Abstract
Introduction
Led by increased access and availability to the Internet, the number of Americans searching for health information through traditional and nontraditional sources has greatly increased in recent years. Consequently, the Internet has become a vehicle of information for professionals and consumers alike. 1,2 At least 10 million Americans turn to the Internet daily for health information for themselves and for others, 3 –5 representing a major outlet for active and personalized engagement in healthcare. 6,7
The majority of online health information seekers report satisfaction with what they find, saying they better understand how to treat an illness after their searches. 3,5 Many utilize unique arenas such as symptom searches, specialized support groups, and direct online interaction with health professionals, combing through a wealth of information that tailors to their needs. 2,8 Despite much promise, health information disseminated on the Internet continues to pose some problematic situations. Health information overloads, medical jargon, inaccurate or misleading information, and lack of accreditation or regulation represent a slice of problematic areas in online health information. 2
Still, the Web continues to be a substantial environment for the cultivation of health information. As such, the Internet also serves as a platform for commercial organizations, such as pharmaceutical companies, to provide information to consumers. 9,10 With substantially fewer costs associated with advertising and dispersing information on the Internet as opposed to traditional mass media, the Web has provided a rich access point for pharmaceutical companies. Such efforts have the potential to improve health literacy and, subsequently, health outcomes. 10 Conversely, pharmaceutical Web initiatives may also be driven by profiteering, 11 possibly leading to the promotion of biased health information.
The explosion of health information online presents a host of new opportunities, both for consumers looking for relevant health information and for health businesses to market their products. The purpose of this article was to investigate press coverage of a particular instance of health marketing online—the joint promotion of the Roche Laboratories Inc. (Roche) flu treatment Tamiflu through its nonbranded
Literature Review
DTC Prescription Drug Advertising
DTC advertising of prescription drugs is a norm that has been adopted and popularized in the United States in recent years. 12 The U.S. Food and Drug Administration (FDA) provides general guidelines for DTC advertising in the United States, which are generally more relaxed than the stringent regulations in other regions of the world such as the United Kingdom and the European Union. 12
The practice of DTC prescription drug advertising in the United States has fueled a number of critical reviews and debates both for and against the practice. 12 –15 Supporters of pharmaceutical DTC advertising note a multitude of possible benefits, including patient education, promoting wellness, improving economic outcomes, improving drug treatment compliance, and improved patient–physician relationships. 12,16 Critics argue that the method is pure marketing, puts pressure on patients and physicians, provides potentially unbalanced information, damages the patient–physician relationship, promotes unnecessary fear and doctor visits, increases patient risk from new drugs, leads to overspending, and diverts funding from research. 11,17 –19
The pharmaceutical industry continues to grow at a phenomenal pace with sales expected to reach nearly $1 trillion in 2013. 20 Such a market lends to the continuation and expansion of current advertising strategies, including exploration of Internet channels for communicating directly with consumers—pharmaceutical companies have begun embracing more cost-effective online promotions. 21 Although initially slow to move into the online movement, largely because of tightening restrictions from the FDA, pharmaceutical companies are spending greater portions of their DTC dollars on the Internet. 22 Such efforts include exploration of social media as well as more novel approaches such as Pfizer's interactive online advertising game design to promote Viagra—the first of its kind for a drug maker. 23 As a signal of the gray area of restrictions to online pharmaceutical advertising, the game was pulled after a warning letter from the FDA, which considered more interactive online approaches by drug makers to be conflicts of interest. 23
Such efforts have led researchers to investigate pharmaceutical companies' online advertising efforts, though research in this area has been relatively sparse. Griffiths et al. 10 noted that pharmaceutical Web sites typically failed to report the identity, institution, or credentials of the authors of their Web pages, sometimes burying such information underneath layers of text and links. More recently, Gomez et al. 24 reported similar findings in their analysis of pharmaceutical Web sites, finding that companies tend to place a superficial emphasis on disease(s) in favor of promoting drugs; the same study noted that Web sites fail to properly identify their sources of information 85% of the time and that >40% fail to indicate that their information is not a suitable replacement for actual medical advice.
As pharmaceutical companies continue to investigate use of the Internet as an advertising medium, they encounter less pushback from the FDA. The number of warnings received by drug makers for a variety of consumer-related issues dropped from 142 in 1997 to 22 a decade later. 25 Heeding the request of companies for more specific requirements, the FDA began requiring information about drug risks on Internet banner advertisements in 2009. 26 Given the relatively minute amount of space provided for such ads, most companies were forced to pull their campaigns, but this has not spelled the end for advertising efforts online. Instead, more creative approaches are being initiated, such as GlaxoSmithKline's launch of its own YouTube channel in 2009. 22 GlaxoSmithKline also created a nonbranded microsite and accompanying YouTube channel as part of its efforts to promote its cervical cancer vaccine. 27
Other campaigns have woven their online efforts with those of existing popular media, such as a joint promotion between Roche and its flu vaccine Tamiflu and the Warner Bros. Pictures movie Happy Feet. The animated film, which tells the tale of a wayward, tap-dancing penguin, grossed more than $380 million and, subsequently, won a 2007 Academy Awards Oscar for Best Animated Feature Film.
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The joint promotion linked Happy Feet and the nonbranded flu education Web site
Given potential confusion over the link between Roche and FluFacts, it is worth studying the outcomes of Roche's Tamiflu media tactics to examine the actual media coverage of the FluFacts–Happy Feet joint promotion. A prime reason such an examination is essential is the potential role journalists could play in clarifying the promotion for healthcare consumers, particularly considering that press coverage of the joint-marketing effort was likely one goal of the campaign—to use public relations to achieve free media exposure of the FluFacts Web site, with news coverage describing FluFacts as an educational resource. The purpose of this study was to investigate the media coverage of the FluFacts–Happy Feet joint marketing effort.
Materials and Methods
To find all news articles covering the FluFacts–Happy Feet joint marketing effort, a search was conducted using Lexis Nexis, Google News, Factiva, and Academic OneFile using two-phrase combinations of the search terms “Happy Feet,” “FluFacts,” and “Roche.” Duplicate articles (e.g., the same article in the same publication appearing in searches of both Lexis Nexis and Google News) were eliminated. This search yielded a total of 29 unique articles (n = 29) related to Happy Feet and FluFacts, all of which were published between October 29, 2006 and December 5, 2007. Fifteen of the articles appeared in 2006 (October, 2; November, 6; December, 7). The remaining 14 appeared in 2007 (January, 4; March, 2; May, 1; July, 1; November, 4; December, 2). Happy Feet was released in the United States on November 17, 2006. Table 1 provides the headlines, dates, and sources of all publications included in the study sample.
Articles Included for Study
A coding guide was developed to assess various important elements of the articles covering the joint marketing agreement between
Article Elements and Prevalence
Two coders for this project were trained to use the coding guide to assess articles in the study sample. After several rounds of practice coding and training, the two coders independently coded the entire sample of articles and achieved intercoder reliability measured by Cohen's kappa of 0.98 averaged across all variables, which is greater than the 0.75 value representing excellent intercoder agreement.
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The remaining disagreements (e.g., whether or not a particular article explained
Results
Of the articles included in the sample, most (44.8%) were, in general, interest news outlets (e.g., The New York Times) or marketing and advertising trade press (44.8%), with the remainder in entertainment news outlets (10.3%).
The majority of articles included the information that Roche operated FluFacts (51.7%) and mentioned the product Tamiflu (58.6%). The majority of articles described the FluFacts–Happy Feet linkage as a marketing effort (86.2%), and a small number explained that FluFacts was a nonbranded Web site (13.8%).
Almost half (48.3%) reported that FluFacts was an educational resource for flu information; yet, no articles mentioned other antiviral medications (e.g., Relenza) or nonmedical options for preventing the flu (e.g., washing hands, using tissues). None of the articles included the fact that antibiotics are ineffective in treating the flu, even though this information is on the FluFacts Web site. Similarly, no articles included actual health information from other sources (e.g., a physician or public health official) or information about other resources readers might use for health information (e.g., the Centers for Disease Control Web site). Only one article included other medical methods of preventing or treating the flu.
Finally, almost a quarter of the articles (24.1%) provided a call to action—telling readers to visit FluFacts or providing a link for them to do so. Table 2 provides additional details about the percentage of articles containing various elements in the general news, marketing and advertising, and entertainment categories.
Discussion
Almost all articles covering the Happy Feet–FluFact joint marketing effort acknowledged that it was a marketing effort, and over half reported that FluFacts was operated by Roche and mentioned Tamiflu. None of the articles included in this sample mentioned other antiviral medications that compete with Tamiflu or nonmedical options for preventing the flu. No articles included health information from other sources or other resources that readers could go for more information, and a quarter of the included articles provided readers with a call to action to visit FluFacts.
This research represents an important contribution to the existing literature on DTC prescription drug advertising efforts online 10,24 by examining a unique, large-scale campaign that may be a trendsetter for future DTC efforts and online marketing. The project also investigates the relationship between DTC campaigns, online health information resources, and mainstream media coverage, thereby assessing the earned-media effectiveness of pharmaceutical-related advertising and public relations. Research into this campaign serves as an initial step toward future work continuing to investigate how journalists cover such marketing efforts—particularly because media coverage of novel marketing campaigns may frequently be one of the goals of these campaigns.
The data raise important questions about the quality of existing reporting across multiple genres (i.e., general news, marketing/advertising, and entertainment). Half of the articles, for example, fail to mention the commercially driven sponsorship of the FluFacts site, a factor that could be essential for consumers seeking health information. A quarter of the media content includes a call to action encouraging readers to visit the site but does not pair that recommendation with any discussion of an alternative to the content on
Criticism of the content of news articles included in this sample must be tempered by the varied audiences journalists were writing for, of course. A journalist covering the advertising industry, for example, might include information about this novel Roche campaign and include a link to the Web site for readers, but the “call to action” in that case is to view a potentially interesting advertising campaign and not to view a reliable source of health information. This suggests that future research investigating media coverage of online DTC advertising campaigns (or other health information campaigns) would benefit from focusing on differences that might exist because of the primary audience of the journalists. Additionally, it may be beneficial to interview journalists writing these different kinds of articles to determine what they feel their responsibilities are to provide balanced health information when covering this kind of DTC advertising campaign.
Future research would do well to focus on actual health consumers' reactions to nonbranded prescription drug advertising campaigns. Such work could help improve the design of disease awareness education campaigns, increasing the public health benefits of these campaigns and also helping improve consumers' understanding and compliance with conditions and treatments. This is particularly important for lower health literate audiences who might have reduced access to medical providers and benefit from additional sources of health information. 31 Similarly, investigations into how consumers read and process journalists' coverage of DTC advertising campaigns—particularly those designed to be novel and garner free media coverage—is crucial to inform how professional journalists should be writing about such marketing efforts.
In addition to research focused on mainstream journalists' coverage of DTC advertising campaigns such as the Happy Feet–FluFacts promotion, it would be useful to investigate how other online channels—blogs, online communities, and social media—react to these mainstream journalists' articles. It is possible that these online channels might serve to balance and correct journalists' mistakes (e.g., providing critical information that an article may have omitted), but they may simply help increase the reach and readership of the original articles without any critical analysis—further advancing the original agenda of DTC campaigns designed to achieve such free media coverage. Again, such research should also consider the different audiences of these online channels (e.g., advertising professionals vs. general health consumers) to sufficiently consider nuance in what should be expected of news coverage.
Regarding the policies surrounding DTC drug advertising online, the use of nonbranded disease education Web sites merits additional consideration. This is particularly the case given that in this case FluFacts does not make it clear that Roche operates the site, and many journalists reporting on the Happy Feet–FluFacts marketing effort failed to note this in their articles. Existing literature already points to the problems DTC advertising campaigns present to consumers, 32 –34 and nonbranded disease awareness Web sites present unique problems to healthcare consumers, such as determining the source, credibility, and agenda of the Web site. The potential problems can be further exacerbated when integration with entertainment media such as movies serves as a platform for free media coverage, and journalists fail to make consumers aware of the nature of these health information resources.
In considering implications for research and policymakers, it is important to recognize the limitations of this project. The primary limitation is that this research was focused on a single novel marketing effort and media coverage of that effort, such that generalization to other marketing campaigns—and media coverage of those campaigns—may not be possible. Additional research into the mediated communication of prescription drug advertising campaigns is necessary to complement these study findings.
DTC advertising of prescription drugs online is likely to increase in the coming years, and the debate regarding such efforts is likely to echo the benefits and concerns related to DTC advertising via old mass media channels. These online marketing campaigns also raise new issues, however, such as the use of nonbranded disease education Web sites that may obscure the source of the information and novel advertising tactics designed to attract journalists' attention and earn free media coverage. This project was an investigation of a particularly novel joint promotion linking a blockbuster movie and nonbranded DTC advertising Web site, and research must continue to focus on DTC prescription drug advertising online and the mediated communication about these campaigns—the findings will inform the policymakers' regulations of these campaigns and potentially improve the practice of DTC advertising online to benefit healthcare consumers.
Footnotes
Acknowledgments
This research was supported by The University of Texas at Austin College of Communication.
Disclosure Statement
No competing financial interests exist.
*
Roche assumed control of Genentech in 2009, also assuming the Genentech name. At the time of the Happy Feet campaign, the ownership of the site belonged to Roche.