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An end run to marketing victory
Drug makers find ways to circumvent an advertising ban and promote
psychiatric drugs for children

By Lawrence H. Diller

Oct. 18, 2001 | In a step that represents an escalation in the
influence of the pharmaceutical industry over parents and children,
Alza Corp. has announced that it will use television commercials in
its campaign to promote Concerta, a drug for the treatment of
attention deficit/hyperactivity disorder (ADHD). Alza, which pioneered
direct-to-consumer print ads to address ADHD last year, becomes the
first drug company to promote -- on TV -- the use of a medication for
a children's psychiatric disorder.

The groundbreaking TV ads for Concerta will not directly mention the
drug -- that would be illegal. Concerta, like most of the medications
used to treat ADHD in children, is a stimulant, which makes it a
candidate for potential abuse. For this reason, its production, like
that of Ritalin, is tightly controlled by the Drug Enforcement
Administration (DEA), and its promotion is subject to controls set by
the 1971 United Nations Convention on Psychotropic substances.
According to these rules, monitored by the U.N. Narcotics Control
Division, drug companies are not allowed to market controlled
substances directly to consumers.

But Alza, along with a half-dozen companies marketing stimulants
directly to parents (in magazines like Redbook and Good Housekeeping),
neatly sidesteps the limits on specific product advertising by
promoting awareness of ADHD, not the drug treatment itself. In its
print ad from last year, Alza features a smiling school-age boy
holding a pencil who is surrounded by his beaming parents and sister.
The caption beneath the photo reads: "Thanks to new ways for
effectively managing ADHD, homework may be a more relaxing time at the
Wilkin house."

Readers of these prints ads, like those who will view the new TV ads,
are advised to call a toll-free number for the "latest treatment
information." Parents are then sent a video, a copy of a government
study on ADHD treatment and material on Concerta.

This strategy mirrors the one used by Purdue Pharma with OxyContin, a
time-release pain medication that has been so widely abused that the
company has been forced to considered a new plan for its formulation.
To adhere to regulations on the marketing of narcotics while creating
a market for its drug, Purdue didn't specifically promote OxyContin to
consumers, but chose an approach called "nonbranded education," in
which the company highlighted the plight of those who suffer pain and
need a drug exactly like OxyContin. In this way they were able to
broaden and prepare the market for their drug, while staying within
the law.

In the fast-growing market of psychotropic drugs for children, only
Celltech, a stimulant manufacturer, has challenged the rules by
explicitly mentioning its product, Metadate CD, in magazine ads aimed
at consumers. Consequently, the DEA has issued a cease and desist
order to Celltech; court actions, as well as international sanctions,
could follow. The company also is taking some heat for using a cartoon
superhero to promote Metadate CD in some of its ads. Comparisons to
the much-denounced Joe Camel campaign have been raised, even though
the manufacturer insists that the cartoon is meant for advertising
aimed exclusively at physicians.

The remaining several companies involved in advertising stimulants for
kids by promoting "awareness" of ADHD maintain that they are
performing a public service. However, in the affluent suburban
middle-class community where I work, you'd have to be living in a cave
without children for the last 10 years to be unaware of ADHD. In fact,
I regularly hear parents and teachers describe children's problems of
behavior and performance in what sounds like a learned catechism of
ADHD symptoms. "He's distractible in the class. He can't focus. He'll
only concentrates on the things he likes."

It's almost as if they've read a script. And that's the point.
Increasingly the pharmaceutical industry has come under fire for
influencing the way we think about ourselves, and now, for influencing
the way we evaluate our children. Recently, David Healy, a prominent
British psychiatrist, was fired from his high-profile mental health
post at the University of Toronto for speaking out about his
provocative revisionist history of American psychiatry. He claims that
our entire psychiatric diagnosis and treatment model of the last 50
years has been determined by drugs like Thorazine and Prozac and by
the pervasive influence of the pharmaceutical industry on research,
publications, professional organizations and promotion.

Meanwhile, a consortium of legal firms have filed class action suits
in five states against Novartis, the maker of Ritalin, and the
American Psychiatric Association, claiming a conspiracy between the
two to defraud the public about ADHD and the need for stimulant
medication.

Our right to free speech allows the powerful pharmaceutical industry
to promote a particular point of view on ADHD, a purported brain-based
disorder calling for a medication. And it is true that a child's brain
is important; but common sense tells us that homework completion is a
complex social/developmental undertaking that involves many more
factors. Unfortunately, there is no equal countervailing influence to
rebut the drug companies' strong suggestion that ADHD is the cause of
poor homework completion. There are no stock dividends or equity for
special education teachers, no TV commercials for family therapists
who might have a different, more nuanced point of view.

Drug advertising works, and pharmaceutical companies rely on it now
more than ever as they compete in narrow markets. With nearly a dozen
stimulants now available without too much to distinguish them
clinically, manufacturers will have to advertise heavily to maintain
or create their niche in the legal stimulant market -- worth some $750
million a year. It took just three years of relentless advertising
directed at physicians, for instance, for Adderall, another stimulant,
to surpass Ritalin in 1999 as the most common brand name drug
prescribed for ADHD.

Stimulants do work -- low doses have been shown to improve
concentration and work completion for everyone (child or adult, ADHD
or not). But stimulants are not the moral equivalent of -- or
substitute for -- helping parents parent and teachers teach. Yet I'm
afraid in our current environment, this doctor's opinion is likely to
be dwarfed by the next 30-second spot.

-- By Lawrence H. Diller

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