Nexium, heavy spending on DTC couldn't save troubled brands such as Propecia for hair loss or Xenical for weight loss, both of which spent heavily to build consumer demand, but failed to generate a positive return on investment (ROl). ROI Gets Scrutinized by Marketers, Critics Since the early days of DTC, a key question has always been whether the investment actually pays off. Over time, the experience was mixed, with some brands achieving measurable and sustainable sales increases, while others saw either short-lived blips or no impact whatsoever. Achieving ROI actually turned out to be a double- edged sword. Critics would claim that marketers who generated positive results were using DTC to exploit the consumer, who would browbeat the physician into prescribing the advertised brand. Research studies that showed the effectiveness of DTC were brandished in the halls of Congress by industry enemies. For instance, in 2001, The National Institute for Healthcare Management found that 22 of the top 50 most heavily advertised drugs in 2000 were also on the list of the 50 best-selling drugs that year—drugs such as Prilosec, Lipitor, Prevacid, Vioxx, Paxil, Prozac, Claritin and Viagra. This report got a lot of coverage that year, but, fortunately, the FDA had commissioned or participated in a sufficient variety of studies to be able to stand up and support the value of DTC as having more benefit than risk. Viagra and the ED Wars Probably the one therapeutic area that generated the greatest amount of interest, intrigue, and investment was the burgeoning arena of erectile dysfunction. At the time of brand launch in 1998, media coverage of Viagra was extraordinary, and the majority of target
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