Are women's heart problems being
neglected because doctors are influenced by images in
ads? A group of University of Toronto researchers thinks
so. They spent nearly two years combing through American
medical and cardiovascular journals, analysing advertisements
for cardiovascular drugs and taking note of the age, gender
and race of the people depicted in them. The research
appears in the November issue of the Journal of Evaluation
in Clinical Practice.
Primary investigator Dr Angela
Cheung, a professor in U of T's Department of Medicine
and associate director of the Women's Health Program
at Toronto General Hospital, knew that women with cardiovascular
disease were often misdiagnosed or treated less aggressively
than men, and she thought advertisements might have
something to do with it.
"Studies have shown that women
are referred later and less frequently for cardiac catheterization
and for coronary artery bypass surgery," explained Dr
Cheung in a statement. "There are also gender-based
differences in the use of aspirin, beta-blockers and
thrombolytic therapies."
"We know from other literature
that ads do play a role in educating doctors, and so
we are wondering if that can affect people's perceptions,"
she adds in a phone interview.
After examining 919 cardiovascular
drug ads in journals published between January 1996
and June 1998, the researchers found that 80% depicted
male patients.
WRONG
ON TWO COUNTS
Dr Cheung and her team also found that the ads were
misleading about both race and gender. The women depicted
were younger than the men, even though heart disease
affects women later in life than men, and the typical
patient shown was a middle-aged white male, even though
cardiovascular disease is the number one killer of blacks,
who are much more likely than whites to have high blood
pressure.
"A majority of women [with cardiovascular
disease] are 60 years old and over and if you look at
the onset of the disease it is 10 years later than men,"
explains Dr Cheung, highlighting the discrepancy between
the advertisements and reality.
Dr Jonathan Bishinsky, an internist
at York Central Hospital who's been treating cardiovascular
disease for over 15 years, says he's certainly noticed
a preponderance of men in ads for drugs treating the
disease.
"There is the notion that we are
under-diagnosing cardiovascular disease in women," says
Dr Bishinsky. "If there were more women in advertisements,
then it would increase the profile."
POWER
OF THE IMAGE
Dr Dan Ezekiel, a family physician in Vancouver who
regularly treats patients with heart disease, says he
pays attention to journal advertisements and is surprised
the percentage of women portrayed isn't even lower.
"I'm trying to think of a cardiovascular
ad that has a woman in it and I can't think of any,"
he says. "The big trend in ads is to put a face to the
drug. We see that with depression and osteoporosis drugs,
and you therefore get a mental image in your head as
to what that patient looks like."
"Having more women in the ads would
make a difference," he adds.
CONFLICT
OF INTEREST?
When asked why their selection of ads was so old, Dr
Cheung explains she and her colleagues chose journals
from the late 90s because strides were made in education
about women and cardiovascular disease during that period,
and this awareness should have had an effect on advertisements.
She also says it was handy that complete collections
of relevant journals were also available for those dates.
There was also a delay between
completion of the study and publication. "Some journals
didn't want to publish it," says Dr Cheung. "Possibly
because journals have advertising as a source of income."
Dr Cheung hopes her team's work
will have some effect on the ads and result in better
understanding and treatment of women with cardiovascular
disease.
"We're hoping that this study will
spur drug companies to work to change the perception
of cardiovascular disease," she says.
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