"He who takes medicine and neglects to diet wastes the skills of his doctors." This Chinese proverb highlights one of the key findings of a new study exploring how consumers in China choose between traditional Chinese remedies and Western medicine when seeking treatment.
In "Health Remedies: From Perceptions to Preference to a Healthy Lifestyle," Wharton marketing professor Lisa Bolton, New York University doctoral student Wenbo Wang and Peking University marketing professor Hean Tat Keh looked at how people's perceptions of a given remedy, their perceptions of their illness and other factors influence medical decision making. The researchers also examined how the choice of remedy, be it Western medicine (WM) or traditional Chinese medicine (TCM), impacts the decision to follow a healthy lifestyle.
They found that on the whole, Chinese consumers tend to prefer TCM but will opt for Western medicine in particular situations, such as when they are hoping to quickly alleviate their symptoms or when they are certain about what is making them sick.
Their study has implications beyond the Chinese market, Bolton and her coauthors note. "Consumers today face a wide array of choice options. Proliferation in choice extends to remedies for illness or disease -- including drugs, supplements, radiation, surgery, chiropractics, acupuncture, massage therapy, homeopathy, Ayurveda and traditional Chinese medicine, to name a few. In many countries of the world, medical pluralism is the norm, with Western and traditional medicine existing side-by-side in the marketplace. Even in countries with a dominant medical tradition, complementary and alternative medicines are increasingly available," the authors write.
According to Bolton, China was an especially good place to study what influences people's health decisions, because Western and traditional Chinese medicine operate alongside each other there, and both forms of medicine are respected. In fact, she says, people will pick what doctor or hospital to go to depending on whether they are looking for a Western or traditional approach.
"In China, TCM and WM have coexisted for more than 200 years ... and both types of medication are licensed as patent medicine and are widely available at pharmacies, hospitals and other outlets," the researchers write. "The majority of Chinese consumers purchase over-the-counter drugs for self-care, and the market performance of the two types of health remedies varies significantly across illnesses."
Scientific vs. Holistic Approach
As a backdrop to their research, which arose from collaboration initiated by the Guanghua-Wharton Joint Research Initiative, Bolton and her coauthors present a basic tutorial on the differences between Western and traditional Chinese medicine. Western medicine "is closely linked to the scientific method and emphasizes empirically measurable biochemical processes that drive disease, its treatment and health," they write, adding that this form of treatment "views all medical phenomena as cause-effect sequences" and relies on drugs, radiation and surgery to alleviate symptoms and cure disease.
"On the other hand, TCM favors a holistic approach, views the universe and body philosophically and develops inductive tools and methods ... to guide restoring the total balance of the body." In Chinese medicine, they add, "the correct balance between Yin and Yang make up the vital energy, 'Qi,' an essential life-sustaining substance of which all things are made." Traditional remedies include herbal medicines, acupuncture, massage and moxibustion, an herbal heat therapy. Herbal medicines account for about 90% of the Chinese drug market, according to the paper. In China, drug labels are legally required to include all ingredients, whether what's inside the bottle is a pharmaceutical product or an age-old remedy.
The researchers analyzed consumer perceptions and preferences by presenting small groups of undergraduate and graduate students in Beijing with various combinations of questions and health scenarios. For instance, the students were asked what category of medicine they preferred for a variety of conditions. They favored traditional Chinese medicine for rheumatoid arthritis and insomnia, and Western medicine for the common cold, coronary heart disease and diarrhea.
Treatment goals and patients' time frames influenced their preferences. "Consumers perceive TCM (versus WM) to have slower action and milder side effects and a greater focus on treating the underlying illness versus alleviating the symptoms," the authors note. Likewise, when consumers were uncertain about their condition and not in any particular hurry for a resolution, they preferred traditional remedies.
"You're matching your goal with the product," Bolton says. "If you want a quick fix, you go for the Western medicine." For instance, a person may want quick relief from insomnia and choose to take a sleeping pill if he has to go on a long drive several days from now, as opposed to looking for a slower-acting remedy (stress reduction techniques, for instance) that may eventually address what's causing the sleeplessness.
The 'Boomerang' Effect
Bolton and her colleagues also discovered that the decision to select Western medicine over traditional remedies has broader implications for health.
In one experiment, they asked participants to read hypothetical scenarios involving a patient's high blood pressure diagnosis and treatment advice based on either a Western medicine or TCM approach. Half of the scenarios in each group (WM and TCM) also included an "intervention" -- additional information about health-protective behaviors that would complement the proposed treatment. Participants were then asked to gauge the patient's motivation to follow through on the treatment advice and to what degree they would recognize the importance of healthy lifestyle factors.
The researchers found that, in general, Western medicine (versus TCM) "reduces the perceived importance of, and motivation to engage in, complementary health-protective behavior, thereby undermining a healthy lifestyle." In other words, patients taking pills for their high blood pressure may be less apt to see the need to exercise, watch their diet or lose weight.
"We know what remedies are supposed to do. They are supposed to improve your health, but Western drugs can actually backfire and boomerang healthy lifestyle intentions," Bolton says. For example, people taking cholesterol drugs may figure they don't need to cut fat from their diet because the pills are protecting them from heart disease.
This "boomerang" effect has been documented in other instances, Bolton adds. She has researched how the marketing of products such as nicotine replacement patches, debt consolidation loans and identity theft products influence consumer perceptions and risky behavior. "Debt consolidation, identity theft protection and drugs should all reduce your risk, but they can, in fact, increase your risk because you say to yourself, 'Well, the risk is manageable so I don't need to worry about it.'"
Traditional Chinese medicine "is seen as holistic, and when you take a certain kind of medicine you are told specifically what behavior to engage in," she notes. For instance, a patient may be advised to avoid greasy foods in addition to taking an herbal remedy. If a consumer sees medicine as a "supplement to other things they need to do, then they are going to be more likely to engage in healthy choices."
While the study was done in China, the findings have implications for the U.S. and elsewhere, given the tremendous growth in the popularity of alternative medicine. "The world market for TCM is estimated at over $23 billion, with most of the growth coming from Europe and the USA," the researchers note. In the U.S., 36% of adults use some form of complementary or alternative medicine, according to a survey published in 2004 by the National Center for Complementary and Alternative Medicine, a branch of the National Institutes of Health. That increased to 62% when use of megavitamins and prayer (specifically for health reasons) were added to the definition of alternative medicine. Ruth L. Kirschstein, the center's acting director, testified to a Congressional committee in March 2007 that 78% of medical schools teach courses on alternative medicine, according to the Association of American Medical Colleges. Some doctors, knowing that their patients are going elsewhere for alternative therapies, are responding by expanding their own repertoire of services.
The authors point out that their research "shed[s] light on the lay theories of medicine that guide consumer behavior." Bolton says the study's findings could be important to marketers and advertisers because while people do rely on doctors and other health practitioners for advice, they also make decisions for themselves about health, and the consumer voice in healthcare decision making is increasing. "People are going to their doctors armed with all this information," she says, whether from the Internet, TV or magazines.
For example, while U.S. marketers of TCM might emphasize the gentle effectiveness of various remedies as opposed to the "harshness" of Western medicine, manufacturers of Western drugs looking to gain a wider market in China could turn that image to their advantage by playing up the get-better-quick aspect and emphasizing the importance of a speedy recovery. "A lot of money is spent on healthcare advertising," Bolton says, "and companies can do a better job marketing their products."
The findings could also help in the debate on whether there should be more regulation of health marketing, given how consumer perceptions of remedies influence their choices.
"From a consumer perspective, decisions in the health domain are important for individual health and the welfare of society as a whole," the researchers write. "Consumers may be driven by lay theories to make health care choices that do not maximize health outcome -- for example, choosing health remedies out of potentially inaccurate perceptions of their action rapidity or treatment focus, or neglecting health protective behaviors when consuming WM (vs. TCM). Thus, our findings add to the growing debate on the regulation of health marketing, the role of direct-to-consumer advertising, and marketing efforts to promote a health lifestyle."