Unintended Consequences of Viagra Advertising

Journal of Marketing Research Scholarly Insights are produced in partnership with the AMA Doctoral Students SIG – a shared interest network for Marketing PhD students across the world.

Marketers often develop advertising campaigns to achieve various brand-related objectives such as increasing brand awareness, stimulating trial, or developing brand equity. However, advertising may also have unintended effects on important societal and economic variables. Sometimes television commercials trigger unexpected outcomes going far beyond the original objectives of an advertising campaign. A new Journal of Marketing Research article investigates the unintended consequences of direct-to-consumer (DTC) advertising of erectile dysfunction (ED) drugs (e.g., Viagra). In their recent article, Tongil “TI” Kim and Diwas KC (2020) explored public health outcomes of direct-to-consumer advertising of ED drugs. In particular, they examined the impact of such advertisements on birth rate at the population level. Basically, the authors set out to discover whether advertising of Viagra, probably the best-known ED drug, can make more babies.

In their 2020 paper, the authors considered potential interactions of pharmaceutical marketing activities and public health outcomes and examined the advertising of three erectile dysfunction drug brands: Viagra, Levitra, and Cialis. Erectile dysfunction, sometimes referred to as impotence, affects up to 30 million men, or around 18% of the male population in the United States. Until 1997, DTC advertising of pharmaceutical products was restricted by the U.S. Food and Drug Administration (FDA). Relaxation of advertising restrictions has prompted a considerable growth of television advertising for pharmaceuticals, with ED drugs taking top spender positions in DTC advertising. Thus, for example, the ED drug advertising expenditures of the two leading producers in this product category—Pfizer (Viagra) and Eli Lily (Cialis)—reached $355 million collectively in 2015. The growth of the erectile dysfunction drugs advertising generated criticism of these commercials as inappropriate for family viewing due to highly suggestive content of sexual nature. There were calls to ban TV advertising of erectile dysfunction drugs during the daytime. 

To understand the relationship between DTC advertisement of ED drugs on population birth rates, Kim and KC (2020) used a quasi-experimental approach by examining birth rates around boundaries of local television advertising. The authors combined birth data from several sources: inpatient data from the 2001–2010 Massachusetts hospital birth data and micro birth-certificate data from the United States between 2000 and 2004. Then, they matched birth data with monthly ED drug television advertising data from Kantar Media to build the data set that they needed to answer their research question. Using these data, the authors sought to understand whether higher ED advertisement exposure would lead to higher birth rates in two adjacent zip codes that were similar in all aspects except the level of erectile function drug advertising exposure.

Kim and KC found that zip codes with more ED drug ads had higher birth rates 10 months after the advertising was screened. In a separate analysis of 15 million U.S. birth certificate records between 2000 and 2004, the authors found similar results with elasticities of .04–.08. An elasticity of .07 suggests that a 1% increase in advertising (i.e., an additional advertising spending of $.173 per 1,000 capita) results in approximately 1,211 more births in the United States.

To provide stronger evidence for their findings, the authors ran two additional analyses. First, they replaced the data on ED drug advertising in their model with advertising data of allergy drugs, an unrelated drug category. The results indicated no impact on birth rates, illustrating that allergy drug advertising was unrelated to birth rates. Second, the authors utilized a unique context of the pregnancy gestation period and investigated whether there was a significant change in birth rate right after the advertising’s airing. Interestingly, they found no evidence of advertising impact on birth rates either before or after the 10-month period after the exposure to the advertising. The ED advertising effect was short-lived, which provides additional evidence in support of the relationship between Viagra advertising and increased birth rates.

The authors believe that the increased birth rate after exposure to Viagra ads might happen due to the suggestive content of ED TV ads. To provide evidence for this assertion, Kim and KC conducted a study using Google Trends data. The authors searched for keywords related to Viagra advertising and getting pregnant in the United States. The authors expected a correlation between the number of searches for ED drug advertisements and population-level interest in getting pregnant. Google Trends data analysis indicated that higher ED drug advertising was indeed associated with higher pregnancy-intent keyword searches. This finding supports the idea that ED drug advertisements increase consumers’ motivations to have more children.

Surprisingly, Kim and KC (2020) found a stronger effect of exposure to ED drug advertisements on birth rates in regions with lower incomes. If the effect of advertisement on birth rates comes strictly through the consumption of ED drugs, one would expect the opposite outcome because ED drugs are costly and typically not covered by insurance in the United States. This unexpected finding suggests that ED drug advertising may drive births without the actual drug consumption and this effect can be attributed to the effect of media. Future research can shed more light on this finding.

Merely watching a DTC advertisement can influence consumers’ health outcomes (e.g., birth rate).

Kim and KC (2020)

Direct-to-consumer advertising has become a popular promotional tool for marketers in the United States, although the FDA regulates some categories. FDA regulations mostly focus on assessing the benefits and risks of the drug to the consumer. While consumption of an advertised drug has direct risks and benefits to the consumer, Kim and KC (2020) show that merely watching a DTC advertisement can also influence consumers’ health outcomes (e.g., birth rate)., providing evidence that exposure to Viagra advertisements leads to higher birth rates; especially for people with lower income and bigger families.

Highlights from the Article

• DTC advertising may have an unintended influence on consumers such as increased sexual activity that leads to higher birth rates.
• ED DTC advertising leads to higher birth rates 10 months after consumers are exposed to the advertisements.
• The suggestive content of ED drug television ads is the primary reason behind increased birth rates.
• Although ED drugs are expensive and they are not covered by insurance, the relationship between ED advertising and birth rate was stronger in regions with lower incomes and larger families.
• Google Trends data analyses indicated that higher ED drug advertising was associated with higher pregnancy-intent keyword searches.

Referenced article:

Kim, Tongil “TI” and Diwas KC (2020), “Can Viagra Advertising Make More Babies? Direct-to-Consumer Advertising on Public Health Outcomes,” Journal of Marketing Research, 57 (4), 599–616.

Journal of Marketing Research Scholarly Insights are produced in partnership with the AMA Doctoral Students SIG – a shared interest network for Marketing PhD students across the world.