Public Relations Review 34 (2008) 399–402

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Public Relations Review

Short communication

Issues management and inoculation: Tylenol’s responsible dosing advertising
Shari R. Veil ∗ , Michael L. Kent 1
Gaylord College of Journalism and Mass Communication, University of Oklahoma, 395 West Lindsey, Norman, OK 73019, United States

a r t i c l e

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a b s t r a c t
Issues management developed as a long-term process interested in the continued health and success of organizations. This essay presents a contemporary issues management case that uses inoculation and a priori solutions as issues management tactics. The case study involving Johnson & Johnson’s responsible dosing campaign demonstrates that organizations perceived to have a high standard of corporate social responsibility are not above using deceptive tactics to protect their brand. © 2008 Elsevier Inc. All rights reserved.

Article history: Received 29 April 2008 Received in revised form 11 July 2008 Accepted 28 August 2008 Keywords: Issues management Corporate social responsibility Inoculation Crisis communication

Public relations practitioners increasingly need to serve as ethical counselors to the dominant coalition (Health, 1994) and as the ethical conscience of the organization (Ryan & Martinson, 1983; Wright, 1996). Despite the role of issues management in guiding ethical decision making (Bowen, 2005), some communication campaigns have suspended organizational ethics to manipulate public perception. This essay examines the misuse of issues management through a contemporary issues management case study involving Johnson & Johnson’s responsible dosing campaign. Inoculation and a priori solutions literature are presented to show the deceptive nature of an advertising campaign that appears to promote social responsibility. A short review of issues management is provided, followed by a description of the case and a critical analysis of inoculation and a priori solutions as deceptive issues management tactics. 1. Issues management In a 1979 issue of Public Relations Review, Jones and Chase (1979) wrote one of the first articles on issues management in public relations. In their essay, Jones and Chase argued, “When challenged by today’s activism, business tends to react to overt symptoms, rather than by identifying and analyzing fundamental causes of the trend which has lead to a critical issue” (p. 3). Jones and Chase noted that issues cannot be managed if they are not planned, for “it is obviously impossible to manage issues that are the predictable result of unforeseen trends” (p. 3); thus, organizations need to be prepared for crises and ready to deal with technical and symbolic obstacles: environmental cleanup, public outcry, calls for regulation, etc. Issues managers have been encouraged to build relationships (Taylor, Vasquez, & Doorley, 2003), engage in corporate philanthropy that serves the interests of organizations and publics (Porter & Kramer, 2006; Stewart, 2006), engage in corporate advocacy and identification to create relationships with publics (Bostdorff & Vibbert, 1994), and practice issues management with an eye toward long term issues and the future sustainability of organizations and the environment (Roper & Toledano,

∗ Corresponding author. Tel.: +1 405 325 5371. E-mail addresses: Shari.Veil@ou.edu (S.R. Veil), MKent@ou.edu (M.L. Kent). 1 Tel.: +1 405 325 7346. 0363-8111/$ – see front matter © 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.pubrev.2008.08.004

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2005). Without question, issues management is a long-term process interested in the continued health and success of organizations. Underlying issues management literature is an assumption that managing issues is a rhetorical, persuasive process (cf., Bostdorff, 1992; Bostdorff & Vibbert, 1994; Bridges, 2000; Heath, 1990, 2006). Nelson (1994), in a special issue of Public Relations Review on ethics, suggested there has been little consistency in terms of what constitutes ethical persuasion in issues management. “Too many individuals in the public relations field today lack the decision making framework tools that a broad-based knowledge of ethical theory provides” (p. 229). Nelson also points out that persuasion is not just an ethical process but a long-term process in which audience members are provided with accurate facts and allowed to make their own decisions. To explore the ethical implications of conducting issues management, this study turns to a recent campaign by Johnson & Johnson and critically analyzes the actions of an organization deemed “socially responsible.” 2. Johnson & Johnson’s responsible dosing campaign In August 2006, a jury awarded a $5 million verdict in a wrongful death suit of a one-year-old boy. The child’s family alleged the Infants’ Tylenol they gave their son did not have sufficient warnings on the label, causing them to accidentally give him the overdose that resulted in their son’s death. The jury determined that the label did not explain the concentration of the Infants’ Tylenol or that even a slight overdose could result in liver failure (“Jury Awards,” 2006). Johnson & Johnson was ordered to pay damages because they knew of the risk, even though the FDA did not require stronger warnings regarding acetaminophen overdose and liver failure until December 2006 (Dworkin, 2006). In 2004, as the wrongful death suit was being filed, Johnson & Johnson began running a new advertising campaign for Tylenol concerning responsible dosing. A television advertisement featured Tylenol’s Vice-President of Sales, stating she would rather sell less Tylenol than have people take the drug incorrectly1 (Tompkins, 2004). According to a feature story in Adweek, the campaign was launched because Johnson & Johnson and their advertising agency, Interpublic Group’s Deutsch, found that consumers took higher than the recommended dosage of over-the-counter medications and mothers dispensed too high a dosage to their children (Sampey, 2005). Johnson & Johnson wanted to drive home the idea that consumers should always read labels for over-the-counter drugs, so Deutsch decided to position Tylenol as “a responsible drug company” (Sampey, 2005, p. 7). Referring to the “Stop. Think. Tylenol” campaign, Chairman Bill McComb said, “Tylenol owns responsibility” (Sampey, 2005, p. 8). While the newfound dangers of common overdose were said to have spurred the campaign, both the FDA and Johnson & Johnson were privy to an advisory panel as early as 1977 concluding that an overdose of acetaminophen “may result in severe liver damage and a warning regarding this effect is obligatory” (Gilbertson, 2002, slide 4). Moreover, acetaminophen overdose is the leading cause of death in poison-control cases and the chief cause of acute liver failure (Alonso-Zaldivar, 2006). Over-the-counter acetaminophen has been linked to more than 56,000 emergency room visits and has resulted in about 100 deaths each year according to FDA estimates (Neergaard, 2005). In one FDA study of 307 patients whose liver damage was linked to acetaminophen use, 22% took less than the maximum daily dose (Neergaard, 2005). The timing of the responsible dosing campaign in the midst of a lawsuit and the obvious prior knowledge of the dangers of acetaminophen require review of the manipulative persuasive theories that inform this campaign. 3. Inoculation and a priori solutions Two theories, inoculation and a priori solutions, have relevance here. The key issue is the timeline. After all, why did not Johnson & Johnson launch the “Responsible Dosing” campaign in 1977 when they first learned that overdoses caused liver damage? Johnson & Johnson might, more effectively, have held a press conference, created training videos for doctors, or, at the very least, issued a news release in the last 30 years regarding the importance of following warning labels. Instead, Johnson & Johnson decided, following on the heels of a lawsuit, to create messages they surely knew were useful for swaying public opinion. 3.1. Inoculation Inoculation theory is based on a biological analogy. McGuire (1964) posited that individuals can be inoculated against persuasive attacks in much the same way they can be inoculated against viral attacks. McGuire predicted that just as a weakened dose of a virus stimulates the immune system, a mild belief-threatening message will motivate individuals to resist future counter-attitudinal attacks. The attack motivates supporters of the message sponsor to defend their attitude thereby “conferring a broad blanket of protection against all potential counterarguments” (Burgoon, Pfau, & Birk, 1995, p. 488).

1 (VFX: Images of female with voice to camera) Woman VO: Some people think if you have a really bad headache, you should take extra medicine. Problem is, that’s not going to get rid of your headache faster. And taking too much of any medication, no matter how safe it is, can cause serious problems. (Super: Use only as directed at the recommended dose. VFX: Image of female’s hands) Your health is important to us, so if you’re not going to take the recommended dose of our medicine, I’d rather you just didn’t take it. And if that means selling less Tylenol, that’s fine with me. (Super: Brenda Bass, Vice President of Sales, Tylenol. VFX: Tagline Treatment STOP. THINK. tylenol.com).

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Burgoon et al. (1995), who examined the effectiveness of issue/advocacy advertising campaigns as inoculation treatments, found the strategy successfully inoculates against attitude change and protects sponsors against slippage of source credibility ratings. In addition, the issue/advocacy messages were found to be more effective as an inoculation treatment among women as opposed to men in terms of corporate credibility (Burgoon et al., 1995; Pfau & Burgoon, 1990; Pfau, Kenski, Nitz, & Sorenson, 1990), an important point considering most healthcare decisions are made by women (Blue Cross Blue Shield, 2007). While not originally intended as a “manipulative” strategy, inoculation has been shown to be effective in limiting negative perceptions. The mild attack in this case came at the start of the advertisement: “Some people think if you have a really bad headache, you should take extra medicine.” According to the campaign, Johnson & Johnson of course does not think this, which is why they would rather sell less Tylenol than have consumers take too much. The plaintiffs in the lawsuit can be classified as the “some people” who took too much medicine even though Johnson & Johnson “warned” them they should not. The inoculation strategy works to protect Johnson & Johnson against future attacks (and lawsuits) regarding responsible dosing. 3.2. A priori solutions A priori solutions are essentially solutions to problems that do not exist yet. As Edelman (1988) explains, “the striking characteristic of the link between political problems and solutions in everyday life is that the solution typically comes first, chronologically and psychologically” (pp. 21–22). “Those who favor a particular course of governmental action are likely to cast about for a widely feared problem to which to attach to it in order to maximize its support” (p. 22). According to Edelman, “solutions can be created by government officials a priori (before the fact) to explain political problems” (Taylor & Kent, 2007, p. 132). The responsible dosing advertising campaign was created in 2004 and ran through the summer of 2006, while the court decision was reported in the news in August 2006. The solution of better warnings was presented before the problem was identified in the media. The theories of inoculation and a priori solutions explain the deceptive nature of this issues management case. Even greater ethical implications are identified when analyzing the target audience of the campaign. 3.3. Ethical issues in Johnson & Johnson’s issues management A key concern is if the true motivation for Johnson & Johnson’s campaign was not to protect consumers, but to change how consumers respond to over-dose litigation on juries and in the court of public opinion. O’Connor (2006) found that over one-third of respondents indicated they would be willing to reduce punitive damages in jury deliberations based on information obtained in values advocacy advertisements. By exposing consumers and potential jurists to messages about “how to be safe” (responsible dosing) Johnson & Johnson was attempting to inoculate potential jurors and consumers against the imminent attacks and create the appearance of a solution (“we care so we are telling you to be careful”) before the issue became front page news. Indeed, the timeline of Johnson & Johnson’s activities give away their priorities. This essay examined the misuse of issues management as a strategy to manipulate stakeholders. The seemingly innocuous, pro social, message of encouraging consumers to read warning labels attempted, in effect, to hide potential legal issues down the road. While Johnson & Johnson is by no means the only organization using advertisements to manipulate public perceptions, as an industry leader that supposedly “owns responsibility,” Johnson & Johnson can and should be held to a higher standard. References
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