In lieu of an abstract, here is a brief excerpt of the content:

c h a p t e r t h r e e Selling Estrogen to Doctors Photograph number one: An attractive woman is seated on a lawn chair in a suburban backyard on a sunny afternoon. She has nicely coi√ed gray hair; her face is unlined. Her husband, also gray-haired and good-looking, is sitting next to her. They are both smiling, perhaps in response to something a little girl in the foreground is saying or doing. Another little girl runs toward the couple. A younger woman, most likely the mother of the two girls and the daughter of the older couple, approaches with a tray of lemonade-filled glasses.∞ Photograph number two: The same older woman is standing under a chandelier in the foyer of a theater, perhaps at intermission. She is wearing a stylish suit and white gloves and holding a playbill. She is chatting with two attractive well-dressed men, and smiles winningly at one of them.≤ Both of these images appeared in full-page advertisements for Ayerst’s Premarin in several issues of the Journal of the American Medical Association and Obstetrics and Gynecology from 1966 to 1968 as part of the company’s advertising campaign called ‘‘The Time of Her Life.’’ The caption for each read, simply, ‘‘Help keep her this way.’’ At the bottom of the ad, Premarin was described as ‘‘specifically designed for estrogen replacement in the menopause . . . and later years.’’ Purchasing advertising space in medical journals was just one of several means used by pharmaceutical manufacturers to market prescription drugs. Drug companies sent out sales representatives, known as ‘‘detailmen,’’ to meet face-to-face with doctors to provide information about the latest developments and to answer questions about the product line. At the start of the 1950s, Ayerst employed 184 detailmen in the United States; by the end of the 1960s, its American sales force numbered 550.≥ All told, there were some fifteen thousand detailmen working in the United States in the late 1960s.∂ Several studies in the 1950s and 1960s reported that the majority of physicians found the information provided by these company representatives to be useful.∑ Surely they also appreciated Selling Estrogen to Doctors 53 the complimentary samples, gifts, and free lunches bestowed by the drug salesmen . In a survey of its members in 1973, the American Medical Association found that more than half (52.2%) listed detailmen as one of the sources influencing their prescription habits.∏ Companies also sent information about their products by direct mail to physicians . These lavishly illustrated promotional materials were designed not merely to inform but also to sell; products were presented in the most positive light. In a 1948 article called ‘‘The Use and Abuse of Estrogen,’’ two doctors cast a critical eye on these direct mail o√erings: ‘‘If one depends on the beautifully embossed brochures which exhort the practitioner with every mail, one falls, unhappily, into the security of the illusion that there are neither contraindications nor side e√ects in the use of estrogens. Such pamphlets, while providing succinct clinical reviews and emphasizing the multiple commercial forms of estrogen, are often full of omissions.’’π Although physicians may have complained about the content and volume of commercial literature they received, most of them opened their mail and gave it at least a cursory review.∫ More often than not, however, these pamphlets probably ended up in the wastepaper basket, because few have survived to become part of the historical record. Since the substance of these mailings was often replicated in the published advertisements, in condensed form, the lost ephemera of pharmaceutical promotions can be gleaned from the related ads, which have been saved in the bound volumes of medical journals. The messages imparted by these ads reached their target audience. A 1971 study of 5,347 internists found that 75 percent of those surveyed read the advertisements in their medical journals; of these readers, 80 percent thought the ads were e√ective in communicating information about drug products.Ω In the 1940s, the New York marketing firm of Murray Breese Associates sponsored studies to evaluate the relative e√ectiveness of di√erent kinds of pharmaceutical advertising . The results indicated that direct mail was slightly more successful than journal advertisements in capturing physicians’ attention; however, the cost of producing and distributing direct mail was three to five times greater than the cost of publishing a comparable advertisement. The author of the survey cautioned that the findings were based on interviews with...

Share