the first nine months of 1998, visits for specific causes related to advertised products and services increased much more dramatically during this time. For example, visits for smoking cessation rose 263 percent, visits for impotence increased 113 percent, visits for hair loss rose 30 percent, and visits for high cholesterol rose by 19 percent (Maguire, 1999).

Commercial and social marketing of health information, products, and services is now a multi-billion-dollar industry. According to the Institute for Policy Innovation, direct-to-consumer advertising of prescription drugs alone increased to $1.8 billion in 1999 (Matthews, 2001). These expenditures are not unique. They represent a small portion of the dollars aimed at providing health information to consumers and motivating specific health behaviors. The United States invested some $1,080,000,000 in its recent 6-year National Youth Anti-Drug Media Campaign (Eddy, 2003). The importance of these expenditures goes beyond the dollar amount. These expenditures are guided by an understanding of consumers and their desires. These are not “information” campaigns, but rather targeted marketing efforts designed to influence what people do by offering new products, new services, lower barriers, and new motivations for changing their behavior—to stop smoking, to avoid fast food, to get a mammogram or to delay getting a mammogram. These expenditures are guided by years of market research studies and experience that have shown what kind of language works, what pictures appeal, and what messages compel people to act (Wilke, 1994). Despite this investment of talent and resources, some programs fail. The most recent evaluation of the Office of National Drug Control Policy’s National Youth Anti-Drug Media Campaign program states: “There is little evidence of direct favorable Campaign effects on youth. There is no statistically significant decline in marijuana use to date, and some evidence for an increase in use from 2000 to 2001” (Hornick et al., 2002).

One characteristic of the commercial and social marketing sector is that the information is not provided objectively. The authors of these messages, whether antismoking advocates or the cigarette industry, carefully select facts, stories, and images that fall far short of full information for an intelligent decision (Mazur, 2003:6–11). This assault on the public may have trained segments of the American public to be skeptical; to expect short sound bites of information and to avoid equivocation in information. As Mazur concludes:

Although we may talk about shared decision making in medical care and the provider–patient relationship, the original goal of the decision scientist, to provide a full discussion of risks and benefits among a full set of alternatives, may or may not be attainable. And it is far from clear whether patients actually want to participate in such a fully shared decision-making environment (Mazur, 2003:177).



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