Paxil is Forever

doctor please, some more of these

All indications are that the agency earned its fee. "Paxil's reintroduction secured nearly 1.1 billion media impressions in 1999, with 400 million generated in the month that the drug was granted FDA approval," raved PR News. "Media highlights included the cover of U.S. News and World Report, The Howard Stern Show, Parade, National Examiner, the New York Times, Good Morning America, and Vogue. Ninety-six percent of media coverage delivered the key message, 'Paxil is the first and only FDA-approved medication for the treatment of social anxiety disorder.'"

Earlier studies had suggested that perhaps two percent of the population suffered badly enough from social phobia to warrant treatment. Far worse than simple shyness, these people harbored "persistent irrational fear and the need to avoid any situation in which one might be exposed to scrutiny by others and potentially embarrassed or humiliated," according to one medical dictionary.

Following SmithKline's PR and advertising campaigns, however, sufferers were presenting themselves for medication in record numbers. "Paxil sales surpassed those of Zoloft," PR News reported, "and tied those of Prozac for the first time in history, and the Social Anxiety Disorder Coalition received nearly 12,000 calls to its 800 number."

Diana Watters

A support group funded by the pharmaceutical industry, the coalition recruited patients to share their sagas with the media. Donny Osmond--diagnosed with the condition by the head of one of the coalition's member groups--recounted his struggles with the disorder on network television. "Never underestimate the power of a celebrity to invigorate a tired media story," observed PR News. A few weeks later, PR News recognized Cohn & Wolfe's campaign with its Platinum PR Award.

"Every marketer's dream is to find an unidentified or unknown market and develop it," Barry Brand, SmithKline's product director for Paxil, told Advertising Age. "That's what we were able to do with Paxil."

Last year, GlaxoSmithKline won FDA approval to sell Paxil for generalized anxiety disorder, a diagnosis that was created by psychiatrists as something of a catchall entry in the Diagnostic and Statistical Manual of Mental Disorders. Sales shot up 17 percent to $2.1 billion. A few months later, post-traumatic stress disorder was added to the list.

SmithKline's so-called public-awareness campaigns were just one half of a coordinated strategy, though. In 1997, the FDA relaxed its rules on pharmaceutical advertising to let the pharmaceutical industry bypass healthcare providers to market its wares "direct-to-consumer" (DTC in marketing shorthand). In 1996, drug companies spent $595 million on advertising. Within a year, spending rose to $843 million. By 2000, the amount had shot up to nearly $2.5 billion.

Paxil was the first central-nervous-system drug to be advertised by name on television, according to Advertising Age. With such tag lines as "Your life is waiting" and "What if you were allergic to people?", the spots targeted 18-to-34-year-old professionals.

In the weeks following the attack on the World Trade Center, Glaxo positioned Paxil as the perfect antidote to post-9/11 anxiety. "Your worst fears," agonized one woman, seated at a kitchen table, "the what-ifs... I can't control it." "I'm always thinking something terrible is going to happen," another woman fretted. "It's like a tape in my mind," a third confessed. "It just goes over and over and over."

"DTC is a great way to create demand," the trade journal Drug Topics quoted one marketing VP as saying. "Advertisers are trying to help consumers recognize a specific symptom and then recognize that something can be done to alleviate the symptom."

The ads pay off for drug companies. Ninety-one percent of people surveyed in 2000 by Prevention remembered seeing a drug ad; one third of them then asked their doctor about the medicine. Seventy-one percent of patients who asked for a drug they had seen advertised left with a prescription.

The statistics don't surprise the Mental Health Initiative's Turnquist. "I get phone calls from people who've seen the ads and they may be doing okay, but they say, 'Hey, I want to try this new drug,'" he says. "The patient sees an ad on TV, and there's a smiley, happy face bouncing across the screen, and they aren't feeling that well." It seems like it's worth a try, especially because the drug is billed as harmless.

The FDA's new rules on promotions freed drug companies from listing all of the side effects associated with every drug in every ad, but they still require accurate and balanced information about a drug. Nonetheless, the FDA frequently reprimands drug companies for TV and magazine ads that downplay a drug's risks, misstate its benefits, or wrongly characterize it as better than another.

In November 2000, for example, the agency took Eli Lilly to task for a TV spot for Sarafem, the name given to Prozac when it is sold as a treatment for premenstrual dysphoric disorder (PMDD). "Think it's PMS?" the voiceover asks, as a frustrated woman tries to wrestle a shopping cart. "It could be PMDD." The FDA complained that the ad made no distinction between PMS and the much more rare and serious PMDD; that jumpy graphics distracted viewers' attention from the list of side effects and risks; and that other vital information was listed in type that was all but invisible.

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