In the US, the ads are famous. 'Bob' walks into a party and is asked if he is wearing a new jacket or has lost weight. In another, 'Joe' enters the workplace to questions over whether he has had a new haircut, gone on vacation or been working out. The questions, of course, are completely off the mark - each ad ends with the announcer revealing that they've "finally asked their doctor about Viagra".
They may make you cringe, but these ads could soon be coming to Hong Kong's TV screens.
Following extensive lobbying by media owners, the Hong Kong Government has initiated a consultation process on ending the current ban on direct-to-consumer (DTC) advertising of prescription drugs.
If the ban is removed, and few believe this will happen anytime before 2005, it will bring a much-needed boost in adspend to Hong Kong's media sector.
In the US alone, more than US$3 billion was spent on DTC ads in 2002 and, while Hong Kong will never match those levels, it is safe to say that prescription drugs will attract a considerable outpouring of dollars.
"I think you're easily looking at HK$1 billion (US$128 million) after a couple of years," says Mark Simon, general manager of sales and marketing at the Chinese-language newspaper Apple Daily. "Prescription drug advertising will easily move into the top six or seven categories."
Only two nations - New Zealand and the US - have legalised prescription drug ads, and in both cases the pharma sector played a pivotal role. Not so in Hong Kong, where the drive to allow DTC ads has been led by the advertising and media industry, hungry for increased ad revenues.
According to John Bertolini, director of DDB's healthcare arm, DDB Remedy, their point of view may be self-serving, particularly given the deep-rooted objections to this form of advertising.
"The problem with DTC adverts for prescription drugs is that patients think that drugs are right for them without knowing the full story of their condition," says Bertolini. "I believe it puts extra pressure on doctors and possibly inappropriate prescribing."
In particular, Bertolini points out that DTC advertising in the US must include information on the various side effects as part of the communication.
"This actually created a negative perception of the drugs and it was shown that the amount spent on advertising did not translate to a significant increase in sales," he says.
Bertoloni's argument is supported by recent research from the US, which indicates relatively low awareness levels for prescription drug ads.
The study, by Intermedia Advertising Group concludes that viewers are less likely to remember prescription drug ads than ads for over-the-counter medicines, and ads for lingerie, soda, food and beer.
Given these results, it is perhaps unsurprising that DTC advertising still only hovers at around 15 per cent of a drug's marketing spend in the US.
Instead, Bertolini advocates disease-specific advertising, which is already allowed in Hong Kong. Questions over adequate monitoring of such ads, however, persist.
A good example of this is Pfizer's recent Lipitor brochure, which stretched the definition of disease-specific advertising by including product information along with its basic message of cholesterol treatment.
Jill Mortensen, Weber Shandwick managing director and senior vice-president of healthcare, worked as a product manager for Novartis on early DTC campaigns in the US. She believes that DTC ads do spur product sales, but warns that the increased regulatory scrutiny may work to the pharma sector's disadvantage.
"The industry just boomed in the US after the law was passed," recollects Mortensen. "It increased sales of drugs considerably but also increased scrutiny of drug marketing - sometimes, the regulator doesn't rule in your favour, and it can get politicised."
Mortensen also points out that DTC ads play a valuable role in improving prescription compliance, a key argument used by the pharmaceutical industry to refute the suggestion that they will result in inappropriate prescriptions.
Says a spokesperson for the Hong Kong Association of the Pharmaceutical Industry (HKAPI): "The easing of such restrictions would benefit patients who pay less attention to their own health, as such advertisements will help to remind some of their symptoms and bring them to their doctors at an earlier stage of their disease."
If Hong Kong is to allow DTC ads, it will be in stark contrast to the approach of other Asian countries.
Aside from China, which outlawed such ads in 2001, the SAR's neighbours appear considerably more sceptical about the idea, citing everything from cost pressures to ethical objections in their opposition.
Pete Schweikert, Asia-Pacific vice-president of commercial development at GlaxoSmith-Kline, believes that such arguments may be futile, given the wealth of prescription drug information that already exists on the internet.
"This information is freely available on the internet," argues Schweikert.
"DTC advertising on mainstream media will put in place all the checks and balances you would want."
Simon also points out that traditional Chinese medicine advertising is completely unregulated, leaving pharmaceutical MNCs at a considerable competitive disadvantage.
"The (Hong Kong) Government has had its hand forced, as Chinese medicine ads are all over the place," he says.
Schweikert believes that the drugs most likely to benefit from DTC ads are "those therapies and disease areas that are chronic and undermanaged" and points to cardiovascular disease, arthritis, asthma and hepatitis B as specific examples.
He also notes that lifestyle areas, such as "erectile dysfunction and hair loss" are likely to see increased advertising. As to whether the costs of marketing drugs will increase, because of the high costs of mainstream media, Schweikert is unconvinced.
"I think there's a self-regulating aspect, where it only makes sense to advertise those where ROI is justified," explains Schweikert. "They will have to be products that are genuinely of need and will justify the spend."
Whatever the various viewpoints, of one thing everyone is agreed. Print and television are likely to be the big winners if DTC ads are legalised, given that the drugs most likely to benefit target a more mature demographic.
"Newspapers are by far the largest beneficiary, but TV guys pick up too," says Simon.
Meanwhile, Bertolini goes the other way and remarks: "TV is the obvious medium. (Also) print media that is more targeted for the demographic in question; for example, older age groups, mothers, etc".
DTC PRESCRIPTION DRUG ADS: ARGUMENTS FOR AND AGAINST
Jill Mortensen, MD, Weber Shandwick Hong Kong
The broadening of DTC advertising in the US in 1997 created a revolution. The FDA makes sure all ads have a 'talk to your doctor' message. In terms of ROI, the jury is still out. It is very hard to measure, as there are so many gatekeepers - the patient, the doctor and the pharmacist. The areas that will benefit are long-term conditions where people are often not diagnosed early enough. For HIV/Aids and any kind of cancer, there is a tremendous sense of shame among patients. If they're able to access information, they can arm themselves in terms of treatment. Smart companies know that you cannot only use DTC ads to reach consumers.
John Bertolini, Director, DDB Remedy
The problem with DTC adverts for prescription drugs is patients think drugs are right for them without knowing the full story of their condition. It puts extra pressure on doctors and, possibly, inappropriate prescribing. The advertising of the condition is more appropriate - for example, high cholesterol is dangerous, go and get tested. Areas that impact on the health budget in the long run should be considered for DTC. A drug company would have to demonstrate that there would be a cost-effective benefit if more patients went on the treatment. Major areas would include cardiovascular disease, cholesterol, smoking cessation, and weight-loss drugs.
Pete Schweikert, VP of commercial development, GSK
There's always an ongoing question of whether (DTC ads) are appropriate or not - but the better-educated patient is, essentially, the better-managed patient. The US requires complete disclosure of related side-effects, while New Zealand only requires the key issues of related side effects. I like the New Zealand approach, as it's more pragmatic. In the US, you get a tirade of side effects at the end of an ad, some of which are extremely rare. I personally disagree with manipulating FMCG techniques to sell drugs. If prescription DTC ads were available, we would combine them with our disease-specific ads.
