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PhRMA Fights the Battle of the Bulge
Why DTC needs to take the long view.

Peter J. Pitts
Medical Progress Today
August 11, 2005

Almost 60 years after the end of World War II, the pharmaceutical industry is fighting its own version of the Battle of the Bulge in a last ditch effort to regain consumer confidence and stave off more regulation or (gasp!) legislation.

While years of increasingly aggressive on-air erectile dysfunction advertising succeeded in selling a lot of product, it also produced a lot of anger together with a potent, no-lose political platform for any politician who wanted a way to look good in front of the home constituency. And, that is to say, all of them.

Historically, the first Battle of the Bulge was Germany's last great offensive of the Second World War. At a time when the majority of the ground war in the Middle East, the Mediterranean basin, Africa, and Europe was all but decided in favor of the Allies, the German High Command mounted one final attempt to even the playing field. And it failed. Why? Because even though it was a perfectly executed plan that took the American and British generals completely by surprise, it was too little to late. Whether or not the pharmaceutical industry can salvage its reputation through a flurry of voluntary guidelines for direct-to-consumer adversiting (DTC) is still an open question.

Too little too late? Maybe. In any event, the parallels are striking. DTC gave ED brand managers multiple opportunities to execute well-funded, strategically developed marketing campaigns that both targeted a willing demographic and smartly used an engaged media to further titillate an astonished American public. It was like an acceptable dirty in-joke. After all, if someone as square as Bob Dole was in on it, then it must be okay.

And then came the elements of the perfect storm. A presidential election season, the emergence of drug importation as a populist political issue, the Medicare Modernization Act, and Vioxx. A grand slam of highly charged issues that made it not only possible, but also predictable that the media, politicians, and the general public would view Big Pharma as the new Big Tobacco. And pharma-bashing seemed to be the next new thing. Hey, everybody's gotta have a hobby. Just ask Chuck Grassley.

Oh yes, and erectile dysfunction advertising on the Super Bowl. And prime time. And on Sunday afternoon golf tournaments. And on racecars. Now Bob Dole is one thing, being that he's a war veteran and everything, but did anyone else think that a television commercial featuring a man throwing a football through a tire was a little over the top?

All this to say that it's little wonder that the big news out of PhRMA's recently announced DTC advertising guidelines was that television ads that discuss lasting erections and satisfying experiences be limited to "adult viewing hours" whatever that means. Seriously folks, will primetime television featuring programming about sex be any better or worse without commercial breaks featuring advertising about sex? But hey, it's throwing the pundits and the pols a bone. Good work Senator you sure showed those big bad boys at Pharma whose boss!

"The people," (by whom is meant the average American) will surely feel that "banishing" erectile dysfunction advertising is a good thing. Except that they were all probably too busy doing something else (like watching reruns of Desperate Housewives and Family Guy).

Arguably, the most important change in DTC advertising will be PhRMA's #10 guideline the de facto banning of reminder ads. While there are many very strong and potent arguments why drug ads truly advance the public health by destigmatizing diseases (such as depression), reinvigorating doctor/patient conversations, and uncovering previously undiagnosed conditions earlier in the disease process, to name only a few there are no good arguments for why reminder ads, in any way, advance the public health. So, there's at least one sharp tooth in the otherwise tame animal that is the set of voluntary PhRMA guidelines.

Hopefully this is a harbinger of things to come. Hopefully this means that the adults in the corner offices at Big Pharma HQs across the nation are willing to question the marketing tactics employed by their brand managers. Hopefully this means that the time is gone when the CEO can speak about "responsible promotion" while turning a blind eye to the actual tactics being used on the air and in the doctor's office to meet those aggressive quotas and keep the Street happy.

Hopefully it means that "long-term thinking" will change from the end of the quarter to the end of the quarter century because that's what's called for if the industry as a whole is to change it's image on the Hill in Washington, DC and in homes nationwide from salesmen to scientists. It's time for Big Pharma to turn from pyrrhic victories to long-term strategies. And, in this respect, the new DTC guidelines, even though voluntary, are a very important step in the right direction.

Besides the new guidelines on media plans for ED and the eradication of reminder ads, what other long-term strategies can we glean from the remaining 12 guidelines? There's significance in between the lines. And that's a good thing because, after all, they are "guiding principles." So, a good question is where are they guiding the members of PhRMA? Consider #3, "DTC television and print advertising which is designed to market a prescription drug should also be designed to responsibly educate the consumer about the medicine and, where appropriate, the condition for which it may be prescribed." Also #14, "Companies are encouraged to promote health and disease awareness as part of their DTC advertising."

While the passive voice wording of these principles makes the overall effect more, well, passive the main thrust of principles 3 and 14 are clear less undisguised selling and more on-purpose education. It's an important first step in the campaign to reposition the industry from being assailed as being nothing but salesmen to a more revered position as scientists, to move from hucksters to healthcare heroes. If we are to view these guiding principles as a roadmap (as they are being promoted), then we must expect forthcoming battles among brand teams and their agencies (both advertising and public relations) over new ways to sell through education. And part of the answer is a shift to longer-term strategies, because "educating" about a disease means accepting the mantle of teacher. The teacher becomes the expert and the expert gets the business but not in the same truncated time frame that a hard sell produces.

Will this be difficult? You betcha. But like Tom Hanks said in the movie A League of Their Own, "If it was easy, anyone could do it." But it's Hank's most famous quote from that film that is the most acutely significant in the current debate not only over the reform of DTC communications but about the long-term viability of a market-based pharmaceutical industry in the United States "There's no crying in baseball."

Peter J. Pitts is a senior fellow in health care studies at the Pacific Research Institute and director of PRI's Center for Medicines in the Public Interest. He is also senior vice president for health affairs at Manning, Selvage & Lee and a former Associate Commissioner at the FDA.

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