The power of the pharmacy is nearly limitless. It holds the key to the undoing of almost every illness our medical system can diagnose. But at what point does one begin to question the intentions of the companies that manufacture, produce and distribute these medications. There is a pill and a drug for every ailment, but does every drug have the research behind it attesting to its safety? What makes this question even more pertinent, is the money spent every year marketing these drugs directly to the people that consume them. It is estimated that drug companies in the United States spent 19 times more on self promotion than basic research, in 2012 alone (according to the Pharmaceutical Research in BMJ (2012)). This essay will utilize the well known case of Vioxx to exemplify and elaborate on the dangers of direct to consumer based marketing.
As numerous critics have observed, direct to consumer (DTC) marketing invites the development and promotion of drugs aimed at very large groups of users suffering from chronic and persistent—but not necessarily life-threatening—conditions. Prescription medications for pain and allergy relief, erectile dysfunction, asthma control, acid indigestion or insomnia are ideally suited to this medium. In his publication (DIRECT-TO-CONSUMER ADVERTISING AND PHARMACEUTICAL ETHICS: THE CASE OF VIOXX), in 2007, Ronald M. Green attests to the large market made available by DTC marketing. The development of new drugs pushed to the public is kept strictly to the mild alteration to preexisting medications known to hold a large share of the public consumption. DTC marketing has self-inspired a demand for the expensive version of already existing drugs. The National of State Legislature published an article, Mareketing and Direct to Consumer Advertising of Pharmaceuticals, that states "...an early analysis provided by the managed care industry for 1999 to 2000 reported that prescriptions written for the top 50 most heavily advertised drugs rose 24.6 percent, compared to 4.3 percent for all other drugs combined." So now that we have established the presence of a market created by DTC marketing, we delve into its effects on advertising.
In the case of Vioxx, an anti-inflammatory used primarily to treat arthritis, this new medication was aggressively marketed with over $100 million in promotion. According to Greens publication, in 2000, Merck spent $160.8 million on DTC advertising, to keep up with its competitor Celebrex, the largest amount spent on DTC for any drug that year. To prove their new drug's efficacy, Merck launched a study comparing Vioxx to naproxen (an NSAID sold under the brand name Aleve). During the trial, Vioxx demonstrated to have significantly less gastrointestinal side effects (stomach ulcers, perforation, g.i. bleeds, etc.) The study also revealed twice as many prothrombic events including myocardial infarction and stroke. Edward M. Scolnick, President of Merck Research Laboratories, claimed this was in large part due to a NSAID's established procardiac side effects, and not to do with any possible side effect of Vioxx. No further study was conducted to validate this claim that would effectively sweep any public concern's for Vioxx's potential harm to its consumers. Merck had actually sponsored the study in the hopes of demonstrating Vioxx’s minimal gastrointestinal effects and possibly doing away with the usual NSAID gastrointestinal warnings on the drug’s label. Here we see one impact of the DTC environment: the desire to minimize serious side effects warnings that might have to be included in broadcast ads.
So while the data from this study, VIGOR (Vioxx Gastrointestinal Outcomes Research), raised doubts as to whether Vioxx was safe for public consumption, the marketing continued, raising over $1.5 billion in sales, in the year 2000. Pre-approval reports had sparked some concerns that Vioxx and other COX-2 inhibitors might encourage the formation of blood clots because they did not