25 March 2007
Academic writing example – Celebrity endorsement
Posted by Amanda Reid under: General .
The literature review below is an example of my academic writing.
Over-the-counter medications in Australia: celebrity and expert endorsements
Key words: over-the-counter, OTC, medications, drugs, medicines, therapeutic goods, therapeutic products, direct-to-consumer advertising, marketing, effectiveness and impact, regulation, ethical issues, endorsements, Australia, celebrities, experts, public attitude, community opinion.
Introduction
Advertisers of pharmaceutical products are dealing with a product that may have a significant impact on a patient’s health (Chandra and Holt, 1999). Special care and additional responsibility is therefore needed in the promotion of these products. This is recognised and reflected in the fact that direct-to-consumer (DTC) advertising is not allowed for prescription medicines in Australia and many other countries (with the exception of the US and New Zealand). However, non-prescription medicines that are judged to be of less risk to the consumer can still be directly advertised in Australia .
Non-prescription medicines include over-the-counter (OTC) and complementary medicines. In Australia, OTC medicines can be bought for self-treatment from pharmacies, with selected products also available in supermarkets, health food stores and other retailers. Examples include cough and cold remedies, anti-fungal treatments, sunscreens, and non-prescription analgesics such as aspirin and paracetamol (www.tga.gov.au). According to the Australian Institute of Health and Welfare (2006), expenditure on overall OTC medications in Australia for 2004-05 was estimated to be almost $AUD 2,917 million (with the bulk of that paid by consumers). Complementary medicines (also known as ‘alternative’ medicines) include vitamin, mineral, herbal, aromatherapy and homoeopathic products; these may also be advertised to the consumer as long as they comply with regulations.
Regulation of advertising of non-prescription medicines in Australia
Before non-prescription medicines can be supplied at all, it is a requirement under the Therapeutic Goods Act 1989 that they be included in the Australian Register of Therapeutic Goods (ARTG). Different categories of the ARTG include registered (requiring a higher level of scrutiny) and listed (considered to be relatively benign). Advertisements are regulated by both co-regulatory and self-regulatory arrangements operated by the Therapeutic Goods Administration (TGA), the Therapeutic Goods Advertising Code Council (TGACC), the Australian Self-Medication Industry (ASMI) and the Complementary Healthcare Council (CHC).
Advertisements directed to consumers must currently comply with the Therapeutic Goods Advertising Code . This Code “provides that the marketing and advertising of therapeutic goods to consumers is conducted in a manner that promotes the quality use of therapeutic goods, is socially responsible and does not mislead or deceive the consumer”. Certain advertisements – those appearing on television or radio, newspapers, consumer magazines, billboards and cinema films – need prior approval.
Characteristics of OTC and complementary medicine advertising
Television, the internet and print mediums are heavily relied upon to reach retail consumers; other communication methods, such as face to face selling, free samples and direct mail may also be used to reach key constituents such as pharmacists and physicians (Kavanoor, Grewal and Blodgett, 1997). An older content analysis of OTC medicine television commercials in the US found that most of the ads (which were primarily for topical, respiratory and central nervous system medicines) were symptom focused, with nearly nine out of ten ads symbolically portraying drug performance to be an easy cure or simple solution, but with little information about the time lapse of drug effects (Tsao, 1997). Many ads use a direct comparative format (eg. Drug 1 is more effective than Drug 2, and works twice as fast) (Kavanoor et al., 1997). Chandra and Holt (1999) state that OTC medicine advertisements tend to be truthful, but that they frequently omit information which the consumer needs to make appropriate product selections.
Kavanoor et al. (1997) emphasised the persuasiveness of credibility enhancement in OTC medicine advertising, for example substantiation and multiple explanations for claims or pointing to respected, third-party verification. One strategy that is controversially used is endorsement by celebrities and/or experts. An endorsement means “any advertising message (including verbal statements, demonstrations, or depictions of the name, signature, likeness or other identifying personal characteristics of an individual or the name or seal of an organisation) which consumers are likely to believe reflects the opinions, beliefs, findings or experience of a party other than the sponsoring advertiser” (FTC guidelines, S255.0).
Celebrities and general advertising
Celebrities sell. The use of celebrities or ‘famous’ people as a marketing strategy is now a commonplace practice for anything from fast food products to make-up, sports shoes and pharmaceutical products. Reasons of marketing managers for utilising celebrity endorsers include attempting to stand out and break through media clutter; defining and refreshing a brand image via celebrity values; instant credibility and free associated PR coverage (Erdogan and Baker, unknown). Silvera and Austad (2004) emphasised that the effectiveness of an endorser is dynamic and possibly dependent on societal and cultural context, for example, American cultural norms might include a stronger identification with the celebrity system than that found elsewhere.
Other important influences on the effectiveness of the celebrity strategy include how well the celebrity fits with the advertising idea, the celebrity-target audience match, the celebrity-product match, cost of acquiring the celebrity, celebrity values, controversy risk, popularity, availability, physical attractiveness, credibility, profession, prior endorsements and whether the celebrity is a brand user (Erdogan and Baker, unknown). Celebrities are typically rated as being more likeable, believable, trustworthy and physically attractive than non-celebrities in similar advertising; celebrity ads are more often rated higher on overall ad-liking (Mehta, 2005). While celebrities are consistently found to make ads more attention-grabbing and memorable (increasing awareness of ads), favourable perceptions of a celebrity endorser do not necessarily translate to increased purchase intentions (Mehta, 2005; O’Mahony and Meenaghan, 1997/8). Erdrogan (1999) provides an overview of the inconsistencies in the literature regarding whether celebrities are able to initiate behavioural intent, and under what conditions. For example, in a study by Mehta (1994; cited by Erdrogan, 1999), receivers in non-celebrity conditions focused more on the brand and its features, while in celebrity conditions, they concentrated on the celebrity; this ‘vampire effect’ is a common concern among marketers.
Controversial celebrity endorsement of medicines
Major pharmaceutical firms in the US have recently come under fire for their use of celebrities in marketing campaigns for prescription medicines. The Financial Times stated that US drug companies are “employing celebrities in the same way that Nike or Pepsi might feature the latest sports or popstar to push their product” and are falling over themselves trying to find sick and ailing celebrities to provide testimonials (Sanghera, 2000). Some appearances by celebrities have clearly fallen into the category of ‘stealth’ advertising. As consumers have become more sceptical and distrustful of traditional advertising messages, covert marketing techniques have been increasingly employed by the advertising industry, and celebrities are in a perfect position to assist. Examples abound of US celebrities discussing their medical ailments, mentioning specific prescription drugs or categories of drugs, or referring viewers to a drug-company sponsored website while casually chatting to a talk-show host – without disclosing any financial arrangements or importantly, without adhering to US government requirements to mention anticipated side effects (Kaikati and Kaikati, 2004). Often this publicity is disguised as “public service disease awareness campaigns” which work well for companies whose drug is the leader in a category (Johnson, 2005; Napoli, 2002; Henderson, 2005).
In Australia, celebrity endorsements make their appearance in the big business of non-prescription medicines. For example, prominent Australian cricketer Shane Warne made headlines in the late 1990s when he was paid by pharmaceutical company Pharmacia Upjohn to quit smoking and to promote Nicorette, their brand of nicotine replacement gum and patches (Chapman and Leask, 2001). Although the exact sum he was paid was unclear, the ethical issues arising from this financial agreement were discussed intensely in the media – along with the fact that Warne was later photographed smoking before the contractual period had expired. The core ethical concern appeared to be not that he endorsed quitting smoking, or endorsed the company and products, but that he accepted money for taking on a difficult challenge that ordinary people have to face without payment (Chapman and Leask, 2001). Regardless, sales of the product increased dramatically in the 3 months following the commencement of Warne’s campaign (Chapman and Borland, 1999; cited in Chapman and Leask, 2001).
A study of celebrities in DTC prescription medicine print ads (commissioned by major drug company Pfizer) stated that while the celebrity ad was more attention getting and liked overall more than non-celebrity ads, celebrity ads were not seen to be providing more important messages or being more informative or believable. While a celebrity endorsed brand was sometimes seen as unique and improving quality of life more and sometimes increased motivation to consult a doctor, its efficacy and performance was not expected to be different to the medicines in the non-celebrity ads.
However, whether it is prescription or non-prescription medicines being advertised, celebrity endorsement can be criticised for not conveying any meaningful information about efficacy or side effects. This topic was notably absent from the report above. Celebrities may divert attention away from these crucial aspects of product evaluation, and research needs to examine this possibility. Although OTC medicines are categorised as such because they are thought to have less associated risks than prescription medicines, adequate comprehension of side effects and contraindications is important precisely because there is no prescribing doctor to assess and explain them. A study of consumer understanding of OTC print advertising in general indicated that the majority of consumer participants felt that the information contained in the ads did not help them evaluate side effects or contraindications, and that participants were unable to identify these (Sansgiry, Sharp and Sansgiry, 1999).
Expert endorsement in advertising
Expertise, or perceived knowledge about a product, is usually cited by researchers as a vital component of source credibility and the overall persuasiveness of celebrity endorsement ads (Silvera and Austad, 2004; O’Mahony and Meenaghan, 1997/8). This appears to be true even for familiar celebrities who get and hold attention (Premeaux, 2005). However, not all expert endorsers can be described as “celebrities”. Expert endorsements may be less common in general than celebrity endorsements, but some authors state that this strategy has been increasingly used in commercials (Biswas, Biswas and Das, 2006) in part because it is cheaper.
In most expert endorsement scenarios, the endorser is presented with a certain educational or vocational background. The credentials or qualifications of the endorser thus become the focus of the ad, implying specialised technical and/or medical knowledge with part of the endorser’s role here to ‘help’ the consumer understand the product class and why it is superior to competing products. Rather than merely associating the product with the public image of the particular celebrity (for example, Warne as a typically Australian, feisty, irreverent ‘lad’), such campaigns attempt to quickly associate the product with the image of an entire profession. There is potential for consumers to be mislead about the qualifications of the endorser as they often cannot be easily verified; the US Federal Trade Commission has strict guidelines for expert endorsement (www.ftc.gov/bcp/guides/endorse.htm). These guidelines state that not only must an endorser have the expertise they are represented as possessing, but that the endorsement must be supported by the actual exercise of their expertise (S255.3).
Expert endorsement is thought to be persuasive via the process of internalization – when the consumer accepts information that appears useful for the solution of a particular problem. In contrast, for some endorsement scenarios, consumers may be influenced by endorsers via a process of identification, encompassing celebrities such as Shane Warne (again, as a typical Australian ‘lad’), or other ‘unknown’ consumers who invoke feelings of similarity (Wang, 2005; Biswas et al., 2006). A study reported by Biswas et al. (2006) compared the differential effects of celebrity versus expert endorsements; the latter were more effective in reducing risk perception for high-technology products such as computers. Medicines are another high technology product, and reducing risk perceptions (of side-effects) may well be a marketing industry goal – although such data does not appear to be publicly available.
An older 1986 study specifically focused on OTC product advertisements, explicitly comparing student responses to mock ads with a celebrity, a ‘typical consumer’, a physician, a pharmacist and a combination of physician and pharmacist. Students were asked to indicate the likelihood that they would purchase a product in each case; the strongest three endorsements were the combination, then the physician, then the pharmacist – demonstrating the power of expert endorsement and regard for the physician. Interestingly, pharmacist ratings were higher if a ‘pre-treatment’ film was shown to raise regard for pharmacists, showing them as concerned, expert health professionals.
Health professionals as endorsers in Australia
In August 2005, the Therapeutic Goods Advertising Code Council recommended new rules that allowed health professionals (including doctors, dentists and pharmacists) in Australia to publicly endorse therapeutic goods. This particularly impacted on and involved those held in high regard in the medical profession: Dr Fiona Wood (2005 Australian of the Year) and Professor Kerryn Phelps (former Australian Medical Association president) endorsed the painkiller Nurofen and a complementary medicines company Metagenics respectively. General Practitioner Dr Diane Wruck promoted Children’s Panadol, in an advertisement that played on her dual role as a doctor and mother. Dr Wood later publicly expressed misgivings about her appearance, calling it a mistake, despite her fee being donated to her research centre for the treatment of burns victims (Smith, 2007).
Eighteen months after the initial change, the Council decided to reverse the decision and the 2007 amendment to the Code re-instated the long-standing prohibition. During its re-consideration of the issue, the TGACC took into account that the Australian Medical Association (AMA) is of the view that such conduct is unethical, and also became concerned that consumers could be misled as to the relevant efficacy of products and, as a result, may not choose the most suitable product for a particular circumstance. The Code more generally provides that an advertisement for therapeutic goods must not (among other things) be likely to arouse unwarranted and unrealistic expectations of product effectiveness or abuse the trust or exploit the lack of knowledge of consumers. The amendment allowed that all existing, approved advertisements could continue until their current, two year approval period expires; and all other advertisements for which approval is not required but which include endorsements, must be completely “phased out” within the following year.
Endorsement by doctors raises ethical issues about the specific doctor that is endorsing the product later recommending that product to their patients, and whether they explain to the patient the nature of their connection the company. Some doctors claim that it is only ethical if the advertisement explicitly states that the doctor is being paid to endorse the product (Urology Times, 2000), and that it makes no difference whether the product is prescription or OTC. Ethical debates about whether doctors should advertise their own services can also inform this issue: “there is a unique vulnerability that comes for want of relief from disability and disease, and patients are unlikely therefore to be capable of defending themselves with the incredulousness they may normally bring to other forms of advertising” (Tomycz, 2006, p.27). Purkey (2003) argued that as physicians are allowed to endorse health care products in the US, the Federal Trade Commission should impose more stringent standards for physicians than for other expert endorsers (such as not allowing the physician endorser to carry out the testing of the product being endorsed), because physicians are often held to higher standards than other professional groups, and have reputations of being reliable, trustworthy and credible in the community.
Central to the debate about the appropriateness of advertisements featuring such expert endorsements is that they undermine the medical profession’s reputation for independent clinical advice, and are poor for the public image of doctors. By playing on the regard and high esteem in which doctors are held by many parts of the community, critics worry that endorsements may actually reduce this esteem and undermine trust in a doctor/patient relationship. The minority of doctors who endorse products might be implying to the public that doctors in general, who are supposed to be patient advocates and give unbiased medical care, may also be product advocates and salesman (Urology Times, 2000).
However, the Australian Self-Medication Industry association argues that there were no formal complaints from the public and no evidence that confidence in doctors has actually been undermined (Smith, 2007). This assertion is correct in that there is little or no academic research on the topic. Most related research is offered from the marketing paradigm that focuses on the persuasive effectiveness of endorsement – as opposed to the impact on the consumer’s view of the endorser’s profession. The Morgan Gallup Poll in 2006/7 found that Australians rate nurses as the most ethical and honest profession (91% said high or very high), followed by pharmacists (85%) and then doctors (81%). This last figure had not decreased from the previous years but instead increased by 2% (www.roymorgan.com/news/polls/2007/4153).
Although effects on consumer/health profession relations with regard to DTC prescription medicine advertising is a separate issue to endorsement, some concerns may overlap. Survey data suggest that consumers generally believe that prescription medicine advertisements assist people to manage their health, but may leave some people with a diminished view of the doctor’s role, making it appear as if a doctor is not necessary (Hoek, Gendall and Calfee, 2004). Chandra and Holt (1999) stated that consumers could be encouraged to ignore or not to seek the advice of a health professional (which can be expensive) when an OTC advertisement is providing desirable information – such an effect could be amplified if doctors endorse OTC products.
The presumed negative effect of doctors’ endorsements is clearly an area in which research is needed to inform regulatory decisions. Does the general community actually respect doctors less after watching the advertisements and do they perceive an ethical problem? Does the presence of a doctor distract a viewer from adequately evaluating the side-effects and contra-indications of the drug themselves? Would they be more or less likely to consult a doctor about a health problem? Would it make a difference if the doctor is qualified or is only an actor playing the role (such as in the example where US celebrity Lorraine Braco, who plays a psychiatrist in “The Sopranos”, discussed her own depression in ads paid for by drug company Pfizer)?
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