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Physician awareness of prescription drug costs: a missing element of drug advertising and promotion.

BACKGROUND: Although the cost of prescription drugs is recognized as an important facet of health care expenditures, many physicians are purportedly unaware of actual drug costs. To test this hypothesis, we surveyed physician awareness of the cost of 20 actively marketed prescription drugs. METHODS: A questionnaire listing four possible cost categories for each drug was administered to 305 registrants of a 5-day family medicine continuing education course. RESULTS: Ninety-two physicians completed the questionnaire. Only one, a 40-year-old, board-certified physician who had been in practice for 3 years, answered 70% of questions correctly. The average score for the other participants was 37% (range 0% to 75%). CONCLUSIONS: The majority of physicians questioned could not accurately identify the price range of commonly prescribed drugs. We recommend drug cost disclosure in drug advertising to help address this problem.

Adult↗

The physician as advertiser: the unintentional discouragement of breast-feeding.

To be consistent with national health goals and ACOG policies and recommendations, physicians providing prenatal care should encourage breast-feeding whenever possible. The parents' choice to breast- or formula-feed their infant is the consequence of a complex decision. The physician's role is to provide information objectively so that the parents' decision can be made on an informed and factual basis. Clearly, the physician must support parents' decisions. However, the distribution of formula or vouchers in the physician's office during the antepartum period places the physician in the position of advertising or promoting a specific product and of potentially contributing to the failure of some patients to nurse their infants. We urge physicians not to distribute formula or formula vouchers to their pregnant patients, and encourage local and national obstetrics organizations to consider devising and discussing a policy statement discouraging such practices.

Advertising↗

Advertising, computers, and pharmacy liability. A Michigan court's decision has ramifications for pharmaceutical care.

Arbor Drugs, Inc., advertised that its computer could detect dangerous drug interactions. A pharmacist failed to warn a patient accordingly and the patient suffered a stroke as a result of an interaction between tranylcypromine and a decongestant. The Michigan Court of Appeals held that this failure to warn was actionable under the theories of negligence and fraud as well as under the Michigan Consumer Protection Act. The court's basic message is that pharmacies may be held legally responsible for preventing harm when they represent themselves as being capable of doing so.

Advertising↗

Dr Eliza Foster McDonogh Frikart: advertiser.

Eliza Frikart was the first woman doctor registered in New Zealand. She moved round Australia and New Zealand and advertised her presence wherever she went. She was struck off the British register.

Advertising↗

Pro-drinking messages and message environments for young adults: the case of alcohol industry advertising in African American, Latino, and Native American communities.

This paper examines targeted alcohol advertising in three ethnic communities: African Americans, Latinos, and Native Americans in the U.S. We focus on the appropriation of cultural systems and the reinvention of them as commodities to consumers. We outline the specific strategies used in each ethnic community. For African Americans, there is an emphasis on selling malt liquor to young adults through the use of "power" and gang-related images. For Latinos, there is an appropriation of historical and cultural symbols such as the national flags and maps of Mexico and Central America. Native Americans have coalesced to keep the image of a chief and warrior, Crazy Horse, from being used to market malt liquor. Each of the ethnic groups is engaged in action to prevent alcohol-related problems in their communities. Generating and implementing solutions is a universal social responsibility.

Adolescent↗

Selective phonotaxis to advertisement calls in the grey treefrog Hyla versicolor: behavioral experiments and neurophysiological correlates.

1. The significance of particular acoustic properties of advertisement calls for selective phonotaxis by the gray treefrog, Hyla versicolor (= HV), was studied behaviorally and neurophysiologically. Most stimuli were played back at 85 dB SPL, a level typically measured at 1-2 m from a calling male. 2. Females preferred stimuli with conspecific pulse shapes at 20 degrees and 24 degrees C, but not at 16 degrees C. Tests with normal and time-reversed pulses indicated the preferences were not influenced by the minor differences in the long-term spectra of pulses of different shape. 3. Pulse shape and rate had synergistic or antagonistic effects on female preferences depending on whether the values of one or both of these properties in alternative stimuli were typical of those in HV or heterospecific (H. chrysoscelis = HC) calls. 4. More auditory neurons in the torus semicircularis were temporally selective to synthetic calls (90%) than to sinusoidally AM tones and noise (< 70%). 5. Band-pass neurons were tuned to AM rates of 15-60 Hz. Neurons were more likely to be tuned to HV AM rates (< 40 Hz) when stimuli had pulses with HV rather than HC shapes. 6. Sharp temporal tuning was uncommon and found only in neurons with band-pass or low-pass characteristics. 7. Many neurons differed significantly in response to HV and HC stimulus sets. Maximum spike rate was more often elicited by an HV stimulus (74%) than by an HC stimulus (24%). 8. Differences in spike rates elicited by HV and HC stimuli were attributable to combinations of differences in the rise times and shapes of the pulses.

Acoustic Stimulation↗

From social behavior to neural circuitry: steroid hormones rapidly modulate advertisement calling via a vocal pattern generator.

Across vertebrates, androgens are rapidly elevated within minutes in response to aggressive or reproductive stimuli, yet it is unclear what the causal relationship is between fast androgen elevation and the ongoing (minute-by-minute) expression of behavior. This study tested the hypothesis that rapid increases in plasma steroid levels induce similarly rapid increases in both vocal behavior and the neurophysiological output of a central pattern generator that governs vocal behavior. In Gulf toadfish (Opsanus beta), males call to attract females to their nesting sites, and both males and females vocalize in aggressive interactions. Previous field experiments with males showed that simulated territorial challenges produce rapid and concurrent elevations in ongoing calling behavior and circulating levels of the teleost-specific androgen 11-ketotestosterone (11kT), but not the glucocorticoid cortisol. The current field experiments showed that non-invasive (food) delivery of 11kT, but not cortisol, induced an elevation within 10 min in the ongoing calling behavior of males. Electrophysiological experiments revealed that intramuscular injections of either 11kT or cortisol, but neither testosterone nor 17-beta-estradiol, induced increases within 5 min in the output of the vocal pattern generator in males, whereas only cortisol had similarly fast effects in females. The field behavioral results support predictions generated by the challenge hypothesis and also parallel the 11kT-dependent modulation of the vocal pattern generator in males. The cortisol effect on the vocal pattern generator in both sexes predicts that glucocorticoids regulate vocalizations in non-advertisement contexts. Together, these experiments provide strong support for the hypothesis that surges in circulating steroid levels play a causal role in shaping rapid changes in social behavior (vocalizations) through non-genomic-like actions on neural (vocal motor) circuits that directly encode behavioral patterning.

Action Potentials↗

Sexual swellings advertise female quality in wild baboons.

The females of many Old World primate species produce prominent and conspicuous swellings of the perineal skin around the time of ovulation. These sexual swellings have been proposed to increase competition among males for females or to increase the likelihood of a female getting fertilized, by signalling either a female's general reproductive status, or the timing of her ovulation. Here we show that sexual swellings in wild baboons reliably advertise a female's reproductive value over her lifetime, in accordance with a theoretical model of honest signalling. Females with larger swellings attained sexual maturity earlier, produced both more offspring and more surviving offspring per year than females with smaller swellings, and had a higher overall proportion of their offspring survive. Male baboons use the size of the sexual swelling to determine their mating effort, fighting more aggressively to consort females with larger swellings, and spending more time grooming these females. Our results document an unusual case of a sexually selected ornament in females, and show how males, by mating selectively on the basis of the size of the sexual swelling, increase their probability of mating with females more likely to produce surviving offspring.

Animals↗

Quantitative genetics of ultrasonic advertisement signalling in the lesser waxmoth Achroia grisella (Lepidoptera: pyralidae).

Males of the lesser waxmoth Achroia grisella (Lepidoptera: Pyralidae) produce ultrasonic advertisement signals attractive to females within several metres. Previous studies showed that females prefer male signals that are louder, delivered at a faster rate, and have a greater asynchrony between pulses produced by the right and left wings. These three signal characters vary considerably within populations but are repeatable within individuals. Breeding experiments employing half-sib designs were conducted on both collectively and individually reared moths to determine genetic variance within and covariance among these signal characters. Heritabilities of all signal characters were significant among collectively reared moths. Heritabilities for signal rate and right-left wing asynchrony interval were not significant, however, among individually reared moths, suggesting the presence of significant nonadditive genetic variance or common environmental variation. Development time was also significantly heritable, but only under individual rearing. The only significant genetic correlation was between signal rate and length of the right-left wing asynchrony and this was negative. Our findings on heritability of signal characters are consistent with a coevolutionary sexual selection mechanism, but the absence of signal x development genetic correlation fails to support specifically a good-genes mechanism. The variation in heritability among conditions suggests that environmental variance may be high, and may render selection on signal characters by female choice ineffective. Thus, additive genetic variance for these characters may be maintained in the presence of directional female choice.

Animals↗

Quantitative genetics of female choice in an ultrasonic pyralid moth, Achroia grisella: variation and evolvability of preference along multiple dimensions of the male advertisement signal.

The mating system of Achroia grisella (Lepidoptera: Pyralidae) is characterized by male ultrasonic advertisement signalling to which females orientate. Although males provide no direct, somatic benefits to their mates, females prefer males whose signal characters are more exaggerated than the population means. Previous studies showed that the signal characters influencing mate attraction are highly repeatable and heritable. We measured the phenotypic and additive genetic variances (heritability) of female preference in A. grisella, as this additive genetic variance is one of the genetic assumptions of indirect models of sexual selection. We determined the preference index of female A. grisella by repeated phonotaxis trials in which a choice of simulated male signals was presented. These playback experiments showed that female preference indices varied but were repeatable within individuals. Specifically, females differ in the relative importance of the several signal characters during mate assessment. A subsequent half-sib breeding design revealed an amount of additive genetic variance for the female preference index (h(s)2 = 0.212, SE = 0.1347, P = 0.0611; CVA = 0.1826). Our study highlights the importance of careful preparation of test signals and experimental design for quantifying individual variation in (female) preference along multiple signal dimensions.

Animals↗

Veterinarians, advertising and competition--three years on.

The views of veterinarians towards the changes that are occurring in professional practice with respect to competition and advertising are examined and compared with the views expressed in a similar study carried out 3 years previously. Data was derived from self completion questionnaires containing 40 Likert scales which were mailed to 300 members of the profession, first in 1985 and then in 1988. The moves made by the New Zealand Veterinary Association since 1985 in relaxing the rules on promotion appear to have largely alleviated any frustrations that were building up amongst the membership at that time. However, the study suggests that the profession will still find the boundaries of acceptable behaviour being tested by entrepreneurial practitioners.

Journal Article↗

A study of an alcohol advertisement for low alcohol beer.

A study was undertaken to measure the blood alcohol levels (BALs) of five men and five women after they had consumed seven middies of Emu 2.2 (2.2% alcohol by volume) beer in 1 hour. This study was conducted in response to a newspaper advertisement which depicted a well-known football player drinking seven middies of Emu 2.2 beer over 1 hour and registering a BAL of 0.012%. As predicted, the BALs of the ten adults varied considerably, but all greatly exceeded the very low result obtained by the football player. More importantly, from the point of view of road safety, all ten BALs exceeded the 0.02% probationary driver limit in Western Australia, and two of the BALs were above the 0.05% legal limit for driving in several other Australian states.

Journal Article↗

A paid radio advertising campaign to promote parent-child communication about alcohol.

This study assessed the impact of a paid radio commercial designed to promote parent-child communication about alcohol use and sponsored by the Bureau of Substance Abuse Services, Massachusetts Department of Public Health. A random-digit-dial telephone survey of parents or guardians of children ages 10-17 years was conducted after a four-week advertising flight. Respondents with unassisted recall of the commercial more often disagreed that parent-child discussion is useful only if children have begun to experiment with alcohol, and more often reported having three or more parent-child discussions about alcohol compared to those who did not recall the commercial. Findings suggest the potential benefit of paid media campaigns to encourage parents to talk with their children about alcohol.

Adolescent↗

Antlers honestly advertise sperm production and quality.

Evolutionary theory proposes that exaggerated male traits have evolved via sexual selection, either through female mate choice or male-male competition. While female preferences for ornamented males have been amply demonstrated in other taxa, among mammals sexual characters are commonly regarded as weapons whose main function is to enhance male competitiveness in agonistic encounters. One particularly controversial hypothesis to explain the function of male sexual characters proposes that they advertise male fertility. We test this hypothesis in red deer (Cervus elaphus), a species where sexual characters (antlers) reach an extreme degree of elaboration. We find that a global measure of relative antler size and complexity is associated with relative testes size and sperm velocity. Our results exclude the possibility that condition dependence, age or time of culling, drive these associations. Red deer antlers could signal male fertility to females, the ability to avoid sperm depletion throughout the reproductive season and/or the competitive ability of ejaculates. By contrast, male antlers could also signal to other males not only their competitive ability at the behavioural level (fighting ability) but also at the physiological level (sperm competition).

Animals↗

Sex in advertising: dioecy alters the net benefits of attractiveness in Sagittaria latifolia (Alismataceae).

The flowers and inflorescences of animal-pollinated dioecious plants are generally small and inconspicuous in comparison with outcrossing cosexual species. The net benefits of an attractive floral display may be different for dioecious compared to cosexual populations because dioecious species experience a more severe reduction in pollen delivery when pollinators forage longer on fewer individuals. Here, we develop a model that predicts the decrease in pollen delivery in dioecious relative to cosexual populations from female-female, female-male and male-male visit sequences as the number of individuals visited varies. To evaluate the predictions of our model we conducted a common garden experiment with dioecious and monoecious (cosexual) arrays of the insect-pollinated herb Sagittaria latifolia. We find that, although increasing the advertisements of floral rewards (i.e. increasing floral display) attracts more pollinators to individuals, the probability that these pollinators subsequently deliver pollen to neighbouring plants depends on sexual system. Because the number of individual plants visited per foraging trip did not increase significantly with floral display, the relative pollination success of dioecious versus monoecious populations decreases with increased floral display. We propose that this could explain why dioecy is strongly correlated with reduced floral display among angiosperm species.

Animals↗

Selection by somatic signals: the advertisement of phenotypic state through costly intercellular signals.

We develop a model of intercellular signalling, to explore the possibility that the signals exchanged between cells within a body may be subject to many of the same evolutionary pressures as signals exchanged between individuals whose genetic interests conflict. Evolutionary signalling theory maintains that signals, to be reliable indicators of need, intention or quality must be more costly than would be required merely to transmit a message. Cost guarantees that poor quality individuals are less able to display the high magnitude signals produced by the higher quality individuals. Receivers have been favoured by natural selection to attend only to the costliest signals, and thereby acquire honest information from the signaller. Hence the extravagant, costly ornamentation found among males of many species, ensures that females can accurately choose among them on the basis of their qualities. However, because somatic cells are normally perfectly genetically related, and are often denied access to the germ line, there will be minimal genetic conflicts of interest. This appears to imply that reliable intercellular signals should be produced without the need for cost to ensure their reliability. Nevertheless, we show that whenever cells vary in their phenotypic qualities in ways relevant to the fitness of the body, and given that there exists a class of cell that remains "ignorant' of its phenotypic state, costly intercellular signalling will evolve as a form of quality control. Specifically, we show that given variation in the cell population, signal cost will aid the identification and removal of cells that over-represent their true phenotypic state, and which therefore could lower fitness. Cells that under-represent their state are simply outcompeted by other cells. The cells of a body employ signals in a variety of intercellular interactions, including the development of the nervous system, the formation of neuromuscular junctions, and during the establishment of the immune repetoire. In each of these cases, cells may employ costly signals to advertise their phenotypic quality to other cells, and we review the evidence in support of this hypothesis: in effect, the cells may possess a molecular counterpart to the peacock's tail.

Animals↗

Condition-dependent traits and the capture of genetic variance in male advertisement song.

The occurrence of additive genetic variance (VA) for male sexual traits remains a major problem in evolutionary biology. Directional selection normally imposed by female choice is expected to reduce VA greatly, yet recent surveys indicate that a substantial amount remains in many species. We addressed this problem, also known as the 'lek paradox', in Achroia grisella (Lepidoptera: Pyralidae), an acoustic moth in which males advertise to females with a pulsed ultrasonic song. Using a standard half-sib/full-sib breeding design, we generated F1 progeny from whom we determined VA and genetic covariance (COVA) among seven traits: three song characters, an overall index of song attractiveness, nightly singing period, adult lifespan, and body mass at adult eclosion. Because A. grisella neither feed nor drink as adults, the last trait, eclosion body mass, is considered a measure of 'condition'. We found significant levels of VA and narrow-sense heritabilities (h2) for all seven traits and significant genetic correlations (= COVAi,j / radical (VA i x VA j)) between most pairs of traits (i, j). Male attractiveness was positively correlated with body mass (condition), adult lifespan, and nightly singing period, which we interpret as an energy constraint preventing males in poor condition from singing attractively, from singing many hours per night, and from surviving an extended lifespan. The positive genetic correlation (r = 0.79) between condition and attractiveness, combined with significant levels of VA for both traits, indicates that much of the variation in male song can be explained by VA for condition. Finally, we discuss the morphological and physiological links between condition and song attractiveness, and the ultimate factors that may maintain VA for condition.

Analysis of Variance↗

Information theory analysis of patterns of modulation in the advertisement call of the male bullfrog, Rana catesbeiana.

Male bullfrogs often amplitude modulate the envelopes of the individual notes (croaks) in their multinote advertisement calls. These amplitude modulations change the envelope of the note from smooth and unmodulated to one with varying numbers of modulations. A Markov analysis shows the pattern of change in the envelope to be highly ordered, but not completely so (semi-Markovian). Three simple rules govern the presence or absence of modulations in individual notes. These rules are (1) all calls begin with an unmodulated note; (2) the first note to be modulated will contain only one modulation; and (3) when a change in modulation occurs from one note to the next, it does so with an increase or a decrease of one modulation only. The addition of modulations is correlated with an increase in note duration. Physiologically, the presence of modulations might increase the precision of temporal coding of note periodicities in the central auditory system.

Animals↗