Unfazed by attacks, marketers plan more aggressive strategies

Despite accusations that they mislead people about critical health issues, advertising executives who market prescription drugs were unapologetic yesterday as they gathered in Boston for a trade show to swap strategies in their rapidly expanding industry.

Consumer advertising for prescription drugs soared to $4.2 billion in 2004, up nearly 30 percent from $3.2 billion in 2003, according to NOP World Health, a pharmaceutical research firm. Against that backdrop, marketers yesterday discussed ways to improve their reach even more, including bringing advertising directly into physicians' examining rooms and even to the hospital bedside.

''The industry should not apologize for being marketers," said Karen Reina, executive vice president for healthcare at New York public relations firm Ruder Finn Inc. Her remarks came during a panel discussion at a conference on direct-to-consumer drug advertising, the DTC National conference, which is expected to attract about 400 participants.

Glitzy and expensive advertising campaigns for prescription drugs have come under increasing fire in Congress and elsewhere, particularly since Merck & Co. withdrew its heavily marketed arthritis pain drug Vioxx from the market in September after a clinical study showed it increased the likelihood of strokes and heart attacks. Critics say a barrage of advertising convinced a lot of people who didn't need Vioxx to take it.

Merck spent half a billion dollars advertising Vioxx in the five years it was on the market. Pfizer Inc. spent similar sums marketing its pain drugs Celebrex and Bextra. They remain on the market but are in the same class of drugs as Vioxx, known as cox-2 inhibitors, and have also been linked to an increased risk of cardiovascular problems.

An official of the Food and Drug Administration, which has been repeatedly accused over the past two years of lax enforcement of drug advertising claims, told members of Congress yesterday that they should consider limits on prescription marketing.

Members of the Prescription Access Litigation project and other Boston health activists, meanwhile, planned to stage a mock awards ceremony at the trade show site at the Boston Marriott Copley Place today, highlighting what they call inappropriate sales efforts targeting everyday patients. The activists accused Merck and Pfizer of suppressing risk information on cox-2 drugs while exaggerating their pain-relieving benefits.

''It's gotten to the point where it's over the top. They are manipulating the consumer," said state Senator Mark C. Montigny, a New Bedford Democrat who planned to attend today's protest.

Merck and Pfizer have defended their TV spots and other ads. Pfizer said yesterday it seeks to strike a balance between providing risk information and motivating patients to seek treatments with its drugs.

''The objective of our advertising is to break through barriers people have to taking action around their health and to encourage appropriate patients to speak to their doctors," said Dorothy Wetzel, Pfizer vice president for consumer marketing.

Judging from panel discussions and interviews with participants at the trade show, pharmaceutical marketing efforts will continue to expand, becoming more pervasive as advertisers compete for consumer attention.

For instance, Healthy Advice Network has introduced wall-mounted marketing brochures into the examination rooms of 20,000 primary care physicians across the country, said Michael Collette, the firm's chief executive. Patients spend considerable time waiting in exam rooms with nothing to do except stare at body diagrams, he said, so planting advertising brochures gives patients a distraction and drug companies a potent marketing tool.

''Your objective is to close the sale right there," Collette said.

An even newer initiative is to introduce advertising, coupons, and vouchers for free samples directly to the hospital bedside through a specialized TV-Internet device. Larry Grossman, chief executive of Media Encounters, which markets the devices, said the company has signed up 100 hospitals around the country to start offering the service. According to a description on the Media Encounters website, the device is ''a hospital bedside appliance providing patients and their loved ones with information, education, entertainment, and communication."

''It hasn't been a major thing ethically with the hospitals," Grossman said.

Gary Norman, vice president at RxEDGE, who stood in a trade show booth full of pharmacy shelf displays his company produces for manufacturers, said the increasingly hostile climate in Washington is an overreaction to the Vioxx debacle. ''The FDA got caught not doing its job," he said.

The backlash against drug advertising stands in contrast to the atmosphere a year ago, when the FDA took an in-depth look at direct-to-consumer marketing and found it was a positive educational influence on American heathcare. It made virtually no recommendations for change, despite widespread criticism at the time from health activists and some members of Congress.

Now -- in the post-Vioxx environment -- ad executives are worried, said Robert Ehrlich, chief executive of DTC Perspectives, a newsletter publisher that is the sponsor of this week's trade conference.

''Clearly there's a lot more to be concerned about than a year ago," Ehrlich said in an interview.

He said the FDA needs to give advertisers better guidance on how to convey side effects and risks. He also said drug companies should do more to publicize the availability of free and discounted drugs through corporate charitable programs. But overall, said Ehrlich, consumer advertising is not as great a problem as free meals, educational junkets, and honoraria that drug companies provide to doctors.

''Advertising is more pure -- it's transparent," he said. ''There's nothing hidden."

Christopher Rowland can be reached at crowland@globe.com.