TELEVISION ADVERTISING OF SELECTED MEDICINAL PRODUCTS ...

Acta Poloniae Pharmaceutica ñ Drug Research, Vol. 73 No. 4 pp. 1083ñ1097, 2016

ISSN 0001-6837 Polish Pharmaceutical Society

GENERAL

TELEVISION ADVERTISING OF SELECTED MEDICINAL PRODUCTS IN POLAND AND IN THE UNITED STATES ñ A COMPARATIVE ANALYSIS OF SELECTED TELEVISION COMMERCIALS EWA WIåNIEWSKA1, ALEKSANDRA CZERW1, MARTA MAKOWSKA2 and ADAM FRONCZAK1 Public Health Department, Medical University of Warsaw, Banacha 1a, 02-097 Warszawa, Poland 2 Department of Social Sciences, University of Life Sciences, ul. Nowoursynowska 166, no. 4, 02-787 Warszawa, Poland 1

Abstract: The aim of the analysis was to establish the differences between television commercials of OTC drugs broadcast in Poland and in the U.S. The study covered 100 commercials of medicinal products of various producers applied to treat a variety of symptoms and diseases. The analysis demonstrated that there are both similarities and differences. The differences concerned e.g., spot length, the time of placement of a brand name and the diversity of advertising slogans. The most significant similarities concerned applied manipulation techniques, locations featured in commercials and the choice of actors.

Keywords: television advertising, OTC drugs, content analysis, USA, Poland, comparative analysis

As an element of marketing television advertisement facilitates the communication between a company and market, and stimulates product sales. The most popular form of television advertising are the so-called TV commercials broadcast during commercial breaks between TV programs or during the programs. The length of an advertising transmission per one hour of a program in Poland is 12 min (1). Until recently, commercials had an average length of 60 s. Today, 30-s commercials prevail. In a report that comprised an analysis of the market in 2013 the National Broadcasting Council of Poland stated that average Pole spends 4 h and 7 min daily in front of a TV (2), and thus comes before Americans who spend 2.5 h per day watching television (3). The report of Polish Internet Research (Polskie Badanie Internetu) demonstrates that television advertising is still an essential element of promotion. Sixty eight % of the society in Poland learns about new products or new offer via this form of advertising (4). The greatest advertisers in 2014 in Poland were pharmaceutical companies selling OTC drugs (5). Medicinal product advertising in Poland is regulated by a few legal acts. These include:

Pharmaceutical Law Act of 6 September 2001, as amended; the Act on Reimbursement of Costs of Drugs, Foodstuffs for Particular Nutritional Uses and Medicinal Products of 12 May 2011; the Regulation of the Minister of Health of 21 November 2008 on advertising of medicinal products (6). The legislative actions in this respect are guided by European Union directives, i.e. in particular, the Directive of the European Parliament and Council no. 2001/83/EC of 6 November 2001 on the Community code relating to medicinal products for human use. In the United States, the issue of advertising of medicinal products is regulated by the United States Federal Food, Drug and Cosmetic Act (abbreviations: FFDCA, FDCA, FD & C), the regulations of the Food and Drug Administration (FDA) and the Federal Trade Commission Act (FTC Act). Unlike Poland, the United States allows for advertising of prescription drugs (DTC ñ Direct-to-consumer) alongside OTC drugs to a wide circle of consumers. Both Polish and U.S. laws provide for a range of penalties for breach of regulations regarding advertising of medicinal products (7).

* Corresponding author: e-mail: [email protected]

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EWA WIåNIEWSKA et al.

Table 1. Types of drugs covered by the study.

Drug type

Number of products

Painkillers

17

Cough medicines

10

Allergy medications

10

Cold medicines

8

Sore throat medicines

8

Heartburn drugs

7

Constipation medications

4

Medications for symptoms associated with venous and lymph circulation

3

Runny nose medications

3

Sinus symptoms medications

2

Antidiarrhoeal medicines

2

Drugs for symptoms of liver diseases

1

Motion sickness medications

1

Drugs for eye irritation/fatigue

1

Herpes simplex medications

1

Drugs for symptoms of prostatic hyperplasia

1

Antifungal drugs

1

Excessive flatulence gas medications

1

Various effects

19

EXPERIMENTAL Method The aim of the analysis was to establish the differences in television commercials of OTC medicinal products broadcast in Poland and in the United States. A hundred purposefully sampled commercials were covered by the study ñ 50 for each country. The sample covered commercials of medicinal products of various producers intended to treat various symptoms. For Poland the analysis covered e.g., nine commercials of USP Zdrowie products, three commercials of Polpharma S.A. products, three commercials of Bayer Group products, and two commercials of GlaxoSmithKline, PPF Hasco-Lek S.A., Berlin-Chemie, Novartis, Sandoz, Sanofi, Teva, Omega Pharma Poland Sp. z o.o., Aflofarm and Polfa Warszawa S.A. (the company is currently a member of Polpharma S.A. group ñ mentioned earlier ñ but the commercial was broadcast at a time when the companies were not linked) products. For the United States the analysis covered e.g., eleven commercials of Bayer Group products, six of McNeil products, five of Reckitt Benckiser, Pfizer Inc. and Novartis products, four of Sanofi products

and two for Prestige Brands, Procter & Gamble and Boehringer Ingelheim products. In all, the analysis covered 37 producers. The study examined commercials of medicinal products for 19 registered indications for use (Table 1). In Poland these included: 8 pain medications, 7 cough medicines, 6 sore throat medicines, 4 cold medicines, 3 runny nose medications, 3 medications for symptoms associated with venous and lymph circulation, 2 heartburn drugs, 2 constipation medications, 2 antidiarrhoeal medicines and 1 sinus symptoms medication, 1 medication for symptoms of liver disease, 1 allergy medication, 1 herpes simplex medication, 1 medication for symptoms of prostatic hyperplasia, 1 antifungal drug. Furthermore, in 7 cases the producers listed more than one indication for use for one drug: 2 medications for pain, cold, fever and runny nose; 1 for pain and cold; 1 for pain and fever; 1 for constipation and indigestion; 1 for pain, cough, fever and sinus symptoms, 1 for pain, cough, cold, fever and runny nose. The drugs advertised in the United States included: 9 pain medications, 9 allergy medications, 5 heartburn drugs, 4 cold medicines, 3 cough medicines, 2 constipation medications, 2 sore throat medicines, and 1 sinus symptoms medication, 1 motion sickness medication, 1 drug for eye irritation / fatigue, 1 excessive flatulence gas medication. Furthermore ñ similarly to the situation in Poland ñ the producers sometimes listed several indications for one drug. This was found in 12 cases: 2 medications for cough and cold; 1 for pain and fever; 1 for cold and runny nose; 1 for pain and good sleep; 1 for cold and pain; 1 for cough and sore throat; 1 for sinus and allergy symptoms; 1 for sinus symptoms and runny nose; 1 for pain, cold and fever; 1 for sinus symptoms, runny nose and allergy symptoms; 1 for pain, cold, fever and runny nose. The differences also applied to the active ingredients of drugs (Table 2). For the purposes of the analysis of commercials broadcast in Poland commercials uploaded on YouTube between March 2007 and December 2014 were used (www.youtube.com). Despite significant differences ñ including phonetic and grammatical ñ between various English dialects spoken in the English speaking countries, the use of videos uploaded on the above website for the purposes of the analysis of commercials broadcast in the United States was unfeasible due to high risk of confusion of videos from the U.S. with videos from the other English speaking countries. This is why videos uploaded on the American website iSpot.tv (www.ispot.tv) were used for the purposes of the analysis. In a Microsoft Excel file the following data were gathered: country, drug name, brand name, commercial length, date of publication on

Television advertising of selected medicinal products in Poland and...

YouTube/last broadcast according to iSpot.tv, the time of placement of drug name, the time of placement of brand name, type of drug, distinctive words, music, actors, actorsí age, atmosphere, setting, manipulation, dominant color, advertising slogan and recognizable character. RESULTS Thirty-second long commercials prevailed among those examined. This applied to both Poland (84%) and the United States (50%). A relatively higher percentage of 15-s commercials was recorded for the U.S. (48%). In Poland, shorter commercials made up only 10%. In the case of Poland there were also some commercials of 20 and 45 s (4% and 2%), and in the United States commercials of 10 s

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(2%) (Chart 1). The trade name of drugs read aloud or displayed in a textual form in the commercials broadcast in Poland usually, i.e., in 48% of cases, appeared at the beginning of the commercial, i.e., up to 1/3 of its length (for 30-s long commercials up to the 10th s) and in the middle, i.e., for 30-s long commercials between the 10th and 20th s. Occasionally (4%), the name was displayed at the top or at the bottom of the screen throughout the entire commercial. In none of the analyzed commercials did the advertisers choose to place the trade name of the medicinal product at the end of the commercial. In the United States, the names of drugs that appeared at the beginning of the commercial made up 58%. In 38% of the commercials the trade name was placed in the middle of the commercial. Placement during

Chart 1. Commercial length

Chart 2. Time of trade name placement

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Table 2. Active ingredients of drugs covered by the study.

Poland Active ingredient Ibuprofen

United States No. of drugs 3

Active ingredient Ibuprofen

No. of drugs 4

Diosmin

3

Loratadine

3

Xylometazoline hydrochloride

2

Acetaminophen

2

Loperamide hydrochloride

2

Acetaminophen, aspirin, caffeine

2

Omeprazole

2

Calcium carbonate

2

Paracetamol, pseudoephedrine hydrochloride, dextromethorphan hydrobromide

2

Cetirizine hydrochloride

2

Acetylcysteine

1

Acetaminophen, caffeine

1

Aciclovir, hydrocortisone

1

Acetaminophen, chlorpheniramine maleate

1

2,4-Dichlorobenzyl alcohol, amylmetacresol

1

Acetaminophen, dextromethorphan hydrobromide, doxylamine succinate

1

2,4-Dichlorobenzyl alcohol, amylmetacresol, levomenthol phenylephrine hydrochloride

1

Acetaminophen, dextromethorphan hydrobromide, doxylamine succinate,

Benzocaine, cetylpyridinium chloride

1

Acetaminophen, dextromethorphan hydrobromide, guaifenesin, phenylephrine hydrochloride

1

Bisacodyl

1

Acetaminophen, dextromethorphan hydrobromide, phenylephrine hydrochloride

1

Dextromethorphan hydrobromide, tilia flower extract

1

Acetaminophen, phenylephrine hydrochloride

Benzoxonium chloride, lidocaine hydrochloride

1

Anhydrous citric ccid, sodium bicarbonate

1

Ambroxol hydrochloride

1

Aspirin

1

Benzydamine hydrochloride

1

Aspirin , caffeine

1

Bromhexine hydrochloride

1

Aspirin, chlorpheniramine maleate, phenylephrine bitartrate

1

Drotaverine hydrochloride

1

Benzocaine

1

1

Fenspiride hydrochloride

1

Bisacodyl USP

1

Oxymetazoline hydrochloride

1

Dextromethorphan

1

Pseudoephedrine hydrochloride, triprolidine hydrochloride

1

Dextromethorphan hydrobromide, doxylamine succinate

1

Terbinafine hydrochloride

1

Dextromethorphan hydrobromide, phenylephrine hydrochloride

1

Butamirate citrate

1

Diphenhydramine hydrochloride

1

Diclofenac diethylamine

1

Diphenhydramine hydrochloride, naproxen sodium

1

Soybean phospholipids with (3-sn-phosphatydyl)choline

1

Diphenhydramine hydrochloride, phenylephrine hydrochloride

1

Ibuprofen, pseudoephedrine hydrochloride

1

Docusate sodium, benzocaine

1

Ketoprofen

1

Dyclonine hydrochloride

1

Acetylsalicylic acid

1

Esomeprazole magnesium

1

Acetylsalicylic acid, phenylephrine hydrochloride, chlorphenamine maleate

1

Fexofenadine hydrochloride

1

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Table 2. Cont.

Poland

United States

Active ingredient

No. of drugs

Active ingredient

No. of drugs

Acetylsalicylic acid, ascorbic acid

1

Fexofenadine hydrochloride, pseudoephedrine hydrochloride

1

Dehydrocholic acid

1

Fluticasone propionate (glucocorticoid)

1

Chlorpheniramine maleate, pseudoephedrine hydrochloride, paracetamol

1

Glycerin, hypromellose, polyethylene glycol

1

Meloxicam

1

Guaifenesin, dextromethorphan hydrobromide

1

Metamizole sodium

1

Loratadine, pseudoephedrine sulfate

1

Paracetamol, guaifenesin, phenylephrine hydrochloride

1

Meclizine hydrochloride

1

Paracetamol, caffeine

1

Phenol

1

Paracetamol, ascorbic acid, pheniramine maleate

1

Pseudoephedrine hydrochloride

1

Rutin, ascorbic acid

1

Ranitidine hydrochloride

1

Naproxen sodium salt

1

Simethicone

1

Dried senna fruit extract standardized to hydroxyanthracene glycosides content

1

Triamcinolone acetonide

1

Coltsfoot leaf extract, thyme extract

1

Trolamine salicylate

1

Saw palmetto extract

1

Table 3. Distinctive words used in adverts.

Percentage Words

Poland

United States

fast/instant

20%

32%

relieve/alleviate

8%

52%

combat/fight off

26%

0%

powerful/the most powerful

12%

26%

disappear

22%

0%

remove/eliminate/get rid of/free from

18%

4%

effectively

16%

10%

make easier

6%

2%

protection

2%

6%

safe

2%

2%

restore

2%

2%

improve

4%

0%

anaesthetize

4%

0%

support/help

4%

0%

well-tried

4%

0%

comprehensive

4%

0%

serious

0%

4%

No distinctive words

20%

6%

the whole length of a commercial (2%) or at the end of it was rare (Chart 2). In the commercials broadcast in Poland the brand name was usually read aloud or displayed on the screen at the end of the commercial (52%) or in the middle of it (26%). In 10% of cases the information about the producer was placed at the start, and in 6% of commercials the name was displayed on the screen the whole time. In 2% of the analyzed commercials the information about the producer of the medicinal product did not appear at all, which is inconsistent with the applicable laws. In the case of American commercials the situation was different. As many as 76% of commercials failed to give the name of the producer. In 2% of cases the brand name was displayed on the screen the whole time or appeared in the middle of the commercial. In none of the analyzed commercials did the brand name appear at the start or at the end of the commercial (Chart 3). The commercials were also analyzed in terms of the use of the so-called distinctive words. In this respect it was observed that the most frequently used distinctive words in Polish commercials are ìcombat/fight offî and ìpowerful/the most powerfulî (26%), while in the United States ìrelieve/alleviateî prevailed (52%). In both countries the use of

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Chart 3. Time of brand name placement

Chart 4. Music in television adverts of OTC drugs

Chart 5. Actors in television adverts of OTC drugs


Chart 6. The age of actors in television adverts of OTC drugs

Chart 7. Emotions in television adverts of OTC drugs

Chart 8. The setting of television adverts of OTC drugs

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Table 4. Advertising slogans that appeared in the analysed commercials (arbitrary sequence).

Advertising slogans Poland Delicious raspberry Ibum, and the fever and pain are gone

United States Fast acting/relief doesn't get any better than this

Heartburn under control

Fast acting

Aspiryn for cold. Aspirin for pain

Break the grip of pain

We have a well-tried remedy for dry cough

Targeted relief with the power of Bayer

Naxii for a whole day without pain

Tough on pain, gentler to your stomach

Xenna Extra for constipation - works the way Nature wanted

Headache gone

I know nothing will stop me - even pain

No pill relieves heartburn faster

It improves your quality of life!

Get moving again

Apap Extra - Discover its Extra power!

Oh what a relief it is

Aspirin. Stronger than cold

Live Claritin Clear

And you're back in action

Six is greater than one. This changes everything

Gripex - fights off all symptoms of flu

Nexium Level Protection

Relief in discomfort

Aleve pm for a better am

FlavamedÖ and the cough is gone

For what matters most

Diarrhoea attacks? Laremid acts!

Same relief as dramamine, less drowsy

Ketonal Lek - power and trust

Wow! That was fast!

Tabcin. Don't waste your time on flu

Up to 10 hrs comfort

Fervex. Pass it on/ Fervex. A healthy family

Start the relief. Ditch the misery. Let's end this.

No-Spa. Enjoy the moment, don't waste time on pain

Silence is relief

Strepsils. First aid in throat issues

Enjoy the relief

Number 1 during cold and flu season

Relief with a Smile

There isn't any faster painkiller

Stop Suffering. Start Living.

After Flegamina the cough will be gone

Nasacort stops more of what makes you miserable

100% with you

Satisfaction guaranteed or your money back

One medication, two benefits for your health

Live Claritin Clear. Every Day.

Acatar. My choice for a runny nose

Live Claritin Clear

SUDAFED XyloSpray HA. A break from allergy

Muddle No More

Pressure and pain are gone

The nighttime, sniffling, sneezing, coughing, aching, fever, best sleep with a cold, medicine

Stops viruses. Treats herpes simplex. Fast.

Powerful sinus & allergy medicine from the makers of Vicks NyQuil and DayQuil

Helps to eliminate sore throat EVEN in men

Serious Power

First for sick throat

Enjoy the Relief

Well-tried medication for your child

Oh what a relief it is

A wise Pole before a sore throat

Start the Relief. Ditch the Misery. Let's End This

UNDOFEN MAX KREM Brings mycosis to its knees

Mucinex In. Mucus out

The only gel effective for up to 12 h

Don't Suffer the Coughequences

Excellent for dry cough!

Serious medicine. Seriously great taste

Moms don't take sick leave, moms take Vicks / Breathe in life to the fullest

Real relief. Real fast

Runny nose will go away with the gel

Be Ready

Modern remedy for heartburn

We care for kids


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Table 4. Cont.

Advertising slogans Poland Fast acting and mild

United States The secret to feel better is simple - Simply Saline

Relief from constipation every morning

It's all in the tin

PYRALGINA No. 1 for great pain

Open Up

No pain during the day and at night

Trust in Triaminic

SOLID SUPPORT for your legs

With the decongestant pharmacist trust most and the formula our communities trust, too

AFLAVIC - It's time for healthy legs

DocuSol, That's All!

Positive effect

The overnight relief you're looking for

Fast remedy for cough

The Gas Xperts

Tantum Verde - it really works!

Fast acting

Comprehensive medicine for cold and flu Man's thing. Man's medicine

ìfast/instantî was equally frequent ñ in Poland they were present in every fifth commercial (20%), and in the United States in every third commercial (32%). In 20% of commercials of medicinal products aired in Poland there were no distinctive words. In all, there were 17 distinctive words used in drug commercials in Poland and in the U.S. (Table 3). For the purposes of comparative analysis of commercials the authors also employed the music criterion. In both countries the music used in drug commercials usually had a fast tempo (from 93 BPM). This was observed for 38% of commercials in Poland and 44% of commercials broadcast in the U.S. In Poland, the use of a shifting tempo was equally common (34%), while there were few commercials with such a tempo in the United States (10%). In over 20% of analyzed commercials from both countries music with a slow tempo (up to 92 BPM) was employed. In Poland there were few commercials with no music (4%) while in the United States every fourth commercial does not feature any music (Chart 4). The actors starring in commercials of OTC drugs broadcast in Poland and the United States were usually adults. In Polish commercials women prevailed over men (84%). Men were present in 66% of the analyzed commercials. In the United States women were present in 76% of commercials and men in 64% of commercials. In Poland there were children in 26% of analyzed commercials, and occasionally animated characters were present (4%). In 4% of cases the actors were not present. In the U.S. every third commercial featured children. In 14% of commercials there were animated characters

and animals. 8% did not feature any actors (Chart 5). When it comes to the age of the actors starring in the commercials it was found that in both countries the majority of actors were adults ñ 94% for Poland and 88% for the United States (Chart 6). In 34% of commercials broadcast in Poland there were children. Eight % of analyzed commercials did not feature any actors. In the United States, children were present in 36% of commercials. In 12% of cases in the U.S. there were no actors in the commercials. However, the commercials featured animated characters/animals (Chart 6). In 66% of commercials in Poland and in 76% in the United States there was more than one actor in one commercial. They were assigned separately to the appropriate group (women and men), which is why the total number in both analyzed cases exceeds 100%. The atmosphere in the commercials was also subject to analysis. It was found that in nearly half of the commercials broadcast in both countries the feelings were mixed. At first, the situation was presented in a negative light only to become positive after the use of the drug. In Poland this was found in 44% of the analyzed commercials and in the United States in 46% of commercials. In Poland, the opposite was observed in 28% of commercials. At first, the atmosphere in the commercial was positive then it evolved to a negative one, and finally, after drug use, the situation was restored to an atmosphere of satisfaction. In the United States, 26% of the commercials evoked positive associations. Other emotions present in commercials in both countries included: mystery and tension, happiness, insecuri-

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Chart 9. Manipulation

Chart 10. Dominant colors in television adverts of OTC drugs


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Chart 11. The presence of a recognizable character in television adverts of OTC drugs

ty. Producers in Poland rarely referred to negative associations (2%), and the American producers did not refer to them at all. Particular data on feelings are presented on Chart 7. The feelings are presented according to the incidence ñ from the most frequent to those that appeared rarely. The analyzed commercials were subject to an analysis also in terms of the setting. The setting usually employed in the commercials in both countries was home (34% of Polish commercials and 40% of American commercials). In 34% of commercials in Poland and 26% in the United States other locations were used (restaurant, airport, hotel, school, cinema, ice hockey rink etc.). In both countries 26% of commercials were set outdoors (garden, meadow etc.). In both countries the setting of around 20% of commercials was hard to determine. Six % of Polish commercials and 10% of American commercials were set in many locations i.e., the action at home, on a busy street or in a shop etc. was combined. The least popular location was the office ñ 4% in Poland and 2% in the United States (Chart 8). If any commercial was set in two places, the locations were assigned individually to appropriate groups. If there were three or more locations used in one commercial they were assigned to ìVaried (3 and more)î group. The manipulation mechanisms and techniques present in the commercials were also subjected to analysis. It was found that the most common manipulation employed in the analyzed commercials was the suggestion that medication users would not need to give up on pleasant activities/plans/work. This pertained to half the commercials broadcast in Poland (50%) and every third commercial broadcast in the United States (34%). In Poland, 18% of com-

mercials appealed to parental feelings (ìbe a good parent and give the medicine to your childî) and in the same number of commercials the drug was recommended by one person to another person. In the case of the United States, in 20% of commercials it was suggested that the drug use will help in regaining the sense of joy in life, and 16% of commercials used humor. In 4% (Poland) and 8% (the United States) the employed manipulation was not classified. All types of manipulation techniques found in the analyzed commercials of medicinal products are listed on Chart 9. The data are presented according to the incidence ñ from the most frequent to the rarest. When it comes to the analysis of the commercials in terms of the used colors it turned out that 46% of commercials broadcast in Poland and 68% of commercials broadcast in the United States did not have any dominant color. In 20% of commercials in Poland and in 16% of commercials in the United States the dominant color was blue. In Poland, 14% of commercials were dominated by red, and 12% were dominated by white. In 6% of commercials in the U.S. white and green dominated. In 16% of cases in Poland and similarly in the United States there was other dominant color (violet, yellow, grey, brown etc.) (Chart 10). Sixteen percent (Poland) and 10% (the United States) of commercials had two dominant colors. Each was assigned individually to one of the groups presented on Chart 10. If there were more than 2 dominant colors it was assumed that none of the colors predominates. The analysis also covered the used advertising slogans. It was observed that the slogans used in commercials in both countries are quite diverse.

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Only one of the commercials broadcast in the United States did not feature any advertising slogan. All advertising slogans that appeared in the analyzed commercials are presented in Table 4. They are presented in an arbitrary sequence. In 44% of commercials in Poland and 22% of commercials in the United States the advertising slogan featured the name of the drug, e.g., ìAfter Flegamina the cough will be goneî (ìKaszel minie po Flegaminieî) or ìTrust in Triaminicî. The analysis of the commercials also concerned the presence of recognizable characters who draw attention and make the commercial more memorable, e.g., Mrs. Goüdzikowa who appeared in Polpharmaís EtopirynaÆ commercials, or an animated droplet of mucus in the American commercial of MucinexÆ by Reckitt Benckiser (Chart 11). DISCUSSION The pharmaceutical market in the U.S. was estimated at $395.2 billion in 2014 (8). It made up 40% of the total value of the global pharmaceutical market (9). Americans spent about $40 billion on OTC medications in 2014 (10). The Polish pharmaceutical market seems small in comparison. In 2014, the value of the market was PLN 28.5 billion ($7.4 billion1). Poles spent about PLN 828,000 ($215,000) on OTC drugs in 2014 (11). Currently, the Polish market is the sixth largest in Europe and the largest in Central and Eastern Europe (12). In both countries the value of the pharmaceutical market increased every year between 2002 and 2012. Year 2012 changed this trend in the U.S. and in Poland, but the next year the market started to grow again in both countries (13). The prognoses for both markets are optimistic. Their value will rise for a number of reasons: aging population, development of medicine, increased health awareness in the society, increased incidence of diseases of civilization, mutating diseases and their resistance to certain drugs. In Poland it is also: improvement of the financial situation of society. In the U.S.: health reform and insurance coverage for more people and an increasing number of citizens (13). We cannot forget about one more crucial factor ñ advertising. In both countries pharmaceutical companies spend a lot of money for this purpose and are considered to be those who conduct aggressive promotion. In 2012, pharmaceutical companies in the U.S. spent more than $27.5 billion dollars on promotion and marketing, out of which $24 billion on promotion among doctors and $3.5 billion on consumer promo-

1

Dollarís exchange rate ñ $1 to PLN 3.85 (02.11.2015)

tion. For DTC companies spend 12.5% of their marketing budget (14). The United States is the only country in the world, except New Zealand, where advertising of prescription drugs may be directed to the public. In Poland, only OTC drugs can be advertised to the public. In 2013, the pharmaceutical sectorís spending to this end in the media increased by 20% and amounted to PLN 3.7 billion ($0.96 billion). The following companies invest the most in OTC drug promotion: Aflofarm Farmacja Polska (PLN 860 million), USP Zdrowie (PLN 366 million), Olimp Laboratories (PLN 171 million), Reckitt Benckiser (PLN 162 million) GlaxoSmithKline Consumer Healthcare (PLN 151 million). Their largest expenses are associated with television advertisements (15). Advertising plays a crucial role in providing the basic information about the pharmaceuticals and influencing patientsí decisions about the purchase. U.S. research suggests that the general perception of OTC advertisement is rather unfavorable (16, 17). U.S. customers watching television may see twice as many OTC advertisements as DTC ads (16, 18). Polish research shows that slightly more than a half of the respondents have positive opinion about drug ads (19). The results of a research study by Diehl et al. show that people may not rely on pharmaceutical advertising, but they tend to believe it. Additionally, they are less doubtful about their informational content compared to advertisements of other products (17). A review of the literature revealed that comparisons between the U.S. and Poland concerning OTC television advertisement had not been made before. We have identified four studies in the U.S. which analyzed the content of OTC television commercials (18, 20-23,) and three in which the content of printed OTC advertisement was analyzed (22, 24, 25). They all used different methods of analysis, which is the reason why they are described separately below. In 1997, Tsao analyzed informational and symbolic content of 150 television OTC advertisements. His study indicated that topicals, respiratory, central nervous system, gastrointestinal, nutritional medications and antiperspirants were the most frequently promoted products. He found that there were on average 3 information cues per OTC advertisement. The information in ads often highlighted benefits instead of the reasons to use the drug. Only 18% of OTC advertisements provided complete information (name and functions) about the promoted drug. Tsao was concerned about the readability and preciseness of disclosure of side effects and drug performance in


commercials. He concluded that product awareness is the primary communication goal of OTC advertisement, and commercials do not provide customers with valuable information (20). In their study Byrd-Bredbenner and Grasso (1999) were brought to a similar conclusion. OTC commercials make people believe that taking a drug is an easy, rapid and risk free way of getting rid of health problems. They analyzed the health content of advertisements broadcast during prime-time network programs for children. Twenty nine (out of 298) commercials with health content concerned drugs (25 were OTC drug commercials). All of them advised to use the drug according to directions, few named side effects, drug interactions or advised to read the instructions on the label (21). Brownfield et al. (23) analyzed quantity, frequency and placement of RX and OTC advertisements on television. They analyzed 504 hours of network TV programs broadcast in the summer of 2001. A total of 18,906 commercials were analyzed. The OTC advisements accounted for 4.8% and DTC for 2.4%. The OTC ads were more common, but the DTC were significantly longer. The length of an average OTC commercial was 21.7 s and DTC commercials lasted on average 42.1 s. The length of all commercials of high cost drugs was 60 s. The OTC commercials were usually aired in the midafternoon (2-4 p.m.) and the early evening (6-8 p.m.). The main target audience of those commercials were older adults and females. Brownfield et al. estimated that Americans are exposed to more pharmaceutical information each year compared to other forms of health information ñ for example, comparing time of doctorís visits and pharmaceutical advertising they discovered that for every minute spent with a physician Americans watch 100 min of ads (23). Faerber and Kreling (18) analyzed the content of TV commercials of drugs that switched from prescription to OTC ñ there were 98 ads of three products (before and after switching) broadcast in the period between 1996 and 2009. The OTC ads contained the same proportion of information as prescription ads, but they used more appeals (9.1 vs. 6.0). The most popular appeals were: control, convenience and long-lasting effect. That shows different marketing attitudes towards the same drug after changing the way customers can buy it (18). Similarly to other research studies (20, 21), they found out that television advertisements of OTC drugs often do not contain good informative content about drug use and the medical condition which this medicament treats. While looking for a comparison of drug advertisements aired in the two countries we

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found the Kansal (24) research that compared the U.S and India. The study does not concern television commercials but OTC advertisements in magazines. However, such comparisons seem to be unique, so it is worth a mention. The results of this study showed that the U.S. advertisements were better balanced in comparison to Indian ones in terms of the use of informative and attractiveness indications. The Indian ads had on average fewer information cues and additionally they had inferior quality. The results highlighted that in India advertisements try to attract customers by showing models or painting a nice picture by using emotional, youth, attractive, excitement appeals. The author claims that Indian OTC marketers should become more ethical and socially responsible (24). Sansgiry et al. (25) made a content analysis of advertisements from U.S. consumer periodicals. The OTC advertisements accuracy based on federal guidelines was judged independently by five clinical pharmacists. Reviewers found out that around 50% of advertisements did not contain accurate statements. Only one did mention the side effects. This study showed that the OTC advertisements did not provide customers with adequate information that would allow them to make responsible purchases. The lack of proper information can lead to harmful events (25). Main, Argo, and Huhmann (22) made a content analysis of 195 advertisements of DTC drugs, 137 advertisements of OTC remedies and 33 ads of dietary supplements from 30 national circulation magazines in the United States. They did not find any difference in the use of rational appeals between the three groups of products, although they discovered that DTC used more often positive and more negative emotional appeals than advertisements of OTC drugs and dietary supplements. DTC advertisements also contained more sex appeals than the two other groups. Additionally, 73% of OTC models were female, 20% were men and 5% were intermediate. Only 6% of models were under 18 years old, 51% had Caucasian ethnicity and 49% other (22). Our study will add some new information to those earlier research studies as it was also conducted based on a different method. Some data seems to confirm what has already been written (e.g., length of TV commercials (23); the fact that the majority of models are female (22); frequent use of the influence of emotions (20, 24)), but it also adds new information (e.g., ways of changing emotional appeals in commercials, room in which commercials take place, dominant color, techniques of manipulation).

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CONCLUSION Advertising of OTC drugs, in the rhetoric of pharmaceutical companies, serves to provide information that enables the patients to self-use specific medications for minor health problems without a prior consultation with a physician. The OTC advertising research included in this article indicates that for manufacturers it is very important that the patient memorize the name of their drug (it is much more important than remembering the name of a producer ñ in the U.S. as many as 76% of commercials do not refer to it at all). To this end, producers use ìcatchyî and ìsimpleî marketing slogans (only one ad from the sample does not contain such a slogan). The name of the drug has to be associated unambiguously with its indication for use. Most commercials linked the drug with only one indication, however, sometimes there were two indications, and in some cases there were more of them. The study presented in this article shows ways of manipulation used in commercials. It analyzes advertisements in terms of starring actors, used music, colors, distinctive words and emotional atmosphere. These elements are present in every commercial and appropriate selection thereof can facilitate memorizing the drug name, and evoke positive associations with the drug. Every day marketing specialists from pharmaceutical companies consider how the commercial will be received by viewers. Information included in this article can prove valuable for them. A proper composition of an advertisement is very important. It should be properly thought out and balanced. This is important in view of the criticism of larger drug manufacturers as they run aggressive marketing campaigns that can lead to undesirable health effects for the society (26). Critics say that there are too many commercials and they include a lot of false statements. Usually commercials show an ìenchantingî reality, promising immediate health effects shortly after consumption of the ìmagic pillî. This may lead to medicalization and pharmaceuticalization of the society. However, according to public data every year the drug industry is giving more attention to the advertising of OTC drugs in order to comply with the requirements of Polish law. In 2007 the Main Pharmaceutical Inspectorate withheld commercials 115 times, in 2010 ñ 47 times, and in 2014 ñ 7 times (27). In the U.S., the Federal Trade Commission (FTC) deals with the compliance of OTC drugs advertising. Together with the Food and Drug Administration it sends to Pharma warning letters when they violate the law. In recent years there were only a few of such warnings. In addition to these

state institutions there are also ethics committees that take care of ethical promotion of drugs. In Poland we have the Committee of Advertising Ethics and in the United States, there are organizations such as: the National Advertising Division (NAD), Council of Better Business Bureaus and the National Advertising Review Board (NARB). Future research should focus on a larger sample of advertisements in both countries and contain more information about the analysis of informative content of advertisements, for example the presence of: ways of treatment, health outcomes, side effects. It should also feature an analysis in terms of emotional, youth, attractive, excitement appeals. This would give us a greater opportunity to compare the study with research carried out earlier. REFERENCES 1. http://mbrokers.pl/marketing/reklama/formyreklam/reklama-telewizyjna (accessed on 18. 05. 2015). 2. Reisner J.: Television market in 2013, KRRIT 2013. 3. http://www.statista.com/topics/977/television/ (accessed on 05. 05. 2015). 4. Content Marketing Polska 2014, Polskie Badania Internetu 2015. 5. KPMG i IAA The television advertising market in Poland is finally turning around, Warszawa 2015. 6. Czerw A., Religioni U.: Acta Pol Pharm. Drug Res. 69, 779 (2012). 7. Czerw A., Marek E.: Acta Pol Pharm. Drug Res. 70, 769 (2013). 8. http://healthcare.globaldata.com/media-center/press-releases/pharmaceuticals/us-pharmaceutical-market-value-will-approach-550-billion-by-2020-says-globaldata (accessed on 02.11.2015). 9. http://www.statista.com/statistics/266547/totalvalue-of-world-pharmaceutical-market-by-submarket-since-2006/ (accessed on 02.11.2015). 10. http://www.chpa.org/marketstats.aspx (accessed on 02.11.2015). 11. http://www.aptekarzpolski.pl/index.php?option =com_content&task=view&id=1850&Itemid= 79 (accessed on 02.11.2015). 12. PAIiIZ: Pharmaceutical and biotechnology sector in Poland, Agencja Informacji i Inwestycji Zagranicznych SA, Warszawa 2013. 13. Makowska M.: The ethical issues in the relationship between medical students and the pharmaceutical industry. A comparative study of the situation in Poland and in the U.S., Wydawnictwo SGGW, Warszawa 2016.


14. http://www.skainfo.com/health_care_market_ reports/2012_promotional_spending.pdf (accessed on 20.10.2014). 15. http://www.marketing-news.pl/theme.php? art=1804 (accessed on 20.10.2014). 16. DeLorme D.E., Huh J., Reid L.N., Soontae A.: Int. J. Pharmaceut. Healthc. Market. 4, 208 (2010). 17. Diehl S., Mueller B., Terlutter R.: Int. J. Advert. 27, 99 (2008). 18. Faerber A.E., Kreling D.H.: J. Gen. Intern. Med. 29, 110 (2014). 19. Chaniecka K.A., Czerw, A.: Hygeia, 49, 148 (2014). 20. Tsao J.C.: J. Drug Educ. 27, 173 (1997). 21. Byrd-Bredbenner C., Grasso D.: Int. Electron. J. Health Educ. 2(4), 159 (1999).

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22. Main K.J., Argo J.J., Huhmann B.A.: Int. J. Advert. 23, 119 (2004). 23. Brownfield E.D., Bernhardt J.M., Phan J.L., Williams M.V., Parker R.M.: J. Health Commun. 9, 491 (2004). 24. Kansal P.: J. Asia Bus. Stud. 7, 140 (2013). 25. Sansgiry S., Sharp W.T., Sansgiry S.S.: Health Mark. Q. 17(2), 7 (1999). 26. http://wyborcza.biz/biznes/1,100896,17513743, My__Polacy__lekomani__(accessed on 06.01. 2016). 27. https://www.gif.gov.pl/pl/decyzje-i-komunikaty/decyzje/decyzje (accessed on 06.01.2016). Received: 4. 12. 2015