Shortly after Vioxx arrived in pharmacies, the painkiller became an adman’s dream.
During the next five years, Merck spent more than $500 million advertising the medicine. Television ads featured former Olympic ice skater Dorothy Hamill or The Rascals’ 1960s anthem, “It’s a Beautiful Morning.”
One reason for the advertising explosion was obvious. Merck was locked in a battle with Pfizer, which launched Celebrex, a similar drug that hit the market a few months before Vioxx in 1999. Since then, Pfizer has racked up $449 million in Celebrex advertising.
But there may have been another reason for Merck’s advertising blitz.
In 2000, a widely publicized study suggested Vioxx may cause heart problems. That same year, Merck spent $160 million on Vioxx ads, double what Pfizer spent, according to TNS Media Intelligence, a market-research firm.
Ultimately, solid evidence did emerge linking Vioxx to heart attacks and strokes, prompting the drug maker late last month to withdraw the drug. Now, critics say such widespread promotion was improper at a time when safety questions remained unanswered.
“I would have liked to have seen less advertising because of the safety issues,” said Ed Langston, a physician in Indiana and an American Medical Association trustee. “I had some concerns about the advertising as soon as the safety data started surfacing.”
Merck spokeswoman Anita Larsen said the company continues to believe its Vioxx ads were “completely appropriate, based on what we knew at that time.” She reiterated the company’s position that the 2000 study compared Vioxx with an older painkiller that may have protected patients from heart problems.
The Vioxx recall, though, is prompting fresh concern about direct-to-consumer advertising for prescription medicines. Some doctors and consumer groups say many ads lack important information or coax people to seek expensive drugs when cheaper ones would suffice.
The pharmaceutical industry says such ads are useful tools that offer valuable messages. In an era of rising health-care costs, drug makers say the ads often prompt consumers to pay closer attention to their health and to seek treatments.
Increasingly, drug makers are running TV ads to combat charges of price gouging. The ads boast a commitment to finding cures and saving lives. One Pfizer ad even features its chief executive, Hank McKinnell, making such a speech.
At the same time, Pfizer has a Viagra ad in which a man grows little blue devil’s horns as he and his female companion shop for lingerie. One critic believes the ad encourages consumers to abuse the pill and may lead to the spread of sexually transmitted diseases.
“The Viagra ad is completely inconsistent,” said Jeffrey Klausner, a San Francisco public health official, who recently petitioned federal regulators to force Pfizer to change its ads. “They’re selling sex, and it’s over the line.”
Dorothy Wetzel, a Pfizer consumer marketing vice president, called the ad “playful,” and said its “overall function is closely aligned with a purpose we take seriously: solving a problem that’s very real for millions of men.”
Overall spending by drug makers on direct-to-consumer ads is big, and getting bigger. Last year, the pharmaceutical industry spent $3.3 billion to advertise medicines directly to consumers, according to Verispan, a market-research firm.
That was triple the $1.1 billion spent in 1997, when the Food and Drug Administration changed its rules. The agency said the move would provide consumers with needed information, but critics say regulators compromised safety—with Vioxx being the latest example.
“The failure of the FDA and the massive promotional campaigns by Merck, which minimized the potentially serious cardiovascular risks, played a role in misrepresenting the safety of Vioxx to the public,” said Sidney Wolfe of Public Citizen, an advocacy group.
One former drug-company executive questioned the wisdom of spending large sums on consumer ads when, in his view, the money could be used more efficiently to target doctors to increase their prescribing.
“I’ve never seen one study to show the economic benefit is there,” said Irwin Lerner, a former chief executive at Hoffman-La Roche.
Nonetheless, experts say little will change. Stuart Klein, president of the Quantum Group, a communications company that specializes in direct-to-consumer ads, said some additional scrutiny may occur, but drug ads are already reviewed very closely.
Arthur Caplan, who heads the Center for Bioethics at the University of Pennsylvania, said drug makers should readily address challenges to their medicines and respond by conveying important information to doctors. But he didn’t predict reduced advertising.
“They won’t back off in a competitive marketplace, because the point of the ad is to generate demand,” he said. “Look, the world of advertising and marketing has no ethics. But if you allow it, this is what you’ll get.”