The United States, along with New Zealand, is one of only two countries in the world that allows direct-to-consumer marketing for medications and drugs. What’s more, drug companies have gotten good at it: according to a study from 2000, every $1 spent on direct advertising yielded a return of $4.20 for the manufacturer. That’s a lot of incentive for companies to invest heavily in television and radio – but, even with so much at stake, manufacturers have always found it difficult to find the right tone for drug commercials.
How do you explain the benefits of your drug – and possible side effects – without sounding scary, overwhelming, or off-putting? How do you convince potential consumers of your drug’s effectiveness without making false – and thus illegal – promises? Targeting people whose health may be suffering is tricky and our natural inclination to shy away from difficult issues involving illness and medicine means every aspect of advertisements has to be – like Goldilocks' porridge – just right. Focus too much on the negatives and you put people off. Focus too much on healthy lifestyle – or your drug’s effectiveness – and you can confuse consumers and end up in trouble.
More and more, drug companies are turning to cartoons and animations to get their message across, inventing characters to represent everything from patients and medications to symptoms and mental conditions. There’s no law against using cartoons to advertise drugs, but earlier this month, the FDA announced that it was concerned about the mixed messages of the animations and has decided to study their use. To do that, the agency plans to run two studies, both using fictional drugs with varying side effects. Presumably, the FDA will monitor how well test panels take in and retain information when it is presented in different ways and will hopefully find out once and for all whether bubbly cartoons distract from the facts. As the FDA puts it:
“Personifying animated characters may interfere with message communication. Although personification may increase involvement with the characters in the ad … it may not increase involvement with the message itself.”
The message itself: that’s what matters here. Does a cartoon help us understand the serious implications of certain medicines? Or is it muddying the message, making things seems safe and warm and ultimately confusing?
Now, there’s two ways to look at the FDA’s public notice: on the one hand, some will be concerned that the FDA will just add another level of bureaucracy, delaying public awareness about important new drugs. On the other hand, this review may be long overdue and could bring some welcome oversight to a muddled and often contradictory part of the pharmaceutical business.
The FDA’s notice starts by pointing out that:
“To our knowledge, no studies have comprehensively examined how animation affects consumers’ benefit and risk perceptions in drug ads.”
It’s clear that the FDA’s biggest concern is how consumers react to animated ads and whether they’re being misled, confused or distracted by the cartoon characters. It’s an understandable worry: in one Zoloft commercial, in which depression is presented as a sad-faced blob, critics have pointed out that the blob goes from downtrodden to happy and smiling as soon as Zoloft is mentioned – presenting a false picture of Zoloft’s impact on those with depression. The blob also gets happy and excited right around the time Zoloft’s side effects are listed by the narrator, which could act to distract viewers from paying attention and gaining an accurate image of the drug.
These might seem like little things, but when it comes to prescription medications, consumers need to be as informed as possible – and more often than not, manufacturers seem to be doing as much as they can to withhold information and present only one side of the story. That, says the FDA, is why it wants to investigate how consumers react to animations and how well they take in information when it’s presented by cartoons.
Cartoons – But Not as We Know Them
Drug manufacturers have been using animations to sell their drugs for years. The general view is that cartoons present a warm, friendly face to uncomfortable topics and let the companies place their products right at the center of the story by showing them literally acting on screen. The New York Times has written before that “[t]he commercials' appeal may lie in their simplicity: childlike animation and elementary-school explanations of mental illness.”
People like the Zoloft blob: they want to buy stuffed toys of it and see it in more adventures, overcoming depression easily and conclusively. That gives the makers of Zoloft, or any drug that manages to build such brand awareness, a crucial opportunity to turns viewers into customers. Medication-as-product is controversial enough – remember that the vast, vast majority of countries don’t allow direct advertising – so it’s easy to see something insidious in cutesy characters being used to push anti-depressants and other very serious drugs. Even the idea that there can be brand awareness about a prescription drug sits uneasily with many people.
There are other problems, though.
A 2003 advertisement for Lamisil, a prescription drug for nail infections, features a toad-like cartoon infection, complete with a Brooklyn accent, fighting a towering Lamisil tablet. While this distracting imagery plays, important information appears in text at the bottom of the screen, easily missed by distracted viewers.
“The eye trumps the ear” as the New York Times put it – though in this case, the text isn’t even read aloud by the narrator, making it even less likely that the information will be retained by viewers. This is what the FDA fears – that in among all the gimmicks, the cartoon infections and friendly faces of illness, consumers simply aren’t learning the facts.
Other examples aren’t hard to find.
A series of Abilify advertisements present depression in various ways – as a black cloud, as a robe that follows the narrator – using pastel colors to show a calm, controlled environment, with a doctor appearing to help the patient get free. As side effects are listed, reassuring animated scenes play out: the family has a picnic, hangs out in their garden, and it’s smiles all around. The reality of what’s being presented – that Abilify is not a golden cure, that it comes with hefty strings attached – is easy to miss. In a more extreme case, a calming advertisement for Lunesta follows the glowing, quasi-magical “Lunesta butterfly” as it visits sleep upon struggling souls, while the narrator lets us know that incidents of Lunesta patients “driving […] without remembering it the next day have been reported.”
Call me old-fashioned, but maybe they should focus on that a bit more. In all these commercials, we come back to the same problem: drugs and health are complicated, difficult topics – and they require us to focus on uncomfortable things that don’t have an easy way of being presented. Cartoons, characters, and soothing music makes things better – but are they doing so at the expense of doing things right?
The FDA’s decision to look into this makes sense and it comes at the right time. With the Affordable Care Act, millions of previously uninsured consumers suddenly found themselves with access to prescription medications. The pharmaceutical business knows this and there’s now as estimated 80 drug commercials for every hour of television in the United States. If there’s a way to make their products less threatening, to increase brand awareness (and loyalty?) and to brush over awkward truths, you can bet drug makers will exploit it. If that negatively impacts consumers, the FDA has every right – and, in fact, an obligation – to step in and regulate if necessary. In announcing its investigation, the FDA stated that:
“The extent to which emotional responses can be fostered by animated characters is especially relevant to this study, as the positive effects these animations induce might transfer to the brands being advertised. It is also possible that animated characters may lead to lower perceived risk by minimizing or camouflaging side effects.”
That, in a nutshell, is the problem – but it will be up to the FDA to find an answer.