Selling Sickness

Clip 3: PMDD

1 min 21 sec ( skip to teachers’ notes)

Taken from the documentary Selling Sickness (2004)

Original title classification not known – this clip chosen to be PG

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Curator’s clip description

Newly created disease premenstrual dysphoric disorder was designed to market a drug. Prozac, an antidepressant, was repackaged as Sarafem specifically to treat the disease.

Teachers’ notes

provided by The Le@rning Federation

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This clip shows excerpts from drug company television advertisements defining, describing and portraying symptoms of premenstrual dysphoric disorder (PMDD) and promoting the benefits of Sarafem, a drug that supposedly controls these symptoms. The clip also features an excerpt from a television show in which a woman describes the condition. Unidentified experts speak about PMDD, asserting that all women will experience hormonal mood swings during the course of their lives and that direct-to-consumer marketing by drug companies may be creating a ‘pill for every ill’ culture. They suggest that the definition and incidence of PMDD in the community are influenced by culture and marketing. A narration links the images and interviews.

Educational value points

  • The clip focuses on one of the outcomes of the direct-to-consumer advertising (DTCA) techniques that have been adopted by US pharmaceutical companies. Traditionally, influencing doctors has been the key to pharmaceutical sales. While doctors are still the primary focus of advertising in the USA, DTCA began there in the 1980s. Its purpose is to influence the public to be more active in selecting particular drugs and discussing drug therapy with their doctors. This type of mass marketing is banned everywhere except the USA and New Zealand. DTCA is now a multibillion-dollar industry and there was a nine-fold increase in spending on DTCA between 1994 and 2000.
  • The drugs that are being urged on the consumer to treat premenstrual dysphoric disorder (PMDD) belong to the drug class known as selective serotonin re-uptake inhibitors (SSRIs). In 1997, the Food and Drug Administration (FDA) in the USA granted approval for broadcast and electronic advertising of prescribed drugs. The approval coincided with the introduction of SSRI drugs into the market. SSRIs are antidepressants, which means they potentially have a huge target consumer base.
  • DTCA is most commonly applied to drugs that claim to treat chronic diseases, and the clip suggests that ‘diseases’ are being created to provide a niche market for drug companies. As drugs come to the end of their patent protection period, their commercial value is threatened by the manufacture of generic forms of the drug by other drug companies. A way of protecting the earning capacity of a drug is to reformulate it under another name as a treatment for another condition. The SSRI Prozac was reformulated as Sarafem to treat PMDD. Sarafem is protected by patent until 2007.
  • The clip raises the question of whether the ban on DTCA in Australia could be overturned. DCTA is prohibited in Australia by the Therapeutic Goods Act. A review of the Act in 2000 and 2001 recommended the retention of the prohibition. DCTA is also prohibited by the Medicines Australia Code of Conduct, which has set a framework to guide information on prescription medicines on the Internet. The Internet is seen as providing a way for DTCA to reach Australian consumers. Trade agreements are also seen as increasing the possibility of future legalisation of DTCA in Australia.
  • Antidepressant consumption in Australia increased by nearly three times between 1990 and 1998. Most of the increase was in the use of SSRIs, most notably the drug Prozac. Paxil, another SSRI, was the eighth-highest selling drug in the USA in 2000. It also had the fourth-highest expenditure in terms of DCTA in the same period. One study found that more than 70 per cent of surveyed patients reported seeing DTCA that advertised antidepressants, indicating the possibility of advertising expanding the size of the antidepressant market.
  • The television advertisement promoting the benefits of Sarafem appeals to women from a variety of perspectives. The language of persuasion includes describing a new condition, PMDD, which has symptoms similar to premenstrual syndrome (PMS), suffered by most women during their reproductive years, and suggesting that the appearance of one or all of the symptoms referred to could mean the onset of PMDD. Women in the advertisement are shown demonstrating acute irritability, further reinforcing the message that taking a drug will assist with this symptom.
australian screen