The malleable effect of name fluency on pharmaceutical drug perception

Introduction

Imagine that a patient is browsing through the over-the-counter (OTC) medicine aisle at a supermarket in order to purchase a drug that can treat his or her symptoms. Similar to cases of other products sold at the store, the patient’s drug purchase decision would be influenced not only by the recommendations from others (e.g. health-care professionals), but also by other factors such as advertisement, brand name, price, and even package design. Extending the range of factors which affect how a pharmaceutical drug is perceived and evaluated by patients, Dohle and Siegrist (2013) recently showed that the complexity of drug names can play an important role in the patient’s perception as well as purchase intention. Their finding is built upon the psychology literature on the role of metacognitive experiences as information (for a review, see Schwarz et al., 2009).

According to the literature, human judgments are influenced by not merely what people think about (i.e. information content) but also how the information is mentally processed—the metacognitive experiences that accompany an individual’s thought process. One form of such metacognitive experiences is fluency with which new information can be processed. In fact, a wide range of variables (e.g. presentation duration, figure-ground contrast, amount of previous exposure to the stimulus and consistency between the stimulus and its context) has been shown to influence fluency (see Winkielman et al., 2003 for a review). According to prior research on the role of metacognitive experiences as information, the feeling of fluency informs a wide variety of judgments, such as judgments of effort, familiarity, truth, risk, and beauty (Schwarz et al., 2009). Furthermore, it suggests that the influence of processing fluency on an individual’s judgment cannot be predicted without knowing how the individual interprets the fluency experience at the time of judgment making. Different variables (e.g. presentation conditions, prior exposures to the stimulus) influence the fluency, resulting in similar phenomenological experiences; hence, the meaning of the fluency experience is open to subjective interpretation. Furthermore, the interpretation that people make depends on which of the many applicable naive theories (e.g. common intuitive beliefs about self or external world) is brought to mind by the current context, such as the judgment task at hand (Schwarz, 2010). For example, one naive theory on familiarity and fluency asserts that familiar (previously seen) material is easier to process than unfamiliar (novel) material. Accordingly, when people are asked to make a familiarity judgment (e.g. Have I seen this target material before?), they erroneously conclude that they have been previously exposed to the judgment target if it feels easy (rather than difficult) to process the target information, even when the fluency is actually caused by other variables (e.g. visual clarity in presentation) that are irrelevant to the previous exposure (Whittlesea et al., 1990).

This “familiar-things-are-fluently-processed” intuition has been shown to underlie the influence of fluency on other inferential judgments as well, including assessments of risk, social consensus, and truth (e.g. McGlone and Tofighbakhsh, 2000; Song and Schwarz, 2009; Weaver et al., 2007). For example, prior studies in risk-related judgment domains portray that difficult-to-pronounce (disfluent) names increase the perceived risk of ostensible food additives (Song and Schwarz, 2009), make investors predict poorer stock performance (Alter and Oppenheimer, 2006) and are associated with lower levels of breadth of ownership and lower share turnover for companies (Green and Jame, 2013). Along the same line, Dohle and Siegrist (2013) indicated that pharmaceutical drugs with disfluent names (e.g. Cytrigmcmium) are perceived as being more hazardous than those with fluent names (e.g. Calotropisin).

Then, does high processing fluency always result in positive judgments and evaluations? Despite the fact that a large body of past research on fluency effects has demonstrated that high fluency leads to favorable evaluations and judgments, recently, some studies have begun to report reversed fluency effects. Pocheptsova et al. (2010) discovered that low fluency (e.g. product descriptions printed in difficult-to-read font) enhanced the evaluation of products in the domain of special occasion goods, such as gourmet cheese (vs regular cheese). This positive effect of disfluency occurs due to disfluency signals, which indicate that such products are infrequent. Furthermore, in the domain of special occasion goods, product traits, such as uniqueness and uncommonness, are positively evaluated. In Galak and Nelson (2011), people with utilitarian reading goals (vs hedonic reading goals) judged disfluent information content to be of higher quality, because when the goal of reading is to obtain new knowledge, people expect the information content to be difficult (rather than easy).

In line with the increasing number of studies discovering the reversed fluency effects, the aim of this study is to identify a new domain of product traits, where low fluency may be interpreted positively, namely, a product’s technological advancedness. In doing so, this study intends to enhance our understanding of the role of fluency in patients’ perception of pharmaceutical drugs. In high-technology industries, such as biotechnology and pharmaceuticals, medical instruments, and computing and electrical machinery (as opposed to low-technology industries, such as foods, apparel, and furniture), R&D and technological advances are of critical importance to product improvement and success. As advanced high-tech products are generally associated with the perceptions of being new, novel, cutting-edge, and complex, the disfluency that signals unfamiliarity and complexity may positively influence the perception of technological advancedness. Extending the work of Dohle and Siegrist (2013), this study demonstrates diverging (i.e. positive and negative) inferential judgment outcomes on pharmaceutical drugs with identical names when people make inferences on the “risk of side effects” versus “technological advancedness” from their feeling of fluency.

Method

A total of 88 undergraduate students (43 men, 45 women) at a large US university participated in this study; each participant received a course credit for his or her participation. All participants completed a computerized questionnaire, in which they were told to imagine that they were reading a US Food and Drug Administration (FDA) report on new drugs from some pharmaceutical companies. Each participant sat in front of a computer screen that displayed four ostensible pharmaceutical drug names one at a time in a random presentation order across participants. Following the operationalization of name fluency used in prior research (e.g. Green and Jame, 2013; Oppenheimer, 2006), two short, easy-to-pronounce names were used as fluent names (Halpam and Temolin) and two long, difficult-to-pronounce names were used as disfluent names (Halyazeoiipam and Theophylliane). Those names were chosen based on a pretest. The participants were randomly assigned to one of the following two product attribute conditions: “advanced technology” versus “risk of side effects.” In the risk attribute condition, participants rated the perceived risk of the drug on a 9-point scale (1 = no risk, 9 = very high risk) for each presented drug name, while the participants in the technology attribute condition rated the perceived advancedness of the drug (1 = not at all advanced, 9 = very advanced). Following the initial attribute judgment task, each participant was asked to guess the likelihood of the drug to be approved by the US FDA for pharmaceutical use and sales in the US market (1 = not at all likely, 9 = very likely).

Results

Judgment on risk versus technology attribute

Repeated measures analysis of variance (ANOVA) revealed a significant main effect of name fluency on the product attribute perception (F(1, 86) = 36.12, p < .001), as predicted. Most importantly, the results revealed that in the technology attribute judgment condition, drugs with disfluent names were perceived to be more advanced than those with fluent names (M_df = 5.51, standard deviation (SD_df) = 1.26 vs M_f = 4.65, SD _f = 1.16; t(42) = 4.43, p < .001), thereby providing the first evidence that name fluency can in fact influence the perception of advancedness. In the risk attribute judgment condition, by theoretically replicating the findings of Song and Schwarz (2009) and Dohle and Siegrist (2013), the drugs with disfluent names were perceived to have a higher level of risk than those with fluent names (M_df = 5.98, SD_df = 1.26 vs M_f = 5.16, SD _f = 1.16; t(44) = 4.09, p < .001). Figure 1(a) shows these results. In addition to the key findings, there was also a significant interaction of attribute and product name replicate (F(1, 86) = 9.89, p < .01). This interaction reflects a difference in product perceptions across different product names independent of name fluency (i.e. irrelevant to our key hypotheses pertaining to name fluency); hence, it is not analyzed further.

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Figure 1.

(a) perceived risk (left) versus advancedness (right); (b) perceived likelihood of FDA approval.

Discussion

In line with the growing number of studies reporting the reversed fluency effects (e.g. Galak and Nelson, 2011; Pocheptsova et al., 2010), this study conveys that the name fluency effect on patients’ perception and evaluation of a drug is contingent on the specific context of judgment that determines how fluency is interpreted. According to the findings, when a patient is browsing through the OTC medicine aisle and comparing the alternatives, new drugs with less fluent names may be evaluated negatively if his or her primary decision goal is to avoid any side effects. However, if his or her primary decision goal is to buy an advanced drug (which is commonly associated with being faster, stronger, and more effective, as typically described in “advanced formula” drug advertisements and product descriptions), then new drugs with less fluent names may be evaluated more positively than those with more fluent names.

The general rule of thumb in naming a product or brand is that names should be easy and simple because such names are easier to spell, pronounce, and remember. However, in the case of naming pharmaceutical drugs, following the general rule does not seem as easy as in other product domains. The reason for the difficulty is because naming a drug involves determining its chemical, generic, and brand name, and moreover, there are many regulatory constraints (e.g. Gundersen, 1998; Lambert et al., 2005; Wick, 2004). The current research findings suggest that the simplicity or complexity of a drug name should be taken into consideration in naming a new drug, not only due to the practical and legal constraints, but because name fluency can affect patients’ perceptions and evaluations. In addition, as fluency-driven misperceptions of important attributes (e.g. risk or advancedness of the drug) can potentially influence patients’ medication-use behaviors (e.g. Mohan et al., 2012; Pineles and Parente, 2012), such as overdose, underdose, and drug combinations (Dohle and Siegrist, 2013), health-care professionals should better educate patients as to how to choose drugs as well as how to follow medication instructions appropriately.

Finally, there are some limitations in this study. As all participants were students, the generalizability of the findings beyond a student sample needs to be tested. In addition, although the participants’ willingness to buy would be likely to mirror their judgments and predictions on the drug’s advancedness and FDA approval likelihood, it needs to be directly measured in order to conclude that fluency-driven risk and advancedness perceptions influence behavioral intentions as well. Finally, the statistically non-significant simple contrast on the perceived FDA approval likelihood between fluent versus disfluent names in the risk attribute judgment condition may be due to the following common knowledge: no FDA-approved and marketed drugs are risk free. Hence, an evaluative judgment (e.g. perceived quality) or behavioral intention, as a subsequent judgment task, may be able to better capture a statistically significant difference.

In conclusion, this study contributes to the literature on fluency effects by expanding the range of contextual variables which can reverse the typical fluency effect and, more importantly, providing the first evidence that the fluency associated with a high-tech product’s name can influence its perceived advancedness. In particular, the present research findings emphasize the importance of considering name fluency when naming a new pharmaceutical product because name fluency may influence patients’ subjective perceptions and evaluations of the product, which can potentially affect their medication purchase and use behaviors.