Inside the murky world of Big Pharma's celebrity partnerships, where stars like Serena Williams and Khloe Kardashian get paid to promote prescription drugs

  • Pharmaceutical companies have huge marketing budgets at their disposal, and one of their strategies involves tapping celebrities as spokespeople for brand-name drugs.
  • Stars such as Serena Williams, Khloe Kardashian, Ray Liotta, and Cyndi Lauper have appeared in ads for prescription medications, and payouts can run into the millions.
  • But the US is one of the only countries that allows direct-to-consumer pharmaceutical advertising, and experts told Insider there are ethical concerns about the practice.
  • Visit Business Insider's homepage for more stories.

It doesn't get much more A-list than Serena Williams. The 23-Grand Slam singles winner is an entrepreneur, board member, fashion designer, influencer, and mother to 2-year-old Olympia, who has 600,000 Instagram followers of her own.

Williams also suffers from migraines. In August, she spoke about her struggle with the condition as part of a campaign for Ubrelvy, a new migraine drug from pharmaceutical giant AbbVie. The partnership includes TV commercials, social media, digital, and print components.

I’m proud to share my story through the @ubrelvy campaign, as I have struggled to find a medication that I could take without worrying when or where I took it. Now with #UBRELVY, I have something that relieves my #migraine attacks and that I can take anytime, anywhere without worrying where I am or what I'm doing. #UBRELVYpartner For full patient information see @ubrelvypi. UBRELVY is a prescription medicine used to treat migraine attacks in adults. It’s not for prevention. Do not take with strong CYP3A4 inhibitors. The most common side effects were nausea and tiredness.

A post shared bySerena Williams (@serenawilliams) on Aug 17, 2020 at 12:02pm PDT

Given her star power, Williams was no doubt an expensive signing. (AbbVie declined to disclose financial information, but celebrity-pharma partnerships can run into the millions.) It's easy to understand the drug developer's logic. The migraine space is crowded. AbbVie is hoping Williams will make it stand out from competitors like Eli Lilly and Biohaven, both of which sell similar oral treatments. Biohaven recently signed its own celebrity spokesperson, Khloe Kardashian.

Williams and Karadashian are far from the only stars who have sold patented brand-name drugs directly to patients. This list, longer than any of these medications' side effects, includes Ray Liotta (Chantix, a drug to help people stop smoking); Ashley Tisdale (Lo Loestrin Fe, a birth-control pill); Cyndi Lauper (Cosentyx, for psoriasis); Shaquille O'Neal (BiDil, a heart-failure drug); Chris Bosh (Xarelto, which treats blood clots); and Blythe Danner (Prolia, for osteoporosis).

Tapping celebrities, who share their stories with an already engaged audience, is a tried-and-true strategy for getting consumers to open their wallets. But in this case, the consumers are patients and the products are prescription medications.

Million-dollar deals, strict vetting processes, and media blitzes

Crystal Cox/Business Insider

"We are a pop-culture society," Amy Doner, president of the Amy Doner Group, which facilitates deals between celebrities and pharmaceutical companies, told Insider. "We love entertainment. We love celebrities. When a Demi Lovato or a Nick Jonas or a Joe Montana speaks up about a brand or a condition, people take notice."

For branded campaigns, which mention a drug by name, pharma companies approach Doner after the drug receives FDA approval. They'll present a detailed list of demographics modeled after the target patient population. From there she mines her network of agents and managers to develop a list of celebrities who meet the criteria.

In many cases, pharma companies are looking for talent who have the given disease. In other cases, they're comfortable signing someone with a less clear connection, "whether it's through a relative or close friend or colleague, someone who has made an impact on their lives," Doner said.

Developing a final list takes anywhere from days to months. Finding a spokesperson for a drug that treats a common disease — such as breast cancer, rheumatoid arthritis, or migraines — is easier than finding one for a condition that is rare or stigmatized, such as irritable bowel syndrome, Doner said. Before names are presented to the client, they are vetted, basic details are confirmed, potential liabilities — such as past or lurking controversies — are hunted down and analyzed.

From there, Doner and her team work with the client to refine the list. "The biggest name isn't always the best name," she said. A compelling recovery story, an engaged social-media following, or a buzzy upcoming project can trump A-list status.

Once the talent is selected, partnerships can take a dizzying array of forms, including television ads, speaking events, social-media posts, and media outreach. Because compensation depends on so many variables, the variation in pay scale is significant. "It can really range from $50,000 to $10 million," Doner said.

Pharmaceutical companies also pay celebrities to raise awareness about diseases in an unbranded capacity

Stars will urge fans to learn more about a certain condition and to bring up treatment options with their doctor. These campaigns typically fetch less than branded ads in which the celebrity is promoting a specific medication. Paid for by pharmaceutical companies, unbranded ads can still sell specific medications, just through murkier strategies.

Take actress and influencer Julianne Hough. A few years ago, Hough began speaking about her endometriosis diagnosis in interviews and on talk shows. Again and again, she urged women to be proactive about seeking a diagnosis if they believed they had the condition.

Hough's series of PSAs seemed uncomplicatedly positive: Endometriosis can be painful and is often misdiagnosed. The motivation behind these repeated disclosures was slightly cloudier, however. Since 2017, Hough has been compensated by the pharmaceutical company AbbVie, the same company paying Serena Williams, to promote endometriosis in an unbranded capacity. AbbVie makes Orilissa, a drug to treat endometriosis-related pain. When it launched in 2018, it was the first new drug approved to treat the condition in more than a decade.

A representative for Hough told Insider in an email that "the campaign was sponsored by AbbVie but she was not engaged to promote any specific product or treatment."

Celebrities can transition from one type of campaign to the other. Cyndi Lauper started out as the spokeswoman for an unbranded psoriasis campaign in 2015. Like many unbranded campaigns, the spot was designed to look and feel like a public-awareness initiative, though it was partly paid for by Novartis, which makes the psoriasis drug Cosentyx.

When the partnership began, "neither side wanted any type of brand-specific activity, but over the course of time with her work with Novartis — by speaking to doctors and other patients — she eventually tried Cosentyx," Doner said. She now promotes the drug by name in a big-budget television campaign.

"Transparency is of the utmost importance to Novartis and since the beginning of our collaboration with Cyndi, we have disclosed our partnership," the company said in a statement. "In both the unbranded and more recent branded campaigns, Cyndi herself has also disclosed the partnership in interviews with media and in her social media posts."

A celebrity stars in a disease-awareness campaign paid for by a pharma company. She eventually tries the pharma company's drug for the condition and loves it. It's entirely plausible this is exactly what happened. ("It's a really inspiring story," Doner said. Lauper did not respond to a request for comment.)

But if it all sounds a little too convenient, it gets at the tricky nature of direct-to-consumer campaigns, specifically those fronted by celebrities who skillfully sell personal stories of suffering and transformation to a wide audience.

Travel outside the US and you probably won't see celebrities promoting prescription drugs

Every other country, with the exception of New Zealand, bars pharma companies from marketing prescription products directly to consumers.

Even in the US, the practice is controversial. Branded pharma marketing is regulated by the Food and Drug Administration. All ads that make a product claim, the administration stipulates, must be truthful, balanced, and include major side effects.

It sounds nice in theory, said Dr. Michael Carome, a health director at Public Citizen, a nonprofit consumer-advocacy organization. But in practice, expecting a short promotional ad — which increasingly appears in the disorienting context of an Instagram feed — to present a balanced view of a drug's risks and benefits is hard to swallow.

In 2015 the American Medical Association, the largest association of physicians in the US, called for a ban on DTC advertising. The move "reflects concerns among physicians about the negative impact of commercially driven promotions, and the role that marketing costs play in fueling escalating drug prices," then AMA board chair-elect Patrice Harris said at the time.

When a decision involves so many high-stakes variables — from side effects to adverse reactions to cost — marketing should stay out of it, Dr. Aaron Kesselheim, a professor of medicine at Harvard Medical School, told Insider. He said ads designed exclusively to sell brand-name drugs, like those churned out by the celebrity-pharma industrial complex, undermine the process by allowing corporate interests to infiltrate the physician-patient relationship.

It can also inflate already staggering healthcare costs. "When people request specific medications, they are more likely to get that medication as opposed to a generic drug that might work just as well for their condition but is less expensive," Kesselheim said told Insider. Unlike generics, brand-name drugs are protected by patents and command significantly higher prices.

Without insurance, for instance, a 10-pill pack of the Serena Williams-endorsed Ubrelvy costs about $850. A brand-name drug, the treatment is protected by patents, which means lower-cost generic copies equivalents don't yet exist. (When a new drug is approved by the FDA, it's granted a period of exclusivity, after which competitors can make generic equivalents.) The pharma companies behind the new migraine drugs are spending hundreds of millions in marketing, costs largely passed down to the consumer.

But experts agree direct-to-consumer ads are too effective for the pharma industry to ever voluntarily give them up, and the industry, which spent $300 million in lobbying last year alone, hasn't encountered much meaningful pushback from Congress.

The FDA first allowed pharma companies to advertise directly to consumers in 1985, but the practice didn't take off till the mid-'90s

Since then, spending has surged, from $2.1 billion in 1997 to $9.6 billion in 2016, as it became clearer that the strategy worked. More broadly, research shows that patients ask for prescriptions drugs they've seen advertised by name, requests that physicians regularly end up fulfilling.

"They wouldn't do it if they didn't have evidence that it affected consumer behavior, patient behavior, and subsequently physician prescribing behavior," Carome, of Public Citizen, told Insider.

Like music or beautiful imagery, a well-selected famous face can amplify an ad's reach and distract from any negative side effects.

Take Ray Liotta, who has appeared in commercials for Chantix, a pill made by Pfizer to help people stop smoking. Liotta's decades-long smoke-filled career, which includes roles in "Goodfellas" and "Cop Land," turned him into a symbol for tough-guy masculinity.

"And now he's quitting," Brent Rollins, an associate professor of pharmacy administration at Philadelphia College of Osteopathic Medicine, said. "It's a combination of image, demographics, and relatability." It seems to be working. Chantix raked in nearly $900 million in US sales last year. (Pfizer declined to comment. A spokesperson for Liotta told Insider he was no longer working on the campaign.)

For some reason some magazines want you to use a cigar as a prop. When they gave it to me the first thing that came to my mind was I don't smoke so why hold a cigar so I just started ripping it apart. I've known people who smoked and smoke and they all have the same characteristics. They start forming lines around their mouth and their skin starts to lose its color and gets grayish. I'm not coming from a higher plane position. I used to smoke but I stopped when my 4 year old daughter told me I stank and I stopped for vanity reasons and I stopped because I want to live long. Not looking forward to the deep sleep. So after this long winded preach this shot is me ripping up what I think of them. It's that plain and simple. I'll be on the cover of New York Moves' November power issue.

A post shared byRay Liotta (@rayliotta) on Aug 1, 2016 at 7:59am PDT

Celebrity drug spokespeople are just one part of the marketing strategy

"There are a million things that companies and ad agencies can do to make advertisements more persuasive to people, like using the right kind of fonts and using the right kind of colors," Matthew McCoy, a medical-ethics professor at the University of Pennsylvania, said.

But because famous faces are particularly adept at selling to a wide audience, adding a celebrity to a drug campaign, particularly one who ostensibly takes the given medication, can fuel widespread use of a drug before its full side effects are known.

There are no regulations barring a celebrity from promoting claiming to use a drug they don't actually use. It can also encourage patients who don't necessarily have the disease in question to inquire about treatments with their physician, potentially leaving with a prescription.

In a best-case scenario, patients can take a drug for a condition they don't have without consequence. In a worst-case one, they take a drug they don't need that comes with serious adverse reactions. While FDA approval is predicated on a rigorous evaluation process, clinical trials don't necessarily catch everything. Frequently, additional side effects emerge during its first few years on the market, when it starts to be used by a wider population for longer periods.

Occasionally these side effects are deadly. That was the case with Vioxx, a painkiller developed by Merck that launched in 1999.

Thanks partly to a splashy direct-to-consumer campaign starring Olympians Dorothy Hamill and Caitlyn Jenner, sales soared, bringing in $2.5 billion in 2003 alone. But troubling data also emerged: Vioxx doubled patients' risk of heart attack and stroke. The drug was recalled in 2004. By then an estimated 60,000 people had died.

"That thing was so heavily marketed, you got a ton of people on the product in the beginning that you, in essence, did a lot more damage," Brent Rollins, coauthor of the textbook "Pharmaceutical Marketing," said.

In response, some experts have called for a waiting period after a drug launches before it can be marketed directly to patients, to better understand its risks and benefits.

Pharma companies and the celebrities themselves say the ads provide valuable information and start conversations around stigmatized conditions.

AbbVie said in a statement: "Our approach of listening to, and learning from, consumers, caregivers, physicians and other healthcare professionals continues to confirm our belief that accurate, balanced and timely information about our prescription medicines and the conditions they treat is an essential component of our commitment to putting patient health first."

In Doner's experience, most of the celebrities she's worked with are genuinely passionate about the cause of getting the word out about a condition or treatment.

"I'm choosing to share my story today because I know how debilitating a migraine can be, and I know how migraine attacks can stop you and stop your life," Williams says in a promo video for Ubrelvy. "When you have such a good experience with something, you generally want to tell people."

All of this may be true. But McCoy feels it's important not to lose sight of the nature of these relationships: Pharma companies are paying famous people for their time and audience to sell more drugs. "In principle, could ads be informative? Certainly," he said. "In practice are they informative? I'm not sure. Is it the case that more information is always better? No."

Laura Entis is a freelance writer who has contributed to Vox, Consumer Reports, Time Health, and Outside, among other outlets. Previously she was an editor at Fortune magazine.

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