Britain has an anomaly when it comes to advertising: we allow
tobacco companies the opportunity to promote products that could kill
us, but ban ad for drugs that could cure us.
Although over-the-counter goods such as painkillers can be advertised,
prescription drugs - in the UK at least - cannot be promoted direct to
the consumer. But many in the industry think this situation is likely to
change, with the UK heading for a situation more akin to that unfolding
in the US.
At present, only specialist doctors’ journals and magazines are allowed
to carry prescription drugs advertising, which has led to an
unparalleled reading choice for the medical profession, paid for by
pharmaceutical companies with nowhere else to promote their products. A
doctors’ TV channel is now being planned. Called the Medical Channel, it
will be broadcast on Sky and is able to exist as a result of the limited
areas in which drugs companies can spend their ad budget.
In the UK, the pharmaceutical industry spends about pounds 50m a year on
prescription drugs advertising, compared with pounds 262m on
over-the-counter medicines, out of a sales and marketing spend of pounds
3bn a year.
But in the US, the situation is different. Drugs companies have been
able to advertise all their products since August 1997 when the Food and
Drug Administration relaxed regulations. They now spend about dollars
2bn (pounds 1.2bn) a year. Famous campaigns include the former
Republican presidential candidate Bob Dole promoting the anti-impotence
treatment Viagra. At the same time, there has been an 11% rise in US
drugs sales, to dollars 100bn (pounds 60bn).
Because of this freedom to advertise direct to consumers (DTC), US
pharmaceutical adspend is in the same league as that of major consumer
brands. A recent calculation touted around the pharmaceutical industry
was that once Glaxo Wellcome and SmithKline Beecham merge, the resulting
company will have the third-highest global adspend after Coca-Cola and
Anheuser Busch, the brewer of Budweiser.
Freedom of the net
The view in the UK now is not whether DTC advertising will be allowed in
the UK, but when. This thought process has been massively accelerated by
the internet. Healthcare has now overtaken pornography as the most
popular net sector. Companies in the US are placing ads and information
on the net and consumers and patients here are able to pick them up. To
get access, all they have to do is tick a box online stating that they
are a US citizen.
UK journals and magazines previously limited to an audience of doctors,
too, are going online, where they can be accessed by all.
Last year, the Medicines Controls Agency, which polices drugs
advertising, announced that journals such as The Lancet and the British
Medical Journal can retain their ads online. This ruling is particularly
significant, because it means that for the first time ads for prescribed
drugs are already reaching a wider audience.
Buoyed with confidence by this ruling, pharmaceutical companies are
blurring the boundaries even further.
Novartis, the Swiss giant, paid for an awareness-raising TV ad about a
fungal nail infection in 1998. The ad mentioned no product, simply
highlighting the condition, but it is little surprise to discover that
Novartis makes Lamisil, a leading treatment. Critics saw this campaign
as a first major step toward DTC advertising.
Last year Pharmacia & Upjohn paid for a pounds 1m campaign orchestrated
by Saatchi &Saatchi about incontinence. Again, no product was mentioned,
but the company hoped patients would be more willing to discuss the
problem with their GP, who in turn might well prescribe Detrusitol, the
market-leading drug made by, of course, Pharmacia & Upjohn.
Insiders say the ad was, in retrospect, too controversial. But the
industry is sure DTC advertising will arrive here. Managers at Glaxo
Wellcome think it will take five years, Roche believes it will be four,
Pfizer says two. Meanwhile, they hope to persuade the government to set
up a group of industry members, doctors, politicians and patients to
discuss how drug information should be disseminated.
But the Association of the British Pharmaceutical Industry (ABPI), which
represents 80 companies in the UK, is more reluctant than individual
members to say DTC is inevitable.
Differing healthcare set-ups
Richard Ley, ABPI spokesman, says: ’It’s a tendency for the media, and
society in general, to look to the US and say it must come over here. It
doesn’t necessarily work like that. In the UK, we have a very different
healthcare set-up and I think to look at advertising in the US and say
it must be here in six months is wrong. No one can tell if we are going
to see similar spends over here. As an industry, we are not pressing for
’I don’t think it’s appropriate for the UK or our type of market. In
America, it’s private healthcare, by and large,’ he says. ’If a patient
sees an ad, he says to the doctor ’I want this’. Here, health is
provided by the state, and having a patient banging down the door
demanding a drug is not an appropriate scenario.
’If you came back in five years’ time, possibly things will have
changed, but not now. What we are interested in is information for
patients,’ he adds.
The ABPI says the web has accelerated companies’ desire to be able to
put out information without fear of being hauled before a disciplinary
body. The ABPI itself has a Code of Practice Authority, which
investigates about 140 complaints a year. But its spokesman says that
what the industry wants is informed patients, rather than people being
bombarded by advertising.
’We find it ironic that if you type the name of a well-known drug such
as Viagra into a search engine on the internet, you will come up with
hundreds, possibly thousands of sites,’ he says. ’Some will be very
good, others shocking and full of misinformation. But the one company
which is not allowed to put anything more than the most basic technical
information is the manufacturer. That doesn’t seem to us to be
reasonable or just, or indeed in the patients’ interest.
’What we would like to do as an industry is to sit down with the
government, healthcare professionals and, very importantly, patients, to
say that the rules have clearly been overtaken by technology, and by the
demands for patient information which didn’t exist 20 years ago. We need
dialogue, not a loosening of the rules to allow multi-million pound
Vic Ackermann, managing director of Roche, recently described DTC
advertising as ’the hot topic’. He thinks that within four years, DTC
will be allowed in the UK, and that three years later, companies in
Europe will be spending dollars 2bn (pounds 1.2bn) on it.
Roche spends dollars 100m (pounds 60m) promoting the anti-obesity drug
Zenical in the US, and its UK marketing team is studying the methods
with a view to emulating them when the time comes. ’We are preparing for
when it becomes a reality here,’ says Ackermann. ’Like the big banks,
there’s a customer-oriented trend, and we do not see that going
Other companies, although keen on increased patient information, seem
reluctant to embrace advertising as keenly as their cousins across the
Atlantic, and feel the American system has gone too far. One industry
source claims the market is just not big enough in the UK to justify
spending the amount major ad campaigns cost.
Regulating DTC ads
Glaxo Wellcome, the UK manufacturer, says it is far too early for any
practical changes to be put in place in its marketing departments to
prepare for advertising. But when it does prepare, according to
spokesman Philip Thomson, it will take account of the US experience.
’There is a train of thought in the US that the advertising needs to be
regulated, because it goes too far with its claims. If it does happen
here, we need to learn from the US.’
Thomson believes that DTC advertising will be here in five years, but
adds that at present, Glaxo spends only ’hundreds of thousands’ on
advertising in the trade press, with creative by McCann-Erickson.
’We think there’s a certain amount of inevitability about it,’ he
’The internet is the prime generator. You cannot split marketing down
into regions anymore, because it’s too globalised. You can see from our
merger with SmithKline Beecham the growth of the global approach. That
filters right down to marketing. I think you will also see a spread in
US marketing techniques.
’We don’t want to push DTC, but we do want to be at the forefront, so we
are researching and taking a close interest in legislation and the
current thinking at European and local level,’ he adds. ’It was probably
inconceivable 30 or 40 years ago to think of a disease-awareness
campaign, and plenty of pharmaceutical companies do those now.’
Markets which would particularly benefit from advertising are expected
to be irritable bowel syndrome, asthma, and migraine treatments. ’There
are millions of people who suffer from migraine, but very few go to
their doctors to get a prescription,’ says Thomson. ’Typically you will
find it’s not the diseases which are classified as serious, but those
which patients might put up with and have not realised there are better,
or indeed any, treatments available.’
The companies have powerful supporters on their side, including groups
such as the Multiple Sclerosis Society, and professional bodies such as
the Royal College of Nursing. They believe patients have a right to more
information and feel that Pharmacia’s incontinence campaign was an
effective way of broaching a subject with a social stigma.
However, others are horrified by the prospect, describing DTC as a
’hypochondriac’s charter’. GPs are already inundated with patients
bringing print-outs from the internet and demanding certain
Dr George Rae, chairman of the British Medical Association’s prescribing
committee, says: ’I’m all for patients getting information from leaflets
or the internet, but advertising is encouraging people to go to their
doctors and ask for certain drugs. It’s not helpful to the consultation
process. The doctor-patient relationship is a partnership, but when it
comes to prescribing, it has to be the doctor who makes the choice and
talks through the options with the patient, so they can decide
Others are concerned that the NHS just couldn’t cope with the financial
implications of patients’ demand for expensive drugs. Soaring drugs
sales are not a government concern in the US, where the bulk of
healthcare is paid for by private insurance.
In Europe though, an advertising-led boom in sales would have to be met
by public expenditure. The government has already set up the National
Institute for Clinical Excellence (NICE), which many see as a charter
for rationing. Tony Blair is expected to be extremely reluctant to
encourage advertising of new drugs which would fuel demand. If a patient
does not know about the latest, more expensive treatments, the rationale
goes, then they cannot ask for it.
The expense issue is a real problem. Although NICE recently rejected the
NHS introduction of Relenza, the anti-flu treatment, on the grounds that
there was insufficient evidence to prove its efficacy, many saw it as a
covert decision to protect the NHS from having to provide a
resource-draining treatment for free.
Pharmaceutical companies are well aware of this issue, and Merck Sharp
and Dohme has asked that its latest high profile ’lifestyle’ drug, an
anti-baldness pill called Propecia, be available only privately.
Frank Dobson, the former health secretary, made it clear that he was
opposed to DTC, saying it would happen ’over my dead body’. But there
seems to have been a change in direction at the Department of Health
since Alan Milburn took over. As well as UK law, a European directive
bans DTC, so the UK would have to wait for the EU before it changes the
But a working group is being set up to gain an EU consensus on the
’There have been quite a lot of developments with patient information,
patient groups and internet sites,’ says one official. ’I’m not
presuming the working group would definitely lead to DTC, but there is a
move in that direction.’
Like the government’s attempts to ban tobacco ads, a relaxation of the
Medicines Act may be a controversial and drawn-out process. But in a
couple of years, if the House of Lords sides with the government and the
billboards are stripped bare of cigarette promotions, you can be sure
the drugs companies will be queuing up to fill them.
TOP 20 PRESCRIPTION PRODUCTS IN UK
Product Company Sales Market
pounds m share %
Losec AstraZeneca 249.3 4.53
Zocor Merck Sharp & Dohme 129.9 2.36
Istin Pfizer 108.1 1.96
Prozac Eli Lilly 107.3 1.95
Zoton Wyeth 104.9 1.90
Seroxat SmithKline Beecham 87.4 1.59
Serevent Glaxo Wellcome 84.9 1.54
Innovace Merck Sharp & Dohme 83.6 1.52
Pulmicort AstraZeneca 81.2 1.48
Ranitidine generic 80.5 1.46
Becotide Glaxo Wellcome 78.6 1.43
Flixotide Glaxo Wellcome 77.5 1.41
Zestril AstraZeneca 69.7 1.27
Ventolin Glaxo Wellcome 60.0 1.09
Adalat Bayer 58.2 1.06
Zantac Glaxo Wellcome 54.1 1.00
Lustral Pfizer 49.9 0.91
Voltarol Novartis 49.1 0.90
Imigran Glaxo Wellcome 43.3 0.79
Becloforte Glaxo Wellcome 41.0 0.73
In 1997, Glaxo Wellcome launched a direct-to-consumer campaign in the US
on TV, radio and in print to highlight treatment for a condition many
found it difficult to broach - genital herpes. Glaxo makes the
anti-viral drug Valtrex, the lesser-known alternative to Zovirax.
The campaign encouraged patients to talk to their doctors about
treatment options. It addressed the psychological components of the
condition, offering hope to those finding it difficult to manage the
Since the campaign was launched, Glaxo has had 800,000 calls from
patients wanting information about the disease. Some 11% had not seen a
doctor about the condition for two years, but 86% now planned to see
In a subsequent survey by Market Measures Incorporated, 49% of those who
had called the toll-free number on the ad had seen their doctor within
three months. Some 76% said they felt the ad provided a valuable service
in educating the public.
In 1996, Valtrex had a prescription share of 12%. Following this
campaign, Valtrex was the fastest-growing brand in 1997. Its market
share for July 1999 was 31%. MMI reported that in 1998, awareness of
Valtrex had risen from 18% to 58% among those with the disease.