Issues surrounding disclosure of pharmaceutical side effects are complicated. The literature abounds with pragm atic concerns regarding limited time or pharmacologic expertise in the clinic, patient nonadherence, and unintended nocebo effects, as well as philosophical arguments over the limits of autonomy, importance of shared decision-making, and the legal mandate to garner informed consent. Yet the actual thoughts and feelings of patients are largely missing from the literature. To investigate in greater depth and expand the debate to capture patients’ perspectives, we conducted a national survey exploring the gap between what patients want to be told about prescription drug risk and what they are actually told. Results from our research study indicate that many patients report having been “blind-sided” by previously undisclosed drug side effects and that a doctor’s failure to warn can result in considerable harm to both patient health and the doctor-patient relationship. Of real concern – and heretofore under-emphasized import – is the potential for erosion of the patient’s trust, which we argue offers a fresh evidentiary rationale to revisit the © 2021 Joshua E. Perry, Dena Cox, Anthony Cox, Dale B. Thompson Graf Family Professor and Chair, Department of Business Law & Ethics, Kelley School of Business, Indiana University. Professor Emerita, Kelley School of Business and IU School of Medicine, Indiana University. Professor Emeritus, Kelley School of Business and IU School of Medicine, Indiana University. Professor of Ethics & Business Law, Opus College of Business, University of St. Thomas. PERRY 02 (DO NOT DELETE) 3/16/2021 12:48 PM 28 JOURNAL OF HEALTH CARE LAW & POLICY [VOL. 24:1 legal standard for what constitutes adequate patient consent and the importance of securing it.

Many adults in the U.S. do not receive recommended vaccines, and the research literature remains inconclusive on the best communication strategies for increasing this behavior. This study examined the association of message framing (gained-framed vs. loss-framed vs. control), and healthcare provider (HCP) recommendation (offered vs. recommended) on uptake of adult hepatitis B virus (HBV) vaccination in a high risk population using a 3 × 2 block design randomized controlled trial. Fear of shots, fear of vaccines, and perceived message framing were examined in secondary analyses. Of the 1747 participants, 47.7% (n = 833) received 0 doses of HBV vaccine, 27.8% (n = 485) received 1 dose, 10.4% received 2 doses, and 14.1% received all 3 recommended doses. There was not a significant interaction between message framing and HCP recommendation (p = .59). Mean number of doses received by the gain-framed group (m = 0.96) was not significantly different from the loss-framed group (m = 0.97, RR = 0.99, 95% CI = 0.88-1.12). However, those receiving any framing message received significantly more doses (m = 0.96) than those in the control condition (m = 0.81, RR = 1.17, 95%CI = 1.06-1.31). Participants who received a HCP recommendation received significantly more vaccine doses (m = 0.95) than those in the vaccine-offered condition (mean = 0.82, RR = 1.16, 95%CI = 1.05-1.28). These results suggest there is no difference in vaccine uptake between gain-frame and loss-frame messages, but both are better than a control message. These results also support advising HCP to provide a strong recommendation for vaccinations beyond merely offering it to patients. This study has implications for vaccine uptake beyond HBV, and can inform future research on effective vaccine communication research. Clinicaltrials.gov Identifier: NCT00739752. Registration date: August 20, 2008.

Consumers increasingly rely on online product reviews when making purchase decisions. However, assessing the credibility of online reviewers presents consumers with unique challenges. This paper examines how consumer perceptions of reviewer credibility are influenced by the presence and type of textual errors in the review itself. The results of an online experiment indicate that consumers’ reactions to textual errors are moderated by their general trust in others. Low-trust consumers are relatively insensitive to textual errors in judging reviewer credibility. However, high-trust consumers are less forgiving of typographical errors (which may signal carelessness) than orthographical errors (which may indicate cognitive challenges). Implications for future research are discussed.

Health-promoting messages can be framed in terms of the beneficial consequences of healthy behaviour (gain-framed messages) or the detrimental consequences of unhealthy behaviour (loss-framed messages). An influential notion holds that the perceived risk associated with the recommended behaviour determines the relative persuasiveness of gain- and loss-framed messages. This 'risk-framing hypothesis', which was derived from prospect theory, has been central to health message-framing research for the better part of two decades and has enduring appeal to researchers and practitioners. It has found its way into several health communication handbooks and is communicated to the general public. The present article examines the validity of the risk-framing hypothesis anew by providing a review of the health message-framing literature. In spite of its ongoing appeal, we conclude that the hypothesis has severe theoretical flaws. In addition, we find that the empirical evidence in favour of the hypothesis is weak and inconsistent. It seems that, in applying prospect theory's tenets to a health-promotion context, some of the theory's key aspects have been lost in translation. At the close of the article, we offer a research agenda for the future, arguing that, above all, new methodology is needed to bring the message-framing literature further.

OBJECTIVE:To determine the effectiveness of asking Anticipated Regret Questions (ARQ) and risk presentation format on enhancing attitudes and behavioral intentions of mothers to have their daughters receive the HPV vaccine.DESIGN:The study used a 2 × 2 between-subjects factorial design with a no message control, involving 2 anticipated regret conditions (asked or not asked) and HPV risk presentation format (text only or graphical presentation of risk). Data were collected from a national sample of 320 mothers of girls ages 11-16.MAIN OUTCOME VARIABLES:The primary outcome variable was mothers' intention to vaccinate their daughters with all 3 doses of the HPV shots. Message involvement, perceived ease of message comprehension, and health beliefs regarding HPV infection and the HPV vaccine were also measured.RESULTS AND CONCLUSIONS:Results indicated there was a significant interactive effect of asking anticipated regret and risk presentation format on message involvement and behavioral intention. ARQ positively influenced behavioral intention only among mothers exposed to the graphical presentation of HPV-related statistics. This effect was mediated by message involvement. Thus, the combined effect of the graphical message and anticipated-regret questions on behavioral intentions was mediated by increased emotional involvement with the information concerning cervical cancer and HPV vaccination. These findings are consistent with the view that the formation of health-behavior intentions often involves the interplay of both affective and cognitive processing.

Health-promoting messages can be framed in terms of the beneficial consequences of healthy behaviour (gain-framed messages) or the detrimental consequences of unhealthy behaviour (loss-framed messages). An influential notion holds that the perceived risk associated with the recommended behaviour determines the relative persuasiveness of gain- and loss-framed messages. This 'risk-framing hypothesis', as we call it, was derived from prospect theory, has been central to health message framing research for the last two decades, and does not cease to appeal to researchers. The present paper examines the validity of the risk-framing hypothesis. We performed six empirical studies on the interaction between perceived risk and message framing. These studies were conducted in two different countries and employed framed messages targeting skin cancer prevention and detection, physical activity, breast self-examination and vaccination behaviour. Behavioural intention served as the outcome measure. None of these studies found evidence in support of the risk-framing hypothesis. We conclude that the empirical evidence in favour of the hypothesis is weak and discuss the ramifications of this for future message framing research.

Background Nearly 1 in 5 people living with HIV in the United States are unaware they are infected. Therefore, it is important to develop and evaluate health communication messages that clinicians can use to encourage HIV testing. Methods The objective was to evaluate health communication messages designed to increase HIV testing rates among women and evaluate possible moderators of message effect. We used a randomized four-arm clinical trial conducted at urban community outpatient health clinics involving 1,919 female patients, 18 to 64 years old. The four health message intervention groups were: i) information-only control; ii) one-sided message describing the advantages of HIV testing; iii) two-sided message acknowledging a superficial objection to testing (i.e., a 20 minute wait for results) followed by a description of the advantages of testing; and iv) two-sided message acknowledging a serious objection (i.e., fear of testing positive for HIV) followed by a description of the advantages of testing. The main outcome was acceptance of an oral rapid HIV test. Results Participants were randomized to receive the control message (n = 483), one-sided message (n = 480), two-sided message with a superficial objection (n = 481), or two-sided message with a serious objection (n = 475). The overall rate of HIV test acceptance was 83%. The two-sided message groups were not significantly different from the controls. The one-sided message group, however, had a lower rate of testing (80%) than the controls (86%) (OR, 0.66; 95% CI, 0.47-0.93; P = 0.018). “Perceived obstacles to HIV testing” moderated this effect, indicating that the decrease in HIV test acceptance for the one-sided message group was only statistically significant for those who had reported high levels of obstacles to HIV testing (OR, 0.36; 95% CI, 0.19-0.67; P = 0.001). Conclusions None of the messages increased test acceptance. The one-sided message decreased acceptance and this effect was particularly true for women with greater perceived obstacles to testing, the very group one would most want to persuade. This finding suggests that efforts to persuade those who are reluctant to get tested, in some circumstances, may have unanticipated negative effects. Other approaches to messaging around HIV testing should be investigated, particularly with diverse, behaviorally high-risk populations. Trial registration Clinicaltrials.gov Identifier: NCT00771537 . Registration date: October 10. 2008

Financial ties between physicians and pharmaceutical companies are pervasive and controversial. However, little is known about how patients perceive such ties. This paper describes an experiment examining how a national sample of U.S. adults perceived a variety of financial relationships between physicians and drug companies. Each respondent read a single scenario about a hypothetical physician and his financial ties to the pharmaceutical industry; scenarios varied in terms of payment type of (e.g., payment for meals vs. consulting fees) and amount. Respondents then evaluated the physician on several dimensions (e.g., expertise, trustworthiness, knowledge of new treatments, moral character, focus on patients' interests). Findings revealed that perceptions of the physician were more strongly influenced by payment type than by payment amount. Specifically, respondents were quite critical of doctors who owned drug company stock or received industry payments for meals and lodging, but were more forgiving of physicians who received free drug samples (which were perceived as benefiting patients) or consulting fees (which were seen as signaling physician expertise). Interestingly, physicians who received no payments, while seen as honest, were also viewed by some respondents as inexperienced or uninformed about new treatments. Implications for public policy and future research are discussed.

Parental intentions to have adolescents receive the human papilloma virus (HPV) vaccine have been noted to be higher than actual initiation rates. Among parents with intentions to vaccinate their young adolescent, we sought to identify factors that predicted first dose acceptance.

The ultimate goal of most advertising is to increase product sales. However, much advertising does not exert an immediate impact on consumer purchase behavior, but rather elicits intermediate consumer responses, such as increased brand awareness, interest, and information seeking.

Prior to the 1980's, it was illegal for prescription drug manufacturers in the United States to advertise directly to consumers. Instead, these companies only advertised to medical professionals. Several prescription drug companies began direct-to-consumer (DTC) advertising during the 1980s. However, this advertising faced strict limitations from the Food and Drug Administration. However, in 1997, the FDA relaxed some of these limitations, and DTC advertising began to grow rapidly. By 2009, drug companies' expenditures on DTC advertising had grown to $4.5 billion. Nonetheless, DTC advertisements continue to face criticism. One criticism of direct-toconsumer advertisements is that product benefit and risk information is often not communicated clearly to consumers, e.g., that the ads contain inadequate information regarding risks, or vague descriptions of medication benefits. The present study seeks to assess the merits of these criticisms. This research is being conducted in two stages. First, secondary research is being conducted to determine what other researchers have concluded regarding the representation of risk and benefit information in direct-toconsumer advertisements. Past studies have examined several aspects of DTC ads, including the balance between benefit and risk information, and the specificity of the information expressed. Second, primary research will be conducted, in which current DTC advertisements will be contentanalyzed. This research will involve collecting DTC advertisements, developing a system of coding the information in these ads, and assessing and critiquing the ways in which product benefits and risks are presented to consumers through such advertisements.

Objective: Hepatitis B virus (HBV) infection remains a serious public health problem, due in part to low vaccination rates among high-risk adults, many of whom decline vaccination because of barriers such as perceived inconvenience or discomfort. This study evaluates the efficacy of a self-prediction intervention to increase HBV vaccination rates among high-risk adults. Method: Randomized controlled trial of 1,175 adults recruited from three sexually transmitted disease clinics in the United States over 28 months. Participants completed an audio-computer-assisted self-interview, which presented information about HBV infection and vaccination, and measured relevant beliefs, behaviors, and demographics. Half of participants were assigned randomly to a "self-prediction" intervention, asking them to predict their future acceptance of HBV vaccination. The main outcome measure was subsequent vaccination behavior. Other measures included perceived barriers to HBV vaccination, measured prior to the intervention. Results: There was a significant interaction between the intervention and vaccination barriers, indicating the effect of the intervention differed depending on perceived vaccination barriers. Among high-barriers patients, the intervention significantly increased vaccination acceptance. Among low-barriers patients, the intervention did not influence vaccination acceptance. Conclusions: The self-prediction intervention significantly increased vaccination acceptance among "high-barriers" patients, who typically have very low vaccination rates. This brief intervention could be a useful tool in increasing vaccine uptake among high-barriers patients.

Within the past 20 years, consumer advertising of prescription drugs has grown from a rarity to one of the most pervasive forms of consumer advertising, with ads for antidepressants and heart medications now as common as those for fast food and automobiles. At the same time, direct-to-consumer (DTC) advertising has attracted a growing chorus of criticism from consumer advocates, health professionals, and elected officials. This article explores the extent to which such criticism has merit and the extent to which it lacks soundness. Specifically, the article casts doubt on the charges that (1) DTC advertising is deceptive; (2) DTC downplays product risks; (3) DTC focuses on trivial or imaginary maladies; (4) DTC doesn’t promote non-pharmaceutical solutions to health problems; (5) DTC harms the doctor-patient relationship; and (6) DTC is responsible for the rapid rise in drug costs.

Risk disclosure is an essential element of the marketing of prescription drugs and other medical products. This study examines how consumers respond to verbal information about the frequency and severity of medical-product risks and how media-induced affect can moderate such responses. The study finds that consumers tend to overestimate the actual likelihood of adverse events described with words such as “common” or “rare” (compared with the probabilities such terms are typically intended to convey) and that consumers tend to give little weight to such probability language when forming product use intentions. However, consumers in positive media-induced moods seem to engage in more nuanced evaluation of product risk information, weighing both frequency and severity information and using such information to make inferences about other product attributes (e.g., product efficacy). These findings suggest that medical marketers and regulators need to devise more effective means of communicating risk probability to consumers and that positive mood induction (e.g., by placing advertisements in upbeat media environments) can enhance consumers’ ability to process product risk information.

Vaginal microbicides are of particular interest in the prevention of STDs. This study examines the acceptability of different microbicide characteristics to adolescent women. Video/Audio Computer-Assisted Self-Interviews were completed by 204 adolescent women (14-20 years old, Mean= 17; 57% African American) recruited from community clinics. Microbicide acceptability was assessed with 8 items, each describing a microbicide uniquely defined along 4 dimensions: 1) Spermicide (Yes, No); 2) Timing of use (1 hour pre-coitus, 15 min. pre-coitus, 10 min. post-coitus); 3) Target (HIV, Other STDs); and 4) Side effects (Burning & itching in 10%, None). Adolescents used a 7-point response format to rate intent to buy each microbicide at least once (1=“Extremely unlikely” to 7=“Extremely likely”). We used rating-based conjoint analysis (RBCA), a marketing research technique that examines how different product dimensions influence intent to purchase, to evaluate microbicide preferences. RBCA results in importance scores (IS), indicating the extent to which dimensions affect microbicide ratings. The sum across importance scores equals 100. Part worth utilities (PWU) indicate the preference for each attribute (e.g., spermicide vs. non-spermicide) within each dimension. Patterns of results were examined for younger (14-15 yo), middle (16-17 yo) and older (>18 yo) adolescents. Mean ratings ranged from 3.3 (non-spermicide, 1 hour pre-coitus, AIDS, side effects) to 5.2 (spermicide, 10 min. post-coitus, AIDS, no side effects). Side Effects most strongly influenced ratings (IS=45), followed by Spermicide (IS=36) and Timing (IS=17). Target did not substantially influence ratings (IS=2). PWU indicated a strong preference for no side effects (PWU= .48) and for spermicidal action (PWU= .39) and there was relative antipathy toward timing of 1 hour pre-coitus (PWU= −.22). Age group analyses indicated that younger and older adolescents had the same pattern of results as those reported above. For the middle group, however, spermicidal action was most important (IS= 42), followed by a desire for no side effects (IS= 30). Adolescents’ ratings of microbicides were quite sensitive to characteristics such as minor side-effects, spermicidal action, and timing of application. The shifts in attitudes across age groups may reflect developmental changes in reproductive health behaviors and priorities. Contraceptive action may have been less important to older adolescents because many (62%) were on hormonal contraception and less important to younger adolescents because most (56%) had not engaged in intercourse. In contrast, relatively few of those in the middle age group were on hormonal contraception (20%), yet the majority (69%) had engaged in intercourse. As microbicides are developed, attention will need to be paid to how characteristics may influence acceptability and to how the influence of certain characteristics may change as a function of development and experience.

American Business Law JournalVolume 43, Issue 1 p. 1-42 Quantifying Brand Image: Empirical Evidence of Trademark Dilution Julie Manning Magid, Julie Manning Magid Indiana University Kelley School of Business *Assistant Professor of Business Law, Indiana University Kelley School of Business.Search for more papers by this authorAnthony D. Cox, Anthony D. Cox Indiana University Kelley School of Business **Edgar G. Williams Faculty Fellow and Professor of Marketing, Indiana University Kelley School of Business.Search for more papers by this authorDena S. Cox, Dena S. Cox Indiana University Kelley School of Business ***Eli Lilly Faculty Fellow and Professor of Marketing, Indiana University Kelley School of Business.Search for more papers by this author Julie Manning Magid, Julie Manning Magid Indiana University Kelley School of Business *Assistant Professor of Business Law, Indiana University Kelley School of Business.Search for more papers by this authorAnthony D. Cox, Anthony D. Cox Indiana University Kelley School of Business **Edgar G. Williams Faculty Fellow and Professor of Marketing, Indiana University Kelley School of Business.Search for more papers by this authorDena S. Cox, Dena S. Cox Indiana University Kelley School of Business ***Eli Lilly Faculty Fellow and Professor of Marketing, Indiana University Kelley School of Business.Search for more papers by this author First published: 17 February 2006 https://doi.org/10.1111/j.1744-1714.2006.00010.xCitations: 15 Read the full textAboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume43, Issue1March 2006Pages 1-42 RelatedInformation