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You too could be the target market of a new drug


Every time I visit the United States, I am increasingly alarmed at the number of TV commercials for prescription drugs, which is something I never saw when I was a child. As a matter of fact, between 1994 and 1998, drug manufacturers increased their spending on direct-to-consumer advertising in the U.S. seven-fold.

Pharmaceuticals are a never-ending growth industry, but the reason they’re seen that way has less to do with advances in medicine and more to do with consumers’ changing perception of the gray area that falls between wellness and illness; a perception that has been molded by advertising. Weight-loss medications reinforce the belief that obesity is a disease. The last time I was in the States, I even saw an ad for a prescription drug that treats a condition I have never heard of — discoloration of the fingernails.

This situation has become so prevalent that the development of new drugs often leads medical treatment rather than vice versa. Until the ’50s and ’60s, with the appearance of Miltown and Valium, most doctors didn’t acknowledge anxiety as a medical condition, much less treat it. That’s what psychiatrists were for. Nowadays, with the acceptance and ubiquity of antidepressants like Prozac and Zoloft (both of which are advertised extensively), Freud is as relevant as Aeschylus.

The drug that is most famous for creating a disease where none existed before is Viagra. Prior to the appearance of the little blue pills, the condition it treated was called “impotence,” a derogatory word that implied weakness or “inadequacy.” This condition is now known as “erectile dysfunction,” a term that, semantically at least, renders it a disease.

Viagra was approved in Japan in January 1999 and went on sale that March, but sales haven’t been as brisk as its manufacturer, Pfizer, anticipated. Considering how much media attention the drug received prior to approval, there was obviously something amiss in the marketing department, so Pfizer surveyed doctors and found that potential users were embarrassed to talk to them about their condition. The solution? As in the U.S., convince the public that impotence is a disease by promoting the initials “ED,” meaning erectile dysfunction, and its Japanese-language counterpart, bokki shogai.

The campaign started last Friday with full-page print ads in the dailies, which featured a studio photo of actor Shiro Sano and a woman wrapped in a bedsheet with the letters ED superimposed on them. It looked like an ad for a new trendy drama. Beneath the picture were three questions: 1) What is ED?; 2) Who is that with Shiro Sano?; and 3) What is it that they want to tell you about? The answer could be found in the next day’s edition.

Saturday’s ad revealed the woman to be Sano’s wife, Maki Ishikawa. The two are shown smiling and locked in an embrace next to the phrase, “Courage brings a couple together.” ED is explained in delicate language. Phone numbers and a Web site address are provided, apparently for those who require less delicate language.

TV commercials were launched the same day, with Sano sitting despondently on a couch, brooding about something. His wife sits down next to him, smiles and gives him a reassuring squeeze. He perks up a little — all is not lost.

The famous American ads for Pfizer used former Republican presidential candidate Robert Dole as a spokesman. In the ad, Dole says, “It may take a little courage” to ask your doctor about ED.

Dole, however, is in his 70s, an age when erectile dysfunction is considered one of the unfortunate side effects of still being alive. Sano is 45. The Japanese public would never accept a man Dole’s age as a spokesman for Viagra, because most people think that sex after 50 is gross. Sano and his wife are an attractive couple. He doesn’t look like someone who needs Viagra, and in fact his testimony implies that ED is not something that he is suffering from now but rather thinking about for the future. He says that he and his wife have made a promise to “face it together.”

Viagra, which is never mentioned by name in the ad, is thus given a romantic function that even those sentimental Americans wouldn’t exploit. However indelicate some people found the Dole ads, they were resolutely clinical. Dole’s wife isn’t mentioned at all. Erectile dysfunction is a male malady. Viagra, the ads seemed to say, will do nothing except help you get it up; your marital situation is your own problem.

By including the female partner, the Japanese ad reinforces a generally held belief that women are the passive half in a relationship. In both print ads, Ishikawa is looking up at Sano. The dishonesty of this approach is that it ignores the complications of everyday conjugal life, where sexual dysfunction takes on a specific meaning for each couple. It says that as long as the husband is happy, the wife will — or should — be happy, too.

Something much closer to the truth of the matter was expressed by Sagami Condoms in a series of commercials for its new, improved line. In one, an embarrassed man stands in a drugstore looking into the camera, with an equally embarrassed but slightly defiant woman standing behind him. The ad implies nothing about the couple’s sex life except that they have one. The woman may enjoy sex with the man or she may simply tolerate it, but in any case she insists he buy the condoms. When it comes to sex, that’s about as honest as you can get.