Public statements by Congressmen and Senators, members of the medical profession, government officials, and responsible citizens have focused on the educational effects of mass media advertising of drugs as one of the causes of the increase in drug abuse. There is little basic research which can be cited to support a causal relationship between drug advertising and illicit drug use. Nevertheless, responsible critics point to television and radio messages which reach adults, youth and the very young alike which say that "you will feel better and your lives will be better if only you 'take something'."

A case in point-you turn on your television set. Before you reach to turn up the volume, you see this: A young girl runs up a flight of stairs, stumbles and drops her books, picks them up hurriedly, enters her classroom, and sits down. She is late; her face shows concern and tension. Then, on the television screen appears a small package of white tablets.

Media advertising does not hesitate to prescribe for a wide variety of common problems. You can't sleep? Your everready radio or television advertisement has something that your doctor might recommend, or at least recognizes as safe, according to the announcer.

Feel tired or run-down, or maybe hypertense and can't relax? To get a prescription, turn on your radio or television set and a confident, intimate, or authoritative voice provides the name of a remedy with which you can medicate yourself.

Are you in a bad mood, grouchy, irritable, become angry with your husband or wife, or the children? You can save your marriage, the ads imply, if only you take enough of the little pills, or tablets, or liquids that you can buy over-thecounter at your corner store or at the shopping center.

All right, you may ask, what's wrong with getting people's attention by reminding them that they sometimes feel bad and need to take something? And if the product works, if it relieves pain and

September 21, 1970

soothes discomfort, why knock it?

These are legitimate questions which deserve answers. The answers however, must go beyond the scope of the questions themselves. There is very little wrong in getting people's attention and helping them to ease a minor discomfort. Unfortunately, people who suffer from the problems the ads describe are not likely to be cured of such family or personal problems by the medication. In other words, products are being advertised as cures for psychological problems rather than physical illness or symptoms. Too often the drug is advertised as capable, by itself, of altering one's mood, one's feelings, one's attitudes.

Another advertising medium has been criticized by four psychiatrists writing in Science (July 1970) who describe similarly designed printed advertising aimed at physicians. They accuse the pharmaceutical industry of making tranquilizers and antidepressants a panacea for the "normal trials and tribulations of human existence." These advertisements, directed at physicians and describing prescription drugs, suggest to the physician that problems of unhappiness, misery, grief and anxiety can be cured through largely chemical means. One example shows the picture of a missing girl, with a message from the parents pleading that she come home. The message to the doctor is that he administer a drug to allay feelings in the parent of guilt, unworthiness, inferiority and incapacity-if he assumes they exist. Another advertisement urges the physician to treat children's fears of the dark, school, monsters, etc. with a drug.

But commercial advertisements are not the only source of drug-oriented educational messages. For some years now, so-called "underground radio" aimed at youth and broadcasting late at night urges, through innuendo or outright double-entendres, that listeners "turn on" with drugs. These stations exist in most major metropolitan areas and play mostly hard rock and "acid rock" music. They also provide drug-oriented interpretations of music played by well-known artists,

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which sometimes are intended to contain them, but which must be hidden if they are to be played by larger stations and better-known disc-jockeys. The Bulletin on Narcotics of the United Nations (October-December, 1969) has published an article entitled "Approbation of Drug Usage in Rock and Roll Music." Some of the popular songs listed may be found in your children's record collections. For example, "Puff the Magic Dragon," "Mr. Tambourine Man," "Along Comes Mary," "Up, Up, and Away," "Sgt. Pepper's Lonely Hearts Club Band," "With a Little Help from My Friends," "Yellow Submarine," and "Lucy in the Sky with Diamonds" have all been described as having overt or implied references to drug use.

The reason cited in the U.N. article for record companies permitting such controversial material to be produced is that they, like the artists, want to make a lot of money, and to do so must follow the trends. However, radio stations must play a record before it can possibly become a hit. Again, the competition of the market place comes before any social concern. The article concludes that though the songs themselves may have done little harm, they serve as advertisements for the attitudes and feelings of the performers. And these, without a doubt, have had a tremendous impact on young people, not only in the United States, but throughout the world.

In connection with the latter, news broadcasts, the teenage press, underground press, and radio personalities all provide information which builds images of pop stars in the minds of the public. Education, as most professional educators will testify, is best carried on through models. The models which a large number of youth have accepted seem to be part of the rock music scene.

The facts, as recited above, make depressing reading. What is being done? As indicated before, there is concern among government officials and agencies over the problem. The Aug. 3 "Weekly Pharmacy Reports" indicated that Attorney General John Mitchell, Vice-President Spiro Ag

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new, and New York Mayor John Lindsay have all postulated a possible relationship between the "climate" of drug acceptance and the increase in drug abuse. Sen. Frank E. Moss (D.-Utah) and Rep. Paul G. Rogers (D.-Fla.) have both indicated interest in the problem. The Federal Trade Commission has asked its staff to submit a report on the effects of "mood advertising" of consumer products.

It will be useful to examine the elements of the media which are involved in the problem. Among the more important are the manufacturers of drugs, the advertising agencies, the radio and television industries, and the thousands of individuals in drug-associated professions, representatives of the public, government officials, and the public itself. What are they individually and collectively doing, and how effective can it be expected to be? There is, at this point, no intimation of censorship. The obvious alternative, public pressure for more responsibility, may not be an immediate response without leadership of the kind that John F. Banzhap III exerted in the case of radio and TV cigaret advertising. The anti-cigaret campaign, however, had the advantage of having indisputable evidence of smoking effects on two generations of heavy smokers. However great its impact has been upon youth as a preventive measure, it still has "turned off" only about 20 percent of cigaret smokers. The effects of 20 years of TV and radio advertising persist, it would seem.

It is interesting to examine the ambivalence of the media when its educational impact is discussed. On the one hand, the "Power of the Press-and of Television" is extolled as in the Saturday Review of June 14, 1969. The anti-cigaret advertising campaign is lauded as an example of its influence as "a magnificent force for public information and public good." The Radio and Television Codes of the National Association of Broadcasters contain broad statements regarding the great value and correspondingly great obligations of the broadcast industries as educational media.

On the other hand,, however, advocates of a laissez faire approach to the drug abuse problem insist that there is little evidence which establishes a cause-andeffect relationship between drug advertising and drug abuse. They argue that the numerous critics of drug advertising are seeking a scapegoat. They are on less solid ground, when the content of radio and newspapers regarding drug-using performers is considered.

Claims made by media themselves for anti-smoking messages, delivered via radio and television, seem to provide clear evidence that the media are in fact effective educational channels to the public.

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There is, however, an even more appropriate method of evaluating the impact of drug advertising messages on the public.

Drug advertising effectiveness is certainly evaluated for its public impact, and reports are provided to clients through the advertising agencies who handle the accounts. Obviously, if a product's sales rise 500 percent shortly after the beginning of a national advertising campaign, it can be concluded that the advertising is effective at least to the extent of getting people to buy the product. If the reasons provided in the advertising are aimed at "mood alteration" such as the relief of fears and anxiety, acceptance, confidence in one's self, or a change in one's family or social life, then we can legitimately ask, "What is the public buying?" There is an old saying in the sales trade, "Sell the sizzle, not the steak." Is the public buying the promises or the product? If the product does not deliver to the extent of the advertising, is the latter deceptive?

The Bureau of Narcotics and Dangerous Drugs does not control either drug advertising or over-the-counter medication, nor does it control the majority of drugs prescribed by physicians. Yet, in its drug abuse prevention activities, it has deep concern about the easy acceptance of drugs and the apparent disregard for the consequences of drug abuse among many in our society. There is a basic logic for this concern.

When the adult public easily accepts the idea that the ingestion of chemicals is a solution for serious problems of living and adjustment, their example is translated into action by their children. The climate of drug acceptance and urgings to self-medicate have been promoted by the media and medical advertisers until the public has come to expect a chemical treatment from its physicians. The billions of amphetamines, barbiturates and tranquilizers manufactured yearly attest to that. When fewer people abuse drugs, the illicit kind like heroin and marihuana, or the legally produced amphetamines and barbiturates, enforcement of the laws will be more effective and less costly.

In our free society, sometimes the public must act to protect itself. Getting our priorities in order requires leadership and responsibility. The gradual erosion of freedom in some areas in our society stems not so much from a desire by a few to dominate as it does from the actions of a few who disregard the public interest for profit. The preservation of freedom to advertise responsibly, and to manufacture products which meet the legitimate needs of the public interest depends upon evidence by media of responsible action, before the public, for its own protection, insists upon legislative

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and governmental redress of grievances.

There are some things that are obviously needed in drug advertising which will make it more informative and more responsible, even if less subtly appealing to the anxious, the insecure, and the uninformed. The public should know exactly what is in a product, and what the active ingredient actually does to affect the body. Responsible advertising should tell what the chemical substances contained in a medication do: that is, how they affect the average person. Implications that taking a pill will alone solve deep-seated personal or social problems are neither logical nor responsible. Stricter application of the NAB Codes on advertising would also remove some of the more flagrant examples of this practice without further action. Evaluation of rock songs and other broadcast material on a voluntary basis would be in the public interest.

Research is needed to determine just what kinds of mass media education are turning people to drugs, and what can be done to counteract it. Some things we know already. If in their earliest years young children are taught a healthy skepticism toward the messages of commercial advertising, they will be better prepared to evaluate them. The manipulation of people's needs and wants is the basis of the advertising industry. Yet unless the media insist upon a basic integrity, they must assume a share of the guilt for the increase in drug misuse. When in doubt, the public interest should be the deciding factor.

Mass media must in some way present a balanced picture of drug use and the whole drug picture. Just as cigaret advertising was, for adequate cause, banned, and a counter-campaign against cigaret use initiated, so the drug abuse problem must have its counter-campaign.

The Bureau of Narcotics and Dangerous Drugs, the Department of Defense and the National Institute of Mental Health are jointly financing an Advertising Council campaign for this purpose. The media can anticipate possible overrestrictive legislation and public pressure by accepting its educational role. It can present all sides responsibly, as it is beginning to do, in the area of drugs. Drug use and abuse is a controversial subject. Its elements include not only advertising. but responsible prescribing, sale and marketing. The "other side" of the issue is not merely non-use of drugs, but responsible use. Obviously, many informed people are deeply in doubt about the proper role of the mass media and its effects upon drug use. They, and the public, expect and are entitled to adequate information and positive action on this aspect of the drug problem.

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It is not surprising that in recent months, as public interest has heightened with respect to the drug abuse problem, that more attention has been directed toward manufacturers. There is much historical precedent for this.

As concern over the nation's highway fatalities mounted in the mid 1960s, the public, championed by a then relatively unknown Ralph Nader, turned to Detroit for deliverance. With passage of the Vehicle Safety Act of 1966 the manufacturers of automobiles were told by Congress that they had special production-related responsibilities in alleviating highway crash losses.

As other issues in our 20th century American society have been given new definition by consumer advocates, environmentalists, and the mass communications media, the public has turned toward those who produce any products involved in the expectation of special insight and special effort.

The oil companies naturally became the target as apprehensions mounted over air pollution and oil spillages. The makers of television sets, pesticides and fertilizers, children's toys, and beverages are expected to assume major roles in preventing environmental contamination and clutter. And this is as it should be.

In this respect, responsible manufacturers of medicines recognize that since some of their products are subject to abuse and misuse, they have special responsibilities to help insure that this does not occur. At the same time, they accept -and encourage-reasonable laws and regulations also aimed at alleviating this distressing condition.

There are many "specifics" in this responsibility. But before looking at them it is only realistic to point out that we must not kid ourselves about the existence of silver bullet solutions to the drug abuse problem-or any other contemporary social problem. They are problems of evolution, multi-causative, spawned by the very society we have created, and not subject to simple remedies, despite the exhortations of politicians, the well-mean

December 21, 1970

ing activities of individuals and organizations, and even the actions of government.

With the achievement of material affluence for at least the majority of Americans, the gap between the rapid changes wrought by science and technology and some of our laggard institutions, the declining influence of our Judeo-Christian values and their replacement among many young people by a cynical Hedonism, is it any wonder that the use of mind-altering chemical substances has burgeoned?

In an era of crashing music, theatrical nudity, and the "liberation" of minority groups, the use of drugs and chemical substances for some appears to be as natural as was a rigid observance of the Sabbath by our Pilgrim fathers. Many of today's youths believe that drugs somehow represent the epitome of life-maximum physical-psychological pleasure, the ability to go "up" or "down" depending upon the desires of the moment, the way to heighten awareness or withdraw from unpleasantness. Such a belief must be regarded as one of the great tragedies of our time. The artificial replacing the real ... harmony giving way to discord... genuine problems that could constructively be engaging the zeal and idealism of youth melting into a kind of irrational, psychedelic blur.

Hopefully, this philosophic excursion puts the drug problem in perspective from the standpoint of society as well as the manufacturers of medicines.

In addition to examining the culture in which drugs are used, it is appropriate to look at the evolution of the problem itself. Originally, drug abuse was a ghetto problem. Heroin was the main substance, other than alcohol, and its use grew out of the abject depression and misery of the slums. During the '60s the conditions for drug abuse, although stemming from other causes, frequently developed in the suburbs. Today, heroin is making the jump from the inner city to our outer communities. Even more importantly, marijuana and LSD have become the commodities of a new cult, along with a

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whole assortment of other plant and chemical substances.

At this level, the problem does not directly involve pharmaceutical manufacturers. All of these substances have been, and remain, illegal. It is against the law to manufacture, process, transport, sell, use or possess marijuana, LSD or heroin in the United States, except for small quantities made available for research purposes under strict control of the U.S. Department of Justice. Still, demand for the three substances has grown at a tremendous rate because of the demand of the illicit marketplace.

More recently, however, attention has been focused on the abuse of what have long been legitimate and important medicines, particularly the amphetamines and barbiturates. It is true that some of the products have been abused and misused by some persons for a long time. This has taken many forms, from their use to escape every day unpleasantness, to overzealous efforts to lose weight, stay awake, or go to sleep. But, in the last few years, we have become aware of a serious, widespread use of certain of these medicines-popularly known as "uppers" and "downers"-within the youth culture, along with heroin, cocaine, mescaline, LSD, marijuana and others.

It is necessary to dispel the belief that the manufacturers of legitimate drug products that are subject to abuse "don't care." It is unfair and contrary to a rational look at the problem to accept this kind of cruel generalization. Responsible manufacturers do care. There are many examples of companies that have discontinued production of certain items or altered their manufacturing/distribution practices on a voluntary basis to help deal with this American tragedy.

The president of one of the largest pharmaceutical companies, Burton E. Beck, of Eli Lilly & Co., said in an October speech: "We feel strongly that we should do all in our power to prohibit the illegitimate use of our products-and this is precisely what we are attempting to do, through support of educational programs, full cooperation with law en

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forcement agencies, participation in legislative hearings, and advocacy of effective national and international programs for drug abuse control."

It is estimated that there are more than 1,200 pharmaceutical manufacturing firms in the United States. About 124 of them, who account for 95 percent of the nation's prescription drugs, are members of the Pharmaceutical Manufacturers Association..

The conscientious, forward-looking manufacturer, wherever he may be, takes all the precautions within his power to see that his products are not diverted from legitimate channels and legitimate usage. Typical PMA member plants have elaborate security systems, often headed by former members of the Federal Bureau of Investigation or other law enforcement agencies. There are strict procedures for handling narcotic-containing products or any product subject to control under the Drug Abuse Control Act of 1965 or earlier legislation. Substances with abuse potential are handled in highsecurity areas, with access limited to authorized personnel. Tamper-proof seals are used on containers, television surveillance is maintained of plant areas, chemicals and finished products are weighed both before and after various steps in the production process. Shipping orders are checked against a list of authorized recipients maintained by the Bureau of Narcotics and Dangerous Drugs. Orders are often sent in unmarked containers to reduce the possibility of theft or tampering in transit.

It is common practice for a responsible manufacturer to check the credentials of anyone placing a new order and to investigate suspicious orders or orders for an excessive amount of bulk chemicals or final dosage forms. Orders may be refused and government narcotics agents are notified where there is any reason to suspect any law violation.

Still, despite such precautions and voluminous Federal and state laws and regulations. it is inevitable that some products will find their way into illegal channels. The reason is the immense distribution system for prescription medicines. Thousands of persons are involved after drug products leave a manufacturing plant-shippers, wholesalers, warehousers, pharmacists, doctors, hospital personnel, detailmen, and the patient himself. There are countless opportunities for theft, counterfeiting. forgery, diversion, loss, and misuse even by authorized individuals.

In addition to observing strict security procedures, it has long been the practice of pharmaceutical companies to be doubly careful in their hiring practices and to minimize the opportunities for pilfer

age and diversion on the job. Employes in some work areas, for example, cannot have pockets in their garments. Packages or containers cannot be carried from a plant. Still there have been instances of diversion, some of it on a fairly large scale, by individuals who have managed to outwit the system. Likewise, there have been cases of illegal, in-plant use of certain products.

Against the backdrop of products flowing from many sources into a large legal distribution system, the term "over-production" that has appeared in the media is a vague one. Various figures, none of which can be verified, have been publicized as the nation has attempted to deal with the misuse of amphetamines and barbiturates. The Comprehensive Drug Abuse Prevention and Control Act passed by Congress and signed into law by President Nixon in October of this year imposes new controls and restrictions on the manufacture and distribution of various products. Products are categorized according to abuse potential, with the Bureau of Narcotics and Dangerous Drugs empowered to move them from one category to another as circumstances may dictate. The new law imposes actual production controls on injectable liquid methamphetamine, commonly known as "speed."

The PMA testified three times before committees of Congress in support of the new act, despite the fact that some of its provisions impose new restrictions upon what some may regard as reasonable prerogatives of private enterprise.

As a followup to the Congressional action, and as an expression of its intention to maximize industry efforts in the drug abuse area, the PMA will hold a series of regional workshops early next year to inform its members of the provisions of the new law and exchange company exnerience on secure ways to handle and distribute all abuse potential products.

Finally, there has been a concerted effort in some circles to establish a relationship between the drug abuse problem and the advertising on television of certain products, particularly over-the-counter medications. Whether such advertising has aggravated the problem, or is merely a convenient scapegoat for a social proclivity, is largely an academic exercise. Since drug abuse must be viewed as a multi-causative phenomenon, it is hardly constructive to resort to such a clean and neat judgment about advertising. This should not in any way be construed as an apology or license for irresponsible, misleading advertising. Companies and advertisers must play a major role in combatting this problem, even without conclusive data as to what their actual impact has been on creating a "climate" for

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abuse.

Remember also that the major medicines of abuse are prescription products and, as such, not subject to public advertising. Under a combination of Federal and state laws and regulations, no company can advertise ethical products directly to the public, but must limit such advertising to ads in journals and publications serving the medical profession. This restriction does not apply to overthe-counter or proprietary medicines, whose advertising is monitored by the Federal Trade Commission. The Food and Drug Administration is responsible for the regulation of advertisements for ethical drugs.

What are some of the other specific activities of the PMA and its member companies to counteract drug abuse? In addition to the many production and distribution safeguards already mentioned, many companies have become innovators and leaders in community and area activities. Some have made films and other materials for schools and adult audiences. A number provide speakers on drug abuse through program coordinated by the PMA. Representatives of several companies have voluntarily appeared before state and Federal committees and panels seeking ameliorative action.

Through the PMA, the industry has contributed $50,000 to develop and promote a curriculum guide for teachers of grades kindergarten through 12th to help them teach about drugs. Twenty-five thousand copies have been printed, and the guide is in use in school districts throughout the country.

The relationship of drug abuse to the pharmaceutical industry is a complex one. Clearly, the requirement is for a reasoned, long-range program, responsive to current realities and future needs, and not one that gives way to emotion, bias, or superficial solutions. The stakes are high not only from the standpoint of the operation of the private enterprise system within the industry, but from the welfare of society itself.

One certainly cannot overstate the dangers of overuse or misuse of legitimate medicines, as well as the harm and heartache resulting from the use of illicit substances. They represent clear and present dangers to America and must be dealt with.

On the other hand, our efforts to combat these evils must not create a negative attitude toward legitimate, medical use of medications or toward the professions and the segments of private enterprise most capable of helping perfect our health care system. Nor do government programs absolve us individually from the responsibilities we must shoulder as parents, neighbors, taxpayers and citizens.

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