Just seven years after the Food and Drug Administration ended decades of restrictions by allowing drug makers to advertise prescription products directly to consumers, spending on such ads has reached $3.8 billion.
To put that sum in perspective, it is more than companies like Coca-Cola, Pepsi-Cola and Cadbury Schweppes spend combined each year to sell their soft drinks. It even exceeds what one of the very largest marketers, Unilever, spends annually on global campaigns for all its brands, including Dove, Knorr, Lipton, Lux, Pond's, Slim-Fast and Wish-Bone.
But as the pharmaceutical industry and Madison Avenue get ready for a new year, they are increasingly concerned about their ability to continue to pitch prescription drugs at the patients who would use them, as well as to the doctors who would prescribe them.
The doubts are being fueled by the intensifying firestorm surrounding Vioxx, the pain medication that Merck & Company withdrew from the market in September amid concerns that its use increased risks for strokes and heart attacks.
Critics complain that the huge sums Merck spent to advertise Vioxx directly to consumers stimulated demand for the drug at the expense of cheaper - and perhaps safer - over-the-counter alternatives like ibuprofen. Last month, the criticism widened to include five other heavily prescribed, and heavily advertised, prescription brands like Bextra, for pain; Crestor, for cholesterol; and Meridia, for obesity.
"There's an arms race in the pharmaceutical industry as it gets more and more competitive," said David Jones, chief executive of the flagship New York office of Euro RSCG Worldwide, the Havas-owned agency with a client list that includes the drug makers GlaxoSmithKline, Novartis, Sanofi-Aventis and Schering-Plough.
"As that happens, marketing becomes a more and more important differentiator to break through the clutter," he said, helping consumers choose among rival products.
Drug ads aimed at consumers are a crucial concern because "consumers are becoming much more empowered" to make their own health care decisions, Mr. Jones said, largely as a result of the Internet.
"Ten or 15 years ago, if I were going to see a doctor, there was limited ability to find out about the condition I had or the drug that might treat it," he said. "Now, people are going in to the doctor's office armed with pages and pages of printouts."
Another reason direct-to-consumer campaigns for prescription drugs are proliferating is that the drugs themselves are proliferating, said Val DiFebo, managing partner of the Deutsch agency, part of the Interpublic Group of Companies, and general manager of its New York flagship office.
"The population is aging and more and more people need these drugs to control ailments facing them," said Ms. DiFebo, whose agency works for Novartis and previously created campaigns for Pfizer. At the same time, she added, the difficulties encountered by Vioxx may change the way consumers respond to the newer prescription brands the drug makers advertise to treat those ailments.
"Not only will the Food and Drug Administration be doing more scrutinizing of newer drugs," Ms. DiFebo said, "but consumers will be saying: 'This is a new drug. It means not that many people have taken it yet. Maybe I should stick with what I'm taking.'"
So, "if you've been using Flonase forever to control your allergies, what will be the likelihood you switch to Flowthru?" she asked rhetorically, inventing a competitor for the GlaxoSmithKline nasal spray.
If such a shift in sentiment were to take place, it would represent a potentially momentous change from current attitudes, which critics describe as unfairly favoring newer prescription brands over older ones. The reason is that until now, consumers have generally perceived the approval by regulators of a new drug - which then becomes the subject of a major ad campaign - as proof it must be more effective than those now on the market treating the same condition.
But the Vioxx recall may generate skepticism among consumers about the safety of drugs, "particularly those seen in ads," said Fariba Zamaniyan, vice president for Ipsos Health, a division of the market research company Ipsos that tracks consumer behavior toward prescription drugs through a study called PharmTrends.
As a result, Ms. Zamaniyan predicted in a report in late October, the level of response to direct-to-consumer drug advertising, which has been declining, is likely to fall further. In February 2002, 25 percent of consumers responding to the PharmTrends study said an ad had prompted them to discuss with their doctors the drug being advertised. The response rate dropped to 19 percent in the study in February 2004 and remained there in the study done six months later.
One way to address that, Ms. DiFebo of Deutsch said, would be for the drug makers "to talk to people from a heart-to-heart place, the way they would want to be talked to about a drug or a condition."
She praised plans by the F.D.A. to reconsider the regulations for prescription-drug print ads to "reduce the amount of copy," which now typically fills a page with words in tiny type, "so people will actually read it."
"You want to make it more digestible," Ms. DiFebo said, "so they don't tune it out." For instance, the complete version of the so-called "fair balance" information, related to a drug's potential side effects, could be posted on a Web site, she added, while the print ads feature the salient points in larger type than they are now.
In the meantime, the contentious dispute over Vioxx is generating more drug advertising aimed at consumers - no longer pitching Vioxx, of course, because Merck stopped running those ads as soon as it decided to stop selling Vioxx. Rather, some of the new ads are sponsored by lawyers suggesting that people who took Vioxx could file damage claims against Merck.
Stuary Elliott, The New York Times. December 6, 2004.
Copyright © 2004 The New York Times Company. All rights reserved.