It all started 11 years ago with a curious
television commercial showing people traipsing through a meadow.
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"At last, a clear day is here," the
announcer said. And in a tagline that would become imitated and parodied:
"See your doctor."
The ad, for Claritin, never mentioned what
the drug was for, leaving viewers guessing what they should see their
doctor about. But plenty of people asked. And doctors wrote plenty of
prescriptions. Sales of Claritin, an anti-allergy drug made by
Schering-Plough, surged from $900 million in 1996 to $2.1 billion in 1998,
sparking a huge, controversial movement known as direct-to-consumer
advertising.
Today, drug companies, including
Indianapolis-based Eli Lilly and Co., spend lavishly to advertise drugs
for insomnia, migraine headaches, dry eye, brow furrow, fungus, high
cholesterol, irritable bowels, arthritis and dozens of other maladies.
But the huge advertising tide, worth about
$4 billion a year, might be turning as a chorus of critics accuse the drug
companies of using the ads to bring consumer pressure on doctors to
prescribe unnecessary and costly drugs.
The industry trade association,
Pharmaceutical Research and Manufacturers of America, defends the
practice, saying it helps inform consumers and starts "important
doctor-patient conversations about conditions that might otherwise go
undiagnosed or untreated."
But congressional Democrats who have
criticized the growing ad campaigns are now in power. Although no bill has
been introduced to curb drug advertising, many observers expect it to
happen.
Many doctors, consumer groups and insurers
have pushed for a ban or moratorium on drug advertising. They say the ads
are high on emotion and low on information about the drugs and their side
effects.
Some doctors say the ads prompt patients to
quiz them on all kinds of medicines, saying they saw ads on television
that promised to help.
"It seems like everything out there is a
miracle drug," said Dr. Edward Langston, a family physician in Lafayette
and chairman-elect of the American Medical Association's board of
trustees. "Patients have an unrealistic idea of what drugs can do, and
what side effects they might have."
Some consumer groups say the advertising is
outright harmful to consumers and creates a culture that tries to convince
people they are ill. Only two countries -- the U.S. and New Zealand --
allow direct-to- consumer drug ads.
Two years ago, Commercial Alert, a consumer
group based in Portland, Ore., circulated a petition calling for an end to
direct-to-consumer advertising. More than 200 medical school professors
signed it. Since then, more than three dozen health and senior groups,
including the Gray Panthers and the Women's Health Institute, have signed
a similar petition, calling on Congress to ban drug ads.
"There's a lot of support for a ban on
direct-to-consumer advertising, and the Democrats know it," said Gary
Ruskin, Commercial Alert's executive director.
In a 2005 study by PricewaterhouseCoopers,
more than 94 percent of doctors, academic researchers, hospital executives
and other health officials said pharmaceutical companies spend too much on
advertising.
Drug company spending on direct-to-consumer
advertising has increased twice as fast as spending on promotions to
physicians or on research and development from 1997 to 2005.
In 2005, drug companies spent $4.2 billion
for direct-to- consumer ads. Spending for 2006 isn't fully tallied, but
drug companies seemed on pace for another record year, with advertising
spending up 9 percent over 2005, to $4.5 billion, according to Brandweek,
a trade publication.
Lilly and its partner, Icos Corp., spent a
whopping $116 million in 2005 on direct-to- consumer advertising just for
erectile dysfunction drug Cialis, making it the 10th-biggest drug brand in
ad spending that year.
Perhaps the best-known Cialis commercial
shows a man and woman reclining outdoors in side-by-side bathtubs,
watching a sunset. "When the moment is right," the announcer says, "will
you be ready?"
Many of the industry's television
commercials have a soft and fuzzy touch: people romping through meadows,
an elderly man blowing soap bubbles with his grandchildren, figure skaters
cutting up the ice.
Some don't even name the drug, just a
condition, such as depression. Others name the drug, but not what it can
do, or the possible side effects.
The Claritin commercial in 1996 wasn't even
the first direct-to-consumer drug ad. More than a decade earlier, Boots
Pharmaceuticals aired the first one when it promoted its prescription
ibuprofen medication, Rufen, according to Advertising Age, an industry
publication.
What the Claritin ad did was avoid saying
what the drug could do, thus skirting a Food and Drug Administration
requirement that drug companies had to disclose risks and benefits alike.
By not mentioning benefits directly, it could avoid full disclosure of the
risks, instead directing patients to ask a doctor about the medicine.
The Claritin ad encouraged other drug makers
to follow suit. Spending on direct-to-consumer advertising soared from $12
million in 1989 to $1.17 billion in 1998, according to Advertising Age.
Today, it's hard to watch an hour of
prime-time television without seeing a drug ad.
Some insurers say the commercials raise the
cost of health care, because consumers demand a certain heavily advertised
brand, even through it might not be any more effective than a generic drug
or other alternative. And drugs often are promoted before their effects on
a wide population are known.
"I don't think pharmaceutical companies
should advertise to consumers until the drug has been on the market for a
period of time, probably at least six months," said Alex Slabosky,
president of Indianapolis health insurer M-Plan. "You need some history on
how the drug is affecting people."
But drug companies, including Lilly, resist
any move to ban advertising or even place an advertising moratorium on new
drugs.
"We would argue that if one of our new drugs
is first in class or best in class, and that physicians and patients might
not be aware of it, this advertising might be appropriate, once we've
educated physicians," said Lilly spokesman Edward Sagebiel.
Regulators are weighing in, too. Last week,
the FDA said it wants to start charging fees to drug companies, a move
that would allow it to hire 27 extra employees to screen drug ads.
Currently, the agency has no power to
preview ads. It can only levy fines and order drug makers to pull an ad if
it determines the ad breaks regulatory rules. Drug companies are
prohibited from downplaying side effects or implying a drug should be used
for a nonapproved use.
Rep. John Dingell, D-Mich., new chairman of
the House Energy and Commerce Committee, has said he will take a hard look
at direct-to-consumer ads.
Sen. Edward Kennedy, D-Mass., new chairman
of the Senate's Health, Education, Labor and Pensions Committee, has
pushed previously for a two-year moratorium on advertising a drug after
its approval.
Even the industry seems to know the tide is
turning. A national conference this year on direct-to-consumer
advertising, known as DTC, will address those issues head-on.
The conference's organizers don't mince any
words. Drug companies should start thinking hard about the subject.
"How likely is a DTC advertising moratorium?
How can I build a product launch plan that will prepare for such action?"
reads one section of the group's agenda. "What must we do better in our
advertising in order to ensure our survival?"
Call Star reporter John Russell at (317)
444-6283.