Efficacy Expectations and Adherence: Evidence of Consumer Biases and Heuristics in Pharmaceutical Marketing - Innovation and Marketing in the Pharmaceutical Industry - page 326

innovative package design. In fact, the representativeness heuristic (Tversky and
Kahneman 1974 ) confi rms this suggestion. Consumers may infer, for example, that a
generic brands' performance is on par with that of a brand name exemplar if the
packaging for the generic is similar to that of the branded good (Kardes et al. 2004b ).
For pharmaceutical marketers this heuristic has particularly signifi cant consequences;
the availability of generic drugs carrying a package design similar to its branded
alternative may drive consumers to infer that the generic is equally effi cacious, even
when package design and effi cacy are uncorrelated. Pharmaceutical executives have
correctly noted that packaging is steadily becoming a tool to differentiate the product
in the marketplace and build brand equity (Wade and Vrain 2005 ). The aforemen-
tioned lay theory is hence crucial for adherence, when consumers estimate the product's
effectiveness for the fi rst time and decide to initiate usage.

11.2.3.2 Inter-attribute Correlations

Aside from attractiveness, consumers also hold implicit theories of inter-attribute
correlations, such as the positive warranty-quality relationship (Boulding and
Kirmani 1993 ; Purohit and Srivastava 2001 ) or the price-quality relationship
(Rao and Monroe 1989 ; Broniarczyk and Alba 1994 ; Dodds et al. 1991 ; Adaval and
Monroe 2002 ). The latter is particularly pervasive, frequently yielding inferences
about product quality on the basis of available price information (Huber and
McCann 1982 ; Johnson 1987 , 1989 ; Johnson and Levin 1985 ; Bettman et al. 1986 ;
Broniarczyk and Alba 1994 ; Pechmann and Ratneshwar 1992 ; Rao and Monroe
1989 ). Not only do consumers tend to overestimate the price-quality relationship
(Kardes et al. 2004b ), but also tend to discount objective information that indicates
otherwise (Broniarczyk and Alba 1994 ). Expectations drive consumers to focus
selectively on cases that support the price-quality correlation and neglect or debunk
nonsupportive evidence, yielding selective information processing, especially as the
quantity of information increases (Kardes et al. 2004a ).
In the pharmaceutical products domain, Western medicines (e.g., drugs), for
instance, are perceived as fast-acting remedies whereas Eastern medicines (e.g., herbal
medleys) are expected to have a slower action course (Wang et al. 2010 ) although this
perception is more common among non- and infrequent consumers of herbal products
(Carlisle and Shafi r 2005 ). Moreover, Burke et al. ( 1988 ) found evidence of perceptions
of inter-attribute correlations driven by medication claims. That is, claims about one
medication attribute affected beliefs about another medication attribute. For example,
claims about a medicine's pain relieving effectiveness resulted in beliefs that the
medicine gives faster pain relief (or, on the other hand, quick relief claims resulted in
stronger beliefs about its effectiveness in relieving pain). Thus, consumers may infer
that a fast-acting medication (given that it is advertised as such) should be more
effi cacious than one that is perceived as having a slower time to onset. Such
beliefs may have adverse consequences for consumers and pharmaceutical companies
alike. If effi cacy judgments post use do not match or exceed the reference point, non-
adherence is probable. Consumers may prematurely abandon a prescription altogether