Date: Tue, 14 Oct 1997 21:08:20 -0500
From: Alamaine <[EMAIL PROTECTED]>
To: [EMAIL PROTECTED]
Subject: Re: Prozac Nation
They say St John's Wart is very good, too. However, despite its being a
natural substance and widely used in Europe (as I understand it), it does
little for the bottom line for Lilly, the psychs, and all of the rest of
the infrastructure. Finance is a very clinical <emotionless> subject. Is
this like Gen X Valium or something?
----------
> From: Lynda Mccloskey <[EMAIL PROTECTED]>
> To: [EMAIL PROTECTED]
> Subject: [CTRL] Prozac Nation
> Date: Tuesday, October 14, 1997 13:44 PM
>
> How can I comment on this without swearing up a storm?! Never mind...
> ------------------------------------------------------------------------
> Source: Psychiatric Times
>
> Ad Campaign Targets Depression
> by Michael Jonathan Grinfeld
>
> September 1997
> ------------------------------------------------------------------------
> When it comes to depression, there is a lot at stake.
>
> A consensus panel convened under the aegis of the National Depressive
> and Manic-Depressive Association (DMDA) in 1996 agreed that the vast
> majority of clinically depressed Americans were either not treated or
> undertreated for their depression. Of those who sought treatment only
> 10% received adequate care. The consensus group, including researchers,
> clinicians, policymakers and mental health advocates, concluded that
> without improving awareness, increasing public education and
> destigmatizing mental illness, the gap between depression's prevalence
> and those receiving treatment would continue to widen. A report of that
> consensus conference was published in the Journal of the American
> Medical Association.
>
> With an estimated 17.6 million adult Americans suffering from
> depression, and only 6 million receiving treatment, the 11.6 million
> undertreated represent a major health risk, one that has a 15% risk of
> death from suicide and an estimated annual price tag of $43 billion in
> direct and indirect costs. Helping those suffering from depression is
> an enormous challenge for health care professionals.
>
> In response to that challenge, Eli Lilly and Company launched a
> multimillion dollar advertising campaign in August. Its drug Prozac
> (fluoxetine) entered an increasingly competitive fray with a
> direct-to-consumer sales effort geared toward capturing a healthy
> dose of untapped market share. Already the world's top-selling
> antidepressant, Prozac pulled in $597.6 million in U.S. and
> international sales during this year's second quarter, and $894.7
> million in U.S. sales for the first six months. While overall Prozac
> sales increased 11% for the second quarter, competition from generics
> in other countries, primarily Canada, drove down Prozac international
> sales by 17%.
>
> Although Prozac's U.S. patent isn't scheduled to expire until the
> year 2001, Lilly is feeling the pressure generated by the marketing
> efforts of other manufacturers of selective serotonin reuptake
> inhibitors (SSRIs). While the current forecast for Prozac's growth is
> about 10% over 1996, sales of the second most popular SSRI, Pfizer's
> Zoloft (sertraline), are expected to increase by more than 20%.
>
> By reaching out to tens of millions of consumers who read the more
> than 20 U.S. magazines in which the ad is scheduled to run, Lilly
> hopes to promote depression awareness and education. It is likely that
> at least some of the undertreated will receive Prozac.
>
> Meanwhile, the three-page ad featuring a dark ("Depression hurts") to
> light ("Prozac can help") motif, explains the facts about depression
> and the availability of treatment in simple, straightforward terms
> almost anyone should be able to understand. Although Lilly is not the
> first to use direct-to-consumer advertising to promote antidepressant
> medication-Bristol-Myers Squibb, for instance, is currently testing a
> TV, radio and print ad cam-paign to consumers in Chicago and Phila.
> for Serzone (nefazodone); Wyeth-Ayerst's Effexor (venlafaxine) has
> been featured in similar ads as has Mead-Johnson's anti-anxiety
> medication BuSpar (buspirone)-the size and scope of Lilly's promotion
> turned the effort into a media event itself, generating nationwide
> coverage.
>
> The publicity is part of what Lilly hopes to accomplish, according to
> the company's president of United States operations, Alan S. Clark,
> who was promoted in January after serving as vice president of U.S.
> sales and marketing. In an interview with Psychiatric Times, Clark
> said that one of the purposes of the ad is to "destigmatize"
> depression, including removing patient barriers to seeking treatment,
> and making sure people with untreated depression are encouraged to
> seek professional help. The ad is also aimed at "providing consumers
> with important information about depression and treatment so they
> will consult with a physician."
>
> Clark downplayed the commercial aspect of the ad, saying that its
> message makes sure that people are aware that Prozac is not right for
> everyone and that only a physician can tell whether prescribing the
> drug is appropriate. "[P]atients should be more informed and that's
> a key issue," he said. "Any public communication by any company
> should be accurate and appropriate and should provide information
> that gives a balanced picture of whatever medication is available.
> I think that's very important."
>
> The Food and Drug Administration thinks it's important, too. Ever
> since direct-to-consumer advertising of prescription drugs was
> authorized several years ago, the federal watchdog has regulated
> prescription drug advertisements, assuring they met regulatory
> guidelines. According to Leah Palmer, Pharm.D., marketing
> surveillance and enforcement branch chief of the FDA's Drug
> Marketing, Advertising and Communications Division (DDMAC), Lilly
> submitted its promotion to the FDA for comment before going to
> press. Although the content of the interchange between Lilly and
> the FDA is confidential, Palmer acknowledged that a dialogue
> occurred prior to publication.
>
> "We have seen this [the Prozac] ad, and we have not objected to
> it," Palmer said. She said the FDA also has not received any
> complaints.
>
> There had been a significant amount of ideological debate over
> direct-to-consumer advertising when it first began, said Nancy
> Ostrove, Ph.D., an FDA public health analyst at DDMAC who is
> considered a guru on the subject. No one has ever provided any
> data, however, that would show it has had a negative effect on
> public awareness or relationships between patients and physicians.
>
> "These ads are designed to get people in to talk to their physicians
> and to give them the necessary information so that they can have an
> informed discussion to the degree that they can understand the
> information," Ostrove said. So long as the ads are accurate and
> "fairly balanced," she sees them as providing an appropriate
> information resource for consumers.
>
> The American Medical Association has never dropped its original
> opposition to direct-to-consumer advertising of prescription drugs,
> although it is supporting a bill in Congress to allow pharmaceutical
> companies to communicate about off-label uses with physicians.
>
> But Frederick K. Goodwin, M.D., director of the Center on
> Neuroscience, Medical Progress and Society, and professor of
> psychiatry, George Washington University Medical School, told
> Psychiatric Times that if prescription drug advertising is going to
> be allowed, there should be no distinctions drawn between medications
> for physical and mental illnesses.
>
> "I generally don't like policies that differentiate mental health
> from the rest of health," said Goodwin, the former head of the
> National Institute of Mental Health and a long-time proponent of
> efforts to destigmatize mental illness. "[I]f the public has
> accepted direct advertising of drugs for hypertension, drugs for
> prostate and drugs for infections, then they should also be
> available to inform the public about psychiatric medications."
>
> Goodwin conceded that advertising does present risks to those
> unable to sort out the information by themselves, but "in some ways
> the drug advertising is the safest of all in terms of comparing that
> with advertising of other products, because it's very heavily
> scrutinized by the FDA."
>
> Nevertheless, Leo Hollister, M.D., a professor of psychiatry at the
> University of Texas in Houston and a former president of the
> American College of Neuropsychopharmacology, is concerned that
> creating consumer demand for prescription medications creates
> tension between patients and their physicians and may result in
> people getting a one-sided view on potential treatments.
>
> Considering the proliferation of prescription drug advertising,
> "what Lilly is doing doesn't sound to me like it's too far off the
> mark," Hollister said. He agreed that if the promotions are allowed
> there should be no distinction between psychopharmacological and
> other agents.
>
> Lydia Lewis, the newly appointed executive director of DMDA said
> that what's more important than any concern over commercialism is
> that the message about mental illness get out to consumers.
>
> "If the Prozac ad is going to get people to see their doctor to be
> screened for depression, then it's a good thing," she said.
