Abstract
Cross-cultural branding is becoming more and more important for pharmaceutical industry. This study aims to investigate how cultural factors influence branding strategies through studying Chinese Patent Medicine in the markets of Singapore, Guangzhou and Hong Kong. With data collected from interviews, observations and media information search in these three markets, this study indicates that cultural identity in target market, culture of Chinese Patent Medicine products and culture of Chinese Patent Medicine corporations are the key influential cultural factors for branding strategies of Chinese Patent Medicine products. It highlights the necessity of cultural consideration in global pharmaceutical branding.
Keywords
Introduction
Branding management in pharmaceutical industry is an ascending trend and is playing a more and more important role in pharmaceutical market. As shown in previous studies,1,2 cultural factors are influential in marketing and branding strategy, especially for multinational brands. Traditional Chinese medicine (TCM), originating from eastern culture and philosophy, provides a proper object for a further research on this topic.
Originated from 3000 BC, TCM has a strong connection with the evolution of Chinese culture. Buddhism, Daoism, Theory of Yin and Yang, as well as Chinese ancient agriculture and animal husbandry, have laid significant influence on it. In the narrow sense, the culture of TCM are the theories of TCM, containing Theory of Yin and Yang, Five Elements (wood, fire, earth, metal and water), Theory of Essence, Qi, Blood and body fluids, etc. In a broad sense, however, it reflects social background, philosophy thought, values and human spirits during the whole evolution of China and has become a part of Chinese tradition. 3
Chinese Patent Medicine (CPM) is a patent medicine based on theories of TCM and processed from Chinese herbs. For convenient employment, CPM comes with various formulations, e.g. pills, powder, paste and pellets. CPM is originally established on ‘Dialectical Thinking’, the core ideology of TCM, which is a unique cultural mixture and combination of the traditional Chinese philosophy, natural sciences and social sciences. Thus, besides the properties of medical sciences, CPM also obviously shows the cultural connotations.
However, the further spread of TCM and CPM globally met obstacles due to cultural diversity and effect. Nowadays, regions admitting and using TCM are limited to Japan, Korea, southeastern Asian countries and Chinese communities in the Western countries, which are more influenced by Chinese culture.4–10 Because of the differentiation between TCM culture and modern scientific methodology, TCM is limitedly used in the Western societies.11,12 Even in Asia, the same situation happens where cultural differences exist, which blocks the spread and development of TCM and CPM.
TCM products are highly related to culture. Meeting the difficulties of dealing with cultural factors is the priority for modernization and internationalization of TCM. 13 However, the gap of how branding management of TCM products should be carried out to solve cultural challenges still exists. Therefore, this study focuses on the influence of culture on branding strategies of CPM products. Via studying in the markets of Singapore, Guangzhou and Hong Kong, differences of branding strategies between brands and influences of cultural elements are displayed.
Literature review
Brand management in pharmaceutical industry
The history of brand management started in the 1930s by P&G. 14 However, brand management in pharmaceutical industry comes relatively late. In traditional pharmaceutical industry, the success relies mainly on three factors: R&D, patent defense and sales force. Some marketers believe that a brand is simply made by just giving a name to a certain product or adding symbolism to a product. 15 Thus, the role of branding is largely ignored, and little evidence shows that pharmaceutical industry takes long-term brand management seriously.
The late development of branding is due to the following facts. 16 Normally, decades of R&D are needed before a product reaches the market. The majority of investment goes into the R&D process, and branding management seems less important and is not paid much attention. Only when the product is close to registration, branding management is involved. For prescription-only medicine, government regulation and political intervention cause obstacles and restrictions for branding of products.
In USA, 64% of the best-known brands are over 50 years old, and 10% are over 100 years old. 17 In comparison with the fast-moving consumer goods (FMCG), the life cycles of pharmaceutical products are relatively short, measured by year rather than decade or century, which makes it more costly and complex for branding development. 15
In 2012, one trend is observed that numbers of notable blockbuster pharmaceutical products lost their patent protection, 18 indicating a change that the industry is experiencing transformation from traditional product-oriented to market-oriented. The role of branding management is becoming more vital and is to be the key to profit in the future industry.
Branding management can not only protect the brand against generic drugs after expiry of patent, but also builds values to brand, leading to tangible and intangible market benefits. 19 Branding management helps in unifying brand positioning, providing more consistent products and services and controlling cost. A powerful brand provides a platform connecting doctors, patients and consumers and makes sustainable influences on behaviours and attitudes of them.
More pharmaceutical products endorse the principles of FMCG industry. 20 Mostly, there are three types of brand hierarchies: corporate brand, therapy area brand and product brand. 21 Successful examples are like Lipitor (Pfizer), Plavix (BMS), Vioxx (MSD) and Keppra (UCB). 22
TCM is gaining enormous interest and acceptance in the recent past globally. As a high-tech industry, the CPM industry shares the same characters of chemical pharmaceutical industry in nature: high input, long life cycle, high risk, high returns, relative monopolistic and significant brand features. Due to the cultural properties, however, CPMs are more than ordinary pharmaceuticals, which lead to more differences and challenges in branding management.
Influence of culture on brand management in pharmaceutical industry
Past studies indicated that factors like language barriers, social habit, customs, ways of thinking, religions, social philosophy, social media, etc. influence brands via affecting consumers’ behavior.23–35 According to the study of Su et al., 36 marketing strategies are significantly different in the Chinese pharmaceutical market for domestic and foreign companies. Study of Aaker 37 also shows that well-informed, brand loyal patients highly influence the medical prescribers on brand and product, especially in primary medical care.
According to Geert Hofstede’s cultural dimensions theory, Chen
38
divided brand culture into three levels (Figure 1): outer layer (Brand communication system), shallow layer (Brand supporting system) and inner layer (Brand spirit core). Therefore, cultural differences between regions and countries will affect the promotion of international branding. Mainstream culture of both original and target country and culture of companies are main factors as well as language restrictions, legal constraints, limitations of media, attitude towards foreign culture and ethnocentrism.
Three levels of brand culture. Source: Chen.
27
(a) Clustering analysis of marketing strategy between products (Bule dots: BFP, the same hereafter). and (b) Clustering analysis of marketing strategy between products (Red dots: LDP, the same hereafter).

In China, brands of CPMs are categorized into four:
Category 1: Lao Zihao brands (Historic Time-honoured Brands); Category 2: Brands derived from well-known TCM product; Category 3: Brands reflecting TCM features and/or human care; Category 4: Brands with geographical characteristics, mainly named with mountains or rivers.
Besides including and presenting traditional culture in brands, now, CPM companies combine more modern elements in brand management and take more initiative and offensive strategies, in comparison with passiveness in conventional companies. Nevertheless, in the internationalization process, how to brand CPM in different cultural context still requires exploratory investigation.
Method
In this study, products of Bak Foong Pills (BFP) and Liuwei Dihuang Pills (LDP) under the brands of Beijing Tong Ren Tang (TRT), Eu Yan Sang (EYS) and Wai Yuen Tong (WYT), in markets of Singapore, Guangzhou (mainland China) and Hong Kong, are investigated as well as the branding strategies. Interviews, observations and media information searching are conducted in this study to collect information.
Information collecting
Interviews
Interviews with sales staff in CPM retail stores and marketing managers in the three companies are conducted in Singapore, Guangzhou and Hong Kong. Retail stores and pharmacies are selected randomly in each administrative division (see Table 1).
In Singapore, 46 stores and pharmacies, distributed in public rental communities, shopping malls, hospitals, touring sites in South West Community, Central Community and North East Community are selected (Chinatown and the Little India also included), among which are six stores of TRT, five stores of EYS and 35 pharmacies. Totally, 42 sales staff were interviewed, for 4–15 min. Interviews were conducted in Mandarin Chinese and English. One manager in TRT retail store was interviewed, for 21 min, in Mandarin Chinese. In Hong Kong, 37 stores and pharmacies, distributed in commercial area and residential communities in Hong Kong Island, New Territories and Kowloon are selected, among which are six stores of TRT, eight stores of WYT, seven stores of EYS and 16 other pharmacies. Totally, 23 sales staff were interviewed, for 5–10 min, in Mandarin Chinese and Cantonese. Regional manager of TRT was interviewed, for 20 min, in Mandarin Chinese. In Guangzhou, 24 stores and pharmacies, distributed in commercial streets hospitals’ surrounding areas in Tianhe, Liwan, Panyu, Yuexiu and Haizhu District are selected, among which are six stores of TRT, seven stores of WYT, five stores of EYS and 35 other pharmacies. Totally, 41 sales staff were interviewed for 5–7 min. Interviews were conducted in Mandarin Chinese. The retail store manager of TRT in Nonglin, Guangzhou was interviewed, for 20 min, in Mandarin Chinese. The administration manager of EYS was interviewed, for 20 min, in Mandarin Chinese. Summary of field study and interview.
The main interview questions with sales staff include (a) product features, target population of BFP and LDP and the differences with other brands, (b) products and brands publicity, (c) promotions, (d) sales channels, (e) local sales, (f) sales staff recommendation and (g) retail price.
The main interview questions with manager include (a) brand positioning; (b) marketing strategy and the reasons for decision; (c) local market environment’s impact on product marketing; (d) competitive advantages to other brands.
Observations
In the retail stores and pharmacies listed above, BFP and LDP products under the brands of TRT, EYS and WYT were observed. The following information was collected. The collected information include (a) product name, (b) product brand logo, (c) package, (d) specification and advertising terminology, (e) prescriptions and formulations and (f) retail price.
Media information searching
Relevant information of BFP and LDP products and the brands of TRT, WYT and EYS were collected from the news media, government websites, online forums, corporate internal publications and search engines. The collected information mainly contains (a) product advertisement, (b) promotions, (c) online sales, (d) consumers’ evaluation and (e) cooperate and product related news reports.
Information analysis
The collected information is classified into three categories of 39 indexes, namely, Modernization, Initiative and the Price including
Coding of collected information
Nonparametric analysis
Analysis was undertaken among three dimensions as product, brand and region, including
Comparison between different products under the same brand in the same market; Comparison between the same products under the same brand in different markets; Comparison between the same products under different brands in the same market.
Non-parametric analysis was undertaken to the encoded information, utilizing Mann–Whitney test and Kruskal–Wallis test, aiming at comparing marketing strategies in the whole between products, i.e. the integral differences of all indexes in three categories between products. Wilcoxon test was also used to analyse the encoded information, in order to compare the marketing tools between products, i.e. the differences of each index between products.
After the comparison above, products that are under the same brand and in the same market but show no significant difference from others were removed. Remained products were taken for further analysis. Those products remained should meet more of the rules: (a) the most common and best-selling product among similar products in local market; (b) sold in all the three markets; (c) in the latest package.
Cluster analysis of marketing strategy
Average values of indexes of ‘Modernization’ and ‘Initiative’ were calculated for each product. The average values were used as the scores for ‘Modernization’ and ‘Initiative’. In a coordinate whose x-axis is Modernization scores and y-axis is Initiative scores, clustering analysis is undertaken in three dimensions of product, brand and market. On the x-axis, 0 indicates most modern and 1 indicates most traditional. On the y-axis, 0 indicates most initiative and 1 indicates most passive.
Results
Totally, 17 products of BFP under the brands of TRT, EYS and WYT were found in the markets of Singapore (5), Guangzhou (4) and Hong Kong (8). In total, 12 products of LDP were found in Singapore (3), Guangzhou (4) and Hong Kong (5).
The mainstream products of BFP and LDP, screened via non-parametric analysis, are as follows:
TRT: Beijing Baifeng Pills (Tongren Wuji Baifeng Wan), Liuwei Dihuang Wan; EYS: BFP, Liu Wei Di Huang Pills; WYT: Bird’s Nest Pak Fung Pills, Pak Fung Pills, Youth Pak Fung Pills, Liuwei Dihuang Wan.
Comparison of branding strategies between products
Nonparametric analysis between products
Results of nonparametric analysis between products, markets and brands.
Comparison of marketing strategy between products and markets.
Marketing strategies of BFPs in SG, GZ and HK.
Clustering analysis between products
Clustering analysis showed that the distribution of LDP was more concentrated and tended to Traditional and Passive, while BFP distributed separated and tended to Traditional and Initiative (see Figure 2).
(a) Clustering analysis of marketing strategy between markets (SG). (b) Clustering analysis of marketing strategy between markets (HK). and (c) Clustering analysis of marketing strategy between markets (GZ).
Comparison of branding strategies between markets
Nonparametric analysis between markets
Mann–Whiney test showed, for the same products under the same brand, no significant differences between markets. Wilcoxon test showed, for Bird’s Nest Pak Fung Pills under the brand of WYT, significant differences between the markets of Singapore and Hong Kong in the index of Initiative (p = 0.005) (Table 3).
Clustering analysis between markets
Clustering analysis showed the distribution of products in Singapore market tended to Traditional and Initiative; in the market of Hong Kong, the distribution of BFPs tended to Initiative and no significant tendency for LWPs; distribution of products in Guangzhou market tended to Passive (see Figure 3).
(a) Clustering analysis of marketing strategy between brands (TRT). (b) Clustering analysis of marketing strategy between brands (EYS). and (c) Clustering analysis of marketing strategy between brands (WYT).
Comparison of branding strategies between brands
Nonparametric analysis between brands
Mann–Whiney test showed, for the same products in the same market, no significant differences between brands. Wilcoxon test showed, in the market of Hong Kong, significant differences between Beijing Baifeng Wan (TRT) and Youth Pak Fung Pills (WYT) (p = 0.039) (see Table 3).
Clustering analysis between brands
Clustering analysis showed that the distribution of TRT products was more concentrated and tended to Passive; EYS distributed separated with BFP tending to Initiative and LDP tending to Passive; WYT distributed separated, with no significant tendency (see Figure 4).
Evaluation system of TCM and chemical medicines.
Comparison of branding strategy among products and markets is summarized in Table 4. In general, we find significant differences between branding strategies of products under TRT, WYT and EYS in the markets of Singapore, Guangzhou and Hong Kong (see Tables 5 and 6), which could be summarized as given below:
BFPs are more positioned as modern CPM products compared with LDPs and taking more initiative marketing methods. More products take initiative marketing strategies in Hong Kong and Singapore, while all products in Guangzhou act passively in market. Diversified positioning, price and marketing methods are applied on products under one brand, especially the WYT and EYS. Marketing strategies of LDPs in SG, GZ and HK.
Discussion
The effect of cultural identity in target market on branding strategies of CPM
Brand promotion is largely the promotion of culture. Via spreading, repeating and enhancing the culture, brands try to build and strengthen the sense of identity and belonging on costumers to their products. However, because of diversity in cultural background, the sense of identity of customers in different market to brands and products varies. Along with the brand, the foreign culture will affect the target market on new entry or even lead to conflicts.
CPM is based on the culture of TCM, which is originated from Chinese philosophy. This makes CPM a representative of Chinese culture although it comes in a modern formulation. According to three levels of brand culture, due to the large differences in philosophy theories between China and the West, the main clashes of CPM culture in the Western counties are on the brand spirit core. While in Asian countries, because of more similarity in philosophy system, the culture conflicts are mainly on brand supporting system and brand communication system such as specifically speaking, language restrictions, legal constraints, limitations of media, etc.
In Singapore, the main population consists of Malaysians, Chinese and Indians. CPM is popular in Chinese community where Chinese tradition and culture are still kept among Chinese people, while Malaysians and Indians use less CPM because Malaysia was colonized by the UK and Indians rely more on traditional Indian medicine. Even within China, people treat TCM and CPM differently between regions because of herbal resources and people’s believes in theories of different TCM branches. For example, Hong Kong is in the southern part of China and is more affected by Lingnan Medicine, a branch of TCM, which leads to differences in the use of TCM and CPM compared with mainland China.
The effect of culture of CPM product on branding strategies
CPMs are rooted in the culture of TCM and follow the pattern of Yin and Yang and Bu and Xie (reinforcing and reducing). TCM and western medicine experienced different paths of development in different background. The mechanism of these two kinds also varies. Thus, the evaluation systems for Chinese and western medicine are not the same (see Figure 5). Generally, year of prescription formed, creator of the prescription, principle of prescription, region the material grows, the way drug processed, etc. are considered when evaluating a CPM. Things are different for chemical medicines. Origin and history are less important and seldom considered. Therefore, history and authority are key features for TCM and CPM and have great importance for the culture of CPM brands.
As the mainstream feature of TCM, history and authority are commonly involved in the culture of CPM brand. Descriptions like ‘Prescription for hundred years’, ‘Classic product’ and ‘Experienced prescription’ are frequently used during brand promotion. Meanwhile, as more new techniques are introduced into the CPM industry, with innovation and improvement of prescriptions, modern elements in brand culture arise. New products are invented for urban diseases. Formulations are adjusted to be easier to be taken in and carried with. Packages and appearance are changed to meet modern consuming habit and psychology. By creating modern intended culture, new CPMs aim to distinguish themselves from traditional products and to attract potential customers such as the younger generation.
In this study, BFP products showed more modern than LDPs. BFP is for gynecology diseases, which is common, but varies depending on individuals. Based on classic prescription and innovated by new ideas and technologies, different new BFP products are made to meet individual needs, where more modern cultural elements are presented. On the contrary, although formed since Song Dynasty (960–1279 AD), LDP products change little because of little differences between individuals. Patients are mainly elderly males, so keeping stable meets their living state and psychology. That is why LDPs tend traditional.
The effect of culture of CPM corporates on branding strategies
Culture of a corporation is the integration of cultures of all its products. Since CPMs are not just goods or ordinary pharmaceuticals but also representatives of the culture itself, corporation culture integrates all the various cultures and makes one unified to present to market as a whole.
Generally, corporation culture is related to the following factors: type of industry, corporation history, establishment background, founders and leaders, corporation size, situation of market, staff, legal and political environment, etc. In CPM industry, affected by Chinese and TCM culture, most corporations are traditionally oriented. Meanwhile, as innovation and development, corporations involve more and more modern factors as part of its culture.
With a history of over 300 years, TRT, the Lao Zihao (Time-honoured brand), was used as royal medicine. TRT favours its rich culture in history and treats it as the most valuable Intangible assets. The corporation culture is as ‘traditional and historic’ and ‘royal and excellent’. In comparison, EYS, the late comer with history of 130 years, prefers modern culture. By following changes of market, introducing new ideas and technologies, and adjusting product portfolio, EYS tends to create a ‘new’, ‘joyful’ and ‘considerate’ image.
It is observed that branding strategy is influenced by corporation culture. When corporations focus more on Chinese history and tradition, because the culture is restrained, branding tends to be mild and passive. When corporations emphasize novelty and innovation, branding tends to be aggressive, initiative and modern.
Conclusions
According to this study, brandings of two same CPM products from three distinct-oriented companies show differences in Singapore, Guangzhou and Hong Kong, respectively, indicating that cultural identity in target market, culture of CPM products and culture of corporations are key influential factors on branding management of CPM products. The findings suggest that branding management of CPM should base on corporations’ cultural positioning and cultural identities and features of products. Moreover, more attention should be focused on market if brands are promoted within different markets, in order to fill the cultural gap between original and target markets and to meet diversified need. For traditional CPM corporations, innovation of structure and technique should be introduced.
In order to find more on the effects of culture to branding in pharmaceutical industry, further study will be focussed on branding of TCM and CPM products in the Western markets and branding of chemistry ‘blockbuster’ drugs in the Chinese market. A comparison of TCM and chemical drugs in different cultural contexts will help to enrich our understanding of pharmaceutical branding in a globalization world.
