Pharmaceutical relationships : intersections of illness, fantasy, and capital in the age of direct-to-consumer marketing

Abstract

This dissertation is a multi-sited ethnography among marketers, consumer-patients and psychiatrists in the U.S. It explores the recent history of styles of pharmaceutical advertising that have come about in response to FDA regulations and ethical issues raised by patients and the press about how the pharmaceutical industry shapes drug research. Specifically this dissertation explores the role of direct-to-consumer drug marketing (DTC) in the consumption and experience of antidepressants, including a cultural shift in the U.S. towards how the consumer negotiates new ethical injunctions to manage his or her own identity through pharmaceuticals. A key focus is how marketers carve out their own ethical niche from which they innovate on ways to persuade consumer audiences with scientific facts that double as public relations. This dissertation gives special attention to how individuals encounter and incorporate the putative neuroscience of DTC advertising of antidepressants to negotiate their personal knowledge of illness, and to manage their identity, everyday practices, and professional pursuits. From these ethnographic encounters I have identified "illness," "fantasy," and "capital" as three key themes for my analysis of DTC marketing. In turn I have combined the very different literatures on illness (which address patient advocacy movements and health care seeking and questions of how medical diagnoses can be deployed as social norms), fantasy (which address psychoanalytic conceptions of desire and self, as well as semiotic understandings of consumption), and capital (which address health care market competition, and negotiations with the FDA over truth in advertising). In sum, this dissertation offers a thick description of "ethical identity management" in the contemporary landscape of U.S. pharmaceutical consumption.