Coming to You Direct
Public service ads-- or just a sales pitch?
Pasted on bus shelters nationwide, the posters ask passersby to imagine being allergic to people. The picture is of a handsome young man, despondently staring at a coffee cup as an apparently happy couple sits at the other end of his table. "Over 10 mil lion Americans suffer from social anxiety disorder," the text reads. "The good news is that this disorder is treatable." A tollfree number and a Web site are listed.
The ads bear the seals of three nonprofit advocacy groups: the American Psychiatric Association, the Anxiety Disorders Association of America, and Freedom From Fear, a trio that together make up the Social Anxiety Disorder Coalition. But funding for their public awareness campaign comes from a far less visible partner: SmithKline Beecham, the pharmaceutical giant whose flagship antidepressant, Paxil, was recently approved by the Food and Drug Administration for the treatment of debilitating shyness, formally known as social anxiety disorder.
Top of the pack. The move made Paxil the first selective serotonin reuptake inhibitor (SSRI) to win that designation. In the crowded SSRI marketplace, which rang up sales of near $7 billion last year, companies are constantly on the lookout for new ways in which their brands can be used--for social phobia, panic disorder, obsessive-compulsive disorder, bulimia. "You really need to keep your brand on the top of the pack," says Sergio Traversa of Mehta Partners, which does investment research on pharmaceutical companies. When you have multiple users, then "it's a relatively cheap alternative to developing new drugs. . . . On one side, it's cheaper, and it also helps keep the brand popular." Not surprisingly, some critics see profit, rather than altruism, as the motive be hind SmithKline's financial backing of the "Imagine being allergic to people" campaign, and they question whether the statistics put forward in such advertising are accurate.
Blurring the line between public service and marketing is common practice in the industry. Back in 1996, when Paxil was cleared for the treatment of panic disorder, SmithKline sponsored the "Paxil Report on Panic," in which one third of those surveyed said either they or someone they knew had suffered from a panic attack--a sudden rush of terror or extreme fear. Bristol-Myers Squibb, which sells the antidepressants Serzone and Desyrel, sponsors the popular Depression.com Web site, which includes an "Are You Depressed?" quiz. And Eli Lilly, the maker of Prozac, the top-selling SSRI, launched an "educational television campaign" last month, featuring a 30-minute program chronicling the tales of 10 depression sufferers--all recovered, thanks to its brand.
SmithKline insists that helping the afflicted, not boosting sales, is the goal of the poster blitz. "We find that less than 5 percent of patients are really treated today," says Barry Brand, product director for Paxil. "There's tremendous need out there." The company, he adds, is adamant about deterring frivolous use. "We don't want this to be a pill that you take for shyness," continues Brand. "We don't want you to think, 'Oh, I'll take a Paxil and I'll feel good.' "
Market forces. Hollow words, says Elliot Valenstein, professor of psychology and neuroscience at the University of Michigan and author of Blaming the Brain. "[Drug companies] can anticipate criticism very well. But at the same time, their marketing will assume there are many more people out there" whom they will attract. Indeed, the track records of other "lifestyle drugs" show that many are used to achieve modest goals such as shedding a few pounds or becoming more productive at work. "When Prozac came on the market, it was just approved for severe depression," says Sidney Wolfe, director of the Health Research Group of Public Citizen, a consumer advocacy group. "But it was used for all kinds of depression." Just as Prozac be came a $3 billion-a-year seller thanks in part to those users, Paxil will bolster its sales by targeting the merely meek, predicts Valenstein. "Shyness can't be marketed be cause most people recognize it as a normal variation on personality," he says. "But 'social phobia' sounds like a disease. I'm sure a lot of thought was given to pushing that particular terminology."
The coalition's brochure is careful to highlight the tag line "It's not just shyness," and the campaign's literature never directly mentions Paxil. But some of the symptoms de scribed are familiar to virtually anyone who has faced pressure: blushing, sweating, dry mouth, pounding heart. And SSRIs are praised as vital to the recovery process. In the campaign's video, a sufferer gives testimony to the healing role of her medication: "I wouldn't have been able to concentrate on therapy and the coping skills" without the drug's ability to "take the edge off." Valenstein says that since Paxil is the only FDA-approved SSRI for the disorder, it will become the prescription of choice for general practitioners, who pre scribe the majority of antidepressants.
Alec Pollard, director of the anxiety disorders center at the St. Louis Behavioral Medicine Institute, says the cynicism surrounding Paxil clouds its positive effects, which can be remarkable. "I can't say to you that people won't be given Paxil that don't need it," says Pollard. "But we wouldn't want to judge a treatment based on the fact that some times it will be inappropriately applied. That's inevitable. That's why particularly primary-care physicians need to be educated on proper use."
But Wolfe is concerned that the direct-to-consumer marketing approach will drive some patients to demand the medication without proper evaluation. "People are going to ask for it, and they're going to get it," he says. In the realm of managed care, doctors may be only too willing to acquiesce to those demands. "It is possible to give people careful diagnosis," says Erik Parens, an associate at the Hastings Center, a bioethics think tank. "But diagnosis takes time, and it costs money. Therefore, it is cheaper to give people the drug they ask for."
This story appears in the June 21, 1999 print edition of U.S. News & World Report.