Ads featuring Olympic gold-medal skater Dorothy Hamill helped send sales of the prescription pain reliever Vioxx soaring. And a catchy tune reminding arthritis sufferers that taking Celebrex would have them celebrating cemented its spot in the pantheon of drugs with yearly revenues of more than $1 billion.
The ads prompted millions of patients to ask for and get a class of specialized medicines most really didn't need — and that now have been linked to an increased risk of heart attack and strokes. That reality is casting a harsh spotlight on pharmaceutical advertising, which has become ubiquitous since federal regulators relaxed rules in 1997, paving the way for medicines to be promoted on television.
Ad executives and drug company officials say changes in advertising strategies are almost a certainty in the wake of the Vioxx and Celebrex news and new studies showing a consumer backlash. Commercials featuring active, happy people with only an obligatory discussion of side effects are not doing enough to explain the inherent risk in taking drugs, experts said.
“This has been a big wake up call for pharmaceutical companies,” said Frank Ginsberg, chairman of Avrett Free Ginsberg, a New York-based ad agency which has worked for pharmaceutical companies. “I think there will be some dramatic changes.”
Only 18 percent of consumers believe pharmaceutical ads can be trusted “most of the time,” according to a study released Friday by the Kaiser Family Foundation. That's down by almost half since 1997, when one-third of people surveyed said you could trust ads most of the time.
Meanwhile, a study by Iposos-Insight Corp. found that consumer response to pharmaceutical advertising has been steadily declining since 2002. Last August, 19 percent of those surveyed said an ad prompted them to call or visit a doctor. That's down from 25 percent in February, 2002.
Pharmaceutical ad spending between December 2003 and November 2004 surged 30 percent from the same period a year earlier to $4.35 billion, according to TNS Media Intelligence. While no one is predicting a major collapse in ad buys, such percentage gains are highly unlikely in the future, experts said.
Some industry officials also suggest the focus of ads will change to describing diseases and encouraging doctor visits instead of touting specific brands. Others say some money earmarked for ads could be shifted to other promotional activities such as doctor marketing or public relations.
“I think education ads will be more prominent,” said David R. Brennan, president and CEO of AstraZeneca, North America, a unit of AstraZeneca PLC, whose best selling drug is Nexium, a treatment for acid reflux. “Lately there has a lot more focus on brands and sometimes we (the industry) do it so well that it overshadows the disease.”
Conveying drugs' risks and benefits is difficult in an ad, Brennan said. “You don't want to scare patients” by including all kinds of caveats about potential risk that might keep patients from taking medicines they need. But he also acknowledged a need for change. “Maybe we need better balance,” he said.
Ginsberg and others said the biggest challenge facing companies will be promoting new products, especially ones that belong to new classes of drugs that don't have long records of safety.
“You just can't come up with a new product and then create a dramatic demand for it,” said Ginsberg. “These companies were moving very fast. Now there is a stop sign that says proceed with caution.”
Both Vioxx and Celebrex belong to a class of drugs called Cox-2 inhibitors that was viewed as a breakout category when they were launched in 1999. Pfizer Inc.'s Celebrex was the ninth most heavily advertised drug in the first 11 months of 2004 with $104.5 million in spending, TNS figures show.
Pfizer is no longer advertising Celebrex at the request of the Food and Drug Administration. Last week, an FDA panel said Celebrex should have a black box warning, the agency's most serious caution, which restricts drug advertising.
Merck removed Vioxx from the market last year after it was tied to increase risk of heart attack and strokes. The FDA panel voted to let Vioxx back on the market, but should it return, a black box warning is practically a certainty.
The new environment may pose a challenge for Sepracor Inc., which recently won approval to market a new sleep aid. The company didn't return calls for comment.
Meanwhile, both Pfizer and Bristol-Myers Squibb Co. are expected to have new diabetes drugs reviewed this year by the FDA. Though each diabetes drug is different, both represent novel approaches that are likely to require detailed educational ad campaigns. Bristol-Myers declined comment. Pfizer wouldn't comment specifically on its drugs but said in a statement that it is working on ways to make its ads more effective in communicating risk.
According to pharmaceutical consulting and information company IMS Health, the industry spent $25 billion on promotions in 2003, the last year for which data are available. The biggest chunk, $16.4 billion, went for drug samples.
David Gascoigne, IMS' practice leader in promotional management, predicts drug companies will shift more spending from broadcast to print advertising campaigns because print offers a more defined audience and an ability to convey more detailed information.
He also expects companies to boost spending for Internet ads and public relations.
“Two years ago, none of our clients were asking us about public relations. Now everyone is coming in asking us about public relations,” said Gascoigne. “I think the days of the $100 million ad campaign are dead.”