Eaves Emery R
Department of Family and Community Medicine, University of Arizona College of Medicine, USA.
Soc Sci Med. 2015 Dec;146:147-54. doi: 10.1016/j.socscimed.2015.10.033. Epub 2015 Oct 19.
Direct-to-consumer marketing has sparked ongoing debate concerning whether ads empower consumers to be agents of their own care or shift greater control to the pharmaceutical industry. Ads for over-the-counter (OTC) medications in particular portend to offer simple, harmless solutions for meeting the demands of social life. Rather than join the longstanding debate between consumer agency and social control in pharmaceutical advertising, I approach self-medication with over-the-counter (OTC) analgesics using Harm Reduction as a framework. From this perspective, consumption of OTC analgesics by chronic pain sufferers is a means of seeking some level of relief while also avoiding the stigma associated with prescription pain medication. Qualitative methods are used to analyze data from two sources: (1) semi-structured qualitative interviews with 95 participants in a trial examining the effectiveness of Traditional Chinese Medicine for Temporomandibular Disorders (TMD) from 2006 to 2011 in Tucson, AZ and Portland, OR; and (2) print, online, and television advertisements for three major brands of OTC pain medication. Participants described their use of OTC medications as minimal, responsible, and justified by the severity of their pain. OTC medication advertising, while ostensibly ambiguous and targeting all forms of pain, effectively lends support to the consumption of these medications as part of the self-projects of chronic pain sufferers, allowing them to reconcile conflicting demands for pain relief while being stoic and maintaining a positive moral identity. Describing OTC medication as "just over-the-counter" or "not real pain medication," sufferers engage in ideological harm reduction, distinguishing themselves from "those people who like taking pain medication" while still seeking relief. Justifying one's use of OTC medication as minimal and "normal," regardless of intake, avoids association with the addictive potential of prescription pain medications and aligns the identity of the chronic pain sufferer with a culturally sanctioned identity as stoic bearer of pain.
直接面向消费者的营销引发了持续的争论，即广告是使消费者能够成为自身医疗保健的主体，还是将更多控制权转移给了制药行业。尤其是非处方（OTC）药物广告，往往声称能为满足社交生活需求提供简单、无害的解决方案。我并非参与制药广告中关于消费者自主性与社会控制的长期争论，而是以减少伤害为框架，探讨使用非处方（OTC）镇痛药进行自我药疗的问题。从这个角度来看，慢性疼痛患者使用OTC镇痛药是一种寻求某种程度缓解的方式，同时也避免了与处方止痛药相关的污名。采用定性方法分析来自两个来源的数据：（1）对2006年至2011年在亚利桑那州图森市和俄勒冈州波特兰市进行的一项关于中医治疗颞下颌关节紊乱症（TMD）有效性试验的95名参与者进行的半结构化定性访谈；（2）三个主要品牌OTC止痛药的印刷、网络和电视广告。参与者将他们使用OTC药物的情况描述为用量极少、负责任，且因疼痛严重程度而合理。OTC药物广告表面上含糊不清且针对所有形式的疼痛，但实际上有效地支持了这些药物作为慢性疼痛患者自我规划的一部分的消费，使他们能够在坚忍并保持积极道德身份的同时，协调对缓解疼痛的相互冲突的需求。患者将OTC药物描述为“只是非处方的”或“不是真正的止痛药”，从而进行意识形态上的伤害减少，将自己与“那些喜欢服用止痛药的人”区分开来，同时仍在寻求缓解。无论摄入量如何，将自己使用OTC药物的情况辩解为极少且“正常”，可避免与处方止痛药的成瘾潜力产生关联，并使慢性疼痛患者的身份与文化认可的坚忍疼痛承受者身份保持一致。
