Side effects included
The U.S. pharmaceutical advertising market is booming, but the campaigns are formulaic and invite parodies
The U.S. advertising market for drugs is booming, but the campaigns are uniform and provoke parodyBy Thérèse BalduzziMore than three years ago, advertising for prescription drugs was liberalized in America. The impact of the mandatory listing of side effects on advertising effectiveness remains controversial. The only thing that is clear is that drug advertising has become a well-known genre that is already happily parodied.
A TV commercial for the allergy medication Allegra begins with a family of three driving into the countryside. Father and son get out of the car and look forward to hiking. Only the wife stays in the car and sneezes because she suffers from allergies. A little later, however, she enjoys the fresh natural air just as much thanks to the prescription Allegra, inhales it deeply. The voice-over announces that Allegra (active ingredient Fexofenadine) can cause headaches, upper respiratory infections and back pain as side effects.
In a commercial for the appetite suppressant Meridia, various women proclaim that they have their eating habits under control. "Cheesecake doesn't turn me on," declares one, "I don't confuse Love and Lasagna," the other. After that, an off-camera voice warns that Meridia is not suitable for people with high blood pressure, depression, anorexia, Parkinson's disease, glaucoma, or those with heart conditions, pregnant or breastfeeding women. Side effects could include headaches, constipation, insomnia and dry mouth. There is also a risk of becoming addicted.
Liberalization triggered ad and spot boom
When the Food and Drug Administration (FDA) liberalized regulations for prescription drug advertising in 1997, it paved the way for an incredible inflation of commercials and ads. Every day, dozens of drug commercials for all sorts of ailments flicker across the screen: Depression, allergies, herpes, obesity, asthma, flu, colds, impotence, irritable bladder, multiple sclerosis, Alzheimer's, heart disease, osteoporosis, arthritis, migraines. And the magazines are teeming with corresponding advertisements.
Billions flow into direct-to-consumer advertising (DTC), as drug advertising is known. Last year, DTC represented the sixth largest advertising category. Spending nearly doubled in 1999 ($1.8 billion) from 1997 ($1 billion). Spending on TV ads alone more than tripled between 1997 ($309.6 million) and 1999 ($1.1 billion).
The "Fair Balance Guidelines" of the DTC guidelines stipulate that side effects must be enumerated. Nevertheless, critics complain that patients are given only fragmentary information, which often creates false expectations. Since patients nowadays visit the doctor anyway with a load of printed information from the Internet, drug advertising only creates additional confusion. Doctors would be pressured by patients pumped full of advertising to prescribe them certain medications, even if they thought others made more sense or a medication was unnecessary.
Even the FDA is divided. On the one hand, it accepts the proponents' argument that drug information emancipates patients and promotes discussion between doctors and patients. Last year, however, the FDA was forced to issue a "public health advisory." This warned consumers that doctors were relying too much on the effectiveness of the new antiviral flu drug Relenza, which may have even caused the deaths of certain patients who might have needed stronger treatment.
Changes in the
Doctor-patient relationship
Also of concern is the FDA's accelerated pace at which newly approved drugs can become big sellers overnight. Under the old regulation, new drugs were distributed more slowly, which gave the agency time to monitor any side effects that may only occur with wider use.
Several studies on the impact of the new campaigns highlight how they have changed the doctor-patient relationship. One FDA study found that of 960 patients who had visited a doctor in the previous three months, 27 percent had been persuaded by commercials to discuss with the doctor a health problem they had never mentioned before. Seven percent requested a prescription for a specific drug they knew from commercials. Half of these had their request approved.
In another study, 329 randomly selected California residents were asked how they would react if their doctor did not fulfill their request. A quarter said they would get the prescription elsewhere if that happened. Fifteen percent would consider changing doctors forever because of it.
However, the extent to which doctors give in to patient pressure depends on the specialization of the doctors and the seriousness of the illness, according to a study by Scott-Levin in Pennsylvania, which measures the effectiveness of DTC advertising. For example, infectious disease specialists who treat AIDS patients are less likely to be talked into their decisions. Foot specialists, on the other hand, would be more likely to be persuaded to write a prescription for the nail fungus medication Laprisil. Women who want a prescription for the birth control pill Ortho-Tri-Cyclen, which also treats acne, almost always get it.
Tepid advertising effectiveness due to naming of side effects
The advertising effectiveness of drug ads and commercials, as in many other categories, is controversial. Various figures are published and passed around in this regard. For example, a survey conducted by the Television Bureau of Advertising (TVB), which covers local television stations in 210 U.S.
markets and benefited from drug advertising that 32.4 percent of respondents visited the doctor as a result of DTC advertisements. One-third of these received a prescription for a drug.
In contrast, a survey by consulting firm Morpace Pharmaceutical Group found that only just four percent asked for a specific drug based on a recent campaign. However, only four percent of the total population requesting a specific drug could represent a sizeable market for a pill maker.
Sometimes, however, the campaigns have the opposite effect: the listing of side effects required by the "Fair Balance Guidelines" can provoke negative reactions and discourage patients from taking a drug even if they urgently need it. It is believed that sales of the Hoffroche product Xenical have suffered quite a bit from the possible side effects mentioned in the ads and commercials, such as "bloating," "increased bowel movements," and "oily discharge."
In such cases, the solution can be found in the so-called Generic Ads: They draw attention to a specific health problem and encourage consumers to talk to their doctor about it, without mentioning a specific drug. This also means they are not obligated to mention side effects. Another option is to mention the name of a drug, but not the health problem it is intended to alleviate or cure. In this case, too, side effects do not have to be listed. The new campaign for Xenical follows exactly these two strategies.
This type of advertising relies on its indirect effect. Namely, on the fact that a certain percentage of viewers will visit the doctor and, in turn, some of the doctors will prescribe the particular drug.
Guidelines make the
Campaigns more credible
Although the "Fair Balance Guidelines" make pharmaceutical companies uncomfortable, another TVB survey suggests that listing side effects helps credibility. In one survey, for example, 62 percent of 2,000 respondents answered that they thought drug ads were more credible than ads in all other categories. 61.3 percent gave credence to nonprescription drug advertising and 56.4 percent to health product line advertising.
Thus, the credibility of drug advertising far exceeds that of other products. The listing of side effects in the campaigns is held responsible for this. In comparison, campaigns for small trucks, for example, achieved a lower level of credibility at 50.6 percent. Statements in ads and commercials for insurance were still believed by 41.8 percent of respondents. However, the degree of trust in the drug effect says nothing about how much respondents are willing to put up with the possible side effects.
Already there are spot parodies on drug campaigns
Many campaigns for drugs are designed according to scheme X: They start with a more or less successful visual presentation of the health problem, introduce the drug and its mode of action, and then show happy, cured people. Finally comes the obligatory litany of possible side effects, usually recited by a soft voice at incredible speed. Because of their frequency, they have become a cliché that has already been made fun of in numerous commercials for other products.
An ad for Energizer batteries by TBWA/Chiat/Day begins like a commercial for a hair loss remedy: a young man in a swimming pool explains how successful the drug has been, then turns around, revealing his unsightly, heavily hairy back. And just at that moment, the Energizer Bunny marches into the frame. Two spots by DeVito Verdi for TheStreet.com, an online business newspaper, use the knitting patterns for Alzheimer's and impotence drugs and parody them by alerting viewers to the possibility of being disoriented when buying stock.
Goodby, Silverstein & Partners also likes to use involuntary laughs, using DTC parodies for two different campaigns, for E-Trade and TiVo. A spot for E-Trade, an address for online investors, pokes fun at the frequent spots for allergy medications. An investor sees a spot for the fictional allergy drug Nozulla. In it, a woman dances around happily in a flowering meadow thanks to the drug. But when the off-screen voice lists the side effects, including hair loss all over the body and babies born with dog heads, the young man immediately sells his Nozulla shares.
Making the most sense with the nonsense is a spot by the same agency for TiVo, the digital recorder that can be used to turn off commercials while watching TV. It opens with an unsavory spot in which two older men talk about "masculine itching," an allusion to spots for "feminine itching" (vaginitis). But before one of them starts to grab the other's pants with a handful of unsightly white paste, an off-screen voice interrupts: "Get TiVo. Skip the stuff you don't want to see. TiVo, TV your way."
A TV commercial for the allergy medication Allegra begins with a family of three driving into the countryside. Father and son get out of the car and look forward to hiking. Only the wife stays in the car and sneezes because she suffers from allergies. A little later, however, she enjoys the fresh natural air just as much thanks to the prescription Allegra, inhales it deeply. The voice-over announces that Allegra (active ingredient Fexofenadine) can cause headaches, upper respiratory infections and back pain as side effects.
In a commercial for the appetite suppressant Meridia, various women proclaim that they have their eating habits under control. "Cheesecake doesn't turn me on," declares one, "I don't confuse Love and Lasagna," the other. After that, an off-camera voice warns that Meridia is not suitable for people with high blood pressure, depression, anorexia, Parkinson's disease, glaucoma, or those with heart conditions, pregnant or breastfeeding women. Side effects could include headaches, constipation, insomnia and dry mouth. There is also a risk of becoming addicted.
Liberalization triggered ad and spot boom
When the Food and Drug Administration (FDA) liberalized regulations for prescription drug advertising in 1997, it paved the way for an incredible inflation of commercials and ads. Every day, dozens of drug commercials for all sorts of ailments flicker across the screen: Depression, allergies, herpes, obesity, asthma, flu, colds, impotence, irritable bladder, multiple sclerosis, Alzheimer's, heart disease, osteoporosis, arthritis, migraines. And the magazines are teeming with corresponding advertisements.
Billions flow into direct-to-consumer advertising (DTC), as drug advertising is known. Last year, DTC represented the sixth largest advertising category. Spending nearly doubled in 1999 ($1.8 billion) from 1997 ($1 billion). Spending on TV ads alone more than tripled between 1997 ($309.6 million) and 1999 ($1.1 billion).
The "Fair Balance Guidelines" of the DTC guidelines stipulate that side effects must be enumerated. Nevertheless, critics complain that patients are given only fragmentary information, which often creates false expectations. Since patients nowadays visit the doctor anyway with a load of printed information from the Internet, drug advertising only creates additional confusion. Doctors would be pressured by patients pumped full of advertising to prescribe them certain medications, even if they thought others made more sense or a medication was unnecessary.
Even the FDA is divided. On the one hand, it accepts the proponents' argument that drug information emancipates patients and promotes discussion between doctors and patients. Last year, however, the FDA was forced to issue a "public health advisory." This warned consumers that doctors were relying too much on the effectiveness of the new antiviral flu drug Relenza, which may have even caused the deaths of certain patients who might have needed stronger treatment.
Changes in the
Doctor-patient relationship
Also of concern is the FDA's accelerated pace at which newly approved drugs can become big sellers overnight. Under the old regulation, new drugs were distributed more slowly, which gave the agency time to monitor any side effects that may only occur with wider use.
Several studies on the impact of the new campaigns highlight how they have changed the doctor-patient relationship. One FDA study found that of 960 patients who had visited a doctor in the previous three months, 27 percent had been persuaded by commercials to discuss with the doctor a health problem they had never mentioned before. Seven percent requested a prescription for a specific drug they knew from commercials. Half of these had their request approved.
In another study, 329 randomly selected California residents were asked how they would react if their doctor did not fulfill their request. A quarter said they would get the prescription elsewhere if that happened. Fifteen percent would consider changing doctors forever because of it.
However, the extent to which doctors give in to patient pressure depends on the specialization of the doctors and the seriousness of the illness, according to a study by Scott-Levin in Pennsylvania, which measures the effectiveness of DTC advertising. For example, infectious disease specialists who treat AIDS patients are less likely to be talked into their decisions. Foot specialists, on the other hand, would be more likely to be persuaded to write a prescription for the nail fungus medication Laprisil. Women who want a prescription for the birth control pill Ortho-Tri-Cyclen, which also treats acne, almost always get it.
Tepid advertising effectiveness due to naming of side effects
The advertising effectiveness of drug ads and commercials, as in many other categories, is controversial. Various figures are published and passed around in this regard. For example, a survey conducted by the Television Bureau of Advertising (TVB), which covers local television stations in 210 U.S.
markets and benefited from drug advertising that 32.4 percent of respondents visited the doctor as a result of DTC advertisements. One-third of these received a prescription for a drug.
In contrast, a survey by consulting firm Morpace Pharmaceutical Group found that only just four percent asked for a specific drug based on a recent campaign. However, only four percent of the total population requesting a specific drug could represent a sizeable market for a pill maker.
Sometimes, however, the campaigns have the opposite effect: the listing of side effects required by the "Fair Balance Guidelines" can provoke negative reactions and discourage patients from taking a drug even if they urgently need it. It is believed that sales of the Hoffroche product Xenical have suffered quite a bit from the possible side effects mentioned in the ads and commercials, such as "bloating," "increased bowel movements," and "oily discharge."
In such cases, the solution can be found in the so-called Generic Ads: They draw attention to a specific health problem and encourage consumers to talk to their doctor about it, without mentioning a specific drug. This also means they are not obligated to mention side effects. Another option is to mention the name of a drug, but not the health problem it is intended to alleviate or cure. In this case, too, side effects do not have to be listed. The new campaign for Xenical follows exactly these two strategies.
This type of advertising relies on its indirect effect. Namely, on the fact that a certain percentage of viewers will visit the doctor and, in turn, some of the doctors will prescribe the particular drug.
Guidelines make the
Campaigns more credible
Although the "Fair Balance Guidelines" make pharmaceutical companies uncomfortable, another TVB survey suggests that listing side effects helps credibility. In one survey, for example, 62 percent of 2,000 respondents answered that they thought drug ads were more credible than ads in all other categories. 61.3 percent gave credence to nonprescription drug advertising and 56.4 percent to health product line advertising.
Thus, the credibility of drug advertising far exceeds that of other products. The listing of side effects in the campaigns is held responsible for this. In comparison, campaigns for small trucks, for example, achieved a lower level of credibility at 50.6 percent. Statements in ads and commercials for insurance were still believed by 41.8 percent of respondents. However, the degree of trust in the drug effect says nothing about how much respondents are willing to put up with the possible side effects.
Already there are spot parodies on drug campaigns
Many campaigns for drugs are designed according to scheme X: They start with a more or less successful visual presentation of the health problem, introduce the drug and its mode of action, and then show happy, cured people. Finally comes the obligatory litany of possible side effects, usually recited by a soft voice at incredible speed. Because of their frequency, they have become a cliché that has already been made fun of in numerous commercials for other products.
An ad for Energizer batteries by TBWA/Chiat/Day begins like a commercial for a hair loss remedy: a young man in a swimming pool explains how successful the drug has been, then turns around, revealing his unsightly, heavily hairy back. And just at that moment, the Energizer Bunny marches into the frame. Two spots by DeVito Verdi for TheStreet.com, an online business newspaper, use the knitting patterns for Alzheimer's and impotence drugs and parody them by alerting viewers to the possibility of being disoriented when buying stock.
Goodby, Silverstein & Partners also likes to use involuntary laughs, using DTC parodies for two different campaigns, for E-Trade and TiVo. A spot for E-Trade, an address for online investors, pokes fun at the frequent spots for allergy medications. An investor sees a spot for the fictional allergy drug Nozulla. In it, a woman dances around happily in a flowering meadow thanks to the drug. But when the off-screen voice lists the side effects, including hair loss all over the body and babies born with dog heads, the young man immediately sells his Nozulla shares.
Making the most sense with the nonsense is a spot by the same agency for TiVo, the digital recorder that can be used to turn off commercials while watching TV. It opens with an unsavory spot in which two older men talk about "masculine itching," an allusion to spots for "feminine itching" (vaginitis). But before one of them starts to grab the other's pants with a handful of unsightly white paste, an off-screen voice interrupts: "Get TiVo. Skip the stuff you don't want to see. TiVo, TV your way."
