Side Effects Include Denial

Pictures are more powerful than words. I suspect Pfizer could run a two-minute crawl about suicide risks, and it still wouldn't distract from a heartwarming testimonial about Chantix.
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Why would Pfizer spend $100 million on two-minute TV ads that use a minute of that time admitting that their drug Chantix can cause "changes in behavior, hostility, agitation, depressed mood," "weird, unusual or strange dreams," and "suicidal thoughts or actions"?

Because they have to, and because it doesn't matter.

With the patent on Pfizer's cash cow Lipitor expiring next year, Chantix, a smoking cessation pill, had been one of their big hopes for the future. Chantix sales in 2007 approached $900 million; by 2009, it accounted for 90 percent of smoking cessation prescriptions. But last July the Food and Drug Administration, which approved Chantix in 2006, said it had received 4,762 reports of "serious psychiatric events" -- including paranoia, homicidal thoughts, hallucinations, 188 attempted suicides and 98 suicides -- and it ordered Pfizer to put a "black box" warning on the drug.

What to do? One tack Pfizer took was to launch a "help-seeking ad" that's now running all over cable TV. You might easily mistake it for a public service ad. As a voiceover reads sentences appearing on a black screen, a match-flame turns the words to smoke: "You wanted to quit before you got married... You wanted to quit before you turned thirty-five. You wanted to quit when you had your first child."

At the end, you're invited to go to, which takes you not to the Surgeon-General or to the American Cancer Society, but to a Pfizer site that in turn leads you to Chantix. There's no legal requirement to include the suicide warning on the faux-PSA, because it never mentions Chantix by name.

Pfizer's other marketing tactic was to air a testimonial. We spend two minutes getting to know Robin, a real-life success story. In her kitchen, over a lovely soundtrack, Robin tells us how Ben, one of her boys, asked her to stop smoking. Her doctor prescribed Chantix. As she and her family walk around a neighborhood of gracious lawns and fall foliage, we hear what good support and a good drug can do. Back at home, her husband makes coffee while she slices apples and cheese for a snack at the kitchen table. Radiant, laughing, she says that Ben finally tired of counting the days since she quit. At the end, an announcer's voiceover invites us to "talk to your doctor to find out if prescription Chantix is right for you."

But wait a minute -- literally. During half the ad, that same announcer is also telling us about the mental health problems that can be worsened by Chantix. Not once, but twice, he says what should be alarming words: agitation, hostility, depressed mood, suicidal thoughts or actions. The words appear yet a third time in the same ad, in a boxed text at the bottom of the screen.

Why isn't Pfizer nuts to spend so much money scaring us to death about their product? While Robin is slicing that apple, why isn't Pfizer worried that the voice warning about suicidal thoughts or actions will make us fret whether it's safe to let Robin be around sharp objects?

Pfizer's not worried for the same reason that Bristol-Myers Squibb isn't worried about its Abilify ad, with piano music under, showing a happy family's outing to a pier, accompanied by a voiceover about seizures, thoughts of suicide, risk of death or stroke. It's why Sanofi-aventis, the manufacturer of Ambien, doesn't mind spending half an ad (sleeping lady, rooster, harp) warning of side-effects like sleep-driving and sleep-eating. And it's why GlaxoSmithKline is unconcerned about undercutting the effectiveness of its Requip ad for Restless Leg Syndrome (relaxing lady, crossword puzzle, strings) with warnings about (this is my favorite) compulsive gambling.

Pictures are more powerful than words. Language and logic don't have the kind of immediate access to our brains that images and instruments do. Feeling comes before thinking. We can be as skeptical about marketing as we like, but media literacy isn't much of a match for music. No wonder Plato banished the poet in The Republic: he couldn't think of a curriculum that could protect people from being enthralled by fiction, spellbound by illusion. The bards who sang the Homeric epics were the ancestors of today's Mad Men.

Robin's harmless kitchen knife brilliantly neuters the suicide warnings, as does the rest of her happy-ending story. In 2005, Duke University researcher Ruth Day presented a study to the FDA demonstrating how ads can use distracting images and music to minimize attention to risk warnings. Her infamous example: the fast-fluttering wings of the Nasonex bee (voiced by Antonio Banderas) prevented viewers from remembering the side effects information. Partly as a result, last May the FDA issued draft regulations declaring that ads will be judged by their net impression as a whole, not just whether they're technically accurate.

Pfizer denies that increased regulatory oversight led them to raise the time devoted to safety warnings in its Chantix ads from 14 seconds to a minute. I suspect they could run a two-minute crawl about suicide risks, and it still wouldn't distract from Robin's heartwarming testimonial. We're suckers for mini-movies. No wonder the corporations just unleashed by the Supreme Court to spend unlimited funds on campaign ads are salivating at the opportunity to enthrall us.

This is my column from The Jewish Journal of Greater Los Angeles. You can read more of my columns here, and e-mail me there if you'd like.

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