Merck's Ad Blitz Draws Fire

During Vioxx's first full year on the market, Merck spent an estimated $160 million marketing the painkiller directly to the public. Millions of consumers, including those swayed by media ads, wound up using the drug.

Many never knew that Vioxx could lead to heart attacks. And some, experts believe, never really needed the risky medicine at all.

Critics blame DTC advertising made possible by a government agency with close ties to the drug industry.

"Most of the most heavily advertised drugs are, in fact, no more effective or safe than other drugs, but billions of dollars 'must' be spent to try to convince doctors and patients otherwise," the consumer watchdog organization Public Citizen declared last April.

"These recent expensive campaigns have probably been much more successful than in years past because the FDA has all but stopped enforcing the laws concerning false and misleading prescription drug advertising -- with an 85% decrease in enforcement actions between 1998 and the end of 2003."

Prior to the Vioxx recall, DTC prescription drug advertising ranked as a growing $3 billion industry. Of the top 25 advertisers in 2002, Public Citizen reported, four were giant drug companies. Pfizer, the maker of Celebrex, stood out as the biggest spender in its group. Johnson & Johnson (JNJ Quote) came in second, followed by GlaxoSmithKline (GSK Quote). Merck -- despite its heavy Vioxx advertising -- placed fourth.

All spent more than $1 billion on DTC advertising annually, Public Citizen reported. Don Strong, an Oklahoma City attorney representing thousands of Vioxx plaintiffs, understands why.

"When you're spending that kind of money," he says, "you're going to be successful selling whatever you're selling."

Bald Spot

The rise of Rogaine, a blockbuster treatment for male pattern baldness, helps illustrate that point.

Deep Pockets Biggest spenders on DTC prescription drug advertising in 2003

Figures in millions of dollars. Source: Med Ad News.

Michael Montagne, a professor at the Massachusetts College of Pharmacy, remembers the evolution of DTC prescription drug advertising quite well. Until the 1980s, he says, DTC really didn't exist within the industry because of uncertainties about the liabilities that might erupt. He calls Rogaine, with its "negligible" potential for serious risks, a good first choice to test the waters.

He says the FDA, which oversees drug marketing, eventually suggested a brief moratorium on the new DTC advertising so that it could study its potential effects. But, he says, the agency found no good reason to halt the ads and, over time, their popularity soared.

Vioxx Pain Lingers

Mess Shows FDA Flaws

Wednesday: Ads Added to Vioxx Sizzle

Thursday: Sizing Up Coutroom Foes

Friday: CEO's Ultimate Challenge

Like Rogaine, prescription drugs such as Prozac, Viagra and -- yes -- Vioxx have gone on to become common, everyday names.

Montagne readily admits that DTC drug advertising works quite well. He says an "amazing correlation" exists between money spent advertising a drug and its sales. From a consumer's perspective, however, he sees little value in such advertising and therefore remains fundamentally against it.

Michael Weinstein, president of the AIDS Healthcare Foundation, believes that DTC advertising has actually hurt the drug industry. He says that drug companies now seem far more interested in marketing their current drugs than in developing new ones. As a result, he says, AIDS patients have been forced to rely on government institutions -- and others outside of "Big Pharma" -- for any new breakthrough treatments.