Not-so-hidden persuaders

by niamh on March 28, 2012

I’m currently spending a great semester in the US (at the University of North Carolina at Chapel Hill, a terrific institution with a long and distinguished history – see this! – and excellent academic standing: the very model of the modern public research university; so please don’t cut any more university education spending, NC legislature).

And this has given me an opportunity, among many others that is, to see some US TV close-up…

One thing that is striking, compared with European TV, is what is advertised and how. In particular,  I don’t think you see ads for prescription medicines in Europe, certainly not in Ireland or the UK. They seem to be all over American TV.

I am particularly struck by the way these ads are made. The visuals  typically show someone having a happy and trouble-free life while using these drugs, overlaid with soothing music and a reassuringly bland voice-over. But clearly the US FDA requires advertisers to include all the small print in their ads as well.

Do you read all the known downsides of the medicines you take? Don’t. The list of potential side-effects is usually pretty hair-raising, and hopefully most people won’t encounter them most of the time. So the voice-over has to balance the putative benefits of taking these drugs with all these possible side-effects. But if you actually listened right through to the end, I imagine the last thing you’d want to do is to expose yourself to even a small risk of any of them. Especially when there is another stream of ads by lawyers offering to take up your case and get you compensation for a whole range of damages caused by taking prescription medicines.

So my question is this. Clearly the advertisers think it’s worth running these ads despite the scarifying spoken bits. How does this work? Do they believe that consumers are more impressed by soft-focus pastel visuals and mood-music than by the words? Are consumers more affected by positive visual associations than by the audio information about risk?

We can’t assess the risk rationally ourselves, and I don’t think decision-theory is very helpful here, which is why we rely on regulators and professionals. Yet it seems the advertisers mean us to lobby our doctors to prescribe their brand-name drug. There must be lots of literature on the psychology of advertising that I don’t know about…

{ 74 comments }

1

Vance Maverick 03.28.12 at 11:30 pm

I’m perpetually astonished at how many medications my fellow Americans know by brand name, and mention in casual conversation (“haha, just take another Ativan” etc.). So the ads must work.

2

Shackleford Hurtmore 03.28.12 at 11:33 pm

I’ve emigrated from the UK to New Zealand, and they do two things that I don’t remember happening on TV:
– They wrap up several adverts into a mini-show in the commercial break called a “Family Health Diary”, with the same smiling presenters each time.
– They advertise brand name medicines and encourage you to ask your doctor/pharmacist for it by Brand Name. Like this one for Efexor-XR: http://www.familyhealthdiary.co.nz/videos/video.aspx?v=floomc56vtY@-5
I assume it works, as they have been doing it for 2 years now.

3

Andrew Smith 03.28.12 at 11:44 pm

Yes, all they are interested in is product awareness.

4

rageahol 03.28.12 at 11:48 pm

from a ROI perspective, it (advertising) sure beats the pants off of doing any hard work like investigating new drugs.

5

QB 03.29.12 at 12:07 am

Because if it can control my blasted hayfever, I can put up with some antenna swelling: http://www.gocomics.com/tomthedancingbug/2011/12/30.

6

Alex 03.29.12 at 12:08 am

Direct to consumer advertising is a relatively new (and rapidly growing) phenomenon in the US. The whole enterprise is troubling, but even worse, there’s been less and less oversight of them in recent years, starting with the Clinton/Bush administrations: http://www.nejm.org/doi/full/10.1056/NEJMsa070502#t=articleResults

7

Andrew F. 03.29.12 at 12:44 am

How much of the side-effect information do you retain after seeing an ad? By contrast, can you recall the imagery, mood, drug name, and condition for which it is prescribed?

8

Alex 03.29.12 at 12:53 am

The ideal TV advertising subject isn’t really watching it and probably has the sound turned down.

9

Kenny Easwaran 03.29.12 at 1:08 am

I suspect that in some of these cases, they are trying to raise “awareness” of the “condition” that the drug treats. (In some cases, like “restless leg” and “erectile dysfunction”, I suspect that some natural hypochondria creates far more people who suspect they have the condition than there are people who actually do.) And I assume they use the customer’s knowledge of the requirement to list side effects to make people assume that these side effects are very very infrequent.

10

malilo 03.29.12 at 1:11 am

@Vance has the right idea. It’s more about brand-recognition, than selling it at that particular time. I’m sure you could do a study by exposing people to such an ad repeatedly over a year, and then some months later asking them what they know about the drug – they might remember “asthma medication”, or even just recollect that they’ve heard of it, but I doubt any of them could rattle off the side-effects. Further, when they hear a drug brought up in a doctor’s visit, I would imagine something they’ve heard of (even if it’s mostly subconscious acknowledgement) is more likely to be taken than something they’ve not.

However, after my own horrible experience with side effects (night terrors, panic attacks, feeling like I was going to die 24/7), I now cringe at every prescription drug commercial. I just hear “take this drug that questionably addresses your symptoms, many of which could be relieved at their root cause by dietary/lifestyle changes or even talk therapy, so that we can continue to make money hand over fist while actually making you feel worse, ideally leading you to require more medication”. Ugh.

11

Barry 03.29.12 at 1:16 am

Andrew F. 03.29.12 at 12:44 am

” How much of the side-effect information do you retain after seeing an ad? By contrast, can you recall the imagery, mood, drug name, and condition for which it is prescribed?”

Seconding this, and adding that the bland voice is also pleasant and soothing. I’m sure that they work a lot on making sure that people both don’t remember the side effects, and have a good emotional impression (rather than having a Voice of Doom read the list).

12

merian 03.29.12 at 1:18 am

What Vance said. After living in the US for a year and a month, I’m still astonished of the degree of familiarity with these brands even among friends that are very low consumers of medical services. I’m also enraged that all this advertising is ultimately financed out of everyone’s health care contributions and hope Europe sticks to their strict limits on drug advertising. (I remember when OTC drugs started to be advertised on German TV…)

13

christian_h 03.29.12 at 1:26 am

Yeah I find it absurd that advertising prescription drugs is even legal. And I agree with what’s been said -I think there’s two purposes to the ads: one, to create a market by convincing people they have the condition the drug treats (witness the astonishing number of ads for anti-depressants [disclaimer: my guess would be depression is both under- and over-diagnosed]); and two, brand retention so when they need a medication they push for that particular one.

14

christian_h 03.29.12 at 1:27 am

Huh? Where did that strike through come from??

15

nostalgebraist 03.29.12 at 1:45 am

Yeah, I think they’re mainly going for name recognition. And given that so many ads like this already exist, creating another entry in the genre isn’t going to make your product look any worse than anyone else’s. People will hear the bland voice-over and the side-effect list and think, “ah, an anti-depressant (or whatever) commercial,” rather than “oh my, so many side effects!”, because they’re used to the format by now. The only result will be name recognition.

16

odm 03.29.12 at 1:45 am

Christian_h: two hyphens make a -strike-through

17

john b 03.29.12 at 2:01 am

Just in case anyone was wondering, prescription medicine advertising is illegal in the EU. Drug companies do still fund advertising campaigns, but these have to be condition-awareness (so the maker of a smoking cessation drug will fund a campaign saying “quitting smoking might be easier if you use a smoking cessation drug”, or the maker of an erectile dysfunction drug might fund one saying “don’t be embarrassed, go to the doctor and get prescribed an erectile dysfunction drug”).

As Christian suggests, the main reason for the campaigns in the US is to get patients to ask doctors for expensive drugs by name, to forestall the risk of doctors prescribing generics that are cheaper and just as effective. Meanwhile, the drug companies also punt vast amounts of money into advertising and marketing aimed at doctors, to ensure that even if the patient doesn’t have a drug preference the expensive one still gets prescribed.

(the sensible way of dealing with this situation – as well as banning DTC advertising – is to ensure that drugs come out of GPs’ primary care budgets, to incentivise them to prescribe cheaper ones, while also having a national body that assesses the cost-effectiveness of all medications and bans state reimbursement for ones which aren’t. This is the system which the current shower of eejits are dismantling in the UK).

18

tomslee 03.29.12 at 2:58 am

My understanding here in Canada is that you can advertise but not make claims. At least, the ads seem to work with a nudge and a wink, and brand awareness as the focus: hence the “C1al1s highlight of the night” is a feature of sports shows.

19

Sev 03.29.12 at 3:10 am

#9 “I suspect that some natural hypochondria creates far more people who suspect they have the condition than there are people who actually do.”

And of course the purpose of these ads is to help this along; therein lie the real profits.

20

Vance Maverick 03.29.12 at 4:05 am

I was recently prescribed a drug which had come out of patent within the last ten years or so. My doctor (by no means a servant of the pharmaceutical-industrial complex) suggested either the generic, or if I preferred it, the brand-name version. I guess this means that even in our enlightened (coastal, liberal, etc.) town, many patients must prefer the name with the advertising budget.

21

nick s 03.29.12 at 4:44 am

Direct to consumer advertising is a relatively new (and rapidly growing) phenomenon in the US.

The rapidity is noticeable; TV ads from just over a decade ago were much more constrained.

one, to create a market by convincing people they have the condition the drug treats

Or to convince people that a part of everyday life is a condition: Christopher Lane’s Shyness: How Normal Behavior Became a Sickness discusses this. Another corollary is that TV ads are a major part in the expansion of drugs to wider markets (where they may already have an off-label presence, in spite of the makers’ denials that they push off-label prescription): atypical antipsychotics are a good example, as they’ve been sold on TV as “

So, you ask your doctor about drug X, and the doctor (who hasn’t at all been softened up by the drug reps recruited from the football team or cheerleading squad) prescribes it off-label, and the fact that it’s being prescribed off-label becomes a way to lean on the FDA for approval, and once that happens they make an ad about it.

Print DTC advertising has been around for ages in the US.

22

ChrisTS 03.29.12 at 4:57 am

My partner and I love to point out the parade of horribles in each of these ads. You have mild indigestion? Our product resolves that in 88% of users! Rare or occasional “side effects” can include headaches, indigestion (!), nausea, stroke, death, infertility, or blindness.

Part of the context, here, is that there are TONS of these ads in magainzes. There, all the scary stuff islaid out in dreadful detail. Compared with that mode of adverstising, the dreamy TV ads with a rapidly and softly spoken mini-list are probably look fairly promising. (Note that they almost always sweetly suggest that you ‘Ask your doctor.’)

23

nick s 03.29.12 at 4:57 am

But to answer Niamh’s question:

Do they believe that consumers are more impressed by soft-focus pastel visuals and mood-music than by the words? Are consumers more affected by positive visual associations than by the audio information about risk?

Yes. This is America we’re talking about. And I’m sure they have the focus group and polling data to prove it.

A short-term resident, attentive to cultural difference, really can’t pick up on this, but the formula for reading the side-effects (now usually spoken by an actor who is either “fake doctor” or “fake patient”, as opposed to a voiceover) is honed to the point where they’re there to be ignored. One reason, perhaps, is because it cleverly occupies the same place in the slot as the bullshitty “science bit” in cosmetics commercials, where people are used to being told how the unique formula of natural polyminaminotides drastically reduces the signs of aging.

Alternatively, in the case of ED pills, it becomes a source of comedy.

24

Neil 03.29.12 at 9:35 am

Slightly off topic, but as I recently discovered when trying to get IRB approval for a drug study, the way in which possible side-effects are collated errs on the side of caution (quite properly, I suppose), so that a listed possible side-effect is *not* a side-effect that is known to occur, even very rarely, as a consequence of the drug. It is rather an effect that has been noted consequent on taking the drug. So if 100,000 subjects take drug A, and one of them drops dead, ‘sudden death’ will be listed as a possible side-effect of the drug even if the number of deaths in the drug cohort was no greater than the number in the control.

25

ajay 03.29.12 at 10:25 am

24 is great. “Known side effects of this drug include getting married, writing your first novel, taking a holiday in France, having arguments with your spouse, and buying a Toyota Corolla”.

26

Katherine 03.29.12 at 11:08 am

Are there not odds added to the side-effects?

Medication I am currently taking has three categories – Common (ie more than 1 in 10), Middling (1 in 100 I think) and Rare (1 in something much higher than that), or words to that effect.

I tend to assume, possibly incorrectly, that those listed as Common really are side effects, and the ones in the higher categories are probably coincidental occurrences and/or severe allergic reactions. Given how many of them completely contradict each other I can’t be far off.

If it were all bundled into one list I can’t imagine how you’d be able to recognise something that was happening as a side effect and something else that, say, could be an indicator of another problem altogether.

27

sanbikinoraion 03.29.12 at 11:15 am

28

Niall McAuley 03.29.12 at 11:16 am

People have lots of training in ignoring the waffly bits of ads, think of all the Irish financial services ads with “Anglo Irish is registered with the Nigerian central bank, and regulated by Watt’s self-designed “conical pendulum” regulator, the value of your investment may go down or vanish altogether forming a black hole which destroys the Irish banking sector and good riddance” in them.

In Ireland, while direct marketing is banned, there is an increase in “Trouble with your todger? Talk to your doctor, this campaign sponsored by PFIZER!” ads, which are obviously as close to direct marketing as they can go.

29

Christiaan 03.29.12 at 11:17 am

Very simple. People don’t parse TV spots, if you think so you’re very naive. TV ads work mostly subliminal. The high-density information at the end basically passes through the ears, but won’t get remembered. What people do remember from TV ads is visuals, feelings, and low-density information, something the brain easily absorbs and passes on to the long term memory, especially if repeated. Like just a brand name that gets, mostly unconsciously, associated to nice feelings and beautiful images. The only thing the ads want is you to remember the brand name, and in that they are effective.

30

Phil 03.29.12 at 11:40 am

“Anglo Irish is registered with the Nigerian central bank, and regulated by Watt’s self-designed “conical pendulum” regulator, the value of your investment may go down or vanish altogether forming a black hole which destroys the Irish banking sector and good riddance”

The really ironic thing is that we all thought they were joking.

31

J. Otto Pohl 03.29.12 at 11:49 am

Part of the advertising is to tell people that treatment is available. In the US a lot of people tend not to go to the doctor if they think there is no solution. This occurs in other countries as well. Here for instance there are a lot of advertisements telling people that Tuberculosis is curable and that they should seek treatment if they think they have it. A few decades ago there was very little public awareness of things like depression, ED, and other ailments that dominate pharm adverts on US television today. You are not going to buy a treatment for a condition if you think the condition can not be treated. Maybe advertising specific treatments connected with commercial firms should be banned, but as a general rule advertising or public announcements to increase health awareness is generally a good thing. People should be told to wash their hands, use condoms, and to seek treatment for contagious diseases.

As far as side effects are concerned most of the serious ones are generally very rare. Even very safe vaccines have the one person in a couple of a million who has a severe allergic reaction and sometimes dies as a result. If there are likely side effects your doctor should tell you about them.

The advertising is in part a function of the creation of a market to fill a need that is covered by the state in most countries. If you have free access to a doctor then you can go regularly and be monitored for conditions. But, if you you have no coverage and you don’t want to spend at least $50 to be told that your complaints are nothing serious and there is no treatment then you won’t go to the doctor. You have to be told in some other manner for instance by the tv that your symptoms are potentially serious and that they can be easily treated. For the vast majority of people in the US without health insurance the economic considerations militate against paying the money to see a doctor otherwise.

32

Daniel 03.29.12 at 12:08 pm

Part of the advertising is to tell people that treatment is available.

Also to tell doctors that people want this medicine and expect it to work. Prozac wasn’t actually pharmaceutically very much more effective than the previous generation of anti-depressants, but it did massively more good because the buggers actually prescribed it, in meaningful doses. The marketing campaign was part of the drug. I really with that someone would do an ad campaign to counteract the popular belief on the part of British doctors that topical steroids are super-dangerous and should barely be prescribed above homeopathic levels even for severe eczema. But it won’t happen because hydrocortisone is a long way out of patent.

33

Tim Wilkinson 03.29.12 at 12:30 pm

Yeah, the ad experts know a large number of people turn down the volume, which is why they increasingly display big lingering upper-case factoid-bites on screen. On video tapes they used to be designed for viewing on fast-forward seek mode (or whatever you call it).

The drug companies do the brand-recognition thing to NHS doctors, too. They are showered with pens, pads, mugs, calendars, executive toys etc. plastered with the names of drugs the reps want them to prescribe. Brand names are designed with lots of letters from the end of the alphabet, because the drug co.s think – presumably on the basis of research – that doctors – not even just patients – think they sound more scientific and are more likely to prescribe them.

(Also conference junkets, etc., of course. A conference organiser from Dubai recently suggested mentioning the competition less in a research paper. This is unusually forward, but a typical attitude (obviou$ly). A very firm refusal, involving ISTR sexual fuckwords, elicited profuse but of course manifestly insincere apologies, and that was the end of it. Better luck next time.)

34

ajay 03.29.12 at 12:36 pm

“Anglo Irish is registered with the Nigerian central bank, and regulated by Watt’s self-designed “conical pendulum” regulator, the value of your investment may go down or vanish altogether forming a black hole which destroys the Irish banking sector and good riddance”

A bank regulated by steam, you say?
http://sydneypadua.com/2dgoggles/series/economicmodel/

35

DaveL 03.29.12 at 1:05 pm

I think drug ads are required (by the FCC? the FDA?) to include those “may cause death, war, famine or pestilence” fast-talk small print segments. My guess is no one pays much attention to them because they figure the drug wouldn’t be on sale if it was that dangerous, and because a lot of the problems are very low probability, and because their physician will (they hope) tell them if there is anything really relevant to their own situation. Of course one or more of the preceding “becauses” may not apply in real life.

I read somewhere that almost every drug has “headaches” as a possible side effect because during clinical trials the subjects are usually required to give up coffee.

36

tomslee 03.29.12 at 1:33 pm

“My guess is no one pays much attention to them because they figure the drug wouldn’t be on sale if it was that dangerous”

This strikes me, from my purely personal reaction to the ads I’ve seen, as true.

37

Katya 03.29.12 at 1:44 pm

If a drug ad makes a claim about what the medication does, it must, per FDA regulations, include the side effects. (You used to see some ads that just mentioned the name of the drug without saying what it did, but you don’t see those so much anymore.) The actual printed material that comes with a prescription usually indicates which side effects are common or rare, and which mean that you should seek medical attention.

Also, most of the drugs advertised treat chronic conditions – high blood pressure, asthma, depression, erectile dysfunction, acid reflux – rather than acute ones. Hence the importance of building brand awareness.

I have mixed feelings about prescription drug ads in general, but I think it not unlikely that ads for drugs treating depression may have encouraged more people to seek treatment by making them aware that treatment actually existed. I’d rather see PSAs that didn’t mention specific brands, informing people that there are treatments for X condition and they should see their doctor, but I suppose that’s pretty unlikely.

38

SusanC 03.29.12 at 1:52 pm

@Daniel

(Disclaimer: I Am Not A Doctor, and you really shouldn’t take any comment from me as medical advice…) It was my undestanding that the risk with steroidal creams (see for example Betnovate Betnovate is thinning of the skin (permanent damage) from long term repeated use. This is down on the information leaflet as “very rare (less than 1 in 10,000)”[*] but I’ve know people who’ve had that side effect. If your doctor is warning you about it, it might be a good idea to take notice. (I get skin ecezma quite easily, but tend to use just a moisteurizer rather than steriodal cream for this reason).

[*] I wonder if that 1 in 10,000 is the risk for a one-off treatment, not the total risk for someone who uses it regularly, for many years, for a chronic condition.

39

niamh 03.29.12 at 2:30 pm

I love all these links – thanks! ‘Underwear goes inside the pants’ – terrific. The weight of the Bank of England, followed by steamulus to the economy – wonderful! All those old ads showing stressed women clearly in need of tranqs – mmm, not so wonderful…

I agree with those of you who want to distinguish between public health information and commercial touting of branded products. (And it’s true that the pharmaceutical industry is trying to sneak its way onto the airwaves in Ireland by ‘sponsoring’ ads that sounds information-y). Fast-talking financial sector ads – yes indeed, but I wonder if anyone ever actually associated Anglo with kites and kittens? I’m still interested in how the button-pushing works, or is supposed to work.

The comment about the corruption of medical research by their industry sponsors is horrifying but far from atypical I’m sure. Further to the comments about the drug companies’ direct lobbying of doctors, Marcia Angell wrote a couple of excellent pieces in the NYRB last year about the recent ‘epidemic’ of mental illness, driven by the interplay between the psychiatry professionals and the pharmaceutical industry.

I suspect we need to know a lot more about the consequences of the industrialization of food production, esp the the effects of uncontrolled consumption of synthetic sugars and hydrogenated fats. Is it going too far to think of these as non-prescription drugs? Lazyboy is right about the obesity ‘epidemic’, but the level of physical activity must only be part of the story.

40

sanbikinoraion 03.29.12 at 4:38 pm

Considering that there is recent research suggesting that sugary drinks incite arterial inflammation and hence cause heart disease, it seems to me that synthetic sugars should be treated as some level of toxin rather than as a “non-prescription drug”!

(My favourite part of Underwear Goes Inside The Pants is near the end: …this homeless guy asked me for money the other day, and I was about to give it to him then I thought “he’s just gonna use it on drugs or alcohol”, then I thought “that’s what I’m gonna use it on,”…)

41

just a guy 03.29.12 at 5:55 pm

Drug companies are aware that, for most people, positive visuals always overwhelm information given verbally. Several years ago, I saw an interview by Bill Moyers of Michael Deaver (Consuming Images, 1990 on PBS). Moyers was asking how Reagan could have had such a good relationship with older Americans while cutting social security. Deaver freely admitted that when the decision was made to make cuts, they would send Reagan out to an old folks home to get the day’s photo ops. That way, even though the reporter’s voice over would say Reagan was cutting SS and hurting old people, the visuals would show him yukking it up with a bunch of old folks in wheel chairs. The visuals stuck with voters after the words were forgotten.

42

niamh 03.29.12 at 6:57 pm

No. 40, Yes, I should probably have called these things toxic alright. The link occurred to me because processed calorie-dense foods are designed to hit the pleasure centres, and while you couldn’t call them addictive, there is something compulsive about them, and intentionally so. I can’t remember who called the huge increase in sugar intake in western diets, especially synthetic and not cane or beet or other natural sugars, and most of it hidden in other foodstuffs, ‘the biggest uncontrolled pharmaceutical experiment ever’.

43

bh 03.29.12 at 7:03 pm

Having done quite a bit of consulting with these people… first, anyone imagining these are some sort of high-end psy ops… please. It’s not that all involved wouldn’t like to control you like Frank Sinatra in the [i]The Manchurian Candidate[/i]. But they are manifestly not capable of it. The typical decision chain involves a brand manager, assorted bullshitters from the agency, plus some senior management with a lot of other things on their plates. Someone in that chain probably has a subscription to [i]Psychology Today[/i], but that’s about as far as it goes.

In the case of pharma, there are additional distorting factors. First, managers often come from the engineering / production side of things, and often aren’t familiar with even basic marketing strategy. So they are, essentially, easy marks for agencies. Agencies are often still compensated on a straight percentage of media spend. It’s an incentive to burn through as much of your clients’ money as possible, and nothing blows client money as easily as broadcast TV buys.

The second, related point: if you have a blockbuster drug patent, you essentially have a license to print money. You are likely to be very, very profitable in a way that isn’t really affected by direct-to-consumer marketing. So if models seem to show that the advertising isn’t worth the money — and they often do — there’s no harm for a manager to keep at it anyway for nebulous long-term brand-building reasons, because they’re going to make their numbers regardless.

These ads are sometimes enough to put the ‘right’ allergy drug in the mind of a consumer who’s soon to see a doctor. But just as often, they’re basically an indulgence by people who can well afford it.

I can’t see the social welfare in these ads, and I wouldn’t really care if they were banned here. But I sometimes think ad agencies and their more over-the-top critics are engaged in an unwitting conspiracy to exaggerate the impact of something that, very often, just isn’t a strong influence.

44

John Quiggin 03.29.12 at 8:44 pm

A minor observation is that in Australia, non-prescription medicines (which are advertised) commonly have brand names that allow a pretty good guess about the active ingredient (try your hand with Aspro, Sudafed, Nurofen, Panadol). The corresponding US medicines all seem to have meaningless brand names (eg Advil, Tylenol etc).

45

piglet 03.29.12 at 9:20 pm

Deleted: we really don’t need pointless snarky comments like this. JQ

46

Tedra Osell 03.30.12 at 12:10 am

All I can report is that every drug I have ever taken that had an Embarrassing Side Effect Having To Do With Private Parts, the side effect has not been reported in the literature or by the doc. Until *after* I complained about it, thinking it might be something else. Then they say “oh yeah, Effexor can cause incontinence” or “yes, Accutane totally dries out the lady parts” etc. You’d think docs might be able to warn you about this shit ahead of time.

47

tomslee 03.30.12 at 12:27 am

bh – fascinating. Thanks for the inside view.

48

niamh 03.30.12 at 12:41 am

As tomslee says. And there was I thinking there were droves of modernized Mad Men trawling through the research literature of the behavioural psychologists. So it really is all about money at this point too. I should’ve guessed.
And Tedra, this is before we even start to think about the interactions between meds prescribed for different things, and sometimes even by different medics. There might be a complicated formula to work out permutations and combinations of possible side-effects. Or maybe not.

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John Quiggin 03.30.12 at 12:44 am

@Tedra Same for me with the first statin I took.

Sort of on the same topic, Lipitor is about to go off-patent, and the Oz government is *very* keen that we should all switch to the generic, which I will certainly do. It’s standard (and I think a requirement) for the pharmacist to offer you the generic equivalent to the brand name prescribed by the doc.

There’s also a minor racket in the changeover period where, as I understand it, pharmacists can be reimbursed at the high rate for Lipitor, but issue the low-cost generic instead.

50

john c. halasz 03.30.12 at 1:09 am

Sorry, I couldn’t resist temptation:

https://mail.google.com/mail/?shva=1#inbox/1364c813f01ab26f

51

Substance McGravitas 03.30.12 at 1:20 am

A link to Gmail’s just gonna send people to their own in-box.

52

geo 03.30.12 at 1:45 am

bh @43: often aren’t familiar with even basic marketing strategy

What is basic marketing strategy? I’ve often wondered.

53

john c. halasz 03.30.12 at 1:58 am

54

Bill 03.30.12 at 2:42 am

AFAIK, at least until a couple of years ago, New Zealand and the US are the only two countries that allowed this sort of direct-to-consumer marketing.
And, re #2, it is interesting how every NZ ad reinforces, ‘Ask for it by name.’ This is also an issue for PHARMAC, which publicly funds medications. The ads encourage you to pay out of pocket for name-brand meds, when PHARMAC is funding only the generic version

55

John Quiggin 03.30.12 at 3:25 am

NZ introduced some very silly policies under the influence of what Brian Easton aptly called “Market Leninism”.

56

JanieM 03.30.12 at 4:05 am

What is basic marketing strategy? I’ve often wondered.

Me too. A young colleague of mine was talking to me a few months ago about her husband’s work in marketing, which involves building “brand loyalty” for his company via social media. I was bemused by the very concept of “brand loyalty” and spent the next week trying to think through what on earth it might mean. Wikipedia says, among other things:

True brand loyalty exists when customers have a high relative attitude toward the brand which is then exhibited through repurchase behavior.[3] This type of loyalty can be a great asset to the firm: customers are willing to pay higher prices, they may cost less to serve, and can bring new customers to the firm.[5][6] For example, if Joe has brand loyalty to Company A he will purchase Company A’s products even if Company B’s are cheaper and/or of a higher quality.

It seems to be a kind of loyalty that works in only one direction…. But then, I am possibly a smidgen cynical about marketing, and apparently either learning disabled about it or constitutionally impervious to it, so maybe I don’t understand these things.

*****

if you have a blockbuster drug patent, you essentially have a license to print money.

About 15-20 years ago I started to have regular arguments with my doctors (a succession of GP’s, since they keep moving on) about whether I was going to take Claritin, HRT, and statins. Claritin I have just ignored. HRT turned out to be not the general miracle it was made out to be, and I’m very glad I resisted taking it. (The medicalizing of natural biological processes — another topic.)

As for statins, my cholesterol is high, but I have no other risk factors, including no family history of heart disease even though a lot of us have high cholesterol. But no matter, the doctors just push, and push, and push the pills, every damned time I go in. Funny enough, today I got to do a great mental “I told you so,” having had an ultrasound on my neck (triggered by another problem), which showed that my arteries are doing just fine, thank you very much, even at the advanced age of 62.

Yes, there are lots of drugs, and lots of uses of drugs, that I’m happy we’ve got. But that they’re a “license to print money”? Nope, that’s out of whack, and I’m determined to enable it as little as I can get away with.

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John Quiggin 03.30.12 at 4:42 am

Having looked at the odds, I concluded that statins were worth it, even without any family history. Of course, the Australian government pays much less than US consumers, and Australian consumers don’t pay much at all, so finance wasn’t an issue. And soon it will be off-patent.

That said, having lost 15kg and kept it off for a couple of years, I plan to see if I can keep my ratios good without medication.

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js. 03.30.12 at 5:05 am

I was bemused by the very concept of “brand loyalty” and spent the next week trying to think through what on earth it might mean.

I’m actually curious if lots of people (i.e. a self-selecting group on CT) feel this way. Maybe it’s a US vs. not-US thing? Because the concept itself is utterly familiar to me. The only real brand loyalties I have are with coffee and cigarettes (and, no, I’m not joking).

In any case, my not very well informed sense is that brand loyalty (and brand proliferation, which I think is not unrelated), actually works better through, e.g., peer group emulation than advertising. (E.g., indie-rock types of a certain age buying chuck taylors; they did it then, and they still do it now, and I don’t think advertising had much to do with it.)

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JanieM 03.30.12 at 5:31 am

For JQ — Hopefully you understood that I didn’t mean to judge anyone’s else’s choices about drugs. My own choices tend to be fairly extreme for a mix of reasons, including that I have a lot of food (and substance?) sensitivities that lead me to fear side effects more than some people might. Plus, when the doc first tried to get me to take statins, $ was indeed a concern. It isn’t quite so much any more, with my $ situation having improved and cheaper drugs being more available. But still, I’d rather just keep working on diet, weight, and exercise improvements.

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JanieM 03.30.12 at 5:38 am

For js. — I was being a little bit tongue in cheek about not understanding what brand loyalty might mean.

The conversation with my colleague included

1) a third person (also half my age) who is more like me, and refuses, as he said, to pay $20 for a t-shirt for the privilege of giving A&Fitch free advertisement when he can pay $5 for a serviceable t-shirt that advertises no one; and

2) a whole segment where the young woman whose husband is in marketing explained to me how brands signal things, like that you’re cool. (Not that I was unfamiliar with this concept….just that I was playing devil’s advocate to some extent.)

But I still wonder what exactly you mean by brand loyalty, e.g. in relation to coffee and cigarettes. I buy, let’s say, certain brands of dark chocolate and not others, and the reasons involve a mix of factors: the taste of the chocolate, perhaps a fair trade label, price, etc. If all my criteria are reasonably well satisfied, I’ll buy any brand. If some brand that I buy often changes — less flavorful, higher price, no more fair trade, I find out it’s not slave-free [though in all honesty I don’t go out of my way to find this out ahead of time] — why would I continue to buy it? I do feel that in some sense the “loyalty” should be a two-way street, and that if a company that makes a certain brand starts taking me for granted by lessening the quality, raising the price, etc., why on earth should I be “loyal” to them if some other company is making what I want and the original company isn’t any longer?

If the brand of coffee you like changed — started charging more, tasting different, etc., — would you still buy it? If you wouldn’t, is that really brand loyalty, or rather loyalty to the product itself? (I’m not being sarcastic, I’m really curious.) If you would, why? You’d rather support a particular company than have coffee that tastes good? (Etc.)

Also, I’m not sure what your reference to US vs. not-US meant. I don’t think I’ve seen a comment of yours where you said where you’re from; I’m US-ian myself, and it’s hard to imagine that there’s another country on earth that could be more steeped in marketing, brand loyalty, and general corporate domination than the good old US of A.

(Also: this is really a vastly more complex subject. For instance, the role of price is complicated I never buy something from Amazon, for instance, just because of a lower price, if I can instead get it locally from an actual store and an actual human being…. Big topic.)

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JanieM 03.30.12 at 5:40 am

Need better proofreaders….or some sleep. Or both.

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js. 03.30.12 at 6:03 am

@Janie-M: Sorry, yes, I agree with everything you say (at 60). I think I was just expressing myself badly. Or rather, I’m not sure I had much of a point. My point about brand loyalty and coffee was really something like: here’s this brand of coffee I really, really, like (Lavazza), and that’s what I’m buying, and to hell with my political convictions that tell me I should buy fair-trade, etc. But that’s really something like “taste”-loyalty, as you point out.

And I entirely missed the tongue-in-cheek element of your comment and figured that you must be in a less marketing-steeped place (as you put it) than the US, which is also where I live.

Maybe I don’t understand brand loyalty after all…

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sanbikinoraion 03.30.12 at 7:38 am

Two thoughts here:
1. I suspect that many good brands in which a certain quality matters (whether it’s taste, price, special tickboxes like veggie, fairtrade) do stick very rigidly to what they perceive to be their brand’s USP. Traidcraft aren’t suddenly going to start selling good that rely on child labour, and so you can trust the brand sufficiently that you can pick up any of their products, not just the stuff you normally get. That’s powerful in the Western world in which there is simply too much choice when it comes to most items in the supermarket. I find myself not brand-loyal but organic-loyal simply to cut down the number of options to choose from.

To drag this back on-topic, Nurofen make a big deal in the UK about advertising that their product deals with pain fast. The brand loyalty with Nurofen is a two-way street: you’ll keep buying it so long as they keep on delivering swift pain relief.

With drugs, perhaps there’s even a placebo effect formed out of habit: “These painkillers did it for me last time, so they’ll do it for me again”. On top of that you’ve got the placebo effect (particularly for pain relief) that well-advertised, attractively packaged and expensive analgesics really are more effective than generics, because people think they are going to be more effective.

2. I strongly suspect that in a lot of markets, the ad execs don’t have to be honest or even particularly understand what they are doing very well, and the ad buyers likewise, because in a dynamic marketplace I would expect to see a high degree of natural selection based on success. You don’t necessarily have to study all the psychology and so on in order to get big clients to spend big bucks on big adverts, you just have to be lucky with what your recipe is; the poorer ad agencies and ad buyers go out of business, or at least get burned on the campaign and try something different. Evolution may look like intelligent design, but really it’s just random flailings. How else to explain the occasional horrific shocker, like this one? In meme-terms, it’s just a (horrible) random mutation that fails.

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ajay 03.30.12 at 9:14 am

43, 48:

Having done quite a bit of consulting with these people… first, anyone imagining these are some sort of high-end psy ops… please. It’s not that all involved wouldn’t like to control you like Frank Sinatra in the [i]The Manchurian Candidate[/i]. But they are manifestly not capable of it. The typical decision chain involves a brand manager, assorted bullshitters from the agency, plus some senior management with a lot of other things on their plates. Someone in that chain probably has a subscription to [i]Psychology Today[/i], but that’s about as far as it goes.

Well, this is just Duelling Anecdotes, but a good friend of mine is in advertising and a former psych researcher – as are a lot of his colleagues – and is continually talking about the degree to which really fairly sophisticated psychological research informs their planning and decision making.
But this is general advertising; I’m prepared to believe that pharma marketing is a lot less sophisticated.

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Katherine 03.30.12 at 9:28 am

This is getting off the topic of prescription drugs, but I think there are many people will under-the-radar brand loyalty that they probably don’t even notice day to day. I’ll buy Heinz tomato ketchup, for example, even though I’ve never sat down and done a blind taste comparison. The time it would take to do that is worth less to me than the cash money I might save doing so, assuming that there is no difference between the brand that has advertised itself to me as reasonable quality and a generic. I’d call that brand loyalty. Would others?

Interestingly, there is a budget supermarket at the moment using an effective advertising campaign to do exactly the opposite, by presenting well known brands next to their own, much cheaper, version, and saying, in a humorous way, that they are the same, so don’t waste your money. Different kind of brand loyalty they are going for I guess.

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Tim Wilkinson 03.30.12 at 9:45 am

bh @ anyone imagining these are some sort of high-end psy ops… please. It’s not that all involved wouldn’t like to control you like Frank Sinatra in the [i]The Manchurian Candidate[/i]. But they are manifestly not capable of it. The typical decision chain involves a brand manager, assorted bullshitters from the agency, (continues).

No, this whole line is absolutely misleading, and just like the analogous attitudes about political corruption etc., gets by largely on emperor’s new clothes condescension typi9cal of ‘debunking’ efforts. The whole “if only you knew, no-one has a clue what they’re doing” has such a faux-wordly kind of appeal (I’m reminded of Myles SG), that the ludicrous Bruce Gold ‘Nothing Succeeds as Planned’ kind of thesis gains traction when it’s manifestly ludicrous. Everything looks like a ramshackle mess from close up, becasue the bits that work are unremarkable. But actually lots of things do work well enough despite being a bit hit and miss, and advertising psychology is one of them.

I don;t really understand why straw men and false dichotomies (high-end psy ops) have so much traction in this kind of area, but they do. Also, they don’t subscribe to psychology journals, any more than electricians subscribe to physics journals. They have marketing publications instead, which contain (or are derived from) the kind of stuff you see at (for randomly Googled examples) http://www.marketingpower.com/ or http://www.consumerpsychologist.com/.

(I’ve worked for a large international marketing company for several years, and in plenty of smaller companies where I often end up sharing an office with the marketing dept. So rather than ‘consulting with these pe0ple’, I’ve listened to the loudmouthed fuckers at work for days and weeks on end and they all go on constantly about their own heavily euphemised form of applied psychology (yes, brand loyalty, ‘aspiration’; etc etc. – and js, Janie M, no-one thinks advertising/marketing works on them, and by reconstructing how you behave in response to marketing, you – and thus your imagined self – are ipso facto attending to the matter of marketing and its effects – which skews your reconstruction since this stuff is largely about what happens when you’re not really paying attention. Or for bh’s benefit, ‘subliminal thought control’.)

That’s all a bit scrambled, sorry, in a hurry (but still thought someone was wrong on the internet in a moderately important way and needed some countervailing input that didn’t seem to be coming from anyone else.)

PS, re: the quasi Darwinian variant of the ‘Nothing Succeeds as Planned’ thesis: Evolution may look like intelligent design, but really it’s just random flailings. How else to explain the occasional horrific shocker, like this one? In meme-terms, it’s just a (horrible) random mutation that fails. Again, an occasional failure, a bit of outside-the-box experimentation or less-than-perfect control are nothing like evolution by random mutation and natural selection. That is a really, really, really really, really, slow and ‘wasteful’ process, and doesn’t go in any direction that can be specified in advance. It’s a world away.

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Chaz 03.30.12 at 9:50 am

My I-am-not-a-marketer explanation of brand loyalty:

Brand is a proxy for quality (leaving aside fashion for this discussion). I guess there’s two kinds of brand loyalty: In Type 1, you are using a product you understand fairly well, you have had the opportunity to try a few options out, and you now are loyal to the one that works the best in your experience. That’s a story about taste and product quality and marketing’s not going to be super important to it.

In Type 2, you are using a product you know very little about, and you are not able to measure quality in a satisfactory way. You don’t want to just guess, so you buy what the salesman recommends, what your friends recommend, or the brand you’ve heard of. If a company’s brand is the only one people recognize it can people who don’t know much about the product to choose it and even pay a huge premium for it. Also, whatever you do end up picking, if it works out okay–even if it’s totally mediocre or overpriced–you’ll probably buy the same brand again. Because on the second trip, you still don’t have a clue but you do at least know that Brand X was adequate so it’s a safe pick. What this means is that if a marketing campaign can just get clueless shoppers to recognize your product on the shelf then that creates a huge profit opportunity.

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Niall McAuley 03.30.12 at 11:22 am

Brand loyalty is like a browser bookmark. You want news on the Republican nomination? You could Google it, and eyeball a huge list of articles to find one to read. Or you could just hit your TPM bookmark.

If you need a sweatshirt, you could search every outlet for every brand, sort them, rank them and buy the one with the highest rank. Or you could just go to a brand you’ve liked in the past and get one of theirs.

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Watson Ladd 03.30.12 at 1:22 pm

Fluoxetine is actually much better then tricyclics in terms of safety profile, and unlike MOAIs does not lead to dietary changes. This two factors ment that patients were more likely to take it, part of what has lead to a dramatic decrease in the suicide rate in the US. Drugs don’t have to be more effective to be improvements: side effects and tolerance matter a lot.

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sanbikinoraion 03.30.12 at 1:23 pm

(Someone tell me to shut up if I’m derailing)

Tim,

I can’t imagine how any semi-competent agency could come up with the ad that I linked to if they were doing any sort of psychological effectiveness analysis. I hope I live in a world where that ad is the result of some random dickhead flailing about rather than a carefully considered brand message.

My point, really, was to agree with others upthread that marketing is (largely) not “high-tech psy ops” and more “copy interesting stuff that other people do and tweak it a bit” — this is clearly the precept behind the recent Nokia Lumia ad, whose goal appears to be “steal neat videos off youtube”, and it’s why all the prescription drugs ads are “people running through fields, or flying kites, or swimming in the ocean” – that’s the safe option, the current local minima. To me it looks a lot more like some form of evolutionary algorithm than carefully considered flashes of genius. You can tell when those come along because suddenly everyone starts apeing them…

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JanieM 03.30.12 at 1:50 pm

Can’t get too much into this because I’ve got some commitments to keep this morning. But a lot of what people seem to be meaning by brand loyalty sounds more like habit to me. I don’t think “loyalty” is the same as habit, and it was the “loyalty” part that I was really trying to figure out in my bemusement. I was going a lot by what Wikipedia said and what my colleague implied about her husband and her own (very fashion-conscious) habits, which suggested that you stick with a brand no matter what, in part because of what it signals, and that companies put a lot of effort into getting people to stay with their brand no matter what.

Tim Wilkinson notwithstanding, I’m not much like that. I don’t have a TV (well, I have a box, and my daughter watches DVDs on it when she’s here, but I have no cable or satellite etc.) and I live in a state where billboards are banned (Maine) and I use Firefox for most things online, and don’t see ads there, either, and I’ve stopped subscribing to magazines long since.

When I see TV on visits to my brother’s house in Ohio, i.e. when we sit around watching sports, I see ads for beer, which I don’t drink, and cars that would cost my annual income (why they advertise these to middle-class sports fans I have no idea). I buy as much food as I can organic and local, and yes, like Katherine, I certainly keep buying a brand of some particular thing, other things being equal, if I’m familiar with it and I know I like it. I wear t-shirts out of the seconds bins at the Maine-Made shop ($6 or $9 depending on how badly they were screwed up) and Henleys from LL Bean (yup, okay, that’s something like brand loyalty because I like the shirts; it’s certainly not because of marketing) and sneakers that I picked out of a bunch I tried on at a store where they purport to be able to help you get something that works especially well for your feet and gait — I literally cannot tell you what brand they are, I would have to walk to my entryway and look in order to find out.

I really do hate it when people tell me I don’t know what I’m talking about, above all when the subject is myself. Maybe everyone does think marketing doesn’t work on them; and maybe some people are really so freaking eccentric that they’re right.

Sorry to be so far off the drug advertising topic, but as to that, I wonder if the hope of an easy no-effort no-change-in-lifestyle miracle from little pills is another part (besides the things people have already mentioned) of why people ignore the scary warnings. Plus, lots of people, to the extent that they think about it at all, probably are sure the side effects aren’t going to happen to them.

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Chaz 03.30.12 at 8:21 pm

@JanieM,

I think you’re reading too much into the word “loyalty”. Habit sounds about right. It’s not as if people swear oaths of homage to their moisturizer manufacturer. Someone that loyal would be called a fanboy if they were loyal to Apple or Sony or Nintendo; I dunno what you call people who’re loyal to Abercrombie and Gucci besides shallow.

I too do not usually see ads in my web browser or on TV (well except product placement); isn’t it grand? The marketers still manage to sneak a few in though. For example, you say you use Firefox. Look at the top right corner where it (probably) says Google in your search bar. That’s there because Google paid Mozilla (the makers of Firefox) to put it there.

I bet you’re “loyal” to a few brands in the Type 2 way I said above, too. Most people are loyal to Google. You’re probably loyal to Microsoft Office too; if you work in certain industries then you don’t have a choice there, but most people would do fine with LibreOffice or WordPerfect if only they knew they existed. Probably there are some restaurant chains you’re loyal to too. Maybe you’re not exclusively, every-meal loyal to Subway, but you know what they are and you know you’ll like their food (or not) when you’re in a strange town and you don’t feel like hunting around.

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JanieM 03.30.12 at 9:19 pm

Chaz — Sure, maybe I’m placing too much literal-minded emphasis on “loyalty.” I’m a literal-minded, OCD-ish kind of person. But it’s exactly that quality that makes me mostly impervious to marketing. Being bombarded with messages I would rather not see about products I will never use strikes me (and I chose the word “strikes” mindfully) as both fundamentally dishonest (the message themselves) and abusive (the constant attempt to claim my attention away from what I want to apply it to).

They’re playing us. I don’t react well to that. They’re also cluttering up the scenery, and I don’t react well to that either. Here in Maine I get to look at pine trees instead of commercial messages along the highway. I prefer pine trees.

If I’m fudging the boundary between habit and loyalty, I’d say that advancing the default-ness of “Google” as an example of being susceptible to marketing, or of being loyal, is equally rather a stretch, and even perhaps a bit of goalpost-shifting.

But FTR, I have my default search engines set to Bing. (I use IE for some purposes, hence engines-plural.) I use Windows and Office because my computer is supplied by work and that’s what work uses. I used a Mac for the first 11 years after it came onto the market in 1984 — not because I swooned at some advertising, but because a buddy who wanted me to go into business writing software with him suggested that I take a look at it. (And when I say “a Mac” I mean the same box, for 11 years, with one or two upgrades along the way.)

As for restaurants, I don’t eat wheat, corn, tomatoes, or very much meat; I have to severely limit my sodium intake; I’m very picky about which cooking oils I ingest; and I prefer organic and/or locally grown foods when I can get them. Not surprisingly, I rarely darken the door of a chain restaurant. They don’t even smell right to me, they smell like bad fat and lots of salt. Even most of the good locally owned restaurants around where I live use too much salt for me to tolerate happily these days. But I admit to being loyal to the locally-owned Thai food / sushi bar two towns away. It’s not the advertising (if there is any; you couldn’t prove it by me), it’s the food — and the really really nice people.

It’s fascinating that people keep trying to prove that I don’t know what I’m talking about when I talk about my own life. CT having been extra sensitized to gender lately, I’m beginning to wonder how many ostensibly male commenters get this kind of “from a few pixels on the internet I know you better than you know yourself” schtick. Either way, I’m tired of it, so that’s enough of this thread for me.

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Tim Wilkinson 03.31.12 at 2:45 pm

Re – the offending passage:

(yes, brand loyalty, ‘aspiration’; etc etc. – and js, Janie M, no-one thinks advertising/marketing works on them, and by reconstructing how you behave in response to marketing, you – and thus your imagined self – are ipso facto attending to the matter of marketing and its effects – which skews your reconstruction since this stuff is largely about what happens when you’re not really paying attention. Or for bh’s benefit, ‘subliminal thought control’.)

In the UK, ‘you’ is a colloquial substitute for ‘one’. Perhaps this is not in common use in the US. The point was intended as a general epistemic-methodological one which happened to be prompted by the comments of js et al. (and nowhere is there any specific imputation of error to anyone).

I certainly don’t think my remark should be regarded as confirming a possible relation between pro-known-male sexism and some putative “from a few pixels on the internet I know you better than you know yourself” shtick.

sanbinikoraien @70: I can’t imagine how any semi-competent agency could come up with the ad that I linked to if they were doing any sort of psychological effectiveness analysis.

I don’t know why not. I’d say it looks exactly like the kind of thing that these people might come up with as a result of following their methodology wherever it leads.

Of course there are all kinds of complicating factors such as showing off to fellow ‘marketing professionals’, ripping off clients, basic incompetence, copying the competition etc. Just as in all kinds of other fields. But this doesn’t mean that the whole multi-billion dollar industry is therefore just random flailing around – and that is very clearly not the case.

To me it looks a lot more like some form of evolutionary algorithm than carefully considered flashes of genius. You can tell when those come along because suddenly everyone starts apeing them…

Could be describing physics, or all kinds of endeavour – and since it describes a mechanism which exhibits (a) designed mutation – ‘carefully considered flashes of genius’, and (b) artificial selection – ‘everyone starts apeing them [because they recognise their effectiveness and understand which aspects of them to ape]’, it’s far from clear why it should be regarded as an example of an ‘evolutionary algorithm’.

Anyway, as I and (I now see) ajay have pointed out, when these people are actually at work, they do pretty methodically draw on a substantial body of applied psychological theory, which is based on research.

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