A victory for truth or a victory for pain? That’s the question everyone’s asking in Britain this week. I’m talking about Nurofen, of course. The Advertising Standards Authority has just banned one of the company’s TV adverts for implying that Nurofen Joint and Back capsules really know their way around a woman’s body.
The commercial shows a lady with back pain taking a tablet, followed by a graphic of the Nurofen symbol moving through her body to her painful spine where it then stays, pulsing with relief. Its route is direct – it doesn’t take any wrong turnings, misapplying its goodness to, say, a pain-free elbow, thus creating a weird zone of anti-pain so that the woman has to bang it on something to restore balance – and, crucially, it doesn’t just send ibuprofen all over the body so anything that happens to be hurting, be it ear, knee, throat or bladder, does so slightly less.
The ad is implying, the ASA has ruled, that Nurofen Joint and Back is a specifically designed joint and back medicine, which makes a beeline for joints and backs where it demonstrates its special joint-and-back-ameliorating knack. And the ad shouldn’t imply that because it’s not true. Nurofen Joint and Back is basically just Nurofen, which is basically just ibuprofen. (Even within the world of the advert, how the tablet knows that the poor woman has back rather than joint ache is unclear. Perhaps it just got lucky and would have gone on to a nearby joint if the back had seemed OK.)
This ban surprised me because it feels like painkiller adverts have always been like this – a bit like the credits to a Bond film but with throbbing. The shape of a lady has got home with a headache, sinus pain or the telltale redness in her silhouette throat that heralds a cold. Paunchless outlines of humans containing livid pain zones have long been “neutralising” those malevolent glows with counteracting soothing glows in the same colour as the advertised product’s branding.
That’s how painkillers are pitched: clean, targeted, medicinal. “Feeling crap? Drug yourself up a bit!” is not a slogan that’s caught on. “Try smothering your body’s warning system with a chemical – hopefully everything will have sorted itself out by the time it wears off!” just doesn’t have the reassuring pharmaceutical feel that’s vital in building brand confidence.
And brand confidence is important here. Companies like Nurofen, Solpadeine or Panadol aren’t just selling whatever their various active ingredients are. Those can be purchased for a fraction of the cost. Boots sell packets of 16 ibuprofen tablets for 35p; the same number of Nurofen Joint and Back capsules costs £3.79. So what is Nurofen doing to justify charging 10 times as much? It’s selling more than just ibuprofen – it’s selling an idea, a feel.
But that’s just for idiots, you may be thinking. That’s how they part the headachey fool and his money. Unfortunately, and surprisingly, experimental data doesn’t quite bear that opinion out. Ben Goldacre, in his book Bad Science, explained that a study of branded and unbranded headache pills found that “the packaging itself had a beneficial effect”, and one of comparable magnitude to whether or not the tablets contained any actual painkiller. So, “Whatever pharmacology theory tells you, that brand-named version is better, and there’s just no getting away from it.”
This confusing manifestation of the placebo effect seems to mean that, if you have an inkling the branded version of a painkiller will work better, then it will feel like it does. And, in the field of painkilling, something feeling like it works and something working are precisely the same thing. Sadly, if you’re sceptical enough only to associate a painkiller’s efficacy with its active ingredient, this added brand-confidence-induced pain-assuagement won’t work on you. As with a deathbed atheist who suddenly misses the solace of religion, your analytical outlook on the world precludes such comfort.
Obviously this puts a different complexion on the profiteering of the branded tablet. I still reckon it is profiteering, fundamentally. I think the scheme was just to overcharge for painkillers – the fact that it caused an extra placebo effect is a happy accident rather than the conscious launch of a new alternative therapy to be administered by an advertising agency. Nevertheless it’s profiteering that’s coincidentally doing good. There are side effects: it makes people feel better.
Nurofen sells quite a range of products – as well as normal Nurofen, Nurofen Express and Nurofen Joint and Back, there’s Nurofen Migraine Pain, Nurofen Express Period Pain, Nurofen Tension Headache, Nurofen Sinus Pain Relief and Nurofen Sinus Pressure & Headache Relief – and they’re all basically just ibuprofen. But RB UK Commercial, which owns the brand, says “Research has shown that nine in 10 people search for products to treat specific symptoms, such as joint and back pain, and seven in 10 say pain-specific packs help them decide which product is best for their needs.” So could it be that buying a generic painkiller that happens to have the specific pain from which you’re currently suffering written on the packet makes you feel like the pain is more effectively killed? It feels more medicinal. It’s almost like you’ve been diagnosed.
It’s often said that a strength of alternative therapies such as homeopathy is that its practitioners, because they’re in a private healthcare environment, have time to listen to, and express concern about, a patient’s problems, in a way an overstretched NHS doctor doesn’t. The listening and concern alone make patients feel better, which is why homeopathy is an ideal treatment for anyone who doesn’t quite feel 100% but isn’t actually at all ill.
Perhaps Nurofen’s targeted packaging works like the homeopath’s avaricious affectation of interest – it somehow provides a fraction of the benefits of homeopathy. Not a fraction of the absolutely-nothing-helpful-at-all that homeopathic remedies contain, but a fraction of the placebo effect brought about by having your ailment solemnly acknowledged.
All of which makes me slightly regretful about the ASA ruling. Those ads are inaccurate, so they probably ought to be pulled. Then again, if you’ve got a bad back, might not the thought of an angelic branded light, heading straight to the bit that hurts, be medicinal in itself? It might not be how ibuprofen works, but perhaps soothing animation, like confidence-building branding, is a vital part of how Nurofen works. The ads, the packaging, the £3.79, are arguably part of the treatment. The advert isn’t misrepresenting the medicine – it is the medicine.
