A Comparison of Pharmaceutical Print Advertisements Between the United States and Taiwan

Transcription

1 A Comparison of Pharmaceutical Print Between the United States and Taiwan ABSTRACT Kuan P. Chiang, University of Rhode Island This paper extends the research in cross-cultural advertising by exclusively comparing the advertising expressions in pharmaceutical print advertisements from Taiwan and the United States. The specific areas examined in the advertisements included headline, copy, appeals and English contents in Taiwanese ads. INTRODUCTION Because of the emergence of global markets, international business represents a significant challenge and opportunity for advertising. With regard to the challenge, the standardization/adaptation dilemma in many cases is likely to be a marketer's most important decision. As today, the issue of whether to standardize or adapt advertising expressions is still debated. Supporters of standardization claim that standardizing advertisements can reduce the cost and create a consistent brand image whereas the cultural barrier is the major argument from opponents (Agrawal 1995). Even though culture plays a significant role in advertising, there is no doubt that the approach for advertising campaigns whether to standardize or adapt will also depend upon the product categories. The great interest of cross-cultural advertising has generated a number of studies which have made valuable contributions to the understanding of the differences or similarities among cultures. Most of these studies evaluating the expressions of cross-cultural advertising can be grouped into two broad categories. The first category of studies has examined advertising expression across cultures that clearly have dissimilar value systems. The other category has analyzed advertising expressions in countries that have less obvious cultural differences, for example, the United States and France (Biswas 1992). Through the comparisons of Japanese and U.S. magazine ads, Hong, Muderrisoglu, and Zinkhan (1987) and Mueller (1987) have shown that some differences between western and oriental cultures in advertising expressions. Also, Mueller (1987) categorized advertisements from two dissimilar cultures by two appeals: traditional and westernized appeals. Another comparative study by Tse, Belk, and Zhou (1989), compared newspaper ads from China, Hong Kong, and Taiwan, concluded that the ads in "China emphasize utilitarian appeal... Hong Kong ads stress hedonistic values, and Taiwanese ads fall between these two." Generally, Taiwanese ads contain more white space and are still more traditional than those of Hong Kong which are perceived to be more westerner in advertisements (Pasadeos and Chi 1992).

2 In fact, these two broad categories mostly aimed at the advertising expressions on general consumer goods or services and these expressions are primarily targeted on general consumers. This paper extends the research in cross-cultural advertising by exclusively comparing the advertising expressions in pharmaceutical print advertisements (prescription drugs) from Taiwan and the United States. BACKGROUND Any kind of international marketing involves with several important environmental factors. These factors often are crucial and represent determinants of marketing success. By considering these factors, a company can monitor and predict the relevant changes taking place in the environment and further formulate strategies to adapt to these changes. These environmental factors include technology, culture, politics, regulations, and economics. In a case of cross-cultural marketing, cultural aspects are widely considered and examined. For international pharmaceutical marketing, the challenge is not only the consideration of cultural differences but also the unique nature of the industry itself. Unlike other consumers products, the pharmaceutical industry is highly fragmented and possesses some unique factors, for example, greater degree of regulations, target of promotion may not be the final consumers (health professional or patients), fair-balance requirement in which both positive and negative aspects of the product have to be presented (in the U.S.), and generally high involvement of product because there are physical and psychological consequences attached to uses of the product as well as financial consequences. First of all, the operation of pharmaceutical industry is highly regulated by authorities, namely, the FDA (Food and Drug Administration) in the United States and the DOH (Department of Health) in Taiwan. These regulations provide guidelines as how the drugs can be marketed as well as advertised. With regard to prescription drug products in America, the FDA has issued regulations for the content of prescription drug advertising. Under Section 502(n) of the Federal Food, Drug, and Cosmetic Act, 21 U.S.C. Section 352(n), the advertising of a prescription drug must contain a brief summary of the indications, warnings, contraindications and use of the product. As indicated earlier, the FDA also requires fair balance to be contained in any promotional materials. Fair balance means that any claim relating to the safety and effectiveness of a drug must be balanced by a presentation of information such as side effects, contraindications, and warning. In Taiwan, the regulation is not as stringent and specific as America's. According to the Law of Pharmaceutical Affairs (1997), the contents of advertising are defined only the inclusion of product name, dosage form, ingredient, dosage, claim, caution, package, manufacture, and address. must be approved by the provincial and municipal heath authorities before the execution. After the approval, the ads can be run for a year. that exaggerate the treatments of products or are obscene in nature will be fined heavily. It should be noted that there is no requirement of brief summary or fair balance in the Taiwanese regulations.

3 Second, the target of pharmaceutical products may not be the final consumer. Generally, there are two types of pharmaceutical products: OTC (Over-the-counter) and prescription drugs. The strategies of how to market these two products would be entirely different because generally the target of prescription drugs is physicians and the target of OTC products is consumers. The common media of prescription advertisements is medical journals. These advertisements in the medical journals are used to persuade the physicians to prescribe the medication, to remind the physicians of the product, and to convince the physicians to continue prescribing the product rather than the competing products (Taylor 1995). Because of the importance of drug advertisements, the contents and appeals used in the advertisements play significant roles. Third, historically the medical profession has been able to retain its cultural authority, economic power, and political influence in the health care system both in Taiwan and the United States. However, the practice of medicine in Taiwan definitely will differ from the way in the America because of the different health care system. The government of Taiwan introduced NHI (National Health Insurance) to cover all citizens in This program was proposed to assure the accessibility to health care at reasonable cost. With the government's control based on the "Price Reference for Medicines," the prescription drugs especially for the brand names are likely to face challenges. While the patients' awareness is relatively low, the health care providers in Taiwan still remain the superior role in the society. However, in the United States the trend of health care is moving toward to the era of managed care. There are fierce competitions all at levels such as managed care and pharmaceutical companies. One of the phenomenon among these competitions is that pharmaceutical manufactures are utilizing more DTC (Direct-to- Consumer) prescription advertising which pharmaceutical manufactures promote their prescription drugs directly to consumers (Parker & Delene 1997). As the health care system is dominated by the third-party payer system and other powerful social forces in the United States, the autonomy and dominance of doctors are decreasing (Starr 1982). It is expected that the advertisements found for this study will reflect those environmental factors as mentioned above and the reflection could be explained by the comparisons of these advertisements. The focus of this study is to examine not only the role of culture in the content of pharmaceutical advertisements but also the reflections in the practice of pharmaceutical industries within the cultures. Clearly, Taiwanese culture is dissimilar than American one. While the expressions of advertisements are examined, the main question is whether the expressions of advertisements for a specific product category such as prescription drugs among various countries can allow marketers to employ standardized advertisements worldwide. Or, is the higher degree profession such as medicine involved in the product, the less cultural boundary is?

4 METHODOLOGY Selection of Medical Journals and A content analysis of pharmaceutical advertisements from the U.S and Taiwan was performed. These ads were selected from leading medical journals in both countries from the time period of September 1996 through September Two widely-read medical journals were chosen. In the U.S., these two journals include Journal of American Medical Association and New England Journal of Medicine whereas Taiwan Medical Journal and Journal of Internal Medicine were selected from Taiwan. The primary readers of these journals were physicians. Because the numbers of advertisements in Taiwanese medical journals were far less than in American ones, the ads of ethical drugs were exhaustedly collected from Taiwanese journals. After the collection of Taiwanese ads, American ads were chosen. In order to perform a fair comparison, the ads were matched from both countries based on the same active ingredient or same generic name (not necessarily the same brand name or manufactured by the same company) and these ads were one-sided only (brief summary was excluded from American ads). Many of the advertisements reviewed occurred more than once in the journals. These repeating ads which were not identical were individually evaluated and included in the study as a separate advertisement. EVALUATION The specific areas examined in the advertisements included information content such as headline and copy, emotional appeals and rational appeals. Operational definitions of headline and copy were adapted from Smith and Visconti (1968). The types of headline included news, product claim, advice, prospect selection, curiosity, product or company name. The evaluation of copy included factual, imaginative, and emotional approach. The rational appeals suggested by Smith and Visconti (1968) were used in the evaluation of the drug product advertisements in this study and included product-related, health care professional-related, and clinical related rational appeals. Emotional appeals included empathy, humor, sex, unusual illustration, and fear. Language is one of the most important elements in term of international advertising because it is one of the tools in communications and often is the best reflection of one's culture. Therefore, in addition to the content and appeal evaluation, the language in Taiwanese ads was rated based on the following rating scale: 5: The ad is entirely presented in Chinese with only the possible appearance of brand name, manufacture name, and medical symptoms in English. 4: The ad is presented mostly in Chinese with some English contents.

5 3: The ad is presented equally in English and Chinese 2: The ad is presented mostly in English with some Chinese contents. 1: The ad is entirely presented in English with only the possible appearance of brand name and manufacture name in Chinese. Initially, five independent evaluators were employed to evaluate each advertisements using the operational definitions (for the evaluations of Taiwanese ads, the operational definitions were translated into Chinese) and five-point scale (for English content appeared in Taiwanese ads) presented above. One could expect that an advertisement may contain more than one appeal. All raters were asked to evaluate all elements (headline, copy, and appeals) applied to the definitions and then in their judgment to determine the most dominant one. It should be noted that the primary audiences of these advertisements in this study were medical professionals. Therefore, all the raters were physicians. The first two were native-born Taiwanese physicians who completed their medical education and practice medicine in Taiwan. The other two were American-born doctors, and the last one was fluent in both Chinese and English. The ads of each country were evaluated by the native raters and the bilingual rater. In case of disagreements from three raters among Taiwanese or American ads, a second bilingual rater was utilized to evaluate these ads and then the evaluations were used to find agreements with previous evaluations. Since this study was only a descriptive research, no hypotheses were tested. RESULTS A total of twenty-one pharmaceutical advertisements from both countries were evaluated. These ads appeared to have the same generic names across different therapeutic categories. Among these ads, no identical ads were found from both countries. Headline Table 1 summarizes the analysis results for headline in both American and Taiwanese ads. The significant difference between these two countries is in Taiwan the product or company name is utilized more often, approximately 43% than in America (14.3%) where usually the company name is not apparently identified. Followed by the company or product name, the product claim is used often in Taiwanese advertisements. The most common type of headline in American ads is news (38.1%).

6 Table I Headline American Taiwanese Headline N % N % News Product Claim Advice Prospect Selection Curiosity Product or Company Name Copy Table 2 shows that among the ads examined, there is no emotional approach used but 81% of factual approach in Taiwanese ads. The factual approach represents 66.7% followed by emotional approach (28.6%) in American ads. On the other hand, imaginative approach is used more in Taiwanese ads (19%) than in American ads (4.8%). Table II Copy American Taiwanese Copy N % N % Factual Approach Direct Selling Narrative Description Imaginative Approach

7 Implied Suggestion Emotional Approach Monologue /Dialogue Picture of People Appeals The appeals used in both countries are fairly proportionate between rational appeals and emotional appeal. Table 3 shows that in Taiwan the percentage of rational appeals used is 42.9% and of emotional appeals used is 57.1 % respectively. In America, the percentage of rational appeals is 38.1% and 61.9% for emotional appeal. Table III Appeal American Taiwanese Appeal Rational Appeal Productrelated Physicianrelated Clinicalrelated Emotional Appeal Empathy Humor Sex 1 4.8

8 Unusual Illustration Fear Celebrity The apparent difference shown in the table reveals that the American advertisements utilize various types of emotional appeals. The most common emotional appeal in American advertisements is empathy in which the picture of people is utilized in the ads. On the other hand, only humor and unusual illustration were used and no picture of people were found in Taiwanese ads. Instead of people's pictures, seven Taiwanese ads contain product pictures. Language content in Taiwanese ads The English content in Taiwanese ads was coded by Taiwanese native-born and bilingual raters. As Table 4 shows, approximate half of Taiwanese ads (48%) contain some English contents (other than manufacture and product name or medical terms in English). Table IV English Content in Taiwanese Ads Scale N % 5: Entirely presented in Chineses : Mostly presented in Chinese : Equally presented in Chinese and English : Mostly presented in English 0 0 1: Entirely presented in English Suprisingly, two ads were expressed only in English and six ads contain only English brand name without the presence of Chinese brand name. Discussion Although ads used in this study may not be representative of all medical ads in Taiwan and the United States, they were matched well by their generic names to make the comparisons. As mentioned earlier, both Taiwan and the United States have regulations about the contents of pharmaceutical advertisements. Undoubtedly, these regulations have the impacts on how the advertisements are presented. Despite of these regulations,

9 the findings of this study show how pharmaceutical advertisements can be differed from two countries because of cultural and environmental differences. First of all, even though in this study the target audience is physicians, the cultural difference still apply in this case and tends to be similar to the consumer behavior in the country because physicians could be influenced by the advertisements rather by their professional judgement. Research done by Lee (1993) indicated that compared with American, Taiwanese tend to feel more positive toward advertising, consider a wellknown brand name as an indication of high quality, and the quality of a product far more important than the price. Therefore, the findings of this study reveal that there is a high use of "product or company" name as headline in Taiwanese ads, leading that the company and product names in Taiwan are more prominent than in America. Secondly, the findings of this study suggest that Taiwanese pharmaceutical advertisements are still more traditional because no emotional approach of copy was rated among Taiwanese raters. The common approach is factual approach, which the facts of the product are presented. It should be noted that even though there are some emotional appeals found in Taiwanese ads, these emotional appeals only include humor and unusual illustration consisting of the largest portion among the samples. However, one should expect what humor or unusual illustration means in Taiwan could be entirely different from the view of Americans. Contrary to Taiwanese ads, American advertisements are more individual and independent oriented. IMPLICATION These findings from the study also provide implications for effective advertising communication strategies relative to levels of standardization. As the study has shown that almost half Taiwanese advertisements contain some English contents, the language barrier of medicine, particularly prescription drugs, is less than other kinds of products. In fact, most physicians need up-to-date medical knowledge of the latest treatment or technology. One of the important sources is medical journals. The United States is well known for its medical advancement in the world. Its medical journals are widely read in many countries including Taiwan and Taiwanese doctors usually prefer American medical journals rather than Taiwanese ones. Since the profession of medicine is highly internationally integrated, the implication for pharmaceutical manufactures is that there is a possibility for the idea of global branding on prescription drugs. However, the effectiveness of English content in such ads should be further examined. LIMITATION One should keep in mind that there are limitations on the interpretation of the results. First, the sample size of ads actually coded was relatively small. These ads may not be the representative of entire pharmaceutical advertisements and truly reflect the industry. Second, the content analysis was conducted by only a few raters given the operational definitions for evaluation and these raters did not necessarily represent the physicians in both countries. Clearly, even though there were operational definitions for the raters, these evaluations still depended upon the interpretation of definitions of the raters. In

10 addition, advertising expression or content is perceived differently from person to person depending upon viewer characteristics such as sex and age. Finally, since the study was focused on print advertisements, it may not be appropriate to generalize the findings to other media. One should keep in mind the regulations may affect the type of media chosen for pharmaceutical advertisements. CONCLUSIONS To author's best knowledge, no one has ever examined the differences between pharmaceutical advertisements among different countries. In a market as highly fragmented and regulated as pharmaceuticals, the question whether pharmaceutical industry can apply standardized or adapted strategy is yet unanswered. Certainly, there is a need for further studies. The task of research is not only tied with the cultural differences but also the environmental factors such as regulation and health care system between two different countries. In order to arrive at more conclusive findings, more advertisements from various medical journals need to be studied. In addition to the size of samples, there are many other potential interests, including the effectiveness of English content of prescription drug advertisements in Taiwan or other countries, and the differences between common consumer products and pharmaceutical products in terms of contents and appeals, and the behavioral difference between physicians and general consumers responding to these ads. REFERENCES Agrawal, Madhu (1995), "Review of a 40-year Debate in International Advertising: Practitioner and Academician Perspectives to the Standardization/Adaptation Issue." International Marketing Review 12(1): Biswas, Abhijit, Janeen E. Olsen and Valerie Carlet (1992), "A Comparison of Print from the United States and France." Journal of Advertising 21(4): Department of Health, Pharmaceutical Affairs, 1997: Republic of China. Taipei, Taiwan. Hong, Jae W., Aydin Muderrisoglu, George M. Zinkhan (1987), "Cultural Differences and Advertising Expression: A Comparative Content Analysis of Japanese and U.S. Magazine Advertising." Journal of Advertising 16(1): Lee, Wei-Na (1993), "Acculturation and Advertising Communication Strategies: A Cross-cultural Study of Chinese and Americans." Psychology and Marketing 10(5): Mueller, Barbara (1987), "Reflections of Culture: An Analysis of Japanese and American Advertising Appeals." Journal of Advertising Research (June/July): Parker, Betty J. and Linda M. Delene (1997), "Direct-to-consumer Prescription Drug Advertising: Analysis and Implications." The 1997 Marketing and Public Policy Conference.

11 Pasadeos, Yorgo and Mei-Chiung, Chi (1992), "Traditional vs. Western Appeals in Chinese Magazine : Hong Kong and Taiwan." Proceedings of the 1992 Conference of the American Academy of Advertising Smith, Mickey C. and Visconti JA (1968), "Appeals Used in Prescription Drug Advertising." Hosp Pharm 3:5-13. Starr, Paul (1982), "The Social Transformation of American Medicine." HarperCollins Publishers. Taylor, Stephanie D., Donald L. Sullivan, Stephen W. Birdwell (1995), "A Comparative Analysis of Prescription Drug Advertising Before and After Patent Expiration." Journal of Pharmaceutical Marketing & Management 9(4):3-18. Tse, David, Russell W. Belk and Nan Zhou (1989), "Becoming a Consumer Society: A Longitudinal and Cross-cultural Content Analysis of Print Ads from Hong Kong, the People's Republic of China and Taiwan." Journal of Consumer Research 15(4):