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The image is chilling: a series of menacing bear traps laid out like footsteps. "Is a bear trap snapping shut on a human foot, your foot, too scary a thought?" goes the copy. "Good ... "

A promotion for the latest Hollywood horror blockbuster?

How about an ad for the Diabetic Foot Care Centers of Paramus, N.J. Now running in newspapers and on radio throughout the area, the campaign, from McQueeny Davis Kohm & Partners, Oradell, N.J., is just one example of the growing use of scare tactics by drug and healthcare marketers.

"It's shock jock advertising, a bit of desperation on the part of marketers who are faced with new challenges," said Burt Flickinger III, manager of consultancy A.T. Kearney, New York.

There are no hard numbers to illustrate the trend, but observers say fear marketing is definitely on the rise.

The issue came to a head in California in recent weeks. There, as in other markets, Abbott Labs' Ross Products division is using heavy print and radio advertising to push its Advera nutritional drink for HIV-positive or AIDS patients.

The print ad shows a handsome, seemingly healthy young man with a pair of running shoes and a glass of Advera nearby.

AIDS groups have criticized the ad, saying it uses an implicit scare tactic since anyone as healthy looking as the ad's model wouldn't need the product.

The medical director of San Francisco General Hospital's AIDS clinic, Dr. John Stansell, called the ads "disgusting."

At about $3,600 a year, Advera has a premium price tag that is not covered by third-party payers while comparable, less expensive products frequently are.

Ross Products is so sensitive about the flak the company re-fused to name the agency that handled the ads or comment beyond a written statement.

"Ross and Abbott have a responsibility to communicate the availability of products that may improve the quality of life for people with special nutritional needs-including those with HIV," said the company.

Some argue scare marketing is actually necessary in some cases to shock people into seeking care that can improve their health.

"Sometimes you have to scare people to save their lives," said Jerry Della Femina, chairman of Jerry & Ketchum, New York. "But I'm very much against it if you're trying to sell a product."

Mr. Della Femina created an outdoor campaign for the Asthma Zero Mortality Coalition now running in inner-city subways and buses nationwide.

The ads, which urge asthmatics to seek professional help, begin, "When those painful, strained breaths start coming, keep in mind that any one of them could easily be your last."

"Is it a scare tactic? You bet," said Mr. Della Femina, himself an asthma sufferer. "But is it without a hidden agenda? You bet."

Drug and healthcare marketers may have a special temptation to use fear marketing since they deal with people when they are most vulnerable.

"We've tried passive-type ads in the past and they did nothing," said Dr. Vincent Giacalone, medical director of the Diabetic Foot Care Centers. "We've gotten a much greater response from our new ads."

Mr. Flickinger said, "It's a relatively easy way to get consumers' attention, but it can be dangerous, especially when it's an over-the-counter product that encourages consumers to bypass their doctors."

He noted that many of today's fear tactics are driven by OTC marketers frustrated with a plateau in sales growth born of greater competition.

"There are a lot of direct marketing companies out there pushing OTCs, nutritional drinks, vitamins, etc. Together with store brands, they've taken profit share from branded companies," he said.

Drug and healthcare marketers are also responding to uncertainties about potential healthcare reform.

Health Midwest, an alliance of 11 Kansas City hospitals, created frightening images of the future-a woman and baby locked out of a hospital, a seemingly homeless family carrying a sign that reads, "Will work for healthcare"-for a campaign it ran a year ago when the Clinton administration's reform efforts were at their height.

"Our purpose was to get people's attention and we did. Within six months awareness was up 20% to 30%," said Paul Barthelemey, assistant account exec for McDonald Davis & Associates, Milwaukee, which created the campaign. "But that kind of approach can backfire. You don't want to terrify. You need to stay as close to the public mind-set as you can."

Alice Z. Cuneo contributed to this story.

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