Feeling Is Believing: Evaluative Conditioning and the Ethics of Pharmaceutical Advertising

Abstract

A central goal in regulating direct-to-consumer advertising of prescription pharmaceuticals (DTCA) is to ensure that explicit drug claims are truthful. Yet imagery can also alter viewer attitudes, and the degree to which this occurs in DTCA is uncertain. Addressing this data gap, we provide evidence that positive feelings produced by images can promote favourable beliefs about pharmaceuticals. We had participants view a fictitious anti-influenza drug paired with unrelated images that elicited either positive, neutral or negative feelings. Participants who viewed positive images rated the influenza drug as significantly more effective, safe, and beneficial than did participants who viewed negative images. This effect, known as evaluative conditioning, is well described in experimental social psychology but has not previously been shown with pharmaceuticals. We discuss how evaluative conditioning in DTCA may compromise viewer autonomy, and canvass possible regulatory responses.

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Figure 1

Notes

  1. 1.

    Although some measurement theorists consider Likert-type scales to be ordinal, there is evidence that Likert-type scales can be validly and reliably treated as interval scales, and can be analysed with parametric statistics (Labovitz 1967; Traylor 1983). Indeed, in experimental social psychology and behavioural economics, treating Likert-type scales as interval scales is common, accepted practice (Hofmann et al. 2010; Pleyers et al. 2007; Redelmeier and Kahneman 1996).

  2. 2.

    The authors thank an anonymous reviewer for this suggestion.

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Correspondence to Paul Biegler.

Appendix 1

Appendix 1

The fifteen statements included in the voiceover were:

  1. 1.

    Fluvent (Fluvamivir) is a new flu medication that may become available in your region

  2. 2.

    Each year between 5 and 20 per cent of the population experience the flu

  3. 3.

    The flu causes fever, cough, sore throat, and aches

  4. 4.

    Flu affects people of all ages

  5. 5.

    Flu poses highest risk for infants, those over 65, and those with chronic medical conditions

  6. 6.

    The flu is spread when an infected person coughs and droplets are inhaled by others

  7. 7.

    Vaccination is the most effective means of prevention

  8. 8.

    In addition, drugs are available that can prevent flu

  9. 9.

    Drugs can also treat flu once symptoms start

  10. 10.

    Fluvent is a new generation medication with a unique antiviral action

  11. 11.

    Initial research suggests it is more effective than existing flu drugs

  12. 12.

    As an alternative to vaccination Fluvent may be beneficial in reducing days off work

  13. 13.

    Fluvent may also lower the burden on healthcare facilities during flu epidemics

  14. 14.

    Fluvent carries some risk of side effects

  15. 15.

    Side effects include nausea, headache, diarrhoea, and rash

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Biegler, P., Vargas, P. Feeling Is Believing: Evaluative Conditioning and the Ethics of Pharmaceutical Advertising. Bioethical Inquiry 13, 271–279 (2016). https://doi.org/10.1007/s11673-016-9702-8

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Keywords

  • Autonomy
  • Behavioural research
  • Drugs and drug industry
  • Health promotion
  • Informed consent