Category Archives: Health Promotion

Ottawa Public Health, Risk Communication & the Endoscopy Infection Scare

In a hastily organized media conference on Saturday, October 15, 2011, the City of Ottawa’s chief medical officer of health, Dr. Isra Levy, announced that a local, privately owned “non-hospital” medical clinic failed to follow proper infection control measures, resulting in the potential exposure of 6,800 patients to Hepatitis and HIV.

According to Dr. Levy, there was no evidence that a single patient had been infected as a result of treatment, and following consultation with infectious disease specialists he confirmed that the estimated rate of possible infection was “very low”:

  • 1 in 1 million for Hepatitis B
  • 1 in 50 million for Hepatitis C
  • 1 in 3 billion for HIV

On his Twitter feed Dan Gardner, author of the critically acclaimed book, Risk: The Science and Politics of Fear, described the risks cited in this case as “indescribably tiny…dwarfed by the risk of driving to the corner store.”

Despite the exceedingly low possibility of infection, the announcement by Ottawa’s health authority predictably generated outrage and intense public and media scrutiny.

Situation summary

Ottawa Public Health (OPH) first became aware of this clinic’s problems in July 2011, when the Ontario Ministry of Health and Long Term Care advised that an inspection by the College of Physicians and Surgeons of Ontario discovered infection prevention and sanitation protocols had not always been followed. It was then that OPH began its own investigation to assess the risk to public health and identify all patients who might be affected.

This involved a lengthy process of tracing several thousand patient records over a 10-year period. This volume of patient records, combined with restrictions on patient confidentiality set by Ontario privacy laws, made the task of informing those affected extremely difficult.

The final list of patients who may have been exposed to infection was not confirmed until Thursday, October 13th. On Friday, October 14th, OPH put its risk communication plan into effect. The first step involved finalizing the preparation of registered letters that would be immediately sent to all 6,800 patients. This included coordinating with the physician at the centre of the health scare, a professional obligation involving medical errors. Second, it involved notifying local physicians to ensure they would be able to address public demand for information and requests for blood testing. And it involved training as many as 50 public health nurses who would be redeployed from other units (e.g., sex education, home visits with new parents, etc.) to staff a call response hotline.

This plan was developed over the course of the health department’s three-month investigation. Given the possibility of an information leak, only a select number of key individuals were involved in the investigation and planning process.

A threatened media leak

Ottawa Public Health originally intended to hold its media conference on Tuesday, October 18th, at which time all information about the findings would have been disclosed. By this point, all affected patients would have been informed directly about what had occurred, physicians would have been prepared to respond to demands for information and testing, and the call response unit would have been up and running.

On the morning of Saturday, October 15th, Dr. Levy’s office was informed that a national news organization had become aware of the investigation and was preparing to break the story on the basis of inaccurate information.

This placed the public health authority in a difficult situation: the risk that a news report containing misinformation was real—certainly not unprecedented—and had the potential of creating vastly more harm than good.

OPH was faced with three options:

1.  Do nothing and respond to the report and the fallout that would ensue after the fact.
2.  Provide full disclosure of the situation, including identifying the name and address of the clinic and physician and the types of procedures which had placed patients at risk.
3.  Provide partial disclosure that would strike a balance between patient needs, the public interest and the capacity of the system to absorb increased demand for information, testing or treatment.

Communicating risk

The risks that kill people and the risks that upset people are completely different.Sandman, 2007

The health department scrambled to organize a media conference for later that afternoon. At this time, Dr. Levy announced what had occurred, confirmed that there were no known cases of anyone becoming ill and reported the very low numerical probability of infection. He acknowledged that some people might feel anxious or nervous about the announcement, and offered an explanation about what actions his office had put into place and would be following in the coming days, including a promise for new information early in the week.

To this extent, he acted in a manner consistent with the basic tenets of risk communication. He did not over-reassure, acknowledged that people would feel anxious about the announcement and described the discovery and response processes.

However, when pressed by journalists for a fuller disclosure of information, Dr. Levy refused to identify the name or location of the medical facility, the physician who operated it, or details about the patient population affected (i.e., children, adults, seniors, etc.).

This was a risky move for two major reasons.

First, it guaranteed that the health department would clash with the media over competing values: whereas the health department values only pertinent information in the interest of protecting public health, journalists value full disclosure, immediacy and thrive on controversy and outrage. Second, the decision to provide only very general information risked intensifying ambiguity and uncertainty, where the objective of risk communication is to lessen it. People aspire for control over their lives, even if they cannot change what might happen.

Ottawa Public Health called a second media conference on Monday, October 17th, where Dr. Levy disclosed all of the known information about:

  • where the breach had occurred (a private health clinic operated by Dr. Christiane Farazli on Carling Avenue in the city’s west end)
  • what caused the lapse in infection control (improper sanitation of equipment associated with the performance of endoscopies)
  • what patients should do next (contact their physician or the public health department’s call response centre to discuss whether they should be tested)

Media response

The news media’s framing of risk has more to do with its reproduction of moral outrage than with “scientific” notions of calculable risk. —Brown, Chapman & Lupton, 1996

Ottawa Public Health and Dr. Levy in particular, came under fire for the decision to provide only partial disclosure in its first media conference.

In a post to his Greater Ottawa blog on October 17thOttawa Citizen reporter David Reevely initially described Dr. Levy’s shift from partial to full disclosure as a “volte-face” move, a “classic emergency communications error,” and mused about whether the public health unit might be “sitting on something more shocking.” (He later revised his position, explaining the full context of Dr. Levy’s shift in tactics, characterizing it as a “judgment call…that makes a whole lot of sense when viewed from inside.”)

In a story published on October 18th, the Ottawa Sun did not report the low levels of infection risk but did note the “potentially fatal” nature of Hepatitis and HIV and cited demands from evidently uninformed patients for full disclosure: “You can’t keep the public in the dark…We have the right to know— it’s not fair…. Especially HIV, when there’s no treatment.”

On CTV National News, public relations consultant Barry McLoughlin characterized Dr. Levy’s decision to not release all of the information at once as “a mistake” that intensified public anxiety.

And in an October 18th editorial, the Ottawa Citizen blamed Dr. Levy for causing “undue public concern by mismanaging the release of the information.”

Risk communication: normative and situational perspectives

These criticisms and the demand they represent regarding full disclosure are consistent with normative recommendations for risk communication.

The World Health Organization defines risk communication as “an interactive process of exchange of information and opinion” among authorities, citizens, news media and other stakeholders.

In the past authorities typically acted on the basis of what they believed was the best course of action. Oftentimes this meant shielding the organization itself from blame. Risk communication hinges on therecognition that citizens deserve to be treated honestly, respectfully and with a view to enhancing their autonomy. The objective is to reduce uncertainty so that people will be capable of making informed decisions that affect their lives. Organizations achieve this objective, in part, by communicating as openly as possible.

Notwithstanding the normative appeal of full disclosure, the ability to report all information needs to be considered against a variety of situational factors, including the seriousness of the threat (i.e., the scientifically measured level of hazard or harm), the organizational resources required to manage the response that full disclosure will produce, and the conflict between patient rights to privacy and the public and media’s right to know.

Focus assessment

The focus on whether the release of partial information was sufficient needs to be determined in light of the probability of harm and in relation to the ability of the health system to absorb the effects of full disclosure.Given the low hazard for harm and the state of system readiness, and the fact that this event was not caused by the public health department itself, it’s not unreasonable that OPH proceeded cautiously in its first communication with the media and public.

The problem, however, is that this limited the flow of information to journalists, whose occupational values—more information is always better—and “nose for outrage” positions them in opposition.

According to the U.S. Centers for Disease Control and Prevention, “scientists want data to be released when it’s ‘seasoned’—the media want fresh data now.” Consistent with previous cases of low hazard/high outrage events, the Ottawa health department and media differed not only in their treatment of information, but also their definitions of how to define what’s in the public interest. The health department’s partial disclosure not only strained its relationship with the media; it also kept the wider public under-informed and in a state of uncertainty.

Risk communication conclusion

The question of when to release risk information is a serious one, not to be taken lightly. It is vitally important to communicate openly and to communicate early. As the CDC advises, public health authorities need to “be first, be right, be credible.” And according to the World Health Organization, “the benefits of early warning outweigh the risks,” even when faced with uncertainty and the possibility of error.

Although prescriptive recommendations such as these are important in guiding decision-making about disclosure, such decisions cannot be made by virtue of normative standards alone.

Rather, as argued here, they must be made in relation to situational factors. They need to be made in a context that acknowledges:

  1. It guaranteed that the health department would clash with the media over competing values.
  2. The resources that will be required to manage the system impacts such announcements tend to produce.
  3. The legislative environment that balances patient privacy rights against the rights of the public to know

In this case, it’s possible that a full disclosure of all available information in its first media conference would have created undue pressure on local physicians, public health clinics and hospital emergency rooms. Keeping in mind that risk is about both uncertainty and possibility, the scenario of an overwhelmed healthcare system surely played out in the health department’s decision making.

It’s important to note that this risk event was not caused by the health department itself, but by a private clinic regulated by the province of Ontario. Ottawa Public Health responded to an investigation by the College of Physicians and Surgeons of Ontario, and to an alert by the Ontario government. It proceeded with its own investigation and a strategy of public disclosure only when it became evident that the other agencies involved would not do so. The decision to provide only partial disclosure was made on the basis of the health department’s interpretation of the scientific evidence relating to infection risk. That this decision wasallegedly forced by a news organization threatening to break the story with erroneous information, is significant in terms of assessing the response.

Ottawa Public Health acted appropriately in balancing the needs of patients in relation with system capacity, but only to the extent that this event involved infinitesimally low levels of health risk. Had the probability of infection been higher, or had there been evidence of patients who had actually been infected, its response (and this assessment) would likely have been different.

Response problematic in one area: social media

The OPH response is problematic in one other way.

In the most recent edition of his book Ongoing Crisis CommunicationW. Timothy Coombs describes the “increasingly important” role of social media for issues management and as a channel for responding to public questions and sharing information. It’s unclear to what extent social media sites are used by Ottawa Public Health to scan or monitor media and public discourse; but for the dissemination of public information sites have been used only sparingly.

For example, (at the time of writing this post) the health department’s under-used Tumblr account does not contain a single update about the infection scare, although it’s been used for other health information purposes during this time. And while its Facebook page and Twitter account have posted synced updates to a low number of fans (363) and followers (5,000+), the fact that both were dormant in the 36-48 hours following the initial media conference suggests social media outreach represents a low priority within the health department’s communication plan.

Given that the period immediately following a public announcement is a critical time when reporters and members of the public are discussing an event and forming their initial impressions, social media platforms present an important space not only for assessing the tone of the public conversation, but for also correcting misinformation if and when it occurs.

Risk events such as the Ottawa endoscopies infection scare can be disorienting because of the intense feelings of uncertainty, anxiety and fear they produce. But to the extent that these situations are potentially destabilizing, they also afford unique opportunities to think critically about how we discuss and practice risk communication.

** This post originally appeared as a guest column on PR Conversations. I thank Judy Gombita and Heather Yaxley for the invitation and their community of readers for the excellent comments and feedback.

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Filed under Crisis Communication, Emergency Communication, Everyday Life, Health Issues, Health Promotion, Public Health, Public Relations, Risk, Social Media

Global Warming and the Problem of Public Opinion

We hear references to “public opinion” all the time but we rarely reflect on what it is, and why it’s important.

Political thinkers have struggled over the meaning of public opinion since antiquity. Plato was deeply distrustful of the public, while Aristotle believed “the many … may yet taken all together be better than the few.” To Macchiavelli, “public opinion” had no moral value, yet strategically it was crucial for political leaders to pay attention to it as a failure to do so could imperil one’s rule.

Around the turn of the 20th century, the political commentator and journalist Walter Lippmann argued that public opinion has little conceptual utility because most citizens have neither the time nor interest to truly understand issues in their complexity. The philosopher John Dewey disagreed, arguing that citizens are perfectly capable of understanding their world – nevertheless, their ability to do so is subjected to different forms of “organized manipulation” (i.e. advertising, PR, etc.).

All of these thinkers were writing about “public opinion” long before polling became a ubiquitous feature of the political and media landscapes.

Whether we are talking about environmental issues, foreign affairs, health-care reform or national security, actors on all sides commonly deploy “public opinion” as a weapon to advance their arguments, as if to proclaim that they speak on behalf of “the public” where others do not. Most agree upon the strategic benefits of such an approach, but has anyone considered the consequences?

Take the issue of climate change.

In 2008, Health Canada commissioned the polling firm Environics to survey Canadians about their understanding of climate change. The resultant report suggests that climate change will have a direct effect on the health of Canadians. Given that “most Canadians” believe climate change is taking place and that “a significant proportion” can see evidence of it in their own communities, the time for the agency to act is now.

Such findings are routinely challenged by others claiming to speak for the public. The Globe and Mail’s Margaret Wente argued recently that citizens are “cooling” to the notion of global warming and that politicians ought to carefully pay attention to public opinion in advance of meeting to discuss binding international agreements. Wente cites several polls that show, for example, how concern for the environment in Canada has fallen relative to other issues (e.g. crime, the economy). She then proceeds from the national to the international scale, arguing that citizens around the world have acquired weak appetites for action, especially for endorsing what she calls “Kyoto-style” international agreements.

The environmental community also uses “public opinion” for its side. Take for example Jim Hoggan, a well-known Canadian PR professional, environmentalist, and author. In March 2009, Hoggan argued that “over 90 per cent of Americans agree that the U.S. should act rapidly to combat global warming, including 34 per cent who feel the U.S. should make a large-scale effort even if it costs a lot of money.” The David Suzuki Foundation (on whose board of directors Hoggan serves as chair) reported in 2006 that Canadians were totally confused about the causes of climate change, attributing the problem to the hole in the ozone layer more than any other factor. A big part of the problem with public understanding about climate change, Hoggan asserts, is that citizens get unreliable information and no longer know whom they should trust. In his recent book, Hoggan reports survey data that shows that 82 per cent of people polled trust scientists, while 66 per cent trust environmental organizations and television weather reporters equally. By contrast, only 47 per cent trust the mainstream media. For Hoggan “the media—print or broadcast—have not succeeded in transmitting even the most rudimentary explanation of the actual cause of climate change.” Hoggan also notes that a whopping 81 per cent of people believe that PR experts deceive the public. Surely this can’t be good news for a PR man on a mission to change public perceptions about environmental issues.

What is one to do in the face of such competing claims about the state of public opinion? I suggest that the best thing we can do is ignore the polls altogether. Indeed, the fundamental problem with the debate about public opinion is that it’s a zero-sum game that only leads us down a path to ambivalence.

In a provocative critique, the French sociologist Pierre Bourdieu argued, “public opinion does not exist.” By this he did not mean public opinion does not come to have objective qualities – rather, his instructive point was that public opinion is a social construction, and a dangerous one at that. Bourdieu’s chief concern was with how polls are reported and the fact that they often carry more weight than they should. This happens, he argues, not only because the media are incapable of dealing with complexity, but also because we do not reflect carefully enough on how “public opinion” is shaped and represented. In other words, his concern is not with the inherent worth of polls but with how they are used. For Bourdieu, “public opinion” is at best a projection of what the media and political elite think about. At worst, it is a rhetorical tool that organized groups (in politics, the economy, and civil society) wield in their respective efforts to exert power and control over public discourse and policy.

I do not believe that polls have absolutely no role to play in how we talk about urgent issues like climate change. Nor do I endorse a nihilistic argument that we ought to just tune out entirely and let the chips fall where they may. The problem is that “public opinion” has been invested with a scientific power that obscures its social and political context – it has been granted far more value and authority than is deserved.

As the sociologist Earl Babbie might have put it, the idea of “public opinion” is probably useful in the context of scientific research, but in the world of culture and politics it could only ever be a “figment of our imaginations.” He did not mean that such concepts are entirely useless, just that we need to remember that the important question is: what do we do with our concepts?

Rather than assenting to what “public opinion” data tell us citizens want our political leaders to do, I think we desperately need to generate new forms of public expression, to raise critical questions about climate change instead of simply responding to those questions posed by others. Until we do so, we are liable to be governed only by the polls, and by those who sponsor them.

** Note: this column also appears under a different title in The Mark News here

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Back to the blog

After several months away it’s time to get back to blogging – it’s not that I’ve been lazy or disengaged, just distracted by other things. Here’s a summary of what I’ve been up to since (gulp) my last post in February.

In late May, I was the conference program co-chair of the Association for Nonprofit and Social Economy Research (ANSER), which met during the 2009 Congress of the Social Sciences and Humanities. The build-up to the meeting was particularly intense with more than 200 conference participants from academia and the voluntary sector — we had Canadians, Americans and conference participants from as far away as Australia. The keynote address was delivered by Michael Edwards, formerly of the Ford Foundation and now with progressive think tank Demos in New York City. I also hosted an event to celebrate the publication of my latest book, Surveillance: Power, Problems and Politics (UBC Press, 2009), which I co-edited with my long-time friend and collaborator Sean Hier from the sociology department at University of Victoria.

I spent most of my summer enjoying holidays with family in beautiful British Columbia and at our cottage in Algonquin Park. Vancouver was especially nice in late July where the temperature stayed consistently in the low 30s and the sun was always shining (quite in contrast to the misery of Ottawa, where it rained the entire time we were away).

I did get some writing finished this summer, including the final touches on a special issue of the Canadian Journal of Communication on public relations, co-edited with Graham Knight from the communication studies and multimedia department at McMaster University. This project was a long time coming, starting way back in 2008. See the  TOC here and check out the editorial and research paper I contributed. I am very pleased with how this issue turned out – lots of excellent contributions by scholars and media professionals from Canada and abroad on such timely issues as risk communication, journalist/PR relations, political campaigning, PR education, professionalism and nation branding, among many others. Post your comments below or send me a note if you have a chance to read any of the articles or reviews.

Toward the end of August I did a little bit of consulting, working with some local public health and housing advocates to help them deal with a particularly thorny NIMBY problem. My involvement in this case piqued my interest in further exploring the literature on communication ethics, deliberative democracy and theories of “public consultation”. It was clear from this experience that communities, politicians and social service providers all operate with different understandings of what consultation really entails and how it can be achieved. All cities (large, medium, even small) face important challenges in dealing with poverty, homelessness, addictions, mental illness and other structural social problems. These are not, as C. Wright Mills describes them, problems of the individual milieu – they are structural issues that require both structural and community solutions. Yet too often the stakeholders in these debates speak around or, more to the point, shout over one another – it becomes a battle geared toward winning rather than achieving mutual understanding. Communication researchers can play an important role in identifying the means and ways in which power relations operate in and through the language community stakeholders use to frame understanding of these issues, and in facilitating a process by which they can, at minimum, agree on the terms of their engagement if not on the outcomes.

It’s already October and I can’t believe the fall term is a month old. I was appointed to be the supervisor of undergraduate studies in our program and for the final weeks of August and the first few weeks of September I was very busy dealing daily with student registration issues, attending recruiting events to entice the country’s best and brightest to come to Carleton, and in getting my own course (MCOM 5204: Media, Culture and Policy) up and running. It’s a graduate level seminar that introduces students to key issues in the study of communication and public health policy (our substantive focus): theories of public policy; media advocacy; impacts of ‘new’ media on the medical and health professions and on health promotion; audience segmentation; risk and crisis communication; framing; and program evaluation. So far it’s going very well – I have a group of 8 really engaged MA and PhD students and we are “collaborating” again this year with the city of Ottawa’s public health department on some of their current and emergent issues.

I have also been actively promoting From Homeless to Home, a film I co-produced about homelessness in Ottawa, first to a meeting of academics, then a coalition of housing and other service providers, and later to the Homelessness Partnering Secretariat, a division within the federal government. I understand the film will be screened by Cinema Politica in Montreal sometime in November. When I know the details, I’ll post them here.

In December I’ll be attending the UN Climate Change Conference to examine how environmental activists and NGOs are using traditional and ‘new’ media to campaign for a new international deal to confront the problem of global warming. This is part of a larger project which you can read about on the blog’s Projects Page. I’ve never been to the Scandinavian countries so intend to take a little time for tourism and site-seeing while I’m there. Anyone with “must do” recommendations for my time there, please leave me a reply below! I’m also getting ready to head off to Atlanta at the end of October where I’ll be participating in a crisis and emergency-risk communication training session at the Centers for Disease Control and Prevention. I was just awarded a small amount of funding to look at how public health agencies in Canada and the U.S. engage the nonprofit sector in emergency planning and response, particularly their means and methods of ‘consultation’. The trip to CDC will be informing some of that research (again, see the Projects Page for more details).

On a personal note, I love this time of year. The colours have turned very quickly and the green of summer has given way to beautiful hues of gold and red. We were recently at the cottage where my family convenes every Thanksgiving and had a stunning drive through Algonquin Park. The smell and sound of falling foliage always puts me at peace. I’m gearing up for a last outing of cycling this coming weekend in Prince Edward County with some good friends. It’s our last grasp of a season we know has already passed us by. I realize that winter is not far off. The episodic flecks of snow encountered this past weekend appear to have followed me home, even if they made only a brief appearance this afternoon. Writing now in my home office, with the dogs at my feet and a steaming cup of coffee, I don’t seem to mind.

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Healthy Cities, Governable Subjects

Ever wonder what it would be like to live in a city where everyone was healthy, wealthy and wise? A city where there were no Big Macs, where everyone rode their bicycles to work and people just seemed to be in better spirits? If you are looking for such a utopia, Manchester England may be your Xanadu.

The newswires were abuzz yesterday with reports that Britain’s National Health Service has cooperated with local authorities in Manchester to provide incentives to citizens to eat more fruit, spend more time at the gym, engage in more preventative health measures and just lead a more productive and healthy lifestyle. Manchester is hoping to fight the fat with a reward system that will operate, for all intents and purposes, like a retail loyalty card program. But rather than earning credit for opening their wallets only, citizens will earn points for spending their hard earned dollars on fresh fruits and veggies and their leisure time doing pilates.

According to a report in the Associated Press, Manchester residents will be able to “swipe their rewards cards and earn points every time they buy fruits and vegetables, use a community swimming pool, attend a medical screening or work out with a personal trainer. Points can be redeemed for athletic equipment, donations to school athletic departments and personal training sessions with local athletes.”

It’s a public health craze that appears to be gaining traction in the UK. Tower Hamlets, the third most deprived London borough, will be undergoing an extreme makeover of its own — according to a report by the BBC, almost £10 million of government and local money has been earmarked for a “Healthy Cities” initiative that will turn the community into a place where people will find it easier to exercise and choose healthy food: walking and cycling routes will be extended, food co-ops will be established and fast food outlets will be enlisted in a campaign to offer more healthy meals on their menus.

With below average life expectancy, low exercise rates and unhealthy eating habits, the people of Tower Hamlets are thought to be at the centre of what the local primary care trust calls an “obesity epidemic.”

Beyond Manchester and Tower Hamlets, towns in other countries have tried similar programs. Varallo, a small town in northern Italy, offered cash rewards for residents who lost weight and kept it off for 12 months. Some U.S. companies wanting to keep health care costs down have also established reward programs for their staff through what HR types would call value-added employee assistance programs. For example, the Michigan-based Freedom One Financial Group sent 21 employees who met weight-loss goals on a four-day Caribbean cruise in 2005.

What does all of this tell us about the politics of public health today?

In The Politics of Health in the Eighteenth Century, Michel Foucault accounts for the emergence of a medical services market, the professionalization of medical practitioners, the development of benevolent associations and learned societies concerned with the observation of social conditions and innovation in medical techniques, among other things. While the state plays a variety of roles in relation to these developments, he argues, the ways in which health and sickness became matters of problematization ‘beyond the state’ contribute to an awareness of them as elements of population management.

Central to the politics of health in this period is the emergence of concern for the well-being of the population as an essential objective of political power – this is a view of power that concerns itself not with the capacity to dominate and repress but to produce things, to manage conduct and coordinate new ways of thinking and behaving. This shift towards policing the social body that Foucault argues was peculiar to the 18th century was related to the broader consequences of the industrial period’s demographic transition, in which an urgent need arose to rapidly integrate increasing numbers of people into the apparatus of production and to control them closely. It was these forces, he argues, that made the notion of “population” appear not just as a theoretical concept, but “as an object of surveillance, of analysis, of intervention, of initiatives aimed at modification.”

The cases of Manchester and Tower Hamlets, Varalla, and many others illustrate not only Foucault’s argument that the exercise of power is concerned increasingly with managing and channeling human conduct (rather than dominating or repressing it) but it also show that while non-governmental bodies play a key role in contemporary health politics, the state also plays a fundamental role in terms of ensuring that “the state of health of a population as a general objective.” Whether this is a good thing, a bad thing or something more dangerous remains to be determined.

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Purple Pills and Puffery

This post is about promotionalism and the pharmaceutical industry. Some of the ideas come from a paper I wrote a couple of years ago (This Ad May be Bad for Your Health) published as a chapter in my book Communication in Question. I was compelled to revisit some of the ideas that informed the paper after listening this afternoon to the latest podcast from White Coat, Black Art – Dr. Brian Goldman’s always stimulating and informative program on CBC Radio 1. You can stream the podcast at the CBC site here.

The section of the program that most intrigued me was Goldman’s Q&A with the vice-president of creative development at the Brand Institute, which bills itself as “the world’s premier healthcare, consumer and business to business (B2B) brand identity consultancy.” Among other services, the firm develops catchy names for drugs and the conditions they are designed to alleviate thereby helping pharmaceutical companies build brand equity and value. According to the executive interviewed, a number of important considerations go into the process of naming a new drug: the name should highlight the product’s unique selling features, it should include embedded concepts that can evoke emotion, it should be memorable and easily pronounced in multiple languages, and it should have a “pleasing tonality”. A case in point is the drug Lunesta, the popular prescription sleep aid – it connotes lunar images and has a soothing tonality that also affirms the product’s “inherent therapeutic properties.”  Roland Barthes must be spinning in his grave.

While you’re waiting for the podcast to download, here’s some promo from the Brand Institute’s website, broadcast as a news story a year or so ago on Fox Business and hosted on the agency’s YouTube page:

Of course, this story is about more than semiotics. Drug advertising is big business. The global pharmaceutical industry is the world’s most profitable stock market sector, with annual revenues exceeding $600 billion. Pharmaceutical sales in North America topped a staggering $265 billion in 2005, and in the United States, where 90% of the continental market is located, big pharma spent close to $5 billion that year on advertising alone. Millions of dollars can be made providing valuable treatment for genuinely sick people, but billions more can be made by convincing healthy people that there may be something wrong with them. Manufacture a risk, cultivate anxiety and deliver an easy treatment. It’s ontological security and a cool buzz in a bottle. 

For communication scholars, there are plenty of reasons to be concerned, which I outline in the aforementioned book chapter. Most importantly, advertising is about more than just the promotion of goods or services that are designed to inform and educate consumers and pad the corporation’s revenues. It is a cultural technology that incorporates images, persons, and commodities into what is often a seamless discourse that blurs the distinction between products and people. The rhetoric of drug advertising encourages individuals to focus increasingly on their minds and bodies as sites of real or potential disease that demand constant attention and administration. Some argue that this serves as an effective tool of governance and as a potential technology for social control. It surely this demands more vigilance on the part of consumers to resist the promotional efforts of drug companies and advertisers, but it also requires more robust state regulation to protect citizens.

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Filed under Everyday Life, Health Promotion, Lifestyle Risks, Politics, Popular Culture