Marketing: Celebrity selling—part two : By admitting he is shy, an American football player has become the latest star to promote disease—and drug—awareness
Authors: Ray Moynihan
Journal: BMJ (2002)

United States professional football sensation Ricky Williams last week sparked a blaze of publicity when he revealed that he had social anxiety disorder and was benefiting from both therapy and Paxil (Seroxat/paroxetine), the drug that earned GlaxoSmithKline global sales last year of US$2.7bn (£1.7bn; €2.7bn).

Items appeared on the front page of the New York Times sports section, in the prestigious Los Angeles Times, and a host of other papers, as well as broadcast media including NBC. Stories described a serious psychiatric condition affecting between 5 and 10 million Americans. Some reports revealed that GlaxoSmithKline was paying the sports celebrity, some didn't.

Williams joins a stellar cast of characters now using the mass media to promote awareness of a whole suite of medical conditions and diseases. In May Camilla Parker Bowles spoke out about osteoporosis at an international meeting in Portugal . While Mrs Parker Bowles received no funding from pharmaceutical companies, that meeting, and another key report that she has promoted, were both sponsored in part by a company with a new osteoporosis drug on the market.

At about the same time Hollywood star Kathleen Turner was talking publicly of rheumatoid arthritis, and promoting a website funded by the company selling a new drug for the condition. And another Hollywood actress, Cybill Shepherd, has educated American consumers about the menopause on behalf of a menopause supplement manufacturer, and presidential hopeful Bob Dole has raised awareness about erectile dysfunction, courtesy of a drug maker with a new pill for the condition.

Without in any way questioning the effects these conditions have on these celebrities, their families, or others in the broader community, it is not hard to tell what is wrong with this picture. Celebrity selling is just one more way in which pharmaceutical companies are indirectly shaping public perceptions about conditions and diseases in which they have an interest. Self evidently, the more severe and/or widespread the condition is perceived to be, the bigger the potential market for the latest drug.

In an interview on NBC TV last week, Ricky Williams said, “I've always been a shy person.” His comments prompt questions about whether raising awareness of social anxiety disorder may in fact be medicalising shyness. “It's an important point, but I don't think so,” said a GlaxoSmithKline spokesperson, who added that there was a big difference between shyness and social anxiety disorder, which he said was under-diagnosed and under-treated. “We're very pleased to be working with Ricky. He's got an important message, he's got an inspirational story, encouraging others who might have the symptoms of social anxiety disorder to seek treatment.” 

The next day on NBC, in a segment providing tips for shy people, a psychiatrist said that for “social anxiety disorders or even a public speaking problem, medication may be helpful . . .” Although the GlaxoSmithKline spokesperson said of Williams, “He's not hired to sell product,” it seems an increase in drug sales may be an incidental outcome.

Social anxiety disorder is another name for “social phobia.” As has been already reported in this journal, some in the pharmaceutical marketing industry have described awareness raising for this condition as a “classic example” where corporate sponsored campaigns help “establish a need” for a new drug by reinforcing “the actual existence of a disease and/or the value of treating it” .

The other obvious problem with such widespread media coverage is that there is often no genuine attempt to explain the actual benefits or harms of a medication.

A quick check of the prescribing information about paroxetine for social anxiety disorder on the website of the Food and Drug Administration is sobering. Key trials are short term and side effect rates, as for other new antidepressants, are not insignificant. Data suggest sexual side effects are common: 5% of those taking the drug experienced impotence, compared with 1% with placebo, 9% experienced “female genital disorder,” compared with 1% with placebo, and 28% experienced abnormal ejaculation, compared with 1% on placebo (all gender adjusted). The prescribing information also recommends a gradual reduction in dose when stopping the drug rather than abrupt discontinuation, and states: “Symptoms associated with discontinuation of Paxil have been reported.”

GlaxoSmithKline confirmed that the company was paying Williams, who currently plays with the Miami Dolphins, but the spokesperson would not reveal the size or length of the deal. With publicity like that generated last week, it is unlikely that the contract will be abruptly discontinued.