Warning: Some Health Ads May Be Dangerous to Your Health

By Richard Morin
Sunday, November 6, 2005

Department store magnate John Wanamaker once famously said that he knew that half of the money he spent on advertising was wasted -- he just didn't know which half.

His wry comment helps describe the serious dilemma now faced by those who create advertising for new drugs or organize public service health campaigns, according to researchers at Indiana University. It seems that many drug ads and public service messages may have the unintended consequence of dissuading people from obtaining potentially life-saving drugs or taking preventive steps such as getting vaccinated, according to studies conducted by Anthony and Dena Cox, professors of marketing in the university's Kelley School of Business, and Gregory D. Zimet, a professor of pediatrics and clinical psychology at the Indiana University School of Medicine.

"People who design real campaigns may -- with the best intentions -- actually end up designing programs that are ineffective or even harmful," Anthony Cox said. And what's more, he added, it is exceedingly difficult to predict whether a particular ad message will help or hurt.

In a study funded by the National Institutes of Health, the researchers tested different print messages to see whether they affected the willingness of people to get vaccinated against hepatitis B, a potentially lethal liver disease transmitted by sexual contact and drug abuse. Their test subjects were 213 randomly selected clients at three public clinics offering treatment for sexually transmitted diseases -- precisely the group that should get vaccinated.

One group saw messages emphasizing that the vaccine would greatly reduce the chance of getting hepatitis B or spreadingthe disease to uninfected partners. Advertisers call this a "gain-framed" message, because it highlights the benefits that would be obtained from getting vaccinated.

The others read a "loss-framed" message that stressed the awful consequences -- death or infecting a loved one -- of not getting vaccinated. (Only a few words were changed to alter the messages. The positive message included this statement: "People who get the hepatitis B shot are gaining a chance to protect themselves and the ones they love," while the negative message read, "People who don't get the hepatitis B shot are losing a chance to protect themselves and the ones they love.")

These subtle but opposing approaches produced dramatically different results. Test subjects who read the positive pitch were inclined toward vaccination, and more likely to discount so-called "nuisance risks" ("the shot will be painful"). The subjects who read the negative appeal were more likely to say they didn't want to get vaccinated and to worry about the nuisance risks, the researchers report in a forthcoming issue of the Journal of Marketing.

The solution seems simple enough to me -- design ads that emphasize the benefits and avoid messages that attempt to scare people into action.

Not so fast, says Anthony Cox. An earlier study produced what he called "a very different" finding.

In that study by the Coxes, published four years ago, women were shown different print ads that encouraged them to get a mammogram. One ad emphasized the benefits of getting the test, including a greatly reduced risk of dying from breast cancer. (Significantly, Cox noted that similar upbeat messages are almost universally employed in campaigns encouraging women to get regular breast exams.)

The other ad emphasized what would happen if they didn't get a mammogram, including the fact that they ran a much higher risk of dying from cancer. A third group saw no ad. Then the women in the three groups were asked whether they intended to get a mammogram and their overall views of breast cancer, including whether they expected to develop the disease sometime in their lives.

Those who saw the upbeat ads said they were less likely to get a mammogram than those who saw the negatively framed ad. And if that weren't enough, they also were more likely to believe that they would not get breast cancer than either the group that saw the negative ad or the women who saw nothing.

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