To the Editor:
I have read with interest the article entitled “Education Program Regarding Labor Epidurals Increases Utilization by Hispanic Medicaid Beneficiaries” by Togioka et al. in the October issue of Anesthesiology.1 The intervention group in the Hispanic arm saw its epidural rate increase from 60 to 80%, while the non-Hispanic arm had a nonsignificant rise from 82 to 86%.
Here, the population previously familiar with the benefit of labor epidurals has the same epidural utilization rate as the postintervention group. What the authors have actually demonstrated is that marketing works.
But we already knew this: Almost no American women shaved their legs prior to 1915, when Gillette created the Milady Décolleté razor and launched it with an advertising campaign. By 1964, 98% of young women were shaving their legs.2,3
Any subpopulation not yet marketed to will be expected to respond to an educational campaign—and in this regard, labor epidurals are behaving similarly to other goods. The Hispanic subset of the population was not captured by previous marketing, so the investigators focused on reaching them with a targeted marketing campaign. We can make similar statements about educational programs regarding hydration with carbonated cola-flavored sugar water or cancer prevention with vaccination for human papilloma virus. Further, we can look at the lessons provided by direct-to-consumer advertising of prescription medications: Marketing works, but utilization does not always equal a health benefit, as the many papers on “natural childbirth” in the nonanesthesia literature might argue.
The author declares no competing interests.