Inside the colourful history of pharma advertising

Pharma companies employ a variety of tactics to increase brand awareness and promote their products. While the tactics used to market prescription drugs may be controversial, today’s advertising efforts are a far cry from the outlandish claims made in the early days of the pharma industry.

With each passing decade, pharma companies and regulators have worked to refine the art of marketing, adapting to new technologies and innovations to deliver creative campaigns. That is not to say that the journey has been a smooth one. So how did pharma advertising transform from a wild world of patent drug quackery to a tightly knit machine of creativity?

1868

The birth of mass marketing

After assuming control of his grandfather’s patent medicine business, Benjamin Brandreth ventured across the Atlantic Ocean in search of a bigger market for his now famous Vegetable Universal Pill.

In an early example of mass marketing, Brandreth was a pioneer in targeting prominent health concerns – in this case, the widespread belief that blood impurity caused various illnesses – using a distinctively literary approach to appeal to the general public.

Through the distribution of books and newspaper adverts, Brandreth positioned the pills as a purgative, claimed to be a ‘cure-for-all’ remedy for all ailments. Unfortunately, in reality – as with most patent medicines at the time, these miraculous assertions were unproven and often not worth the ink they were printed with.

But, despite a lack of confirmed efficacy or safety, this early example of mass marketing proved immensely influential. Soon, ‘Brandreth’s pills’ became a household name, with esteemed authors Herman Melville and Edgar Allen Poe referencing the pills in their works.

By AlanEisen – Own work, CC BY-SA 4.0, https://commons.wikimedia.org/w/index.php?curid=119856985

By Clark Stanley – https://www.nlm.nih.gov/exhibition/ephemera/medshow.html, attributed to:Clark Stanley’s Snake Oil Liniment,True Life in the Far West,200 page pamphlet, illus.,Worcester, Massachusetts, c. 1905,23 x 14.8 cm., Public Domain, https://commons.wikimedia.org/w/index.php?curid=47338529

1890s

The rise of snake oil and quackery

Before the early 1900s, little, if any, regulation was in place to govern how drug companies (as well as any medicine-minded layman) developed, patented, and marketed their formulas. Stemming from England, where ‘patents of royal favour’ were granted to those who provided medicine to the Royal Family, patent medicines took the US by storm. Unlike their royal counterparts, however, most 19th-century patent medicines were not officially patented.

Although the booming industry received criticism from physicians and medical circles, demand for remedies to cure and prevent all manner of ills grew. The press stoked the popularity of patent medicines. Patent pages dedicated to advertising these concoctions – often fortified with morphine, opium, or cocaine – to adults, children, and infants became an essential source of income for newspapers at the time.

Into this wild west of ‘miraculous’ tonics and concoctions entered one of the most prolific examples of deceptive marketing in medicine – the snake oil salesman. Unlike the original snake oil remedy brought to the US by Chinese workers, which was rich in inflammation targeting omega-3, the knock-off imitations across the country contained ingredients deemed useless in treating any medical condition.

Having learned of the anti-inflammation benefits of rattlesnake oil, entrepreneur and famed “rattlesnake king” Clark Stanley caused a stir when he unveiled his remedy at the 1893 World’s Exposition in Chicago. But, surprisingly, when investigators seized a shipment of the product in 1917, Stanley’s Snake Oil was found to contain no snake oil at all, instead comprising mineral oil, a fatty oil believed to be beef fat, red pepper, and turpentine.

The term ‘snake oil salesman’ is now more commonly associated with fake cures and fraud than the legitimate remedy it originated from.

1905

The Great American Fraud

Towards the end of the 19th century, the tides appeared to be turning for patent medicine. Journalists had started investigating significant public health threats, including misrepresenting harmful substances as medicine.

Fed up with watching swindlers peddle unregulated and unproven ‘medicines’ to unsuspecting people, American journalist Samuel H Adams made his views on patent medicines clear in a publication titled “The Great American Fraud”. In this series, Adams exposed the dangers posed by unregulated patent medications to the general public, explaining in plain terms why the practice could not go on.

The Great American Fraud proved to be instrumental in driving legislative changes to improve the safety and efficacy of drugs for patients across the country.

Collier’s, illustration by E. W. Kemble, Public domain, via Wikimedia Commons

University of Washington, Public domain, via Wikimedia Commons

1906

Congress passes the Pure Food and Drug Act

The work of muckraking journalists like Adams and ‘The Jungle’ author Upton Sinclair pushed the US Government to take decisive action against publishing unproven medical claims. In 1906, then-President Theodore Roosevelt signed the Pure Food and Drug Act, otherwise known as the Wiley Act, into law.

Under this new legislation, the manufacture, sale, or transportation of tainted, misbranded, poisonous, or harmful foods, drugs or medicines, and liquors was now prohibited. Importantly for legitimate drugmakers, the Act stipulated that drugs had to comply with the standards of strength, quality, and purity defined in the United States Pharmacopoeia and the National Formulary. If a product contained variations from the applicable standards, it could not be sold unless the specific variations were clearly stated on the label.

In addition to increasing consumer protection efforts, the passing of the Pure Food and Drug Act also formed the cornerstone of what would become the US Food and Drug Administration (FDA).

1911-1938

Defining, and redefining, drug fraud

Not everyone was satisfied with the definitions laid out in the Pure Food and Drug Act. Specifically, although false statements as to the identity of the drug were illegal under the law, debate arose over whether or not it specifically outlawed false curative or therapeutic statements.

With adverts claiming to cure cancer still adorning newspaper pages, the US Supreme Court was called upon to clarify the issue in the United States v. Johnson case.

The court ultimately ruled in favour of publishing outlandish and exaggerated claims, as the law only banned companies from misrepresenting a drug’s ingredients.

In response, Congress passed the Sherley Amendment barring false therapeutic claims on drug labelling the following year. However, there was one slight issue as regulators needed to demonstrate that the company had fraudulent intent, which is very difficult to prove.

In 1938, the passing of the Federal Food, Drug, and Cosmetic Act ended the debate over what constitutes fraud. Under this new law, drug fraud, intentional or not, was publishable by law.

Moreover, the Act gave the FDA power to regulate the drug market. Before any advertising or marketing efforts could begin, companies had to gain FDA approval.

1962

The FDA takes control

The next major milestone came in 1962, with the introduction of the Kefauver–Harris Amendment (also known as the Drug Efficacy Amendment).

In addition to requiring companies to provide proof of safety and efficacy before approval, the amendment ushered in significant changes for the pharma marketing world. Significantly, the FDA was given authority to regulate prescription drug advertising and labelling.

The amendment also prohibited drugmakers from marketing cheap generic drugs as expensive, breakthrough treatments under a new brand name.

Further stipulations were made in 1969, when the FDA published four fundamental rules to govern how pharmaceutical companies could market prescription drugs. Under the new regulations, companies were not allowed to be false or misleading, drug risks and benefits had to be described in a fair and balanced way, marketing materials were required to include facts relevant to the drug’s advertised use, and companies now had to create a summary that contained all of the risks listed on the drug label.

1980s

The return of direct-to-consumer marketing

After years of regulatory reforms, the appeal of direct-to-consumer advertising had dwindled since the passing of the Pure Food and Drug Act. But in the 1980s, the combined impact of a favourable political climate and cultural changes pushed patients to pursue a more active role in medical decision-making, reigniting interest in targeting patients directly.

In 1981, Merck spearheaded the direct-to-consumer marketing movement by running a print ad that promoted its new anti-pneumococcal vaccine, Pneumovax, in Reader’s Digest.

Boots Pharmaceuticals upped the ante in 1983, when it released the first direct-to-consumer TV ad for a prescription drug. Through the TV campaign, Boots Pharmaceuticals publicised the lower price of its pain relief drug Rufen – without directly referencing any specific medical benefits of the product. Within a few days, the company was sent a cease-and-desist letter by the FDA and told to pull the ad from the air.

Pfizer and Eli Lilly were also key players in the rise of modern direct-to-consumer marketing, using carefully placed adverts on television networks and radio stations to advertise medications.

Responding to the growing popularity of direct-to-consumer TV ads, in 1985, the FDA established regulatory authority over this new marketing approach. In a notice published in the Federal Register, the regulator stated that while drugmakers could air TV ads, they had to follow rigid rules for disclosing side effects and other information.

1997

Blue skies for Claritin

Presented with strict rules for disclosure and limited time constraints for TV adverts, companies quickly began exploring ways to get around the FDA’s regulations.

Reminder ads and help-seeking ads offered a productive solution to the problem, as these types of adverts were not subject to the FDA’s regulations. Schering-Plough’s cautious and ultimately confusing television campaign for its hay fever drug Claritin was one notable example. The ad made no reference to the drug’s intended use or benefits. Instead, it simply repeated the phrase “It’s time for Claritin”, a perplexing statement for viewers who were unsure what the product was and what it did.

While the FDA had already begun to address issues in TV regulation, experts note that the Blue Skies for Claritin campaign pushed the regulator to relax the rules on direct-to-consumer advertising on television.

As of 1997, direct-to-consumer drug ads on the radio and TV are were only required to mention the major risks of a drug and direct consumers to where they can find more information.

1998

Viagra launches a lifestyle movement

On the surface, former US congressman Bob Dole may have seemed like an odd choice to become the first Viagra spokesperson. But in 1998, impotence was something of a stigmatised subject. Although Pfizer had developed a strong product, in the run-up to launch, the company’s marketing team realised that this perception of the condition could hinder the drug’s impact and that the benefits could be overlooked in favour of cheap jokes.

With his trusted and serious reputation, Dole provided the quiet gravitas needed to position the drug as a serious product. Before Viagra even hit the market, Pfizer established a focused educational campaign to rebrand the sensitive subject of ‘impotence’ as erectile dysfunction.

Although the ad became a national punchline, even for Dole himself, the impact this campaign had on how drugs are marketed cannot be overlooked. Through marketing, Pfizer changed the narrative of the market it was entering. While subsequent campaigns took on a more light-hearted and jovial tone, it was this first approach that began to connect medications with lifestyle aspirations in marketing materials and acted as a springboard for the coveted celeb endorsement in future campaigns.

2000-2022

Pharma advertising heads online

Following the public introduction of the ‘world wide web’ in 1991, the internet became a hot commodity for companies looking to bring product marketing into consumers’ homes. Undoubtedly, the internet revolutionised how people seek out and access information – including details about their personal health and medical treatments.

The potential offered by this cultural shift was not lost on pharma companies, and soon search and display adverts for prescription medications began to appear online. In 2009, the FDA sought to address the growing popularity of sponsored search engine links, which often included the name, intended use, and benefits of a drug, but not the risk and side effect information.

To police the situation, the FDA sent 14 warning letters to the pharma companies buying up these sponsored search ads, declaring that sponsored links were “misleading” and violated US regulations.

The regulator ruled that drug company−sponsored links had to include either the name of the drug or the name of the disease it was used to treat – but prohibited the use of both simultaneously.

Online pharma marketing grew steadily over the following years as companies experimented with and refined engagement approaches.

Today, marketing teams utilise a combined force of apps, social media, mobile, TV, and radio ads alongside traditional print campaigns.

Eloise McLennan is the editor for pharmaphorum’s Deep Dive magazine. She has been a journalist and editor in the healthcare field for more than five years and has worked at several leading publications in the UK.

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