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Cholesterol is definitely on the outs. Restaurants tout low-fat foods and cholesterol counts are monitored as closely as new wrinkles and gray hairs.

So, why haven't ads for new cholesterol-lowering drugs been clogging up the airwaves a la Claritin or Rogaine before it went over-the-counter?

For one thing, "There is no background on whether DTC advertising is going to work in this category," says Alex Zisson, a pharmaceutical industry analyst with Hambrecht & Quist. "For drug companies in general, it is very difficult to calculate the return on investment of DTC advertising, [and] it just isn't clear whether DTC ads work especially well for symptom-less diseases like high cholesterol."


Mr. Zisson points out that the leading drug in the category -- Warner-Lambert Co.'s Lipitor -- reached the No. 1 spot with almost no consumer advertising while Bristol-Myers Squibb Co.'s Pravachol and Merck & Co.'s Zocor "seem to be struggling with the results they are getting."

Between January and November of last year, Lipitor was the runaway leader in the category with about 22 million prescriptions written, according to IMS Health. Zocor came in second at 16.8 million and Pravachol third at about 11.5 million. Together, the three drugs hold about 85% of $6 billion business.

Lipitor has just thrown its hat into the DTC ring with the launch last month of a national TV and print campaign. Print ads broke in a variety of national magazines, some newspapers, USA Weekend and Parade. The TV campaign is heavily weighted to national network programming; the first TV spot ran during NBC's "ER" on Feb. 25. Bates Worldwide's Healthcom, New York, handles creative; J. Walter Thompson USA, New York, buys media.


"We have really spent the last two years [since the product launch] solely marketing to doctors," explains Robert Ehrlich, senior director of DTC communications for Warner-Lambert. "We decided to wait and let Lipitor establish itself in the medical community . . . Before any ads hit, we were already No. 1 in the category."

The campaign uses the tagline, "The lower numbers you are looking for." It was tested last year in regional markets including Dallas, Kansas City, Milwaukee and Philadelphia. Separate TV spots target men and women; print ads target both.

Originally, the TV spot now aimed at women was intended to appeal to both genders, explains Howard Courtemansche, exec VP at Bates. But in test the agency discovered that the spot "skewed more toward women . . . there was not a huge disparity but there was enough" to call for the creation of a second spot with a male sufferer.


Mr. Ehrlich would not discuss media spending or how long the campaign is set to run, saying only that it will be "a major educational effort in the category."

A typical DTC campaign, according to Mr. Zisson, will cost $30 million to $40 million -- a fraction of the overall sales effort. It is probably a pretty safe bet that Warner-Lambert will be spending at least that much.

Mr. Ehrlich says that while there are currently between 6 million and 8 million people in the U.S. using some kind of cholesterol-lowering drug, the condition is so widespread that "there are probably 50 million-plus people that need treatment -- and that figure might be as high as 70 million to 80 million."

Merck & Co. would not discuss any aspects of its campaign for Zocor and declined to return phone calls. According to Competitive Media Reporting, Merck spent $39.2 million in media for Zocor from January through November 1998, compared with $44 million for the same period in 1997.

According to CMR, Pravachol was backed by $62 million in media for January-November 1998, a decrease from $66.5 million in same period of 1997. Lipitor, on the other hand, was backed by a total of just $6.3 million in media last year and spent nothing at all in 1997.

Hament Shah, a healthcare analyst with HKS & Co., believes that Zocor and Pravachol will be cutting back on DTC advertising "big-time" this year.

He points out that while campaigns last year by both drugs "were expanding the market, most of the benefit went to Warner-Lambert, which had been focusing on marketing to doctors. In less than two years, Lipitor went from fifth place to an incredible 43%-44% share in the category."


And there's the rub: According to IMS Health, in 1997 and 1998 Lipitor spent about $53 million on representatives' efforts to reach doctors in their offices and at hospitals -- in line with competitors.

"Remember these ads may motivate patients to go and have their cholesterol checked, but the decision-making process lies with physicians," Mr. Shah notes.

Pravachol, he says, "was the most aggressive a little while ago, but I haven't seen anything from them in months."

However, Mr. Shah points out, it makes sense for Lipitor to launch now because "Warner-Lambert's interest as the dominant player now is to begin to expand that

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