eLetters to:

FROM THE AMERICAN ACADEMY OF PEDIATRICS: Committee on Communications Children, Adolescents, and Advertising Pediatrics 2006; 118: 2563-2569 [Abstract] [Full text] [PDF]

eLetters published:

Reining ads is utopian idea; parental control is supreme

Rajan TD   (2 December 2006)

excessive regulation

beth curtis   (7 December 2006)

Response to (1) Being overly idealistic and (2) Too much regulation

Vic Strasburger   (11 December 2006)

serious errors, uncorroborated statistics

michael j rosen, m.d.   (11 December 2006)

The Statement Stands!

Victor Strasburger   (12 December 2006)

Implications of Erectile Dysfunction Commercials During TV Sports on Male Youth Sexual Activity

Rodney B. Dieser Ph.D.   (12 July 2007)

Reining ads is utopian idea; parental control is supreme 2 December 2006
Rajan TD, Specialist, Skin & Sex Transm Diseases, Andheri, Mumbai, India Consultant, CMPH Med College., Tel: 0091-22-66982747 Send letter to journal: Re: Reining ads is utopian idea; parental control is supreme rajan.td{at}gmail.com Rajan TD	Advertising is a modern invention of today's materialistic society. If people do not publicise products available in the market, the manufacturers do not earn enough. If the manufacturer does not prosper, he cannot send provide decent education and a respectable lifestyle to his children. The latter obviously means access to newspapers, television and computers. So can anyone keep advertisements away from children? It is too idealistic to expect that Paediatric Society recommendations, government regulations and protest letters to magazine editors would minimise the impact of advertising products targeting children. Although all these efforts are necessary, the basic necessity of parents to bring up their child with the right ideas cannot be discounted. Let the child see the advertisement but make him mature enough to reason out whether it is right for him or her to use the product. While lawmakers debate with the legal issues and paediatricians examine the medical angle, the parents need to have a watchful eye on the child as he leafs through magazines or browses the internet. Conflict of Interest: None declared
excessive regulation 7 December 2006
beth curtis, retired none Send letter to journal: Re: excessive regulation bcurtis555{at}hotmail.com beth curtis	The passion for regulation has remarkably altered our society in the last two decades. Not surprisingly, regulation is welcomed if it regulates others and promotes our point of view. Sometimes we promote regulation because it shows that we care deeply about making life better for society as a whole, or for those individuals we preceive as helpless. Of course, since we do not all walk in lock-step yet, groups and individuals all have their own priorities and opinions about what is essential, and what should be altered in the behavior of others. In order to accommodate all these varied values and ethics, elected officials have passed federal legislation to restrict and intervene in every aspect of American life. This has also required the hiring of cadres of federal regulators, enforcers, investigators, and law enforcement. I just feel that individuals and groups should be very prudent about what they request of their government. I feel that this is yet another imprudent demand by a well meaning group. Remember - there are many opinions out there about how everyone should live and conduct business. Beth Curtis Conflict of Interest: None declared
Response to (1) Being overly idealistic and (2) Too much regulation 11 December 2006
Vic Strasburger, Professor of Pediatrics Univ of New Mexico School of Medicine Send letter to journal: Re: Response to (1) Being overly idealistic and (2) Too much regulation vstrasburger{at}salud.unm.edu Vic Strasburger	As the lead author of the AAP's statement on Advertising, please allow me to make a few comments: (1) Yes, of course we are being idealistic. Isn't that our job? The relatively "small" AAP going up against Madison Avenue? Maybe we can accomplish something, maybe we won't; but that doesn't mean we shouldn't keep trying. (2) When $250 billion a year is spent on advertising in the U.S. -- more than twice the amount spent by the 2nd-place country (Japan) -- isn't it time to stop blaming parents for their kids' responding to such ads? (3) When children's health comes into conflict with capitalism, guess who wins? Regulation is absolutely necessary in a free society to protect the rights and public health of those who are unable to speak (or vote) for themselves. In addition, the First Amendment does not protect business or commercial speech to the same extent that it protects Free Speech. The Supreme Court has ruled that commercial speech can be regulated IF THERE IS A COMPELLING PUBLIC HEALTH INTEREST IN DOING SO. Doesn't that apply to junk food, alcohol advertising, and tobacco advertising? Conflict of Interest: None declared
serious errors, uncorroborated statistics 11 December 2006
michael j rosen, m.d., Medical Correspondent WPIX-TV, NY; Daily Health Updates Send letter to journal: Re: serious errors, uncorroborated statistics drmikerosen{at}aol.com michael j rosen, m.d.	December 10, 2007 To the editor, I have noted some serious errors in the citations, as well as uncorroborated statistics, in the policy statement “Children, Adolescents, and Advertising” published in the December issue of Pediatrics. The errors may affect the overall mission of the statement. Indeed, the thesis of the policy statement is that, “Advertising is a pervasive influence on children and adolescents.” The statement quantified that “pervasiveness” by stating, “Young people view more than 40,000 ads per year on television alone…” It goes on to state that, “The average young person views more than 3,000 ads per day on television, on the Internet, on billboards, and in magazines.” The statement further makes some quite significant and broad recommendations regarding the advertising industry, based upon these numbers. However, the facts, and indeed, the cited sources of the facts, are dubious. These dramatic statistics led me to investigate the citations. Citation number 2 (Goodman E. Ads pollute most everything in sight. Albuquerque Journal. June 27, 1999:C3) and Citation number 5 (Span P. Marketers hang on affluent teen-agers' every wish. Albuquerque Journal. June 27, 1999:C3) did not appear in the Albuquerque Journal according to the assistant librarian of the Journal, a reporter, and an editor. When I called Dr. Strasburger, lead author of the policy statement, and brought this up to him, he replied, “This was an AP article.” He could not explain the erroneous citation, and the fact that no one at the Albuquerque Journal could find it. I asked him for citation number 5, and he could not provide it to me. The article in citation 2 was written by syndicated columnist Ellen Goodman, appeared August 12, 2001, in the Boston Globe. The correct title of the article is “NAMING RIGHTS - AND WRONGS”. It is about two parents who put the naming rights to their son out on two Internet auction sites. In the article, Ms. Goodman mentions, “The kid who couldn't become an ad will be confronted by them. The half-million-dollar baby will be assaulted by some 3,000 ads a day. He'll be the target of a $250 billion ad industry with 900,000 brands to sell.” I called Ms. Goodman, and asked for the source of the 3,000 number. Her assistant referred me to an internet research page which cites a variety of sources which provide a broad range of numbers of ads a child might see each day (the age range, types of ads are not denoted). (http://answers.google.com/answers/threadview?id=56750). Indeed, it cites numbers anywhere from 247 commercials a day to 3,000. As well, this statistic was meant for the average American who deals with the internet, reads the newspaper, magazines, listens to the radio, sees billboards etc., and receives emails with advertisements; it was not considering the average American child, of unspecified age. Dr. Strasburger confirmed to me he did not vet Ms. Goodman’s numbers. Regarding the 40,000 number, the source is citation number 13, Comstock G, Scharrer E. Television: What's On, Who's Watching, and What it Means. San Diego, CA: Academic Press; 1999. In that same year, 1999, Dr. Strasburger himself wrote an article, “Children, Adolescents, and the Media: Issues and Solutions” [http://pediatrics.aappublications.org/cgi/content/full/103/1/129#B28], where he states that the number of ads we watch are only 20,000 a year. That 20,000 number is obtained from the previous version of this policy statement, “American Academy of Pediatrics, Committee on Communications Children, adolescents and advertising. Pediatrics 1995; 95:295-297. Even if one considers a difference in viewing habits between 1995 and 1999, did children double the number of TV ads they see annually in that time period? And why did Dr. Strasburger choose to use a higher number for the arguments in the policy statement, from an outside source, rather than his own? Why did he not at very least state the reasonable range and include his very own number he published that very same year? These points are important, because again, they are the premise of the policy statement. Indeed, there are arguably laudible positions Dr. Strasburger, et. al., make in this most recent policy statement. The positions on tobacco, alcohol, and ads in schools would be difficult to counter. It would be incorrect to discard all the positions based on what is at least shoddy fact checking (he used Ms. Goodman’s article as a citation because he told me, “ I like her as a journalist”), and at worst, an intentional changing of data and sources. In a zealous effort to “push the envelope”, did Dr. Strasburger change titles of articles and exaggerate numbers? (It’s possible that Ms. Goodman’s article was re-titled elsewhere, in another source, but I have not been able to locate it; it could be argued he should have used the original title in the citation). Is it policy of the AAP to use statistics quoted by a newspaper columnist, unvetted, as a premise for a position statement? Are these indeed evidence that this position statement is not based on data, or a validation of all the problems with advertising as noted in the statement, but rather, a forwarding of the authors’ personal agendas? This is poor journalism at best, and certainly unworthy of such an important document by the AAP. As well, this statement, which the AAP promoted with a press conference, is designed to forward policies such as mandating the curtailing of ads to children. For example, it wants to end erectile dysfunction ads before 10pm, but would allow condom ads at any time. There is nowhere in the statement direct or even indirect evidence of the specific danger of these erectile dysfunction ads to children; it also gives a free pass to condom ads (one might consider the Trojan ad showing a teen boy in bed with two girls is inappropriate for young viewers). Was there a blanket statement made, both against erectile dysfunction drugs and for prophylactics, with no science, or indeed, common sense behind the arguments? Also, the statement argues in sum that all pharmaceutical ads are to blame for illegal drug use? How is that connection made? What ads are problematic? Fedex ads? Ads for toys with a strong learning or dexterity component? Healthy snack ads? The statement does not delineate. It merely says that “too much” is bad. And “too much” is not defined. Given the false citations, the incorrect and exaggerated numbers, and the un-based arguments, I would submit that this policy statement should be reconsidered, and at least re-written. Sadly, many good arguments (ie for tobacco ad control) are lost in what was not only an overreach, but also a statement that is at best unscientific, and at worse, factually incorrect. The AAP’s gripe is with an irresponsible use of media. The AAP itself used the media, in a press conference, to forward this very statement. Indeed, the story got many media “hits”. I would submit, perhaps the AAP is guilty of the same irresponsible use of media. Maybe the authors should go back to the drawing board, use sound science as the premise for a revised statement, focus on the true areas of advertising that are valid issues, and not forward what some might consider a McCarthy-era like vendetta against an entire advertising industry. Conflict of Interest: None declared
The Statement Stands! 12 December 2006
Victor Strasburger, Professor of Pediatrics Univ of New Mexico School of Medicine Send letter to journal: Re: The Statement Stands! vstrasburger{at}salud.unm.edu Victor Strasburger	I'm not quite sure I understand why Dr. Rosen is on such a reference warpath here. I can assure him -- and your readers, and the AAP -- that the references are all quite legitimate. I live in Albuquerque, and reference my local paper frequently. A week after publication, it is virtually impossible to find any given article online. The ABQ Journal does not have a very user-friendly SEARCH engine. The articles are legitimate, Dr. Rosen. Please keep your insinuations to yourself. Ellen Goodman is a legitimate source, a Pulitzer-prize winner author, and I referenced her appropriately in the article. Yes, perhaps 3,000 ads a day is only her estimate. So what? What if it's only 2,000 ads a day? Would that make a difference? As for my "changing titles" of articles and "exaggerating numbers," I should probably think about suing you for libel. Citing references from the popular press and media is not quite like citing references from the scientific literature; yet when writing about the media, such references are absolutely appropriate and necessary. As for the many objections to the policy statement's conclusions: (1) A number of studies have found that pharmaceutical ads have resulted in a dramatically increased number of requests by patients for exactly those drugs advertised. (2) The statement about erectile dysfunction drugs is based on common sense, not any scientific study. Even if we could find a bunch of parents of 5 year-olds who would let us beam a dozen ED ads at their kids and ask what they thought, no IRB would approve such research. We are simply pointing out the hypocrisy of airing ads that make sex seem recreational while not airing ads for birth control products. There are now 6 or 7 peer-reviewed studies showing that making birth control available to teens (and think of the media as one way of doing that) does NOT increase their sexual activity but DOES increase their use of birth control. All of the above references are in the scientific literature, Dr. Rosen. Please don't call me and ask me for them, or write another comment that I made them up. Find them yourself! Conflict of Interest: None declared
Implications of Erectile Dysfunction Commercials During TV Sports on Male Youth Sexual Activity 12 July 2007
Rodney B. Dieser Ph.D., Associate Professor School of Health, Physical Education, and Leisure Services University of Northern Iowa Send letter to journal: Re: Implications of Erectile Dysfunction Commercials During TV Sports on Male Youth Sexual Activity Rodney.Dieser{at}uni.edu Rodney B. Dieser Ph.D.	A recent policy statement by the American Academy of Pediatrics Committee on Communication in the December 2006 issue of Pediatrics has rightfully underscored the pervasive negative influence that advertising has on children and adolescents, such as the early onset of sexual activity and intercourse.(1) The harmful effects of media advertising and media consumption on children and adolescents have been known for some time, (2 3 4 5 6) including reports, position papers, and policy statements written by the American Medical Association,(7) the American Psychological Association,(8) the Center for Disease Control,(9) and from the Surgeon General. (10) The purpose of this commentary is to raise two questions relevant to the American Academy of Pediatrics Committee on Communication policy statement pertaining to erectile dysfunction (ED) commercials being viewed by youth. First, the implications of ED commercials during televised sporting events on male youth sexual behavior. Second, to underscore the problematic aspects of the “family- hour” social policy suggested by the American Academy of Pediatrics Committee on Communication. Televised Sports and ED Advertising: Implications on Male Youth Sexual Activity ED television commercials are peppered throughout sport television programming. At a superficial level, it would appear that marketing ED medications during televised sport programs makes sense for the simply fact that so many men watch sports. In fact, David Pernock, senior vice President for GlaxoSmithKline (GSK), explicitly stated that ED commercials linked to National Football League (NFL) games is a strategy to help men talk openly to their doctors about erectile dysfunction without feeling awkward. (11) Further, pharmaceutical companies have purposely used sport to send their message of male sexual power and erectile performance. For example, GSK and Bayer Pharmaceuticals Corp. signed a sponsorship deal with the NFL, which gives them exclusive rights to market the ED drug Levitra to an estimated 120 million viewers (in which they paid an estimated $6 million dollars to the NFL). (12) In particular, these ads use head-to-head competition (like sport) to underscore that Levitra is better than Viagra because it helps users achieve erections faster (16 minutes versus 30 minutes for Viagra) and has longer staying power. (13) There is no denying that some men do not feel comfortable when they have ED problems and that drug intervention is important when there is a real medical need. However, I suspect there is a much deeper and even sinister side to such superficial thinking. As Schor has underscored, adult oriented products (e.g., Budweiser Beer) are purposively marketed to children and adolescents to develop envy so that when old enough these youth are commercialized/socialized toward buying adult products.(14) The troubling aspect for me is that millions of children and adolescence observe (implicitly and explicitly) sexual activity while watching ED commercials, which provide early expose to sexual content and the possibility of early onset of sexual activities and intercourse. (15 16) As Rounds and Ormsby have underscored, sexually transmitted infections (STIs) are a significant health problem facing adolescents in the United States.(17) These researcher, summarizing differing research studies, highlight that (1) forty-eight percent of the estimated 18.9 million new STI cases in 2000 were among young peopled aged 15-24, (2) seventy four percent of all reported Chlamydia infections in 2000 were among young people aged 15 to 24, (3) half of the HIV infections in the United States were among young people aged 15 to 24, and (4) that the United States still has one of the highest rates of teen pregnancies among developed countries. To understand the hidden messages of sexual activity in ED commercials I pay special attention to the advertisements that are aired on television during the regular sporting events and programs that I typically watch (with my three sons!). In one Viagra commercial a voice states “Remember the one who couldn’t resist a little mischief” while the man is gazing at black bras, panties, and negligee in a store window. Another Viagra advertisement uses phallic imagery, which has NASCAR driver Mark Martin racing and revving his race car – pistons pounding up and down – symbolic of sexual power. Enzyte commercials also use symbolic phallic imagery to mock men who have erectile dysfunctions (e.g., a man holding a limp garden hose with a trickle of water coming out – implying that he doesn’t use Enzyte) and to illustrate how Enzyte helps men develop larger and more powerful penises (e.g., long golf clubs, limos, and very tall glasses of ice tea). While watching ED commercials I find it interesting how of the many side effects of ED drugs, it is the side effect of a four hour long erection that is most emphasized (e.g., the first, last, or only side effect mentioned). I believe that this is a reversal technique in which a side effect is communicated in a false way to underscore a potential benefits – the ability to maintain an erection for an incredible long duration of time. For example, Healy underscored how early marketing of Prozac that highlighted that it had weight-reducing side effects helped Prozac become a popular anti-depressant– especially among women.(18) A Problematic Aspect of the “Family-Hour” Social Policy The overall recommendations presented by the American Academy of Pediatrics Committee on Communication are useful and pragmatic (e.g., ask Congress and the Federal Communications Commission to limit advertising toward children, implement media literacy programs). However, the Committee on Communication’s recommendation to not air ED commercials until after 10:00 p.m. is somewhat problematic. Potter underscored that television “family-hour” public policies (e.g., adult hours after 10:00 p.m.) are unsuccessful because even as late as 11:00 p.m. children and adolescents are watching television in large numbers. (19) Potter highlighted that immediately after “family hours” the number of youth who continue to watch television drops by only twelve percent – leaving approximately 10.8 million youth watching television. Further, by 11:00 p.m. nearly 3.2 million children and 3 million adolescents are still watching television. As such, not airing ED commercials until after 10:00 p.m. might have a small effect on children and adolescents (ten to twelve percent). However, a better approach would be to eliminate advertisements and television programming that has implicit and explicit sexual messages. To this end, I think a better policy would be for the American Academy of Pediatrics (and other allied health, youth, and human service profession) to petition or partner with the Federal Communications Commission to regulate the sexual content of ED commercials (and similar drug advertising which has a sexual activity dimensions). For example, ED advertisements could be developed for television in a manner that provides medical and health information without any mention of sexual activity (e.g., black bras, phallic imagery) or the side effect of a four hour erection (this can be communicated by medical doctors in practice). Unlike other countries which regulate child and youth advertising, American social policy regarding children/adolescent and advertisement has a shameful history of government who consistently protects industry over the well-being of youth by letting industry create self-regulating policies (e.g. television rating system). As such, a partnership between the American Academy of Pediatrics with the Federal Communications Commission to regulate advertising to children and adolescents, including the sexual content of ED commercials, would be a positive step forward in helping children and adolescents in the United States. References 1. American Academy of Pediatrics Committee on Communication. Children, adolescents, and advertising. Pediatrics, 2006; 118 :2563-2569 2. Kirsch SJ. Children, Adolescents, and Media Violence: A Critical Look at the Research. Thousand Oaks, CA: Sage; 2006 3. Schor JB. Born to Buy: The Commercialized Child and the New Consumer Culture. New York: Scribner; 2004 4. Paik H, Comstock G. The effects of television violence on anti- social behavior: A meta-analysis. Communication Research, 1994; 21 :516- 546 5. Anderson CA, Bushman BJ. Effects of violent video games on aggressive behavior, aggressive cognition, aggressive affect, physiological arousal, and pro-social behavior: A meta analytic review of the scientific literature. Psych Sci., 2001; 12 :353-359 6. Grossman D. On Killing: The Psychological Costs of Learning How to Kill in War and in Society. New York, NY: Little Brown and Company; 1996. 7. American Medical Association. Physician’s Guide to Media Violence. Chicago, IL: American Medical Association; 1996 8. American Psychological Association. Violence and Youth: Psychology’s Response. Washington, DC: American Psychological Association; 1993 9. Centers for Disease Control. Position Paper for the Third National Injury Conference: Setting the National Agenda for Injury Control in the 1990’s. Washington, DC: Department of Health and Human Services; 1991 10. Surgeon General’s Scientific Advisory Committee on Television and Social Behavior. Television and Growing Up: TheIimpact of Televised Violence [Report to the Surgeon General, U.S. Public Health Service]. Washington, DC: U.S. Government Printing Office; 1972 11. Gannon J. Bayer GlaxcoSmithKline banking on NFL ads to boost sales of Viagra competitor. Post Gazette. July 31, 2003. Available at: www.post-gazette.com/pg/03212/207374.stm. Accessed December 5, 2006 12. Gannon J. Bayer, GlaxcoSmithKline banking on NFL ads to boost sales of Viagra competitor. Post Gazette. July 31, 2003. Available at: www.post-gazette.com/pg/03212/207374.stm Accessed December 5, 2006 13. Gannon J. Bayer GlaxcoSmithKline banking on NFL ads to boost sales of Viagra competitor. Post Gazette. July 31, 2003. Available at: www.post-gazette.com/pg/03212/207374.stm. Accessed December 5, 2006 14. Schor JB. Born to Buy: The Commercialized Child and the New Consumer Culture. New York: Scribner; 2004 15. American Academy of Pediatrics Committee on Communication. Children, adolescents, and advertising. Pediatrics, 2006; 118 :2563-2569 16. Brown JD, L’Engle KL, Pardun CJ, Guo G, Kenneavy K, Jackson C. Sexy media matters: Exposure to sexual content in music, movies, television, and magazines predicts black and white adolescents’ sexual behavior. Pediatrics. 2006; 117 : 1018-1027 17. Rounds KA, Ormsby TC. Health policy for children and youth. In: Jenson JM, Fraser MW, eds. Social Policy for Children and Families: A Risk and Resilience Perspective. Thousand Oaks, CA: Sage; 2006 : 131-165 18. Healy D. Let Them Eat Prozac: The Unhealthy Relationship Between the Pharmaceutical Industry and Depression. New York: New York University Press; 2004 19. Potter WJ. The 11 Myths of Media Violence. Thousand Oaks, CA: Sage; 2003 Conflict of Interest: None declared