Nurofen – a popular pain killer, a case of misleading marketing and the power of suggestion

Sounds great doesn’t it? Pain killers targeted at different kinds of pain. You can pick the pill for your particular pain.

Consumers in Australia were, until recently, offered this choice. The pain killer, Nurofen was sold in different brightly coloured packets each labelled to target one of four kinds of pain (Tension Headache, Migraine Pain, Period Pain, Back Pain). The only problem was that, despite the specific labelling, the drugs inside the four packets were identical and behave the same whatever the labelling says. Following a long campaign by the media, the Australian Federal Court last week ordered the makers, Reckitt-Benckiser to stop selling the drug in this misleading manner.

Nurofen and the over-the-counter market

In many parts of the world, Nurofen is the brand name for the drug ibuprofen, one of the leading over-the-counter (non-prescription) analgesics. This market is very lucrative for pharmaceutical companies but it is also very competitive. Here in the UK, the over-the-counter market for all medicines and supplements nets £2.5 billion a year, corresponding to sales in pharmacies, drug stores, supermarkets, corner shops and filling stations. Pain killers, including ibuprofen, are the largest individual sector in this market, worth about £550 million. With such large sums of money and in a competitive market, companies work hard to maximise their share and this perhaps explains Reckitt-Benckiser’s behaviour. Should you want to know about other tricks used by companies to boost sales, take a look at Ben Goldacre’s book, Bad Pharma.

Targeted marketing in the UK

Given the Nurofen marketing scam in Australia, I wanted to find out if the same was happening in this country so I went to our local branch of Superdrug. This is not a pharmacy but they sell a range of permitted medicines alongside all kinds of beauty products, perfumes, baby supplies etc. The over-the-counter drug section is not hard to find and there is a dizzying array of brightly coloured products especially in the pain section. Nurofen is the principal branded form of ibuprofen on sale but it’s not the only one and generic versions of ibuprofen are also available.

When I looked carefully I found that Nurofen is indeed being sold in the UK in the same targeted manner as in Australia. I didn’t find all four targeted forms but I did find packets of Nurofen labelled Tension Headache and Migraine Pain, both containing the identical drug. It’s not just Reckitt-Benckiser who play this game: Feminax Express (made by Bayer) is marketed for period pain relief but inside the packet it’s just ibuprofen. To be fair to Feminax, they do say that the drug targets other kinds of pain but you can’t avoid the connotations of the brand name. Superdrug have their own generic versions of ibuprofen, ibuprofen labelled for period pain and ibuprofen labelled for migraine pain and again the drug inside each packet is the same.

Should we be concerned about targeted marketing in the UK?

The Australians believe this targeted labelling is misleading but should we also worry in the UK? This turns out to be a complex question.

Labelling packets to imply that they treat different kinds of pain is deliberate deception when the drug inside is the same. It’s not that the ibuprofen doesn’t work, it does work but it cannot target a specific kind of pain. On this basis, the targeted packets should be withdrawn.

There is, however, another side to this story and to understand this we need to go back to 1981 to an experiment conducted by Branthwaite and Cooper who studied 835 women with headaches. They gave the women aspirin or dummy pills (placebo) and the two treatments were further subdivided by packaging. Half were supplied in neutral boxes, half were supplied in flashy, branded packets. Neither the experimenters nor the subjects knew who was receiving aspirin or placebo. As expected, aspirin was better than placebo for headache but, surprisingly, both aspirin and placebo did better when supplied in branded boxes. If we can extrapolate these findings to the Nurofen story, then perhaps the targeted packets of Nurofen do perform better against specific kinds of pain, not because of pharmacological effects but because the packet says so and the consumer believes this.

This borders on quackery and makes me feel very uneasy. Surely we should not be using misleading marketing to achieve a specific effect, and make a tidy profit along the way. Can I suggest a compromise? Ditch the targeted labelling and have a single Nurofen or generic product but put all four indications on the packet. That way there would be no deception but people would be reassured that the drug worked on the pain they wanted to treat.