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Advertising executives agree. From a creative perspective, direct-to-consumer prescription drug advertising often fails to send a slick and interesting message.

"It's mediocre," confides Illyssa Levins, vice-chairman at Grey Advertising's Grey Healthcare Group, New York. "But it's as good as it could be, given the evolution of DTC."

Privately, many agree that a lot of DTC creative is lousy. As a result, says Jim Sandino, managing director at Lowe McAdams Direct, New York, "Most people in DTC creative are lucky that consumer interest is so high."


It is a world of dreary chemical molecule pictures, surreal imagery, faces-of-diversity and relationship photos with accompanying text of complicated, confusing and often scary legal language.

To explain these curious ads, one group creative director assessed the category as being "in a growth stage, adolescent. I have yet to see anything that is brilliant or earth-shattering."

The mundane advertising has caused agencies to point fingers. While agencies that specialize in healthcare advertising criticize general marketing shops for being inexperienced with drug products, mainstream agencies accuse specialists for their lack of consumer ad savvy. The result is trial-and-error -- particularly evident on the newly opened TV frontier.


As Ellen Perless, senior VP-group creative director at Foote, Cone & Belding, New York, explains, speaking to consumers rather than medical professionals "is a new area for the pharmaceutical industry. I think they're a little wary of it."

Many drug companies have in fact moved their advertising to more traditional agencies for this reason.

"I think there's a tremendous amount of confusion on the client side," says Dave Mulryan, president at Mulryan/Nash, New York. "The drug companies have to make the transition to consumer and have to encourage their agencies to make that transition."

Mulryan/Nash handles healthcare clients such as Home Access Health and Agouron Pharmaceutical's HIV drug Viracept.


"This is virgin territory," says Kathy Jenkins, exec creative director and founder of Quantum Group, a Parsippany, N.J.-based subsidiary of CommonHealth USA. "The consumer has been brought into the healthcare loop and they've been empowered to seek intelligence."

Even with new FDA rules that allow the product and the disease it treats to be named, Schering-Plough Corp.'s original advertising imagery from its "Blue Skies" campaign for Claritin remains relatively unchanged.

In the original ad the profile of a clear-skinned woman is superimposed atop a bright blue sky and a vibrant green landscape. A Claritin pill is superimposed atop what would be the sun. In the original ad, prior to revamped FDA regulations, the drug could have been anything from a dermatological wonder drug to a hallucinogen. New ads tell us that Claritin is an antihistamine.

Most ad executives privately acknowledge this is the $70 million campaign they love to hate.

Without question, the spot that offers the finest production values in the DTC category is Hoechst Marion Roussel's Allegra commercial, "Wheat surfer."

It was a rare exception in DTC advertising and its successful use of the wheat field later challenged FDA because consumers were able to deduce what the product treated. The campaign is from Medicus Group International, New York.


In spite of the loosening of ad restrictions, the FDA maintains a stranglehold on creativity.

Now, in addition to product benefit statements, DTC ads must include ill-fitting "fair balance" statements. The result is a visual/aural dichotomy that's hard to accept. Images of healthy, friendly, familiar faces in enviable locations juxtaposed with copy such as, "in studies, drowsiness occurred in one out of 100 people; others reported cold or flu, nausea or menstrual pain," become not only foreign, but parodic.

Mr. Mulryan describes the unseemly, yet necessary situation as "a compromise, and compromises are never pretty. FDA would be well advised to simplify the information mandated."

Many DTC ads are impersonal and confusing rather than trustworthy and authoritative. A TV spot from KPR, New York, for Glaxo Wellcome's herpes drug Valtrex depicts a couple in a variety of romantic moments. The commercial could just as easily be for wine or investment banking.


Although required to provide every bit of information the consumer may need to know, most DTC ads provide sensory overload. The category takes itself so seriously it's hard for the consumer not to laugh at it. And many do.

The result is that some prescription drug marketers are reluctant to use TV advertising.

Lacking precedent and stringently supervised by FDA, DTC represents a full spectrum of creativity for an isolated category. Putting effectiveness aside, DTC advertising spans the scale of aesthetics. Such advertising can be as disconnected as a chemical molecule illustration of a "new non-nucleoside reverse transcriptase inhibitor" (from KPR for HIV treatment Rescriptor) and as right on as a very simple and warm broken-vase analogy for antidepressant Prozac (from Leo Burnett USA, Chicago).

In some cases, the challenges are done comparatively well. Ads from Foote, Cone & Belding Healthworks for Merck & Co.'s Fosamax target older women with soft pathos. A print ad promoting awareness of the post-menopausal osteoporosis drug emphasize a modern woman's pursuit for independence with the copy, "Thanks to Fosamax and its power to rebuild bone, Susan Brenner is still paddling her own canoe after 50."


Broadcast work from Quantum Group for Sporonox, an anti-fungal treatment, personifies feet, dancing and flirting. Even with the fair balance statements, a visual that directly corresponds with the product is most conducive to consumer attentiveness.

The work echoes a common trend in DTC creative, emphasizing relationships. Children show up frequently in campaigns these days: a man teaching his grandson to ride a bike for Merck's Zocor cholesterol treatment; a kid putting his arm around a hospital bed-ridden relative for Bristol-Myers Squibb Co.'s diabetes remedy Glucophage; and children and babies for Pharmacia & Upjohn's Depo-Provera contraceptive.

HIV therapies have had a dramatic effect on patients but many of the campaigns take strikingly similar approaches. Such ads, running in targeted magazines like Poz, Advocate and Out, tend to sell one of two main ideas: diversity or virility.

Most show people enjoying the outdoors, inevitably posed with their dog or bike. And a "faces of diversity" theme that depends upon a model's skin tone can be found in print campaigns for Combivir, Viramune, Zerit and Marinol. The result is a series of unrelated ads that are mistaken and forgotten. And some, such as Rescriptor, still look like they should be in a medical journal.

But HIV drugs is one of the most active ad categories. Mulryan/Nash's latest creative for Viracept juxtaposes a lion with a tabby cat and the tagline, "Powerful and easy to live with." The tagline underscores the difficult regimen required for protease inhibitor medications.

Still, it might be a while before a DTC ad will look like a Coca-Cola ad. "I think they might, if it were appropriate to the product. But Coca-Cola sells lifestyle -- you don't have to sell lifestyle to a HIV patient," says Mr. Mulryan.

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