Saturday, March 28, 2009
In 1999 Paxil, manufactured by SmithKline Beecham (now GlaxoSmithKline plc), was third among the pharmaceutical industry’s best-selling SSRIs, a class of drugs then used primarily to treat depression and anxietyrelated maladies. The drugmaker’s strategy for gaining ground on rivals Prozac and Zoloft included extending Paxil’s market by winning approval by the U.S. Food and Drug Administration (FDA) to treat other forms of mental illness. When, in May of that year, the FDA made Paxil its only approved treatment for social anxiety disorder, the drug finally found itself in a position, after seven years on the market, to outsell its rivals. Social anxiety disorder was a little-known condition at the time, but estimates by SmithKline Beecham put the number of potential Paxil customers in the United States at close to 10 million. Enlisting the public relations firm Cohn & Wolfe as well as Paxil’s advertising agency of record, McCann Erickson Consumer Health, SmithKline Beecham mounted a combined physician, PR, and directto-consumer branded campaign that was meant to inform Americans about social anxiety disorder and to let them know that Paxil alone had been approved to treat it.
Immediately after learning of the FDA ruling,
SmithKline Beecham increased its spending on physician-targeted ads to get the word out about the new Paxil designation. Meanwhile, the drugmaker funded a public-service campaign meant to spread awareness of social anxiety disorder. Then, in September 1999, a $30 million push of the Paxil brand began its run on television and in magazines with national circulations. SmithKline Beecham focused its message about social anxiety disorder on professionals between the ages of 18 and 34, with an emphasis on men, who were believed more likely to seek help for the condition because of career concerns.
The PR campaign resulted in more than a billion media references to social anxiety disorder, up from roughly 50 in previous years, almost all of which mentioned that Paxil was the only approved treatment for the condition. Seven months after its launch, the campaign had made the Paxil brand name one of the most recognized prescription drugs in the United States, and the drug was responsible for a sizeable increase in the anxiety medication category. Paxil gained on its SSRI rivals and experienced sustained sales growth, a trend that continued as the drug won further treatment designations, and the company adapted its marketing accordingly in the following years.
In 1987 Eli Lilly and Company won U.S. approval to sell Prozac, the first among a class of drugs called selective serotonin reuptake inhibitors (SSRIs) that treated clinical depression by elevating levels of serotonin—a chemical believed crucial to regulating mood—in the brain. Prozac’s effectiveness and lack of side effects compared to existing medications for depression revolutionized not only the way mental illness was treated by psychiatrists but also the way it was perceived by the public. By 1992, when Pfizer and SmithKline Beecham introduced their own SSRIs, Zoloft and Paxil, respectively, depression had lost much of its stigma in the United States. In the following years SSRIs became one of the best-selling prescription drug categories.
For its first several years on the market, Paxil remained in third place among SSRIs, and SmithKline Beecham set its sights on new markets for the drug. In the mid-1990s Paxil won FDA approval for the treatment of anxiety-related conditions like panic disorder and obsessive-compulsive disorder. Though these markets led to substantial growth for the brand, it was the FDA’s approval of Paxil in 1999 as a treatment for a little-known condition called social anxiety disorder that gave the drug its first significant advantage over competitors. Social anxiety disorder, or debilitating shyness, was a condition that, according to SmithKline Beecham, affected as many as 10 million Americans, and Paxil was the only FDA-approved treatment. SmithKline Beecham was aided in its attempt to reach this untapped market by an easing of FDA regulations in 1997 that governed the advertising of prescription drugs. The policy shift almost immediately changed the nature of the advertising of prescription drugs, as pharmaceutical companies, which traditionally had focused on physicians and other medical professionals in their marketing efforts, began to rely on advertising their products directly to consumers, much as was done with other consumer goods. Though restrictions remained regarding the disclosure of side effects and though the FDA retained a role in approving advertisements, directto-consumer pharmaceutical marketing quickly became ubiquitous in the United States, increasingly putting patients rather than their doctors in the position of deciding which drugs might best satisfy their needs.
The social anxiety disorder campaign targeted professionals aged 18–34 who, despite appearing normal, experienced overwhelming fear in social or work-related situations. SmithKline Beecham estimated that the total number of people suffering from the condition in the United States numbered 10 million, and the company believed that only 5 percent of these people were being treated. The company thus set out to define social anxiety disorder for an enormous untapped market, to let people know that they were not alone in their suffering, and to urge people to seek out Paxil, the only available FDAapproved treatment. As the Paxil product director, Barry Brand, told Advertising Age, ‘‘Every marketer’s dream is to find an unidentified or unknown market and develop it. That’s what we were able to do with social anxiety disorder.’’
The National Institute of Mental Health, however, placed the number of sufferers from social anxiety disorder at around 5 million. This discrepancy pointed to a controversy surrounding the subjectivity of diagnosis and, by extension, SmithKline Beecham’s marketing of Paxil. While SmithKline Beecham argued that it was catering to an overwhelming need and helping relieve previously untreated suffering, critics believed that the drugmaker was artificially creating a market for Paxil by encouraging the merely shy to diagnose themselves with the more debilitating form of social phobia. It was estimated that twice as many women suffered from social anxiety disorder as men, but in a departure from conventional wisdom men appeared more likely to seek treatment for the condition. In most medical matters men were less likely to seek treatment, but as McCann Erickson’s Nan Dillon told Advertising Age, ‘‘This tends to be the exception because social anxiety disorder can actually damage a man’s career.’’
When the Paxil social anxiety campaign was launched, Prozac was the SSRI market leader and Eli Lilly’s biggest earner, with annual sales approaching $3 billion. In the summer of 1999 a Prozac campaign narrowly preceded Paxil’s social anxiety disorder ads to become the first-ever TV marketing of a psychiatric drug. The centerpiece of the Prozac campaign was a 30-minute infomercial that aired on local and cable networks late at night and on weekends, when people with untreated depression were believed likely to be watching. The infomercial featured a mostly female cast of Prozac users giving testimonials, as well as imagery of presumably depressed people and informational segments with doctors talking about depression and its treatment. Mental health experts were divided on the question of whether it was appropriate to pitch Prozac under the cover of public-service programming. The company supported the infomercial with 30-second TV spots offering a toll-free number to call for more information.
Paxil’s other major competitor in the SSRI market, Pfizer’s Zoloft, whose 1999 sales were estimated at $2 billion, had not yet used direct-to-consumer advertising. In early 2000, however, Pfizer initiated an account review with the intention of moving the duties for Zoloft advertising away from health care specialists Lyons Lavey Nickel Swift to a general-market agency. Deutsch Inc. won the review and began preparing a Zoloft direct-toconsumer message. Having already won approval for treatment of post-traumatic stress disorder, Zoloft was well positioned to benefit from the dramatic increase in SSRI prescriptions following the terrorist attacks in the United States on September 11, 2001. direct-to-consumer campaign supporting BuSpar. One of only two drugs approved to treat generalized anxiety disorder at the time, BuSpar was also used to treat depression. Unlike its competitors among psychiatric drugs, BuSpar was not associated with such side effects as drowsiness and loss of libido. The BuSpar campaign targeted women via magazines like Good Housekeeping and People and, using an image of a cartoon female with symptoms of anxiety, on broadcast and cable TV.
Soon after the FDA decision in May 1999 allowing Paxil to be marketed as a treatment for social anxiety disorder, SmithKline Beecham increased its spending on physician-targeted ads by $1 million, according to Medical Marketing and Media. The company changed the copy in medical journals from ‘‘Paxil means peace . . . in depression, panic disorder, and OCD’’ to ‘‘Show them they can . . . the first and only approved treatment for social anxiety disorder.’’
Meanwhile, SmithKline Beecham funded an informational and public relations campaign to spread awareness about social anxiety disorder. Sponsored by a trio of advocacy organizations—the American Psychiatry Association, the Anxiety Disorders Association of America, and Freedom From Fear—the campaign was orchestrated by the New York PR firm Cohn & Wolfe and was designed, according to PR News, ‘‘to educate reporters, consumers, and, in some cases, physicians, in an effort to encourage diagnosis and treatment.’’ Featuring posters placed at bus stops across the country and the tagline ‘‘Imagine being allergic to people,’’ the PR campaign did not explicitly mention Paxil or SmithKline Beecham. Likewise, Cohn & Wolfe technically represented the nonprofit organizations and the doctors involved, even though SmithKline Beecham paid for the campaign. Virtually all of the sizeable media coverage Cohn & Wolfe generated mentioned not just the Paxil name but also the fact that it was the only FDAapproved treatment for the condition.
In September 1999 SmithKline Beecham launched its first Paxil direct-to-consumer ads, a TV and print campaign crafted by McCann Erickson Consumer Health and with an estimated cost of $30 million. Like the public relations efforts, the branded advertising was intended to define the condition for potential Paxil users and to give afflicted Americans comfort by sending the message that they were not alone. This portion of the campaign also sought more directly to raise awareness of the Paxil name.
In an attempt to reach its core target of 18- to 34-year-old professionals, SmithKline Beecham bought airtime on prime-time shows like Ally McBeal and ran the print ads in magazines that included Rolling Stone and Sports Illustrated. Both the television spots and the print ads used the tagline ‘‘Your life is waiting,’’ and they directed consumers to ask themselves whether they experienced anxiety that made them avoid social interaction, that resembled a panic attack, or that was detrimental to their social or professional life. The 60-second TV spot informed viewers that more than 10 million Americans suffered from social anxiety disorder and that sufferers were a mix of male and female professionals engaged in productive office and social activities. In keeping with the belief that men were more likely to seek treatment for social anxiety disorder, the print ads primarily targeted male professionals, with the primary image being a distraught man in business clothes.
PR News reported that, as a result of the campaign to advertise social anxiety disorder, media references to the condition climbed to more than 1 billion articles, up from 50 in 1997 and 1998, with 96 percent conveying the information that Paxil was the only FDA-approved treatment then available. After the campaign had been running for seven months, according to Medical Marketing and Media, Paxil scored third among advertised prescription drugs in unaided recall, behind Viagra and Claritin. Paxil’s market share among anxiety drugs from December 1998 to May 1999, the months immediately preceding the campaign, was 9.3 percent of 6.7 million prescriptions. From June to October 1999, as the campaign ran, Paxil’s market share not only grew to 11.5 percent but was responsible for half of the increase in the entire market, which grew to 7.2 million prescriptions. In 2000 British rival Glaxo Wellcome merged with SmithKline Beecham. In its 2000 annual report the new entity, GlaxoSmithKline, claimed that Paxil ‘‘became number one in the U.S. selective serotonin reuptake inhibitor market for new retail prescriptions in 2000.’’ In 2001 GlaxoSmithKline won FDA approval to market Paxil for both generalized anxiety disorder and posttraumatic stress disorder. Paxil continued to outpace its rivals in sales growth. The terrorist attacks in the United States on September 11, 2001, resulted in a dramatic increase in prescriptions for all antidepressants and anxiety drugs. During this time Paxil’s advertising positioned it as an answer to the uncontrollable feelings of fear and helplessness that many people felt in the aftermath of the attacks.