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By Raequel Roberts, UM News Service

MISSOULA – Most people would agree that television commercials are an irritant at worst and beverage break at best.

For Ñý¼§Ö±²¥ marketing researcher Jesse King, commercials – namely pharmaceutical advertisements – are intensely interesting and a focal point of his studies for the past several years.

Specifically, King studies how images used in those ads are juxtaposed against the stated benefits and risks of taking a drug.

“The FDA requires pharmaceutical advertisers to present both the benefits and risks of a drug in a fair and balanced manner without visual distractions,” said King, an associate professor of marketing in UM’s College of Business, who has extensively researched the field of deceptive advertising practices. “We’re looking at how the visuals are different during that risk statement relative to other portions of the ad and how that affects people’s perception of risk taking that drug.”

Spoiler alert: He and his research assistants noted lots of side-effect warnings set against scenes of grandmas doting on grandchildren, majestic snowcapped mountains and couples walking hand-in-hand on tropical beaches. One of King’s studies, in fact, is titled “Look, Puppies! A Visual Content Analysis of Required Risk Statements Embedded in Direct-to-Consumer Pharmaceutical Advertising.”

“There’s literally an ad where the lady is handing her kids puppies as they’re describing all these horrible side effects associated with the medication,” King said, “so that was where that title came from.”

Pharmaceutical advertising, as one might expect, is a big business with big impacts. In his studies, King notes that pharmaceutical companies spend $6 billion each year on direct-to-consumer ads, with every dollar spent netting more than $4 in sales. And while physicians continue to serve as the primary source of patient information about prescription drugs, direct-to-consumer marketing impacts their decisions – sometimes contrary to their initial recommendation. In one national survey, for example, physicians reported filling 69% (75 out of 108) of DTCA-motivated requests by patients for interventions that the physician considered to be inappropriate.

The United States and New Zealand are the only two countries in the world that allow pharmaceutical companies to advertise directly to consumers, King said, and although it could be argued these ads empower patients, he speculates doctors are not fans.

“You have patients coming in and asking about conditions and looking for treatments that maybe aren’t relevant to them,” King said. “There’s some evidence that while doctors won’t always give patients what they asked for, patients will usually walk out with something in the ballpark of that medication.”

For his initial study, King’s research team watched 230 pharmaceutical advertisements for 45 different drugs – typically new-to-market and expensive formulations. They employed a behavioral coding software to collect data while also manually recording metrics such as scene durations, percentage of outdoor imagery, number of people featured in a scene and onscreen motion. The work required multiple viewings of each ad and two years to complete.

“You would expect that if you’re talking about risks of taking this medication the imagery would at least be neutral or sort of congruent with that message,” King said. “But it’s the opposite. You see all this positive happy stuff going on, and one of the things we know about risk perception is that it’s based on feelings, it’s based on our emotions, so if I see happy imagery, it would make sense that it would downplay the perceptions of risk that go along with this.”

In addition to raw data tabulation, King aired commercials to audiences, with participants seeing various versions of the ads, including just the audio and just the visual.

“We found that when the visual refreshes during the major statement of risk, it takes people a second to catch up,” he said. “The visual is a distraction from what they are being told. And they can easily miss side effects that can sometimes be serious.”

King is now expanding his research, dissecting every pharmaceutical ad run in the U.S. from 2016 to 2022 – some 5,800 total. For this work he is turning to artificial intelligence.

“It’s too big to code with research assistants, so we’re using the Amazon Web Services cloud platform,” he said. “I can send off a video and get back a set of labels about how many people are on the screen at every half second, and then it gives a set of labels of what’s going on in that image. I can use that to do the same type of coding that I was doing with people, but it’s automated.”

With this comprehensive cache, King said, they plan to look deeper into advertising based on individual markets – rural versus urban for example – and identify the drugs getting the most hype.

“I’ve already been surprised at how specific some of the ads are,” King said. “It makes sense to have ones that are about high blood pressure or other conditions that are prevalent in large swaths of the population, but I’ve seen ones about very specific cancer treatments for a specific type of cancer.”

Despite the size of his study, King notes, it only touches the medium of television. There is still an enormous amount research needed on social media advertising, such as a study he completed involving Facebook drug injury ads, in which attorneys targeted ads toward the LBGTQ+ community in an attempt to recruit plaintiffs who might have been injured by HIV-prevention drugs.

“The danger of these legal ads, of course, is that someone might stop taking a medication they actually need to take,” he said.

King notes that while the FDA has set rules on what pharmaceutical companies must include in their drugs ads, the federal agency rarely enforces them.

“The FDA needs to get formal complaints to mandate changes,” he said. “It has to set a pretty high bar so it doesn’t happen often.”

That means consumers must be sage observers of drug ads, whether online or on air.

“Some advertising is more concerning than others,” King said. “The reason the medical ones are interesting to me as a researcher is that the consequences are really high. I think consumers need to critically evaluate these ads and consider the message and determine, with input from their doctors, if it’s appropriate for their health.”

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Contact: Dave Kuntz, UM director of strategic communications, 406-243-5659, dave.kuntz@umontana.edu; Jesse King, UM associate professor of marketing, 406-243-6461, Jesse.King@mso.umt.edu.