the remote while your grandpa makes a crude joke and your grandmother turns bright red. But, these advertisements are doing more than making you want to crawl under the rug, they are changing the way the healthcare system works.

While a slight deviation from the public health campaigns described up to this point in this blog, the direct to consumer (DTC) marketing of a product that consumers can't buy directly brings up a few interesting points. And, it seems to be adding to the pharmaceutical companies bottom line.

In fact, every $1 the pharmaceutical industry spent on DTC advertising in that year yielded an additional $4.20 in drug sales. DTC advertising was responsible for 12% of the increase in prescription drugs sales, or an additional $2.6 billion, in 2000, according to the summary findings of a study by Harvard and MIT researchers.

Direct to consumer advertising of prescription drugs is creating a demand market for a traditionally supply driven market. Consumers are demanding products now while they used to take whatever was supplied to them.

A consumer reports health blog reports, "In a 2006 survey by our National Survey Research Center, 78 percent of doctors said that patients asked them at least occasionally to prescribe drugs they had seen advertised on television, and 67 percent said they sometimes did so."

I'll use the same example the above linked article does. The first time I saw the Restless Leg Syndrome commercial, I was convinced that because I sometimes was fidgety, I was an unlucky sufferer of RLS. That night when I tried to go to bed, my legs were tingly. I knew it! RLS! The power of suggestion is, well, powerful. By advertising all the things that can go wrong with you (and a drug to fix them) consumers can now diagnose themselves, ask for the corresponding drug, and be on their way.

Creating brand-name demand for a drug that has potentially serious side effects and may not be right for each patient is a dangerous game to play. Patient demand for specific products and doctor supply of those products creates a health care system where the best brand wins, not the best treatment.

As far as advertising prescription drugs goes, how far is too far? Or are prescription drugs just the new brand battleground? We'll see.

Again, for levity:

Bringing sexy back...to condoms.

Public health campaigns in developing countries are developed by public health officials and communication professionals in those countries. Sometimes, foreign aid assists in the educational and resource provision to accompany those campaigns. When those campaigns are finished they traditionally have a print component (posters, flyers, etc) and a resource component (free condoms, birth control, vaccines, etc). Without big budgets, this is the best that public health officials can do.

The trained sexual health advisor in the video below doesn't think these tactics work. In fact, she's taking down the public health provided condom usage promotion posters. She thinks the plain white packaged free condoms are making condom usage boring. She's on a mission to bring the sexy back, to condoms.

The take-away here is that marketing socially responsible products doesn't have to be boring. Smart branding, coolness, and relating to your audience are just as important in public health campaigns are they are selling anything else. The other take away is that communications professionals and public health policy folks aren't the only ones that need to be around the table when campaigns are conceptualized. Those on the front lines have the best connection to the lives that everyone is trying to save.

Throwback Special

Jonas Salk's discovery and successful implementation of a polio vaccine eradicated polio from the United States. The polio vaccine became standard for EVERY child born in the United States, so standard, that polio is no longer a concern for parents in the U.S.

So, how was this new health standard integrated into the American psyche? Here's some throwback footage to one of the first fully integrated health marketing campaigns.

Community events, television coverage, and a celebrity spokesperson (Franklin D. Roosevelt) worked to educate American's on the importance of vaccination. Vaccinations against preventable diseases for children became part of the American way.

The polio vaccine campaign, "Victory over Polio" , was one of the first successful public health campaigns in the United States, thanks in part to the March of Dimes. This campaign set the pace for health communication strategies in the United States until technology began to set the pace in the 1990's with the invention of cell phones, the internet, and social media.

Texts in the Time of Cholera

In 4th grade, we got to play Oregon Trail if we finished our keyboarding lesson early. I always finished early. My mother was the Louisiana State Typing Champion in 1973. Needless to say, she thought knowing how to type quickly and accurately is something her 9 year old should know. So, I crushed all the keyboarding lessons in about 5 minutes so I could play Oregon Trail. I was not as talented at Oregon Trail as typing. I always got the error message "You have died of cholera." Ugh.

This is about as close to cholera as any kid in the United States has gotten. Unfortunately, children and adults in Haiti are facing the real cholera head on. Last week, a few cases of cholera were reported in a camp just north of the capital, Port-au-Prince. Cholera spreads quickly and viciously through contaminated water and food. It causes severe dehydration and death if left untreated. Within the week 300 Haitians had died of cholera and 4,000 had been sickened.

Public health officials scrambled to slow the spread of cholera. The spread of cholera to a densely populated city, like Port-au-Prince or the camps around them could lead to an epidemic of disastrous proportions.

Public health officials quickly began an education and awareness campaign about cholera through radio, text, and 1:1 communication.

The International Organization for Migration broadcasted a live cholera education seminar to 40 radio stations, "Since people in Haiti get most of their news from radio, it's one arm of the frantic campaign to keep the cholera epidemic that started to the north from coming here to these overcrowded camps" according to Christopher Joyce's article on NPR.

Texts are used to directly reach Haitians. The texts provide a phone number for Haitians to call to learn how to prevent cholera. IMO officials say "Cholera doesn't need to be a killer, they say, if people just know more about it", also from Joyce's recent article.

Thanks to the timely, relevant, and simple health messaging the cholera epidemic seems to be losing steam. Click here to hear a short summary by Christopher Joyce in Haiti.

This cholera education campaign is a shining example of how effective messaging and a careful understanding of how audiences use media can prevent, or at least allay, an epidemic.

Integrated Marketing and Pregnant Boys

If health communication campaigns are supposed to get your attention, this one does. For sure. I was browsing the staff side of the United Way Worldwide website and came across this campaign. This campaign was part of the One Milwaukee project which was partially funded and advised by the United Way of Greater Milwaukee. The One Milwaukee project website has some bad links, but, I was able to track down the agency who did this work: Serve.

Check out Serve's way of getting people to pay attention by watching the video available here.

Serve's took an integrated marketing campaign approach to decreasing the teen birth rate in Milwaukee. In addition to the 'pregnant boy' ad (targeted at business and community leaders/activists), as seen above, Serve used graffiti like messaging to get people to call a phone number. See the results of that campaign at the video below.

In addition, they used bathroom posters in girls high school bathrooms and various other tactics. It is an integrated campaign as they used multiple avenues to reach segmented audiences to not just encourage behavior change but support that change through business and community leader buy-in. This is a critical factor in Milwaukee's dropping teen pregnancy rates. In fact, "on November 18, 2008, public health officials announced that births among 15-17 year olds in Milwaukee had dropped to the lowest level in 28 years" according to the UW Milwaukee website.

Awesome job Serve and United Way Milwaukee. Your communication tactics coupled with research and community wide buy-in is enacting real change.

Public Health Goes Guerrilla

What is public health? Don't worry. Most people don't know, that's why The Association of Schools of Public Health went guerrilla to spread the message of the scope and services public health provides.

Click here to watch the video.

Then, check out the website . There are tons of resources for folks who are want to know more about the role of public health and for advocates who want to spread the work of public health initiatives.

The Association of Schools of Public Health do a fantastic job of advocating for their cause through guerrilla marketing. They connected everyday objects and services with the role of public health-everything from bike helmets, to sewers, to running water.

Pretty cool. I just wish it was a national campaign, but, I suspect limited funds is to blame.

Self-Efficacy and Cage Fighting

I received this poem from a family friend the day I graduated from high school.

The Victor

by C. W. Longenecker

If you think you are beaten, you are.
If you think you dare not, you don't.
If you like to win but think you can't,
It's almost a cinch you won't.
If you think you'll lose, you're lost.
For out in the world we find
Success begins with a fellow's will.
It's all in the state of mind.
If you think you are out classed, you are.
You've got to think high to rise.

When I got this poem I was 18 and, naturally, thought it was really, really lame. I actually still do. It's not a great poem. But, I share it here because it is still what I think of when I think of self-efficacy. Self efficacy is the perceived ability to perform a given behavior given the skills you posses. That's why I think the above poem is sort-of stupid. I think I can be beaten in a cage-fighting match because I do not possess the skills to be successful in a cage fight. I do think I can be successful in buying groceries at Central Market because I like Central Market, I like buying groceries, and I have experience buying healthy, cost-effective groceries (both direct and indirect).

But, suppose you hated buying groceries. You hated your grocery store, for whatever reason, and you had no experience in buying healthy, cost-effective groceries. You have no self-efficacy in your ability to buy groceries to feed your family healthy, good food. So, you bail. You go to Wendy's and feed your family of 6 for $20 bucks and no one complains they don't like it. You win.

So, self-efficacy plays a big role in getting individuals to make healthy decisions. The "perceived behavior control reflects motivational factors that have an indirect effect on behavior through intentions", meaning that someones intentions to make a behavioral choice are formed by their motivation to and confidence in their ability to perform that behavior (Madden, Ellen, Ajzen, 1992). Remember my cage fighting match example? It should be noted that, "only when the perceptions of control were accurate was perceived behavioral control a significant predictor of target behavior" (Madden, Ellen, Ajzen, 1992). My 100% confidence in my inability to win a cage fighting match predicts my behavior not to engage in such a match.

When health communications campaigns seek to change individual behavior, they are seeking to increase the confidence that individual has in being able to complete the healthy behavior change, among other things. Instead of telling a family they should buy more produce, perhaps the campaign is incomplete in effectively changing behaviors unless the campaign shows the family how to choose, cook, and serve the produce. Without those elements, the self-efficacy of individuals to complete the behavior change is likely to be low. Going to Wendy's is much easier, is comfortable, and predictable.

It seems, then, that understanding the ways in which people make decisions before asking them to make lifestyle change decisions is crucial to maximizing the effectiveness of health communications campaigns.

See, even Kung Fu panda learns to have self-efficacy.

References

Madden, Thomas J., Ellen, Pamela Scholder , Ajzen, Icek (1992). A Comparison of the Theory of Planned Behavior and the Theory of Reasoned Action. PSPB, Vol. 18 No 1. February 1992 3-9.