The ads for the Pfizer painkiller Celebrex feature a man holding a boy’s hand as they walk up a stadium staircase. “52 steps won’t keep you from taking him out to the ballgame,” they say.

But a heart attack would.

Each ad includes a boldface warning that begins, “Important Information: Celebrex may increase the chance of a heart attack or stroke that can lead to death.”

As it resumes ads for the controversial medicine, Pfizer, the world’s biggest drug maker, is offering consumers a decidedly mixed message. But 16 months after the company stopped advertising Celebrex over concerns about its heart risks, Pfizer has returned to the consumer ad market in hopes of reviving sales of the drug, which plunged last year during the ad moratorium.

The new campaign in magazines has raised the ire of consumer groups, who say that Celebrex is so dangerous that Pfizer should stop selling it, not encourage patients to use it.

The campaign is more evidence of the drug industry’s dependence on consumer advertising to prop up sales, said Dr. Sidney Wolfe, a frequent critic of drug makers. “There’s no objective evidence of any unique benefit with this drug, and there is objective evidence of a unique risk,” said Dr. Wolfe, the director of health research for the consumer advocacy group Public Citizen.

Pfizer stopped advertising Celebrex in December 2004, after Merck stopped selling Vioxx, a similar drug, because of its heart dangers. Four months later, federal regulators ordered Pfizer to put a so-called black-box warning on Celebrex, detailing its risks.

In 2004, before the advertising moratorium, Pfizer spent $117 million promoting Celebrex. That year, Celebrex sales were $3.3 billion worldwide. In 2005, during the ad moratorium, sales plunged to $1.7 billion. Pfizer says that all painkillers carry some risk and that its new ads disclose Celebrex’s potential dangers.

“Celebrex has proven to be an important option for many patients,” said Andrew McCormick, a Pfizer spokesman. The Food and Drug Administration has reviewed the new campaign, Mr. McCormick said. Pfizer has not yet decided whether it will expand the campaign to television.

When it was introduced in 1998, Celebrex was thought to be safer for the stomach than older painkillers like naproxen, whose brand name is Aleve. But Celebrex’s stomach benefits have never been proved, and clinical trials have repeatedly linked Celebrex to heart problems. In addition, Celebrex is far more expensive than the older painkillers, costing about $3 a pill, compared with a few cents for naproxen or ibuprofen.

“If it were my money, I wouldn’t pay $2.85 for it,” said Michael Krensavage, a drug industry analyst at Raymond James. “I would try an ibuprofen first.”



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