Drug Ads: Education or Endorsement?

The young woman in the TV commercial moves as if in fast forward. She flies through city streets on a mad shopping spree by day and feverishly dances and paints her walls red by night.

But alternately she is sad and listless.

"This is who your doctor sees -- that deeply depressed 'you' who barely dragged yourself in for treatment," the voiceover says. "But depression is only half the story. Your doctor has to know about your ups as well as your downs. Help your doctor help you."

The commercial, funded by pharmaceutical giant Eli Lilly and Co., is a departure from the existing ads by prescription drug makers because it doesn't mention any drug at all. Instead, it's packaged as a public awareness spot targeting people with bipolar disorder, also known as manic depression, who have been misdiagnosed with depression.

At least 20 million Americans suffer from depression, a psychological disorder characterized by profound sadness, hopelessness and a tendency to eat and sleep too much or not enough. About 2-3 million Americans suffer from bipolar disorder, a combination of periods of depression and periods of mania.

According to the Depression and Bipolar Support Alliance, 69 percent of bipolar patients were incorrectly diagnosed -- most mistaken for those with depression. A misdiagnosis can be very serious: The illnesses are treated with different drugs, and antidepressants aren't appropriate by themselves for bipolar patients.

"This may be a new approach," Dr. Michael Blumenfield, a psychiatrist at New York Medical College, said of the commercial. "They're promoting the recognition of bipolar. That will benefit their own product."

Lilly makes the drug Zyprexa -- originally developed for schizophrenia but recently approved by the Food and Drug Administration for bipolar.

The ad, which Lilly consulted on with the Depression and Bipolar Support Alliance (DBSA), directs viewers to www.bipolarawareness.com, a site containing information about the disorder and three drugs used to treat it -- Depakote (made by Abbott), Lithium and Zyprexa.

"We do manufacture Zyprexa, so obviously we have an interest in that," said Eli-Lilly spokeswoman Marni Lemons. "But the real purpose of this was to help people recognize the signs. It was a non-branded campaign."

Skeptics worry that pharmaceutical companies are more interested in the bottom line than public awareness.

"It's good to educate people, but there's a bias with drug companies," said New York City psychologist Elizabeth Saenger. "They slant things and people are unsuspecting."

The medical community is divided on this type of marketing, called "direct-to-consumer" advertising because it targets the public, not doctors, as was traditionally the case.

"The good part is that any increased awareness of mental illness is going to allow many people to get treatment they might not otherwise get," Blumenfield said.

But doctors have grumbled about the flip side -- patients clamoring for drugs they've seen advertised, even if they don't need them. That can rattle the patient-physician relationship: Doctors may feel pressure to please their patients, and patients may lose faith in their doctors if they don't get what they want.

"If the medical community is not strong enough to insist that patients get the products that are best for them, we get slippage towards the richest [drug] companies," Blumenfield said. "That's something we have to guard against."

Blumenfield and other experts say they haven't seen an ad like Lilly's, that merely describes a condition without mentioning a product, in several years. Such ads were more prevalent before 1997, when the FDA relaxed its regulations on direct-to-consumer ads.

The FDA had earlier required all direct-to-consumer ads to include thorough information on the drug's possible side effects. Drug companies who found such regulations cumbersome fell back on two formats on television: "Help-seeking ads," encouraging treatment for a condition without mentioning a specific drug, and "reminder ads," which reference a drug but don't explain what it's for.

Consumers found both types confusing. So the FDA agreed to allow TV drug ads to simply mention major health risks and advise where to go for more information. That led to a generation of pharmaceutical ads depicting a condition and mentioning the name of a drug to treat it.

Since 1997, the pharmaceutical industry has tripled its spending on direct-to-consumer advertising, which accounts for a sizeable portion of pharmaceutical ad spending: $2.7 billion in 2001.

"They want to bypass the professionals and go straight to the end users, and have the end users go straight to the doctor and ask for medication," said Saenger. "They're saying, think about a pill as a solution, instead of therapy."

But even though DBSA program director Daniel Mendelson believes today's medical climate puts too much emphasis on drugs, he thinks the educational benefits of the Lilly ad and others outweigh the negatives.

"The Lilly ad was trying to point out that we see our doctors when we're depressed, not manic -- but both can be symptoms of the same illness," he said. "Any awareness is good."