Not-so-hidden persuaders

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.

Yes, all they are interested in is product awareness.

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

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?

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.

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).

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.

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.

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).

#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.

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.

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 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”.

Dennis Leary was complaining about drug ads in 2004…

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.

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.

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.)

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.

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.

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.

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.

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.

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

bh – fascinating. Thanks for the inside view.

@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.

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

O.K. How’s this:

http://marxandsparks.tumblr.com/post/18971462923/bliss-street-feeling-sad-depressed-you-may

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

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.

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.

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

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.

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.

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.

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.

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.

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.