Assessing the Impact of a Social Marketing Campaign on Program Outcomes for Users of an Internet-Based Testing Service for Sexually Transmitted and Blood-Borne Infections: Observational Study.

BACKGROUND: While social marketing (SM) campaigns can be effective in increasing testing for sexually transmitted and blood-borne infections (STBBIs), they are seldom rigorously evaluated and often rely on process measures (eg, Web-based ad click-throughs). With Web-based campaigns for internet-based health services, there is a potential to connect campaign process measures to program outcomes, permitting the assessment of venue-specific yield based on health outcomes (eg, click-throughs per test). OBJECTIVE: This study aims to evaluate the impact of an SM campaign by the promotional venue on use and diagnostic test results of the internet-based STBBI testing service GetCheckedOnline.com (GCO). METHODS: Through GCO, clients create an account using an access code, complete a risk assessment, print a lab form, submit specimens at a lab, and get results online or by phone. From April to August 2015, a campaign promoted GCO to gay, bisexual, and other men who have sex with men in Vancouver, Canada. The campaign highlighted GCO's convenience in 3 types of promotional venues-location advertisements in print or video displayed in gay venues or events, ads on a queer news website, and ads on geosocial websites and apps. Where feasible, individuals were tracked from campaign exposures to account creation and testing using venue-specific GCO access codes. In addition, Web-based ads were linked to alternate versions of the campaign website, which used URLs with embedded access codes to connect ad exposure to account creation. Furthermore, we examined the number of individuals creating GCO accounts, number tested, and cost per account created and test for each venue type. RESULTS: Over 6 months, 177 people created a GCO account because of the campaign, where 22.0% (39/177) of these completed testing; the overall cost was Can $118 per account created and Can $533 per test. Ads on geosocial websites and apps accounted for 46.9% (83/177) of all accounts; ads on the news website had the lowest testing rate and highest cost per test. We observed variation between different geosocial websites and apps with some ads having high click-through rates yet low GCO account creation rates, and vice versa. CONCLUSIONS: Developing mechanisms to track individuals from Web-based exposure to SM campaigns to outcomes of internet-based health services permits greater evaluation of the yield and cost-effectiveness of different promotional efforts. Web-based ads with high click-through rates may not have a high conversion to service use, the ultimate outcome of SM campaigns.

Hypoactive sexual desire disorder: inventing a disease to sell low libido.

Condition branding is a marketing technique in which companies develop conditions concurrently with developing drugs; examples include gastro-oesophageal reflux disease, premenstrual dysphoric disorder, social anxiety disorder, erectile dysfunction and hypoactive sexual desire disorder. Although it is illegal for pharmaceutical companies to market drugs prior to regulatory approval, there are no restrictions on marketing diseases, and industry seeks to establish a disease state in the minds of clinicians years before an expected drug launch. Continuing medical education (CME) courses are an important part of promotion prior to drug approval and have become a key marketing tool for increasing clinician receptivity to new products. We systematically identified 14 free, internet-based, industry-funded, accredited CME modules on hypoactive sexual desire disorder in women which came out before a new drug, flibanserin, was being considered for regulatory approval in the USA. Common themes in these modules included the following: (1) Hypoactive sexual desire disorder is common, underdiagnosed and can have a profound effect on quality of life. (2) Women may not be aware that they are sick or distressed. (3) Simple questionnaires can assist clinicians in diagnosing the disorder. (4) It is problematic that there are medicines available to treat sexual problems for men but not women. In fact, there is no scientifically established norm for sexual activity, feelings or desire, and there is no evidence that hypoactive sexual desire disorder is a medical condition. Hypoactive sexual desire disorder is a typical example of a condition that was sponsored by industry to prepare the market for a specific treatment.

[Non-medical applications for brain MRI: Ethical considerations]. / Applications non médicales de l'IRM cérébrale : considérations éthiques.

INTRODUCTION: The recent neuroimaging techniques offer the possibility to better understand complex cognitive processes that are involved in mental disorders and thus have become cornerstone tools for research in psychiatry. The performances of functional magnetic resonance imaging are not limited to medical research and are used in non-medical fields. These recent applications represent new challenges for bioethics. OBJECTIVE: In this article we aim at discussing the new ethical issues raised by the applications of the latest neuroimaging technologies to non-medical fields. METHODS: We included a selection of peer-reviewed English medical articles after a search on NCBI Pubmed database and Google scholar from 2000 to 2013. We screened bibliographical tables for supplementary references. Websites of governmental French institutions implicated in ethical questions were also screened for governmental reports. RESULTS: Findings of brain areas supporting emotional responses and regulation have been used for marketing research, also called neuromarketing. The discovery of different brain activation patterns in antisocial disorder has led to changes in forensic psychiatry with the use of imaging techniques with unproven validity. Automated classification algorithms and multivariate statistical analyses of brain images have been applied to brain-reading techniques, aiming at predicting unconscious neural processes in humans. We finally report the current position of the French legislation recently revised and discuss the technical limits of such techniques. DISCUSSION: In the near future, brain imaging could find clinical applications in psychiatry as diagnostic or predictive tools. However, the latest advances in brain imaging are also used in non-scientific fields raising key ethical questions. Involvement of neuroscientists, psychiatrists, physicians but also of citizens in neuroethics discussions is crucial to challenge the risk of unregulated uses of brain imaging.

The neglected repercussions of a physician advertising ban.

Although the adverse implications of physician advertising are the subject of a fierce and sustained debate, there is almost no scholarly discussion on the ethical repercussions of physician advertising bans. The present paper draws attention to these repercussions as they exist today in most of the world, with particular focus on three serious implications for the public: (a) uncertainty about the physician's interests, namely, that patients must trust the physician to put patient wellbeing ahead of possible gains when taking medical decisions; (b) uncertainty about alternative treatments, namely, that patients must trust in the physician's treatment decisions; and (c) uncertainty about the exclusive patient-physician relationship, namely, that patients must develop and maintain a good relationship with one physician. Physician advertising bans continue to tell the public in most of the modern world that these are irrelevant or inappropriate issues, meaning that they are effectively left to the public to resolve.

Tobacco control in the Russian Federation--a policy analysis.

BACKGROUND: The Russian Federation (Russia) has one of the highest smoking rates in the world. The purpose of this study is to analyze past and current trends of the tobacco epidemic in the Russian Federation, review current tobacco control policy responses, and identify areas of opportunity for policy priorities. METHODS: We used a policy triangle as analytical framework to examine content, context, and processes of Russian tobacco control policy. The analysis was based on secondary data on supply and demand sides of the Russian tobacco epidemic, tobacco-related economic and health effects during Russia's economic transition, and compliance of Russian tobacco policy with international standards and regulations. RESULTS: Tobacco-promoting strategies have specifically targeted women and youth. Russia's approval of a "National Tobacco Control Concept" and draft for a comprehensive tobacco control bill increasingly align national legislature with the WHO Framework Convention on Tobacco Control (FCTC). However, several structural and cultural factors represent substantial barriers to the policy process. The influence of transnational tobacco companies on policy processes in Russia has so far impeded a full implementation of the FCTC mandates. CONCLUSIONS: Several strategies have been identified as having the potential to reduce the prevalence of tobacco use in Russia and decrease tobacco-related national health and economic burden: adjusting national tobacco policy by raising tobacco tax from the current lowest level in Europe to at least 70%; consequent enforcement of a complete smoking ban in public places; marketing restrictions; and smoking cessation interventions integrated into primary care. Russia's tobacco control efforts need to target women and youths specifically to efficiently counter industry efforts.

The ethics of social media in dental practice: ethical tools and professional responses.

This article considers several important trends in dental practice that result from innovations in digital and social media. It provides ethical tools for analysis, Illuminates areas of ethical concern in the current practice environment and offers recommendations for future practice. A summary in the form of a checklist is posted at the end of this essay for dentists considering the use of social media in their practice.

[Social marketing--seduction with the aim of healthy behavior?]. / Social Marketing - Verführung zum gesundheitsbewussten Verhalten?

SOCIAL MARKETING - SEDUCTION WITH THE AIM OF HEALTHY BEHAVIOR? Social marketing is the use of marketing principles to design and implement programs that promote socially beneficial behaviour change. Contrary to the marketing of consumption goods, social marketing does not deal with material products, but with behaviour, e. g. not smoking. This 'product' has a basic benefit (i. e. reduction of health risks in the long run), which is, however, difficult to convey. Therefore, the intended change in behaviour has to be related to a further reward which consists of symbolic goods, e. g. social appreciation or a better body feeling. The communication policy is essential for information on and motivation for the preventive issue. Social marketing campaigns whose development and management follow the principles of classical marketing can render preventive efforts more effective. In addition, social marketing can lead to a better quality management as compared to conventional preventive activities. These advantages can be explained by a) tailoring the campaign more specifically to the target group's needs and motives, b) presenting health risks more convincingly, and c) continuously analysing and evaluating the campaign and its effects. On the other hand, the marketing of preventive aims through mass media can bear several risks, as exemplified by different national and international public health campaigns. The necessity to communicate briefly and succinctly can lead to misleading simplifications and, in case of cancer screening, to the trivialization of a behaviour's consequences and adverse effects. Also, many campaigns do not intend to educate and inform, but try to persuade target persons of a certain behaviour, using emotions such as fear. This has led to social marketing being criticized as manipulation. Sometimes, social marketing campaigns cause stigma and discrimination of certain population subgroups, e. g. obese or HIV-positive people. Health promoters who plan mass media campaigns can be recommended to follow marketing principles in order to improve the campaign's impact. However, they should also consider possible adverse effects of the communication strategy on the social perception of health behavior, health risks and the responsibility of certain subgroups.

What popular bars post on social media platforms: a case for improved alcohol advertising regulation. / Publications non conformes des bars populaires sur les plateformes de médias sociaux : une invitation à améliorer la réglementation de la publicité sur l'alcool.

INTRODUCTION: The aim of this study was to document the scope of violations of the Canadian Radio-television and Telecommunications Commission (CRTC) "Code for Broadcast Advertising of Alcoholic Beverages" (CRTC Code) by drinking venues posting alcohol-related content on social media platforms, and to assess whether CRTC Code violations by drinking venues relate to their popularity among university students and to students' drinking behaviours. METHODS: In phase 1 of the study, a probability sample of 477 students from four Canadian university responded to a questionnaire about their drinking and preferred drinking venues. In phase 2, a probability sample of 78 students assessed the compliance of drinking venues' social media posts with the 17 CRTC Code guidelines. We pooled both datasets and linked them by drinking venues. RESULTS: Popular drinking venues were overwhelming posting alcohol-related content that contravenes the CRTC Code. Adjusted effect estimates show that a decrease in the mean level of compliance with the CRTC Code was significantly associated with a 1% increase in popularity score of drinking venues (t-test, p < .001). With regard to drinking behaviours, a 1% increase in the overall mean level of compliance with the CRTC Code was associated with 0.458 fewer drinking days per week during a semester (t-test, p = .01), 0.294 fewer drinks per occasion (t-test, p = .048) and a lesser likelihood of consuming alcohol when attending a drinking venue (t-test, p = .001). CONCLUSION: The results of this study serve as a reminder to territorial and provincial regulatory agencies to review their practices to ensure that alcohol advertising guidelines are applied and enforced consistently. More importantly, these results call for the adoption of federal legislation with a public health mandate that would apply to all media, including print, television and radio, digital and social.

The role of corporate credibility in legitimizing disease promotion.

OBJECTIVES: We explored what corporate "credibility" means to tobacco companies to determine why it matters to companies and what a lack of credibility means to them. METHODS: We collected documents from an online tobacco industry document archive and analyzed them with an interpretive approach. RESULTS: Tobacco companies conceptualized credibility not as being worthy of belief or confidence but as inspiring it. Thus, credibility was understood primarily as altering public perception of the industry. "Truth" was largely absent from tobacco industry conceptualizations of credibility, which were linked with "responsibility" and "reasonableness." However, industry research found that the public regarded credibility and responsibility differently, expecting these to entail truth telling, advertising reductions, less harmful products, apologies for deception, making amends, or exiting the tobacco business altogether. Overall, industry credibility-building projects failed repeatedly. CONCLUSIONS: Public health discourse increasingly attends to the roles of corporations in promoting disease. Industries such as tobacco and alcohol have been identified as profiting from harmful products. Yet corporations' ability to continue business as usual requires sustaining an implicit societal assent to their activities that depends on corporate credibility. For public health to address corporate disease promotion effectively, undermining corporate credibility may be strategically important.

The unlicensed lives of antidepressants in India: generic drugs, unqualified practitioners, and floating prescriptions.

Antidepressant uses have been rising rapidly over the past decades. Two main theories have been advanced to explain this. One claims that socio-economic change causes a global rise of depressive illness. The other holds that European and North American corporations are aggressively marketing antidepressants to expand their global reach. Both theories assume that multinational capitalism drives rising depression rates. Based on ethnographic data from India, this article shows that antidepressants are increasingly used in this country as well, but for reasons than have been little explored yet. Taking fluoxetine (Prozac) as the main example, it is argued that the spread of antidepressants in India is ;unlicensed' by Euro-American corporations in at least three ways: (i) drug marketing is driven by Indian generic producers; (ii) fluoxetine is given by practitioners who have no license to do so; and (iii) knowledge of fluoxetine is spread through unlicensed ;floating' prescriptions that patients take from one prescriber to another.

Autonomy, paternalism, and justice: ethical priorities in public health.

With attention to the field of public health ethics growing, significant time has been devoted to identifying a sound ethical justification for paternalistic interventions that override individual autonomy to prevent people from adopting unhealthy behaviors. Efforts focused on specifying the conditions that warrant paternalism, however, are largely misplaced. On empirical and ethical grounds, public health should seek instead to expand individual autonomy to improve population health. To promote autonomy, the field should redirect current efforts toward clarifying principles of justice. Although public health's most highly visible stance is associated with an egalitarian conception of "social justice," it is imperative that public health professionals address gaping divisions in public understandings of justice. I present recommendations for initiating this process.

Direct to confusion: lessons learned from marketing BRCA testing.

Myriad Genetics holds a patent on testing for the hereditary breast and ovarian cancer genes, BRCA1 and BRCA2, and therefore has a forced monopoly on this critical genetic test. Myriad launched a Direct-to-Consumer (DTC) marketing campaign in the Northeast United States in September 2007 and plans to expand that campaign to Florida and Texas in 2008. The ethics of Myriad's patent, forced monopoly and DTC campaign will be reviewed, as well as the impact of this situation on patient access and care, physician liability, and the future of DTC campaigns for genetic testing.