Efficacy Expectations and Adherence: Evidence of Consumer Biases and Heuristics in Pharmaceutical Marketing - Innovation and Marketing in the Pharmaceutical Industry - page 331

11.3.1 Placebo and Placebo-Like Effects

People are often unable to evaluate the quality of a treatment accurately even after
starting the medicinal regimen (Pinto and Leonidas 1994 ; Pontes and Pontes 1997 ).
In such situations, effi cacy expectations, rather than the active ingredients of the
medication, may become infl uential for achieving health outcomes via an
expectancy- confi rmation (or disconfi rmation) route. An interesting phenomenon
that unites the role of effi cacy perceptions in the awareness and trial stages is the
placebo effect: expectations that the medication will be (in)effective lead to actual
(in)effectiveness of the medication (Stewart-Williams and Podd 2004 ). In fact,
researchers argue that any response to a medication may be partly due to the active
ingredients of the drug and partly due to the placebo effect (Stewart-Williams and
Podd 2004 ). However, research also suggests that misconceptions and overly
optimistic expectations about medication effi cacy may lead to consumer disap-
pointment, translating into non-adherence to the medicinal regimen (Sabate 2003 ).
As such, while the two stages seem to be separate from one another, there may be
conditions under which increasing expectations about effi cacy at the fi rst stage leads
to self-fulfi lling prophecies, which in turn infl uence consumer experiences (effi cacy
judgments and adherence) at the second stage.
Indeed, effi cacy expectations that drive adherence at the awareness stage have
spillover effects into the trial and adoption stage, such that they may act as a refer-
ence point from which effi cacy judgments are made. Research on the placebo effect
in marketing shows that expectations—which may be infl uenced by marketing
actions and operate nonconsciously—can also alter experiences (Shiv et al. 2005 ).
Shiv et al. ( 2005 ) found that participants who paid a discounted price for an energy
drink thought to improve mental acuity subsequently solved fewer puzzles than did
those who paid full price. These effects were magnifi ed when expectations
were reinforced. However, when the price-effi cacy relationship was made salient
(e.g., participants were asked to answer “Given the price I was charged…”) the
effect was eliminated; expectancy ratings were not different across those in the
reduced-priced vs. regular-price condition. For pharmaceutical marketers and
retailers of OTC medication, this phenomenon suggests that discounted medica-
tions may be perceived as, and subsequently be, less effi cacious. These effects
would presumably be less likely to arise when the medicine's effects are unambigu-
ous (e.g., of erectile dysfunction medication), but present and persistent when the
effects are more ambiguous (e.g., of relaxation drugs). Thus, while discounting
pharmaceuticals may increase short-term sales, it may also lead to poorer effi cacy
perceptions. If consumers' experiences are in line with such expectations during the
trial phase, they may discontinue the medicinal regimen or use the product at their
own discretion. After satisfactory initial product use, research shows that consum-
ers exhibit placebo-like effects in which they expect to experience the benefi cial
effects of medication more quickly on subsequent trials (Faro 2010 ); in the case
where the effects lag onset expectations, poor effi cacy judgments may be made,
leading to subsequent non-adherence (Sabate 2003 ).