How Can Marketers Help Prevent Acetaminophen Overdose?

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.

Over-the-counter (OTC) drugs are an important part of the U.S. healthcare system. According to the Consumer Healthcare Products Association, in 2023, OTC medicine was a $43 billion business, and an average American household spends about $645 annually on OTC products (based on 2022 statistics). OTC medicines have benefited consumers in many ways, including making it easy to treat minor or temporary conditions and avoiding missing work, school, or other activities. Clearly, OTC drugs play an important role in consumers’ everyday lives. However, it is also critical that OTC drugs are consumed in a safe and effective way, as overdosing may harm consumers and lead to emergency room visits and hospitalizations.

When taking medications that contain acetaminophen (e.g., Tylenol, Excedrin, Mucinex, NyQuil/DayQuil, Robitussin), many consumers do not follow the instructions on the product label, potentially leading to hepatoxicity, or liver damage. Using acetaminophen as a basis, researchers in a Journal of Marketing Research study explore which consumers are likely to deviate from drug label instructions, why they do so, and what effective interventions can be implemented to help consumers better follow the directions. Benefiting from the unique diary data and advanced modeling techniques (including dynamic models of consumer choice, structural modeling, and Bayesian modeling), the authors model the consumption process of drugs and provide answers to these important questions.

This study provides valuable insights for various stakeholders, including consumers, pharmaceutical companies, and policymakers. As consumers, it is important to be aware of what makes us more likely to deviate from drug instructions (e.g., suffering from multiple symptoms, ongoing pain, mental health problems, overconfidence in self-medicating, etc.). It is recommended to be more cautious about the negative effects and risks associated with the drugs consumed for our own benefit. Pharmaceutical companies should deliver better drug instructions that consumers can more easily follow and should provide more consumer education to help develop more favorable drug consumption behaviors. For policymakers, such as the FDA and other organizations responsible for consumer well-being, it is crucial to explore ways to improve consumer awareness of drug ingredients.

Check out this interview with the authors for detailed insights:

Q: Your study identifies multiple label deviations by consumers using acetaminophen. What do you see as the most critical information missing from current labels that might prevent these deviations and how could practitioners incorporate these insights into future label designs?

A: Our paper suggests that, in addition to the current list, the label could emphasize the importance of matching the symptoms with the product. For example, if a consumer has symptoms other than pain, such as sinus issues, they should look for a combo-ingredient product that can treat sinus symptoms. If such a patient selects a single-ingredient acetaminophen product, the sinus symptoms will persist and continue to drive future pain and enhance the odds of label deviation.

Practitioners could incorporate these insights by emphasizing symptom-specific recommendations and designing labels to make acetaminophen ingredients more salient.

Q: What recommendations would you give to each of the stakeholders (including policymakers, e.g., the FDA, pharmaceutical companies, and consumers) on leveraging the insights about the profile of consumers (i.e., their demographics, health conditions, and behavioral markers) who are more likely to deviate from label instructions?

A: For policymakers like the FDA: In product labels:

Emphasize the importance of matching the symptoms to the medication
Clearly communicate acetaminophen as an ingredient. After years of policy interventions, this continues to be a struggle; 41% of consumers do not know that the medication they take contains acetaminophen

For pharmaceutical companies:

Add symptom-match label instructions
Make the information about acetaminophen as an ingredient clearer
Educate consumers about the interplay between label deviations and their attitudes toward self-medication, health history (chronic pain, mental health problems), and demographics (women, smokers, heavy drinkers). Target messages to high-risk groups to emphasize the importance of taking the right product at the right time. Feasible platforms could include websites, display ads, and in-person hospital visit instructions

For consumers: As consumers we need:

To understand that the “too soon” and “too much” label deviations are gateways to the >4g label deviations, the most critical clinical outcome. Therefore, self-managing the process (when and how much medicine to take) at a time when you are fragile because of illness is key
To select symptom-matching medications and to be disciplined about this can mitigate acetaminophen overdose
To pay greater attention to knowing the harmful effects of ingredients in the medicines we take; to read labels (vs. popping pills indiscriminately)

Q: The findings of this study are truly impactful and important, considering the consequences of deviating from the recommended drug dosage. The following drug instructions become even more critical when it comes to prescription drugs (in which case, patients’ conditions are more severe or side effects are more serious). Are you working on any projects that extend the findings to prescription drugs? Do you foresee any implications of your study for prescription drugs?

A: The collection of diary data on medicines is extremely difficult and expensive. I can’t emphasize the uniqueness of these data enough. Once you have it, the model and measures we developed can be straightforwardly applied to other contexts. For prescription drugs, these could include opioids, benzodiazepines, stimulants, sleep aids, antidepressants… As you can imagine, the hard thing here would be good quality data for the consumption of prescription drugs. Applications in the OTC space (e.g., ibuprofen, aspirin, dextromethorphan [for cough]), vitamins, nicotine (e.g., vaping), and Epsom salt (sore muscles) are easier to extend.

Q: It is wonderful to see that an increasing number of marketing researchers devote their attention to the healthcare industry, which is a very meaningful sector. Do you see any trends in terms of what topics researchers are working on to provide practical insights for policymakers and consumers/patients? What would be the promising areas to focus on in this field over the next 5 years?

A: The promising areas:

Why haven’t the label changes worked over the years? Why is consumer knowledge of acetaminophen so poor (despite significant label changes and educational initiatives)? What are the hurdles and how best to overcome them?
Many people buy branded versions of commoditized OTC drugs which are more expensive. Why is that, and are there nudges that could incentivize consumers to be more rational?
Can healthcare apps mitigate label deviations? Any other tech-enabled (e.g., LLMs) solutions?
DTC prescription drug marketing is much more regulated outside of the U.S. What are the implications for consumer welfare? This is a difficult but very important topic to study.

Q: Did you face unique challenges while studying healthcare or drug-related topics compared to traditional marketing topics? If so, do you have any recommendations for your fellow researchers?

A: There is a good appetite for healthcare-related questions and consumer welfare implications. Therefore, there were no real hurdles in the topical area. The review process was challenging with almost all the questions centered on the methodology. The review process took some time.

Q: The study highlights consumer overconfidence in self-medication as a factor in label deviation. What strategies would you recommend for brands or retailers to balance consumer autonomy with effective guidance discouraging unsafe practices?

A: There is a series of experimental studies that could test a series of hypotheses (promoting overconfidence awareness, seeking second opinion, etc.). I hope that someone will take it on. At a more practical level, an easy intervention is for doctors or nurses to simply remind patients that overdosing comes with the possibility of long-term deleterious effects. Therefore, health care professionals could be very effective.

Q: Given that digital tools are increasingly part of consumer interaction, what specific technological approaches (such as apps, reminders, or digital labels) do you believe would most effectively support safe consumption? How should practitioners prioritize these approaches? What motivated you to pursue this fascinating and impactful research area?

A: Apps, reminders, digital labels, and websites such as https://www.getreliefresponsibly.com/ are all great ideas. My thinking would be to pick those where it’s easy to take an A/B test to assess effectiveness. Here, it’s important to note that label deviations are “tail” behaviors, infrequent, and occur for a small percent of people. This presents a significant challenge in assessing what will move the needle on >4g outcomes.

Three of the four authors (Saul, David, and Neeraj) served on the steering committee for “the acetaminophen behavioral surveillance program” sponsored by McNeil Consumer Healthcare (which makes many OTC drugs, including Tylenol). On this committee, we got to work with researchers with deep medical and policy expertise, so we learned a lot in the process. While Saul and David (both subject matter experts on acetaminophen) wrote several papers in medical journals on the topic, we felt that audiences in marketing and the business world could benefit from what we learned from our work on behavioral surveillance of OTC drugs. We brought methodological rigor to this unique data, which included dynamic models of consumer choice, structural modeling, and Bayesian modeling. Therefore, the intersection of very relatable policy-relevant questions with broad societal impact, done rigorously, was the key motivation.