The first "F" word is, of course, "Franchise."
Film critic Mark Kermode recently gave a very nice review to the upcoming film American Mary which, being a movie about the underground world of illegal surgery, has been on my radar for awhile now. He uses references like Takashi Miike and David Cronenberg, so this movie is not fucking around. He expresses some surprise that more critics haven't been all over the movie, but in his discussion of it, I think he pretty much answers his own question.
He basically observes that advertising this movie for horror fans includes putting together a trailer with some sleaze to it, as if horror fans need to be lured in with a guarantee of lurid content before they'll go see something. So that sucks, but what what bothers me even more is that I'm not sure which alternative is worse: That he's wrong, but the perception of someone who enjoys horror film as someone who can and should be pandered to with lurid, sensationalistic bullshit is so firmly entrenched in popular culture that it's a throwaway point, something so part of the conventional wisdom that it doesn't even merit critical examination; or that he's right, and horror movies are mostly (if not entirely) viewed by people chiefly attracted to lurid, sensationalistic bullshit.
Either way, why should the mainstream pay attention to this movie? Why should it pay attention to any scary movie? More to the point, why should horror films be given serious critical attention if they're just spectacles for bloodthirsty cretins who need sleaze and gore before they'll pay attention to something?
It's tough to navigate the demands of art and commerce, and that's true for pretty much any mode of expression. It's even tougher to navigate the demands of art, commerce, and a specific audience who by their nature straddle the line between the two. Expectations for genre film are routinely low to start with, and visible, vocal fandom often drives them even lower. So yeah, I see fandom as a problem, and this sort of discussion is a symptom of that problem.