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If you watch commercial TV, there's a fair chance you've seen the advertisements for Celebrex and Vioxx, the prescription COX-2 inhibitors that treat arthritis. Vioxx, and its competitor Celebrex, hit the market in 1999. When they launched, they each made their benefits familiar to millions with widespread advertising campaigns. These prescription drugs are two of the most heavily advertised pharmaceuticals in the country, and they are also two of the best selling drugs.

How did their fight for market share become a public spectacle? It all had to do with a 1997 change in Food and Drug Administration (F.D.A.) regulations. According to Arthur Levin, Director of the Center for Medical Consumers, "Prior to 1997, the F.D.A. required what was called a 'brief summary,' which was extracted from the product label, and that brief summary had to be part of any direct to consumer advertisement. It's a very long 'brief summary,' and it made TV advertising impractical. Once that was no longer required, then TV ads could really take off."

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And they have. These so-called "direct to consumer" ads are tough to escape. "You can hardly watch TV from 8 to 11 anymore without often being deluged by these ads," says David Goetzl, a reporter for ADVERTISING AGE magazine. Between 1997 and 2000, drug companys' direct to consumer spending rose from just over one billion to an estimated 2.5 billion dollars. The ad blitz appears to be working. A 1999 survey found that a third of all respondents had spoken with their doctor about a prescription drug they saw advertised.

While retail spending on prescription drugs has gone up 40% between 1997 and 1999, the relationship between direct to consumer advertising and the increasing numbers of prescriptions being written can only be inferred. Goetzl added, "It's just difficult to determine. But perhaps anecdotal evidence could be used in this case and we see the drug companies continuing to spend more and more on these ads. So presumably they're deriving some bottom line benefits."

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But Dr. Mike Magee, Pfizer Pharmaceutical Group's senior medical advisor, says their advertising campaigns are designed to raise awareness, not boost their company's bottom line. According to Magee, "Direct to consumer advertising plays a very important role in educating the patients and giving them confidence so they can interact on par with doctors."

At New York City's Cabrini Medical Center, Dr. Douglas Dieterich agrees that direct to consumer advertising can educate patients. "In some ways, it will start a conversation, or begin a dialogue about a problem a patient may be having that they're not going to necessarily bring up to their physician at first. In other ways, there could be problems with it, because perhaps they would be insistent on having this drug they've been convinced they need by watching a TV commercial, when in actuality they don't need it."

And that's the bottom line for consumer protector Arthur Levin, who told THAT MONEY SHOW, "The industry says this is information for consumers, but if it is, it's distorted information. These ads emphasize benefit and play down risk, and that's really not doing the public a service." What's more, says Levin, asking for the advertised drug comes with a price. "The products that are advertised on television tend to be new, brand name products that are very expensive. So they are not telling us about the older, often generically available products that are the equal [of] or sometimes even better than the new products and are much cheaper."

For Dr. Dieterich, that sometimes means suggesting his patients try over-the-counter asprin before he will prescribe those heavily advertised new arthritis drugs, Vioxx and Celebrex. According to Dieterich, "Just because it's new and sexy -- that's sort of the danger -- I think that every patient wants the newest drug on the market and they will think that's the best."

But Pfizer's Magee says the decision whether to write a prescription still ultimately rests where it always has -- with doctors. Says Magee, "Pfizer believes that the patient physician relationship is, has been, and must always remain at the heart of American healthcare. That relationship with patients and doctors is changing. The relationship that is developing is a mutual partnership -- a 50/50 partnership -- between doctors and patients that's basically consummated by patient education."

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