Paternalism and the myth of homo-pharmaceuticus: why the ASA ruling on Nurofen is not very people-centred.
By Tim Brooks and David Gray
The ASA’s ruling on Nurofen advertising is a setback for Nurofen/Reckitt Benckiser. It is also a fundamental body blow to the OTC industry. Now, and in the medium/long term.
But, the real denouement is that it is actually a small retrograde step in the broader approach to one of the bigger problems facing the world – the funding/management of our healthcare system. Against this issue a vibrant and effective self-medication market is not just ‘nice to have’ it’s ESSENTIAL.
And whilst the importance of the success or otherwise of a large pain brand is of no material importance, this broader issue really matters.
We are, and will continue to be, on the edge of a crisis. The developed world is caught between the rock of aging populations/technological healthcare advances and the hard place of finite resources.
In the UK prescription drug use continues to grow and service use – often unnecessary if you even take a cursory look at GP visits/A&E admissions data – is growing rapidly.
The system is run and organised by administrators, academics and healthcare professionals. They are almost blindly focused on their ‘day job’ - the supply side of the equation; efficiency, service delivery, resource management etc. We need to focus more resources on DEMAND.
For demand, we must continue to explore ‘nudge’ and service design, but in reality there is actually only one solution. A vibrant, effective and commercially attractive self-care market where manufacturers, brands and retailers/own label, are able to use unpleasant things like marketing and advertising to help people feel confident, empowered and better able to treat themselves.
We are fully aware that Nurofen’s marketing employs some smoke and mirrors in that they have a generic ingredient and they are presenting it to create a sense of difference. So, what?
We are not aware of any fundamental lies they tell in their presentation of the basic data around the performance of their product in specific pain situations. Both the MHRA and PAGB approved their approach. It is a perfectly good painkiller for joint/back pain. Its mode of action will [admittedly among other things] involve it basically treating the pain at its site.
For the record, we totally believe in regulation. We need it. The consumer needs it. Markets need it. But our approach to regulating medicine in the self-medication space is misguided.
It is driven by paternalism and an inherent belief that pharmaceutical companies don’t quite have our interests at heart. It [and most HCPs/regulators we’ve listened to/met] naively [stupidly!] believe that the route to solving the problem is information/education and a world filled with generic ingredients. A world where everyone knows what guaifenesin is. The myth of HOMO PHARMACEUTICUS is alive and well. The rational goes like this. ‘Surely if we present rational/technical data and choices to people they will make the right decisions.’ And pigs will fly. Just read any behavioural economics work of note – even if you choose not to fully believe that it is the answer to all our ills – and this approach disappears in a puff of smoke.
We don’t know who brought the complaints – a paltry 18 loud voices - not even worthy of the title ‘minority’. But it is almost certainly either HCPs or a scientifically minded ‘experts’ who understand the mode of action of an NSAID. Lucky them. They clearly feel that the average unscientific persons on the Clapham Omnibus need to be educated to see the error of their ignorance. It’s critical they are able to understand and make a rational, considered choice based on the data and act in their interests to buy the cheapest generic ibuprofen they can. Maybe…
The myth of homo-pharmaceuticus, like the myth of homo-economicis, is just that - a myth. People just don’t – and never will – work like this. And neither do they need to. It adds no value to our complicated, full to over-flowing lives.
Between us we have been involved in millions of pounds of research with real people in the area of self-medication. We have read and seen 100s millions £££ more of such data. Much of it is robust, insightful and relevant. This data is as useful in shaping our approach to healthcare as is any clinical trial. Yet, we ignore it.
So, for the record. Three fundamental things drive people’s self-selection of medical products selection in store.
- What symptoms [not ‘indications’] is it for?
- What benefit does it deliver? [What can I expect it to do for me?]
- Interestingly, even if someone buys own label/generic they use brands to navigate, to find things and to make choices. The decision to buy own label is almost entirely made before someone gets to the store.
Price and format and pack size are obviously important, but these three are key. All the extensive research we have seen highlights that ‘segmentation’ – targeting products at specific needs [e.g. specific products for headache or joint/back ache] is REALLY helpful to people who don’t understand or want, even need, to understand the technical attributes of an ‘ingredient’ [safety information notwithstanding]. HCPs can get as frustrated as they like about the logic gap in this…but, it’s behavioural and therefore they are wasting their breath.
So, the people centric, if not the clinical data, would on balance support the Nurofen approach. And again, given the way the OTC market works, own-label products are able to copy this and create a value/price alternative for people with the same segmentation. So the only ‘advantage’ a brand has is that it invests in advertising the product [a choice with risk, not an unfair advantage.] And against our need to drive the demand side of the healthcare conundrum if we make advertising of OTCs more and more unattractive the holistic situation can only get worse, not better. That’s ultimately a problem for all of us.
Further, we are seriously struggling to see how the person buying Nurofen Joint and Back is misled in a meaningful way by this advertising? The product is as good a treatment as there is available for their problem. Buying own label ibuprofen will not increase their comfort – given the placebo effect of branding it might even lessen it! They certainly wouldn’t be harmed. If manufacturers charge dramatically different prices for the same product it is a different debate. But not specifically an advertising one. Even here, brands will [rightly] get caught out in the long run if they do these things.
Conclusion. This ruling is a retrograde step. It has huge knock on effects and the ASA either doesn’t understand what it’s done, or it knows and is complicit in a paternalistic out-dated approach to the regulation of self-medication and the unhelpful ‘protection’ of ‘the consumer’. Shame on you ASA.
We need to do 2 things and do them fast.
- Put people’s actual behaviour at the heart of our approach to regulation/self-care. And, unless meaningful numbers of people are going to be seriously harmed… base policy and interpretation of regulation on this real behaviour.
- Within a clear regulatory framework change the balance between paternalism and empowerment in healthcare. We need to experiment to drive OTC demand and rightly or wrongly ONLY brands will ever have the commercial self-interest to drive this. This doesn’t need any ‘de-regulation’, just a more 21st century interpretation of the current regulations.
Let’s stop trying to make the system work for a mythical species - homo-pharmaceuticus - and make it work for real people. Nurofen Joint and Back is a small part of this equation. If it’s a good idea it will flourish and the result is more people will treat pain. If it’s not… it will wither and disappear. In the meantime, nobody would have been hurt and the fact they don’t understand prostaglandin synthesis is not a meaningful gap in their lives.
About the authors: Tim Brooks runs Muzeable a healthcare strategy consultancy and is a non-Executive Director of Creative Leap.
David Gray is CEO of Creative Leap, one of Europe’s leading healthcare branding and creative agencies.
Tim and David have worked together and in healthcare for far too long.