Prescription Drugs

1. Prescription Drugs The Effects of the Advertising Industry on the Awareness & Use of Anti-Depressant Drugs

2. Outline • Introduction • History of Anti-Depressants • Trends • Consumers vs. Doctors • Marketing Trends • Statistics • Marketing Deconstruction • Example 1 - Lexapro • Example 2 - Zoloft • Example 3 - Effexor XR • Forecasts • Conclusion

3. Introduction • With annual U.S. revenues of about $100 billion and worldwide revenues of $300 billion, the pharmaceutical industry is one of the largest, most powerful, and most profitable businesses in the world, producing some of the most sophisticated marketing and advertising anywhere • Rules Change • For years the pharmaceutical industry was allowed to market its drugs only to doctors. • In 1981, the drug industry proposed that the FDA allow advertising directly to consumers, arguing the public shouldn’t be denied access to the "knowledge" provided by such marketing. Four years later, the FDA agreed to allow "direct-to-consumer" (DTC) advertising. • Drug Marketing Reborn • Pharmaceutical advertising has grown to a new, pop culture-savvy level • Car and pharmaceutical commercials use the same hooks -- popular music, good acting and lofty promises -- to hook consumers and reel them in. Both are almost always intended to look "cool“ and “feel good” • Pharmaceutical advertisements are becoming increasingly common and increasingly effective • In this presentation, we will review the marketing tactics of the pharmaceutical industry, and the length they will go to seduce drug consumers, and rake staggering profits every year

4. History of Anti-Depressants • Before the discovery of antidepressant drugs, depression was commonly treated with barbiturates or shock treatment • Monoamine oxidase inhibitors (MAOIs) and Tricyclic antidepressants were the first two classes of drugs used to treat major depression • Iproniazid, the first modern anti-depressant, was originally developed as an anti-tubercular drug in the early 1950's • Imipramine, the first among the tricyclic antidepressant, was originally developed in a search for drugs useful in the treatrement of schizophrenia • Selective serotonin reuptake inhibitors (SSRIs) were developed to effectively work on the symptoms of depression without the side effects of the MAOIs or the tricyclics, such as constipation and blurred vision. • The first SSRI, fluoxetine (Prozac) was released in 1987

5. Targeting consumers vs. doctors Why do pharmaceutical companies spend billions of dollars on direct-to-consumer advertising when consumers can only obtain prescriptions for these drugs through a doctor? Doctors prescribe whatever the patient names "Surveys reveal that when a patient comes into a doctor's office and requests a specific drug that he has seen advertised in the media, the doctor writes the exact prescription the patient requested more than 70 percent of the time!" Pharmaceutical companies are in business to make money Their goal: “The pursuit for maximum profit”

6. Marketing trends • In the 1990s, direct-to-consumer advertising increased at a compounded-annually rate of 30 percent • From 1996 to 2000, totals rose from $791 million to nearly $2.5 billion   • Between 1999 and 2000, prescriptions for the 50 most heavily advertised drugs rose six times faster than prescriptions for all other drugs • In 2000, $2.5 billion was spent on direct-to-consumer advertising. This number increased to over $3 billion in 2003 • Pharmaceutical companies spend more on advertising than they spend in research and development of products

7. Statistics • Expenditures for prescription drugs is growing faster than any other major healthcare sector. Americans are expected to spend over $500 billion on drugs this year • Prescription drugs account for 11% of total U.S. health care spending in 2002 and was a whopping $200.7 billion in 2005, almost 5 times more than the $40.3 billion spent in 1990 • Antidepressant use has risen rapidly in most developed countries, driven by increased awareness of depression, and the availability and promotion of new antidepressant drugs • The average number of prescriptions per person in the United States increased from 7.3 in 1992 to 10.4 in 2000 • In 2006, nearly 25 million American adults were estimated to have experienced severe psychological distress • 16 million American adults, or 7.2 percent of the population, reported experiencing a major depressive episode during the year prior • According to Wikipedia, a 2007 study purports that 25% of Americans were over-diagnosed with depression

8. Marketing Deconstruction Example #1 - Lexapro

9. From Forest Laboratories™the manufacturers of Lexapro® and Celexa®

10. Target Audience Individuals, especially women, and doctors who may be prescribing antidepressant medications Ad’s purpose To educate current individuals currently taking Celexa about a more effective and popular choice for a selective serotonin reuptake inhibitor (SSRI) antidepressant called Lexapro What is implied The reference and comparisons to Celexa (Lexapro’s predecessor), implies that audience is educated and informed about the drugs Claims The ad claims that Lexapro is the fastest growing SSRI in the US and is prescribed to over 13 million patients in the US.  Subtext or hidden story -No mention of side effects -No mention that it could take up to 6 to 8 weeks of treatment before seeing results. -No mention that this medication may not work for everyone

11. Fowles Basic Appeals • Need for affiliation – Illustrates two women confiding in each other.   This especially plays on an individual’s fear of loneliness; which is likely a more susceptible fear in people diagnosed with depression. • Need for aesthetic sensations – Displays women dressed in bright pastel colors.  They are the focus of the advertisement with the background in less focus.  The water that one woman is drinking and the salads on the table both look refreshing. • Need to satisfy curiosity – Exhibits a variety of information including statistics, comparisons to other antidepressants, and safety information.

12. Use of Color • Yellow (worn by woman)– is associated with happiness, cheerful feelings, joy, intellect, and energy. • Light Blue (worn by woman)– is associated with healing, health, tranquility and softness.  Blue is considered beneficial to the mind and body.  • Dark Red logo – brings text and images to the foreground.  It simulates people to want to make quick decisions. • In addition, the logo makes use of similar shades of yellow and light blue as worn by the women.

13. Marketing Deconstruction Example #2- Zoloft

14. Zoloft

15. Zoloft • Target Audience Any person who is experiencing symptoms of depression. This ad may appeal to a broad range of ages, from teens to older adults • Ad’s purpose To bring awareness about “Zoloft” in a simplified way by making use of animation. Also, to reinforce brand recognition • What is implied Indirectly, the maker of this ad wants to communicate to its audience that more information on Zoloft is available on the internet • Claims This ad claims that Zoloft is the #1 prescribed medication for depression and anxiety • Subtext or hidden story -No mention of side effects or any implication that may come about by using this medication -No mention that it could take several weeks of treatment before seeing results -No mention that this medication may not work for everyone

16. Fowles basic appeals • Need to nurture- By showing a cute, fragile-looking character, the reader is touched by a need to nurture, to care • Need for reassurance-By showing a doctor in this ad attesting that “Zoloft has helped millions with depression” one can feel very positive of the medications’ effectiveness • Need to satisfy curiosity-It is implied by this ad that more information about Zoloft is available online. Thus, this ad drives its audience to the product’s website

17. Use of color The colors used in this ad are: • White- In advertising, white is associated with coolness and cleanliness. It is used to suggest simplicity in high-tech products, and safety when promoting medical products • Yellow (background)– is associated with happiness, cheerful feelings, joy, intellect, and energy • Light Blue (background at the doctor’s office)- is associated with healing, health, tranquility and softness.  Blue is considered beneficial to the mind and body. Light blue symbolizes that Zoloft is a healing medicine

18. Marketing Deconstruction Example #3- Effexor XR

20. Ad description: This advertisement features a smiling woman looking directly at the reader.  The ad also displays text highlighting a myth, reality, and general health information regarding the antidepressant Effexor XR • Target Audience:  Adult individuals, especially women.  Given that this advertisement was taken from the magazine Psychology Today, it likely also targets psychology students, psychiatrists, and doctors • Ad's purpose: To inform readers who feel they may be suffering from depression that they have options about their treatment – most notably the prescription, Effexor XR • What is implied: The reader deserves a change (text: "the change you deserve"); notably to be happy like the woman portrayed and not depressed • Subtext or hidden story: The advertisement lists that its readers have options, yet it only mentions one – Effexor XR prescription medication.  It fails to mention that Effexor XR might not work for everyone

21. Fowles Basic Appeals • Need for aesthetic sensations: By displaying a woman with perfect facial features – her hair is beautifully done, her smile is symmetrical, and her skin is flawless – this advertisement appeals to the audience’s aesthetic sensations • Need to satisfy curiosity: This advertisement features text displaying a myth and a reality, in large bold letters at the top of the page.  This appeals to people's desire for tidbits of trivial information

22. Use of color • Dark Red (text) – Red is a very emotionally intense color; often used to stimulate people to make quick decisions.   The word "myth" is written in red to represent danger • Yellow (text) – Yellow is often used to convey feelings of joy and happiness.  In this advertisement, the word "reality" is written in this color: to represent hope and optimism • Green (background) – The background of this advertisement is green.  This color is often associated with safety, stability, and endurance. It reassures the audience that the product is safe.

23. Forecast • Globally, the antidepressant market has seen extraordinary growth over the last decade. But, with few entrants, and a flood of patent expiries by 2009, the dynamics of this $16.9 billion market are set to undergo a major change • Brand name antidepressant drugs are being challenged by their generic counterparts who are about 50-60% cheaper • Fluoxetine, the generic version of Prozac, became available in 2001 and cost about 14 cents a pill as oppose to $2.22 for Prozac • Since FDA warnings were issued, antidepressant prescription for children and teens has dropped dramatically making this drug market more vulnerable • For these reasons, antidepressant sales are expected to decrease by 21.5% to $13.5 billion by 2011

24. Conclusion • The pharmaceutical industry has become one of the most profitable businesses in the world • Direct to consumer marketing has enabled an explosion in pharmaceutical revenue • $300 billion world wide revenues • Savvy marketing tactics are a pillar to the industries success, equal in scale to R&D • Marketing is geared to allure consumers by playing with their fears, emotions, and vulnerabilities • Consumers beware • Direct-to-consumer advertising is largely responsible for over-medication of prescription drugs • Pharmaceuticals are responsible for 100,000 deaths/year; 750,000/ year if you include malpractice • Deep pockets of the pharmaceutical industry influence scientists and academics through support of medical research, medical schools, and hospitals creating interlocking interests • What to do • Become more informed about pharmaceutical companies’ marketing tactics • Be cautious of where we seek our information. Many informational websites are funded by these big giant companies. • Advice: It’s always good to get a second opinion …. and always, listen to your mom!

25. Resources • http://www.celexa.com/ • http://www.usatoday.com/money/industries/health/drugs/2005-05-31-drugs-ads-side_x.htm • http://www.color-wheel-pro.com/color-meaning.html • [1] Prescription Drug Trends Fact Sheet - May 2007 Update http://www.kff.org/rxdrugs/3057.cfm • [1] Prescription News http://pn.psychiatryonline.org/cgi/content/full/42/20/10-a • [1] The Daily Texan Online http://media.www.dailytexanonline.com/media/storage/paper410/news/2007/06/29/Opinion/Depressing.Our.Prescription.Dependency-2919772.shtml • [1] Katharine Greider's book, The Big Fix • [1] Commercial Insight: Antidepressants - Sliding SSRI Revenues Inevitable, Published February 2004 • http://www.bio.com/store/product.jhtml;jsessionid=QBJPLUSUINB33R3FQLMCFEWHUWBNSIV0?id=prod1960009 • [1] Wellmark, BlueCross BlueSheild; Generic Findings Report; http://www.wellmark.com/health_improvement/reports/antidepressants/generic_findings.htm • http://www.newstarget.com/010315.html