Placebos and Branding

Boots Pharmacies have been told to stop listing medical conditions in their in-store advertising of homeopathic products by the medicines regulator, following a complaint.

The point-of-sale advertising in Boots stores recommended homeopathic products as suitable treatments for a wide range of medical conditions including allergies, infections, insect bites, headaches and earaches. But homeopathic products contain only sugar — they have no active ingredients.

The products Boots were advertising (manufactured by A Nelson & Co Ltd of Wimbledon) are prohibited from indicating any medical conditions by the Medicines and Healthcare products Regulatory Agency (MHRA), which is the statutory body charged with regulating medicines and homeopathic products.

The Boots products are registered under the MHRA’s Simplified Scheme for homeopathic products. This does not require the manufacturer to provide any evidence that they actually work — unlike the conventional medicines licensed by the MHRA.

Alan Henness, Director of the Nightingale Collaboration, which campaigns against misleading healthcare advertising to the general public, said:

This is a victory for informed consumer healthcare choice. These products are frequently displayed near the pharmacy areas and could mislead members of the public into thinking they were effective medicinal products. However, as well as being biologically improbable, there is no good scientific or medical evidence that any homeopathic product has any effect over placebo.

Essentially, things like herbal medicines and anti-ageing creams can’t work. Legally, they are not allowed to have any medical effect – if they did they would need to be tested properly and move out of the easy, cheap manufacturing plants and possible back behind the prescription desk.

This means that the companies that make them have to give the impression that they are very effective, but at the same time make sure they don’t accidentally make a very effective product.

Strange isn’t it, but I would say that often placebos are fantastic.

Take the placebo effect of branding for example. It has been shown that the intrinsic and extrinsic elements of branded products need not be independent. McClure et al. (2004) investigated the psychophysiology of the fact that, while Coca-Cola and Pepsi have nearly identical chemical compositions, people still display strong taste preferences for one or the other. Using fMRI scans; they found that when the brand is unknown taste tests comparing the two brands led to distinguishable activity restricted to the ventromedial prefrontal cortex (VPFC). However, when the subjects were aware of the brands, taste tests also activate areas in the dorsolateral prefrontal cortex (DLPFC), involved in higher-order brain functions. Hence, the physical sensory experience is not wholly responsible for preferences between the two brands. Being aware of the brand behind the product significantly changes the subjective experience of drinking the beverage.

Ultimately, the taste of Coca-cola is rated higher from a cup baring its logo than from one without (Ariely, 2008).

The Pepsi Challenge, launched in 1974, was a marketing campaign that proved that a majority of people preferred Pepsi to Coke in a double blind test. It resonated with consumers, compelling many Coke drinkers to abandon their brand loyalty and winning Pepsi significant market share (Foley, 1994). This shows that the consumers did not appreciate that in their normal consumption experiences they are aware of the brand and their perception, and hence benefit from the product, would not be the same as in the double blind test. The underlying assumption of the Pepsi Challenge was that the brands were only selling the tangible product qualities. Its success demonstrates the common misconception that it is fair to scrutinize branded corporations on the tangible aspects of their products alone.

In fact, many experiments have shown that “cultural messages combine with content to shape our perceptions” (McClure et al, p.379). A serving of turkey is rated higher if thought to have come from a popular brand than an unpopular one (Makens, 1965), Perrier is only preferred to Old Fashioned Seltzer when the labels are showing (Nevid, 1981), consumers have limited ability to pick their preferred beer brands if stripped of branding (Allison & Uhl, 1964), the presence of the word ‘soy’ causes nutrition bars to taste “more grainy, less flavorful and have a stronger aftertaste” (Wansink et. al., 2000, p.85), women prefer the taste of cigarettes if they are given a feminine name, while men prefer the taste of the same cigarettes if given a masculine name (Friedman, 2007), bitter coffee tastes less bitter if consumers are repeatedly told that it is not bitter (Olson and Dover, 1978), people enjoy the taste of “MIT brew” beer (regular beer plus a few drops of balsamic vinegar) until they know it contains balsamic vinegar (Lee et al, 2006) and strawberry yogurt, cheese spreads (Wardle and Solomons, 1994), vanilla ice cream (Bowen et. al., 1992) taste better if labeled “full-fat” than if labeled “low-fat” and preschoolers indicated a significantly higher preference for the taste of foods and beverages when they were placed in McDonald’s packaging compared with the same foods presented in plain packaging (Robinson, 2007).

It has proven more difficult to design accurate experiments to investigate this phenomenon in inedible commodities; however, Hoch and Ha (1986) found that people evaluate shirts more favorably if their qualities had been exaggerated prior to inspection. Furthermore, Branthwaite and Cooper (1981) found that women experience 25% greater relief from branded aspirin, than from the same active ingredients if unbranded. The advantage conferred by the branded aspirin was higher in women that were loyal consumers of the brand. This suggests that the stronger the relationship with the brand, the greater the psychophysiological effect. Branthwaite and Cooper proposed that a branded product “encourages a sense of wellbeing and coping”, and suggested that the brand may add to the functionality of the product “by supplementing the analgesic effect of placebos, which are mediated by the release of endorphins” (Branthwaite and Cooper, 1981, p.1578).

However, it is worth noting that Waber et al. (2008) found equivalent outcomes in therapeutic effectiveness when a placebo was said to be an expensive painkiller or a cheap painkiller. Nearly all of the test subjects that were told the drug cost $2.50 per dose reported pain relief, while of those told that the drug cost $0.10 per dose; only half reported pain relief. They concluded that the efficacy of physiological effect of placebos is determined by one’s expectations. This makes it difficult to conclude that the effects shown in the above experiments were the result of the branding and not the fact that the test subjects assumed that the branded products were more expensive; and related this to effectiveness in their expectations.

These experiments show that branding can have a great effect on our expectations and our propensity to make rational decisions – and hence our consumption behaviour. They show quite conclusively that we are no ‘Homo economicus’ (Persky, 1995) and beg the question whether branding can be used to sell us things we don’t need. “Advertising encourages us to buy stuff we don’t need, with money we don’t have, to impress people we don’t like“ (Jeremy Waite, 2010). One direct example of how this is said to occur is the design of advertising strategies to utilise the ‘nag factor’ or ‘pester power’ of children on their parents. This is the targeting of children with the specific intent to encourage them to influence their parents to buy certain product that the parents are unlikely to buy given the free choice (Soni and Upadhyaya, 2007). However, the general accusation is that marketers aim to create desires, rather than directly force target customers to buy things they don’t want.