Healthy Skepticism Library item: 2005

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Freudenheim M.
The Media Business: Advertising; Influencing Doctor's Orders
New York Times 2002 Dec 17

Full text:

Pharmaceutical companies are increasingly souping up their advertising for prescription drugs in a style more commonly associated with products sold from open shelves in drugstores and supermarkets.

Consider the blowups of Joan Lunden, a former host of ABC’s ‘‘Good Morning America,’‘ elbowing aside other drugstore displays in a promotion for Claritin, an allergy treatment. Ms. Lunden is also featured in television commercials for the drug — the first TV celebrity endorsement of a prescription drug.

The Schering-Plough Corporation, which makes Claritin, has even handed out leaflets inviting customers to try Claritin and enter a contest to win a vacation in Hawaii.

Merck & Company has also joined the promotional fray, offering a money-back guarantee in full-page newspaper ads to customers who are not satisfied with Zocor, a cholesterol-lowering drug, after six months. Pharmaceutical analysts said the offer was yet another first for prescription drug advertising.

Spending on consumer advertising has exploded since the Food and Drug Administration in August 1997 loosened longstanding restraints on television commercials for prescription drugs. Consumer advertising for prescription drugs rose to $100 million a month this year, almost five times the total only three years ago, according to Competitive Media Reporting, a marketing research firm. The ads have paid off for a number of drugs, particularly allergy treatments, whose sales have surged.

But the demand generated by consumer advertising has raised questions about how such ads are changing the practice of medicine. Some physicians contend that the ads artificially stoke demand for the most expensive treatments and waste time for both patients and doctors. And insurers complain that the demand is inflating their pharmaceutical budgets.

Nearly 3 patients in 10 who had taken any prescription drug said they had talked with their doctors about a drug they saw advertised, according to a survey of 2,015 people in June by Louis Harris & Associates for the Harvard School of Public Health, Andersen Consulting and London & Associates. But only 40 percent said the doctor had prescribed the drug they had discussed.

‘‘The Harvard study means half the effort caused by the advertising is probably wasting the doctor’s time and wasting expense within the H.M.O., which drives up the cost for everybody,’‘ said Stephen W. Schondelmeyer, a professor of pharmaceutical management and economics at the University of Minnesota.

The most successful ads have been for treatments for allergies, stomach problems, impotence — conditions that are apparent to the sufferers, unlike, say, high blood pressure.

Indeed, sales of three allergy treatments — Claritin, Hoechst Marion Roussel Inc.‘s Allegra and Pfizer Inc.‘s Zyrtec — have risen sharply this year, according to IMS Health, a health care information company.

Claritin was the No. 1 prescription drug advertiser in the first half of the year. Its sales rose 32 percent, to $912.5 million, for the six months from the similar period a year ago, said Neil Sweig, a Wall Street analyst at Southeast Research Partners. Allegra sales doubled to $186 million in the first half of 1998, while Zyrtec sales rose 56 percent, to $178 million.

Over the same period, spending on consumer advertising for the three products jumped 15 percent, to $132 million from the first half of 1997, before the F.D.A. lowered some barriers on commercials, according to Competitive Media Reporting.

Zyban, Glaxo Wellcome P.L.C.‘s new smoking cessation treatment; Prilosec, Astra Pharmaceuticals L.P.‘s treatment for stomach problems, and Paxil, SmithKline Beecham P.L.C.‘s antidepressant, also showed strong sales gains.

The new drug commercials are following temporary guidelines issued by the F.D.A. in August 1997. The guidelines allow drug makers to name their products and discuss their effectiveness without including a full list of possible side effects. Only doctors can prescribe the products, and the agency requires advertisers to tell consumers that they can get more information by consulting a physician, a print ad, a Web site or calling an ‘‘800’‘ number.

Drug manufacturers say their advertisements are educating consumers and empowering them to discuss useful treatments with their doctors.

Indeed, market research surveys affirm the effectiveness of drug ads in alerting prospective customers. But no one has measured precisely how many people visited a doctor solely to ask about an advertised condition, compared with those who broached the subject during a visit scheduled for other reasons.

Still, some health care economists contend the advertising is fueling a renewed upswing in drug costs, which rose 12 to 15 percent this year and are projected to be even higher in 1999, according to Watson Wyatt, a management consulting firm.

To be sure, drug costs have also been pushed higher by the introduction of dozens of effective new drugs and the growing reluctance of embattled H.M.O.‘s to anger members by denying their requests.

But ads ‘‘are essentially encouraging the more expensive drugs within a category,’‘ said Dr. Thomas Simmer, medical director of the Health Alliance Plan of the Henry Ford Health System in Detroit.

Patient visits to doctors increased 2 percent between January and September but visits for allergies rose five times as fast, said Scott-Levin, a drug marketing research firm. Looked at another way, the number who got in touch with a doctor after seeing an antihistamine ad increased to 9 percent in 1998, from 7 percent in 1997 and 5 percent in 1996, when Claritin began its consumer advertising, said Market Measures Inc., another drug market research firm.

In seven heavily advertised groups, there were 3.2 million, or 22 percent, more new patients in the first half of 1998 than the first half of ’97, according to IMS Health. The areas were cholesterol problems (Pravachol), smoking cessation (Zyban), osteoporosis (Evista), hair loss (Propecia), ulcers (Prilosec), postmenopausal problems (Premarin) and depression (Prozac).

There was a cost for a doctor’s time, and at least half the consultations motivated by drug ads did not result in a prescription for the drug. A recent study by Princeton Survey Research Associates for Prevention magazine said 54 million people had spoken to their doctors about a medicine they had seen advertised.

Fee-for-service physicians often charge more than $100 for a routine visit. Employers and employees often divide that cost. A visit to a managed care doctor costs less — about $60, on average, said Gary Lin, an actuary with Watson Wyatt, ranging from $40 in a health maintenance organization in Minneapolis to $70 in some New York health plans.

And insurers say that growing demand for heavily advertised drugs is inflating health plan pharmaceutical budgets. ‘‘Except for antibiotics, we are spending more money on runny noses than anything else,’‘ said Mark DiGiorgio, a spokesman for Cigna Healthcare, a big health maintenance organization. It spends 10 percent of its $250 million pharmacy budget for allergy and sinus drugs, a Wall Street analyst estimated.

Some employers and health plans plan to buck the trend by paying for only 60 percent of the price of expensive, advertised drugs in some cases, if other equally effective, less costly drugs are available, said Helen Darling, a health care expert with Watson Wyatt. Health plans typically pay all but a nominal amount for drugs on their approved lists.

A daily dose of Claritin, Allegra or Zyrtec can cost $2 or more, while Tavist, an over-the-counter allergy treatment costs about 96 cents a day, pharmacists said. (Tavist, made by Novartis, is more likely to cause drowsiness.)

Spokesmen for drug makers and advertisers say that many medicines, however costly, reduce costs by keeping patients out of hospitals.

‘‘We are all eager to attempt to address the major problems — underdiagnosis and undertreatment of disease,’‘ said Alan F. Holmer, president of the Pharmaceutical Research and Manufacturers Association, a trade group. ‘‘All the consumer ads are doing is to empower the patients so they can have a more informed conversation with their doctors.’‘

And such conversations can have unexpected benefits. The study by Prevention also showed that 1 in 20 patients who spoke to a doctor about an advertised medicine were found to have a different problem that might otherwise have gone untreated.

If advertising ‘‘leads to a discussion, that’s fine,’‘ said Dr. Phil R. Manning, an associate vice president of health affairs at the University of Southern California. But he is concerned that insistent demands by patients ‘‘open the door to injudicious use of certain drugs.’‘

Indeed, almost 3 in 10 respondents in a recent market survey for Time Inc. said they would consider switching doctors if they did not get a prescription they requested. Health plan officials said that some drug companies were brandishing the statistic in an unsubtle sales pitch. But Caryn Klein, associate director of research at Time, said she was not satisfied with the finding because respondents were not asked about specific drugs and maladies.

‘‘The patient is not an educated consumer,’‘ said Dr. Brian Strom, chairman of epidemiology and biostatistics at the University of Pennsylvania. ‘‘The patient is really an unwitting tool of the manufacturer’s marketing department.’‘

Nancy M. Ostrove, chief of marketing practices at the F.D.A., said the agency was evaluating consumer ads to see whether they were undermining physician-patient relationships, promoting ‘‘inappropriate prescribing’‘ or otherwise affecting public health. She said the increased costs, if any, generated by the ads were not within the F.D.A.‘s purview.

The lowering of barriers to medical marketing — once confined largely to professional journals and visits to physicians by salespeople — has not been limited to TV.

For their blockbuster products, drug makers have Web sites where prospective customers are offered referrals to doctors, information about medical problems and personalized newsletters.

And as drug makers pursue new marketing opportunities, they are also continuing their longstanding tactic of dispatching thousands of salespeople to visit doctors.

Industry analysts expect the F.D.A. to revise the guidelines within a few months. But unless the rules are drastically tightened, aggressive campaigns to reach consumers are expected to continue, even though many physicians object.

‘‘Pharmaceuticals are not toothpaste or types of cereal,’‘ Dr. Strom said. ‘‘If a patient isn’t bothered by a problem, why create demand by driving them to the physician? We spend too much on health care. The focus nationally is on trying to reduce health costs.’‘