Healthy Skepticism Library item: 758

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

Rowland , C .
Drug firms seek profit in giveaways: Marketing targets consumer loyalty
The Boston Globe 2005 Jan 17

Full text:

Christopher Lemley is a marketing professor at Georgia State University who has seen it all when it comes to consumer advertising of prescription drugs.
Yet even he was impressed when GlaxoSmithKline sent him a free pillowcase.

‘‘It was kind of cool,” Lemley said.

It was not just any pillowcase. It was an ‘‘allergen barrier pillow cover,”
his reward for being prescribed Flonase allergy nasal spray for three months. If he keeps getting his doctor to prescribe Flonase, Lemley could be rewarded with a ‘‘Sweep N’Clean” device to wipe dust out of his house, or a ‘‘Pristine Pillow” that is made of hypoallergenic fibers. He also gets $5 coupons to cash in with each 30-day prescription.

Prescription drug manufacturers and their Madison Avenue advertising firms are targeting consumers with more aggressive marketing techniques, including sophisticated loyalty programs and the nearly ubiquitous use of coupons and free-trial offers that were once the domain of over-the-counter medications, dishwasher soap, and breakfast cereals.

The coupons and free trials are especially common in drug classes where patients and their doctors must choose among competing brands for drugs that are taken for months, if not years. These include allergy drugs, anti-cholesterol drugs, asthma remedies, and antidepressants. The offers also frequently appear in advertising for so-called ‘‘lifestyle drugs,” such as treatments for erectile dysfunction and sleeplessness.

Safeguards are built into the system. To redeem an advertising coupon for a free-trial offer of a prescription drug, a patient must bring the coupon to a doctor to get a prescription before redeeming it at a pharmacy.

Still, critics of consumer advertising for prescription drugs say the giveaways can lead to inappropriate medical decisions.

‘‘I’m really concerned that patients are being baited and hooked on free samples,” said Dr. Edward Langston, a physician in Lafayette, Ind., and a member of the American Medical Association Board of Trustees. ‘‘Sometimes there might be an economic incentive, but it might not be the right medical incentive.”

Merck & Co. and Pfizer Inc. enticed consumers with free-trial offers and discounts on their Vioxx and Celebrex painkillers, helping to build them into billion-dollar blockbusters before problems came to light with the drugs. Merck withdrew Vioxx in September 2004 because of an increased risk of heart attacks and stroke. Pfizer has disclosed one clinical study of Celebrex that showed a cardiovascular risk, although Celebrex remains on the market. Pfizer and Merck did not respond yesterday to questions about promotions of Celebrex and Vioxx.

AstraZeneca Pharmaceuticals LLP is running a consumer-oriented promotional campaign that provides a 15-day, free supply of Crestor, its drug to treat high cholesterol, even though Crestor is under scrutiny for a possible higher risk of muscle deterioration and kidney problems.

The Washington consumer group Public Citizen has petitioned the FDA to have Crestor removed from the market. Dr. Sidney Wolfe, director of the medical research group at Public Citizen, said consumers should not take Crestor even if they get it for free.

‘‘The fact that someone gets it for free is not going to compensate them if they end up on kidney dialysis,” Wolfe said.

AstraZeneca says its drug is as safe and has the same side-effect profile as any of the other anti-cholesterol drugs, called ‘‘statins,” such as Lipitor and Zocor. An AstraZeneca spokeswoman, Emily Denney, said free-trial offers are an effective way to encourage dialogue about cholesterol levels between a doctor and patient. It puts a physical reminder, a coupon, in the patient’s hand, she said.

‘‘It’s an extra incentive to go have that talk with their doctor,” said Denney.

AstraZeneca also offers consumers a seven-day free trial coupon for Nexium, a prescription brand similar to its old heartburn drug, Prilosec, which is now sold over-the-counter. Although Nexium is more expensive than the over-the-counter version — $125.99 for 30 pills compared with $19.99 for 28 pills — AstraZeneca’s marketing campaign for Nexium produced $3.3 billion in sales in 2003.

Boehringer Ingelheim GmbH offered a 30-day free trial coupon in advertisements in large city newspapers for its prescription painkiller Mobic immediately after Merck withdrew Vioxx from the market, hoping to attract attention as a safe alternative. It followed that up with a 15-day free trial offer in smaller media markets, including one offer in Detroit that coincided with a visit by Mobic spokesman and former football star Joe Namath.

The competitors in the erectile dysfunction drugs have been especially creative with coupons and free trials. Cialis, marketed by a partnership of Eli Lilly and Co. and ICOS Corp., is running a promotion it calls ‘‘The Cialis Promise.” Lilly ICOS offers men a free trial of Cialis. If they like Cialis, Lilly ICOS provides another free sample. If the patient doesn’t like Cialis, Lilly ICOS will pay for a sample prescription of any other sexual dysfunction drug.

Pfizer’s Viagra has a ‘‘Value Card,” which entitles a patient to a free refill after the first six prescriptions. The price for a 10-pill Viagra prescription on drugstore.com is $90.99. The Viagra website also encourages men to ask their doctors for free sample packs containing six pills that Pfizer distributes to doctors.

Free trial programs were once limited to doctors’ offices, where drug salespeople supply physicians with small sample packs they can give to their patients. The practice of offering free samples directly to consumers has emerged on a parallel track, keeping pace with the explosive growth of drug advertising on television, which surged after the US Food and Drug Administration removed most regulations on the practice in 1997.

Academics and consultants who study prescription drug advertising said they were unaware of any data that would demonstrate the extent or effectiveness of coupons and free trial offers. Studies of drug advertising have shown that all drugs in a class benefit by advertising for even just one of the brands in the class.

In addition to giving firms an edge over competing brands, there is a clear side benefit, said Marta Wosinska, an assistant professor of marketing at Harvard Business School. Most free trial offers require the consumer to fill out a form on a website, allowing the drug companies to capture coveted marketing data for individual patients.

‘‘Pharmaceutical companies cannot buy any third-party data about who is using their drugs, because of medical privacy laws,” she said. ‘‘This way, they get medical marketing information.”

That means the drug companies can send consumers more advertising — through the mail.