Health-Care Advertising Gearing More Towards Consumers
Mar. 20–The women’s faces flash by, their expressions shifting from earnest to bewildered to confident. “Why didn’t I know that?” one of them asks. “Everyone we know should know,” says another.
The commercial, launched this month by Gaithersburg-based Digene Corp. shows five women in their 30s, set in what appears to be a New York-style loft. The ad implies that their regular gynecological routines are not enough. Women may be putting themselves at risk, it suggests, if they don’t use Digene’s test for human papillomavirus, the sexually transmitted virus known as HPV.
“If your Pap test is normal, you don’t have to worry about cervical cancer, right?” the commercial’s narrator asks. “Wrong. A pap isn’t enough. There’s another test, the HPV test. Ask your doctor, tell your friends.”
From pills to procedures, health-care advertising continues to carve out new territory. More than three-quarters of the roughly $25 billion spent annually on medical advertising is still directed at physicians, but the fastest-growing segment of the industry is in direct-to-consumer marketing. Consumer advertising in health care grew to $4 billion last year, 15 times as much as the roughly $260 million spent a decade ago. The industry’s successes have made household names and overnight sales sensations of everything from allergy cures to Viagra.
For the past decade, prescription drug companies have been the main drivers of the advertising. But more recently, makers of diagnostic tests, such as Digene’s HPV test, and others are pitching direct to consumers — what the industry calls “DTC.”
“There’s an expansion of DTC to sectors outside of drugs, to medical devices, for example,” said Nipon Das, a former health care consultant who is now director of business development at the Economic Alliance of Greater Baltimore, a business promotional group. In his prior job, he helped Michigan-based Stryker Corp., which employed golf legend Jack Nicklaus to promote a ceramic hip replacement on television.
The increase in DTC advertising has dovetailed with the rise of consumer influence in health care. The rise of the Internet and changes in insurance have led people to become more involved in their own diagnoses. And prodded by messages from both health professionals and advertising, people have become more health conscious, looking for ways to prevent — rather than just treat — disease.
Consumer advertising took off about eight years ago when the U.S. Food and Drug Administration relaxed rules for health-care related commercials on television. It allowed manufacturers to air commercials that skipped the lengthy risk information required of print ads if they directed viewers to places where they could find more details, such as toll-free information numbers and the Internet, emerging at the time.
Last year, the FDA began exploring similar relaxation for print advertisers, which could provide a further boost for direct consumer advertising.
Proponents of consumer marketing say it removes the stigma associated with some maladies, empowers patients with information and enhances public health by reducing “underdiagnosis” of disease. According to a 2003 FDA survey of doctors, 88 percent of people who asked about an advertised drug had the condition it was meant to treat.
But critics claim drug prices rise to cover advertising costs and that it leads people to demand — and get — inappropriate and unnecessary medication.
Nearly half of the 30 percent of adults who ask their doctors about advertised medications received prescriptions for them, according to the Henry J. Kaiser Family Foundation. And though the FDA study found that ads can “prompt thoughtful discussion,” half the doctors surveyed said the ads made the drugs seem better than they are. Some physicians said they felt pressured to write prescriptions for patients.
“It seems to me the hook would be to play on people’s fear and the desire to take action,” said Meredith B. Rosenthal, an assistant professor of health economics and policy at the Harvard School of Public Health.
Digene’s new commercials appear to follow that tack, she said.
The 30-second television spots began two weeks ago in Baltimore, Atlanta and Philadelphia. The commercials can be seen online at www.thehpvtest.com.
The print ads, part of the $3 million to $5 million campaign, read, “If you’re a gambling woman, then getting a pap test is just fine” and “You’re not failing your Pap test, but it might be failing you.” The ads begin in April or May in 10 national magazines, including People, Family Circle, Cosmopolitan and Parents.
“These ads are really written to be an educational piece to inspire women to learn more and have frank conversations with a gynecologist,” said Digene spokeswoman Shelley Ducker. “There really is a lack of awareness on the consumer side.”
The Centers for Disease Control estimate that 80 percent of people will contract the human papillomavirus — or HPV — by the age of 50. Most strains of the sexually transmitted virus go away on their own and don’t cause any problems other than common warts. But 13 versions are considered “high risk” in women and the precursor to cervical cancer.
Pap tests look for cancerous cell changes on the cervix, but they have a 15 percent failure rate. Adding an HPV test like Digene’s, can determine whether a patient has the high-risk versions of the virus and lead doctors to watch a patient more closely. The test can also offer peace of mind by confirming a woman is clear of HPV.
Digene’s test is the only FDA-approved HPV test. In 2000, the administration said it could be used as a follow-up test if abnormal cells are found. Three years later, the FDA also approved using the test in conjunction with Pap smears for women 30 and older.
U.S. sales of the HPV test were nearly $18 million for the last quarter of 2004, up 32 percent from the same period a year earlier. The company expects revenues to increase up to 50 percent by June, in part because of the increased marketing.
An earlier diagnostic test marketed directly to consumers has fared well the past few years. In 1998 and 1999, Massachusetts-based Cytyc Corp. spent $6 million on a consumer campaign in 12 cities to sell its Pap test. Today, 96 percent of gynecologists use Cytyc’s “ThinPrep” test according to a 2004 article in the Health Services Research journal.
“It did have an impact on the adoption rate,” said Dan Levangie, a Cytyc executive vice president. “Overall, it was very successful.”
But a big difference between Cytyc’s and Digene’s tests and other advertised medical products is that theirs are covered by insurance. Most advertised drugs are not, appealing to a “high-end” customer willing to pay for them out of pocket. The drugs also tend to fall into a lifestyle-enhancement category, which allows for more patient-driven diagnosis, illnesses such as depression and erectile dysfunction.
“For certain drugs, (advertising has) been an instant success,” said Frank Palumbo, executive director of the Center for Drugs and Public Policy at the University of Maryland. “Look at drugs like Viagra. That company saw results — major results — from DTC advertising within a week.”
Viagra, made by New-York-based Pfizer Inc., has benefited from $3.5 billion in advertising last year alone, with hundreds of millions of dollars estimated to have been spent on direct-to-consumer messages. The company said it does not break out that figure. DTC Perspectives, a pharmaceutical industry marketing magazine, named Pfizer the leader in direct consumer advertising last year.
Pfizer also makes such recognizable drugs as Zoloft (for depression), Lipitor (a cholesterol lowering medication), Zyrtec (an allergy suppressant), and Celebrex, an anti-inflammatory. The company has stopped advertising Celebrex to consumers, however, at the request of the FDA which is investigating claims that the drug causes heart problems. The FDA had also chastised Pfizer for its commercials, claiming they were misleading.
In September, a similar anti-inflammatory, Vioxx, made by New-Jersey based Merck & Co. Inc. was recalled for its cardiac side effects. The drug had been competing for customers with Celebrex.
Some medical professionals and advertising analysts speculate that concerns about such high-profile drugs might lead companies to tone down their advertising, and focus more on potential risks and side effects. But with every dollar worth of marketing returning $4.20 in revenue, according to Kaiser, most said they expect the practice to grow, not shrink.
“It wouldn’t surprise me if down the road we see (attack) ads” aimed at other drugs or products, said Mark S. DeFrancesco, a Connecticut gynecologist who serves as a consultant for Digene. “It’s a jungle out there.”
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