Science. Communication. Community.
Whether it’s Ashton Kutcher hawking cameras or cute cartoons peddling sugary breakfast cereal, advertising is designed to boost sales and turn a higher profit. But when the product is a pharmaceutical drug, marketing might also do something more unexpected.
Anyone who’s watched television in the last fifteen years is well aware of the rise of direct-to-consumer advertising of prescription drugs. Despite the comically long lists of moderately to absolutely terrifying side effects for products consumers cannot find on a shelf in any store, these advertisements have been hugely lucrative for drug companies, which happily spend about $5 billion on them in the U.S. every year. Following the recall of several heavily promoted drugs, theses tactics have become more contentious, with many physicians concerned about safety and calling for more regulatory oversight by the FDA.
But a trio of interdisciplinary health economics researchers at the University of Chicago thought that there might be an upside to the pervasiveness of such advertising. If consumers are constantly told how great a drug is, was it possible that when they took the drug it might actually work better for them?
Such placebo effects are well documented, but they had never been tied to advertising. In fact, the placebo effect is often a problem when trying to get drugs approved because the onus is on the new drug to perform better. So this time, a randomized controlled clinical trial was designed to measure the placebo effect instead of testing the efficacy of a drug. The researchers chose the popular antihistamine, Claritin (loratadine), because its effects were quickly visible and measurable, and it has a storied promotional history. Now sold over-the-counter, Claritin was once a blockbuster drug with annual sales of $3 billion, and the poster child for successful direct-to-consumer advertising.
After injecting volunteers with histamine to trigger an allergic hive, the size of which could be measured to serve as a baseline control, scientists gave volunteers one dose of Claritin and had them settle in to watch a movie with multiple commercial breaks. These included ads for either Claritin or Zyrtec (Cetirizine), a competing antihistamine. Two hours in, the volunteers were injected again, and the hives were again measured. The results, which were published this month in the journal PNAS, found that Claritin was effective in reducing the allergic reaction (as compared to the baseline), but it was nearly 6% more effective if the volunteer had seen the Claritin ads. Importantly, the placebo effect here is not just how well the volunteer thinks the drug has worked (although the Claritin viewer does now believe more in the efficacy of the drug), but also extends to the physiological allergic response. Just by showing a few commercials, the drug has literally become more potent.
Regrettably, the authors do not share what happens to the hive size of volunteers who don’t view any allergy medication commercials. Similarly, their main result is not replicated in the histamine-induced hives of volunteers who test positive for one or more common allergies—the very people you would expect to be taking Claritin. These potentially-real sufferers seem to be more jaded, as they do not report higher belief in the drug after viewing the branded commercials, in contrast to the allergy-free viewers. It’s possible this could explain why the allergic volunteers don’t see the increased effectiveness of the drug, but the cause and effect here is still unclear. The researchers suggest the advertising placebo effect may only apply to new allergy patients.
It certainly seems plausible that patients who are so swayed by advertisements that they exhort their physicians to prescribe them a particular drug would get at least a temporary placebo boost. But I’m less confident that these small improvements qualify as “important effects on public health,” as the authors claim, or in any substantial way offset the damages and inefficiencies of prescribing unnecessary medication.
Nevertheless, the experiment is the first to try and get at how advertising might be doing much more than even its biggest promoters would have proposed. Advertising and the placebo effect have one thing in common, at least. No one ever wants to believe it works on them.