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The exploitation of "sicko-chatting" by the pharmaceutical industry : a strategy for the normalization of drug use

Abstract : The Exploitation of 'sicko-chatting' by the Pharmaceutical industry: a strategy for the Normalization of drug use Pharmaceutical drugs are consumer goods. As such, they inscribe the transition from normality to pathology within the ambit of health marketing (Duclos, 2008, p. 109). It is now widely acknowledged that this pathology is not just a mere quantitative modification of the normal state, but that it also implies the patient's qualitative assessment of his or her experience (Canguilhem, 1943). This representa tion of pathology involves a certain degree of autonomy of action in the constitution of oneself as a suffering subject (Ehrenberg et al. 2005/6, p. 115). The level of subjectivity in volved in evaluating one's own health is no less dependent on the normative expectations of the social environment, expressed in terms of relief, comfort, welfare, produc tivity or performance. To be sure, the individual interna lizes and codifies his/her discomfort, but the language he/ she uses corresponds to the one that is conveyed in the media representations of sickness, through journalistic and fictitious medical narratives (Rose, 2007, p. 701). The pharmaceutical industry, well aware of the subjective and social nature of the meanings attached to the definition of a pathology, ensures that the marketing of its products is based not only on the dissemination of information but also on the media construction of a shared symbolic value. In a context where the advertising of health products is highly constrained --and in some cases prohibited-- pharmaceu tical communication penetrates the market in two ways: first, it contributes to naturalizing standards of well-being and performance of the body and mind (as if they simply emanated from biological nature) and secondly, it norma lizes the use of drugs. Convincing the audience that phar maceuticals can help one reach an optimal level of physical and mental condition is not enough : consuming pharma ceuticals must be a way of life, and be part of the collective imagination. The daily uses of medication must become a shared practice. Beyond the inherent regulatory function of the remedy, the creation of normative discourses on the uses of the drug, within social networks, requires serious attention. More than ever, the insertion of pharmaceuticals in social processes is a central concern for the professionals in pharmaceutical marketing. Influencers marketing is still prominent. But there is a decrease in direct-to-prescri ber activities (in this case, for the physicians) in favor of activities aimed at peer influencers. The marketing depart ments of many major biotechnology and pharmaceutical companies have begun to focus more on multi-channel approaches to promote their products. The creation and maintenance of social networks quickly became a neces sity for them. It is not coincidental that, in recent years, there has been a rapid growth of associations of health care users' and of patients' groups, as well as of countless health-chat forums (or rather "sicko-chat" forums). The industry's contribution to the development of these asso ciations is often direct. Thus, Johnson & Johnson created the site "BabyCenter", McNeil Pediatrics (also a subsidiary of Johnson & Johnson) has created two Facebook pages, and UCB has partnered with the site "PatientsLikeMe. com" to create an online community about epilepsy. These initiatives fall within the scope of "conversational marke ting", a branch of marketing 2.0 which aims to establish a "dialogue" with online forum participants through conver sational agents in order to make "friends" and to turn those friends into customers (Tuten, 2008 , p. 33-54). The role of conversational agent is played by a real person, hired to interact with Internet users, or by a software mimicking human conversation. The possibility of creating a pseudo dialogue allows advertisers to provide Internet users with a list of arguments that can be used in their discussions with their families, thus transforming them into brand evange lists (also called "brand ambassadors"). The use of incentives to increase drug consumption is a cause of concern for public-health departments, but very little is known about the pressures experienced by indi viduals in their daily lives. Even less is known about how these pressures are related to the new so-called conver sational marketing strategies. To study the formation of normative discourse on drug use in the context of conver sational marketing, the analyst needs a grammar of action capable of relating linguistic agency to sociological agency. The method should also allow one to identify, within the content of the exchanges, the shifts in the registers of information, social support and advertising. A sentence like "Since my son is on medication, I know I am a good parent" could have been written with or without finan cial sponsorship. The reason why it might be considered as promotional depends on its inclusion in a set of clear representational patterns of the curative treatment, of the actors involved, and of the transformations that occurred. In the wake of works in critical analysis of discourse (Fowler, 1991; Van Dijk, 1993; Fairclough, 1995), espe cially that of Karmen Erjavec (2004), which aims to identify journal articles written for purely commercial purposes ("advertorials"), I deployed the systemic functional gram mar of transitivity of Michael Halliday (2004) to compare the contributions of Internet users to two different Facebook pages. This included one developed by the leading manu facturer of a drug for the treatment of Attention Deficit Hyperactivity Disorder (ADHD), and one created by a Bri tish citizen to form a discussion group on (ADHD). Accor ding to Halliday, studying transitivity involves analyzing the process of meaning represented by the verb in a clause, the relations between actors, and the circumstances of the action. Who recommends what to whom? What is good for whom and under which circumstances? What is appearing and on what? Who knows what's best? The study allowed me to identify how the promotional nature of the corporate Facebook page expresses itself in relation to agency in the texts of the Internet users: 1) through a representation that exaggerates the consumers' power, 2) through a sanctimonious image of the sick per son, 3) through remarks which are always favorable to pharmaceutical drugs 4) and through an emphasis on the judgment of the prescribers and other influencers. Overall, this paper will permit us to reflect on how the electronic media serve to standardize both our understanding of contemporary pain and our treatment of it.
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Manon Niquette. The exploitation of "sicko-chatting" by the pharmaceutical industry : a strategy for the normalization of drug use. Communiquer dans un monde de normes. L'information et la communication dans les enjeux contemporains de la " mondialisation "., Mar 2012, France. pp.296. ⟨hal-00835818v2⟩

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