When The New York Times decided to run a story in July about refractory depression, the article was entitled "Some Still Despair in a Prozac Nation." Even after a decade on the market, and despite the availability of a host of competing drugs, the headline exemplifies the extent to which Eli Lilly and Company's popular antidepressant remains a pop culture icon. So when the Indianapolis-based pharmaceutical manufacturer launched a 30-minute program that featured Prozac (fluoxetine) in May-it avoids using the term infomercial-the cutting edge direct-to-consumer (DTC) ad naturally raised questions and a few eyebrows as the company sought to gain even wider exposure for the drug.
The program was originally scheduled to air through July on national cable channels and in select affiliate markets, and has been extended through at least mid-October, targeting the estimated 9 million adults in the United States who receive no treatment for depression. Combining education about depression, patient testimonials and product information, the infomercial was meant "to provide factual information about Prozac that may be useful to anyone whose life has been touched by depression," said Gino Santini, president of U.S. Operations and Global Marketing for Lilly, in a Lilly press release.
Lilly declined to release figures enumerating the number of times the infomercial was broadcast and how many individuals called the toll-free number to request an information packet, saying the information was proprietary. But Greg Kueterman, a Lilly spokesperson, told Psychiatric Times "we are very happy with the response; we received more calls than we anticipated."
He also said that the reaction to the long format advertisement was generally positive. "The general response from the callers was that they were glad to learn more about depression and about Prozac. They felt the spots were up front about the drug, about what it does and doesn't do, and about its potential side effects."
For psychiatrist Freda Lewis-Hall, M.D., director of Lilly's Center for Women's Health, however, the issues of professionalism versus commercialism were particularly important. Asked by her employer to host the program, Lewis-Hall had to reckon not only with the impact she could have on individuals, but also with her own reputation as a physician.
"Actually, I did think about it a lot," said Lewis-Hall in an interview with PT. "What finally won out was my passion for reaching out to people who otherwise would not receive treatment...Television reaches people where they sit. You can't educate people in 30 or 60 seconds about things that are hugely complex, like diabetes, hypertension or depression. This was an opportunity to give people the story and to tell them how serious a disease depression is, and to show them how hard it is to [be diagnosed] by your physician. I was able to tell people how difficult it is to step up to the plate, admit that something's wrong and to seek medical help, to recognize that this is a medical condition and not a weakness."
To get her message across, Lewis-Hall said, she was "willing to suffer whatever hits came," though she added no one has criticized her participation thus far. "I started out as a physician thinking I was going to end up as the ethics police," but the collaboration with the production and marketing personnel turned out what she believes is a tastefull and informative program. The infomercial included statements that there were any number of treatments for depression and that Prozac is not right for everyone. It consistently urged viewers to discuss their concern with their doctors, important qualifiers Lewis-Hall said.
"When I went to the APA [American Psychiatric Association] annual meeting in Washington, D.C., in May, I was a little nervous because that was around the time the program would premier," said Lewis-Hall. "I expected at least a couple of colleagues-ones who knew me really well-to pull me aside in the hallway of the convention center and say, 'You've really crossed the line and have gone to the other side.'" Instead, she continued, "the company and I were congratulated for having participated in something like this. So my fears have been unfounded."
Michael Blumenfield, M.D., the chair of the APA's joint commission on public affairs, told PT that the organization has not taken any official position on the use of infomercials, although he recognized that any effort to help educate the public about depression is welcome. "There is always a possibility that there will be pressure but you have to weigh that against the positive effect of education and destigmatization of depression and mental illness," he said. "There are potential problems. Psychiatry will have to look closely at them and weigh in with [its] opinion and influence."
Nevertheless, Blumenfield added, if the ad could encourage people to seek treatment, then ultimately the physician would take over the role of educating the patient. "Physicians will have to pick up where the infomercial leaves off. They're going to have to make the diagnosis and educate the patient about the options for treatment. This may include no medication or a different medication," he said.
The National Alliance for the Mentally Ill reacted favorably to the effort. In a Lilly-prepared press release, Laurie Flynn, executive director of NAMI, said that the program raises "awareness and reduces the stigma that some people still associate with depression." Later, NAMI spokesperson Bob Carolla told PT that NAMI does not endorse any particularly treatment as a matter of policy, but "anything that promotes awareness and that educates people and helps to break down stigma fits in with what NAMI tries to do each and every day."
Carolla added, "People need to remember there is someone here selling a product," though he cautioned against becoming too cynical. Ultimately, he agreed that when individuals seek treatment, they will listen to the more authoritative voice of the psychiatrist "who may tell them some other treatment is more appropriate."
Although the Lilly infomercial created a stir in the national media, none of the pharmaceutical manufacturers contacted by PT said they were planning to develop long format ads, though some conceded they will consider all options. Generally, each company makes a choice about whether to market to physicians or DTC based on evaluation of its own best interests.
Pfizer Inc., for instance, recently launched an education initiative for panic disorder in conjunction with the Anxiety Disorders Association of America. Singer Naomi Judd, who disclosed using Pfizer's selective serotonin reuptake inhibitor Zoloft (sertraline) to treat her condition, is a spokesperson. "We had a very successful press event in July," said Celeste Torello, a spokesperson for Pfizer. "She is very touching when you hear her speak about it."
"We don't do any DTC ourselves," said John Eggers, a spokesperson for Forest Pharmaceuticals in New York City, makers of the antidepressant Celexa (citalopram), whose marketing strategy is directed toward physicians. "We find that for most pharmaceutical products, DTC is really a strategy of the market leader, and Prozac has the largest share of the market."
Keeping the market growing is important to Lilly, Eggers added, but it also helps all of the manufacturers of antidepressants. "We get our share of those new patients who are coming in and our share is growing. I don't view it as an unfavorable thing for us, and it's probably what they [Lilly] should be doing."