Legendary golfer Arnold Palmer hops in a golf cart with NASCAR driver Brian Vickers and comedian Kevin Nealon. Seem like an odd combination?

Maybe not for a commercial promoting a prescription drug. Pharmaceutical companies are constantly looking for ways to get a leg up on the competition, and using celebrities is a popular tactic.

As if three celebrities weren’t enough, Chris Bosh joined the trio in September. The two-time NBA champion missed the last 30 games of the 2014-15 season after doctors discovered a blood clot in his lungs. He was treated with anticoagulants (blood thinners), and now he’s promoting Xarelto (rivaroxaban) in commercials and on social media.

“This affects so many people,” Bosh said at a press conference announcing his partnership with Janssen Pharmaceuticals, a maker of Xarelto. “I don’t want people to lose their life or go through what I went through.”

All four celebrities took Xarelto to reduce their risk of blood clots and joined each other on Palmer’s hometown golf course to shoot a commercial endorsing the blood thinner. The commercial touts Xarelto’s benefits compared to warfarin, a generic blood thinner that’s been around for decades.

The celebrities aren’t endorsing the drug for free though, and Janssen hopes its investment in the testimonials will encourage people to talk to their doctor about taking the company’s drug. There aren’t any celebrity testimonials for generic warfarin, even though it costs thousands of dollars less and no studies have shown Xarelto to be more effective.

Dr. Micheal Carome
Dr. Michael Carome (Credit: Angela Bradbery/Public Citizen)

“Brand-name pharmaceutical companies use celebrity endorsements because they hope such endorsements will cause patients to blindly pressure their doctor to prescribe the companies’ products, regardless of the merits of using those drugs,” Dr. Michael Carome, the director of Public Citizen’s Health Research Group, told Drugwatch.

Public Citizen is a nonprofit organization that advocates for the interests of the public in Washington D.C.

It wouldn’t be the first time someone famous did something morally questionable for a paycheck. Big Pharma’s reputation isn’t for trustworthiness or integrity either. But some experts insist celebrity promotions get a bad rap, and they’re providing a health benefit to society.

“They are speaking out on a topic that they too have been affected by, whether it’s something they personally deal with or have a family member who has been touched by,” Amy Doner, president and founder of the Amy Doner Group, told Drugwatch. Doner’s company connects celebrities with pharmaceutical and healthcare companies.

“This personal connection makes it a very real crusade for these spokespersons,” Doner said. “They are armed with information, and they are using their recognizability to educate their fans.”

Regardless of the celebrity’s motive, some academics wonder if mass media advertisements of drugs or diseases are worth the cost.

“Research is kind of lending to the idea of a drowning effect in a way, or a direct-to-consumer fatigue effect, where certain things really don’t matter at this point,” Dr. Brent Rollins, the author of the textbook Pharmaceutical Marketing, told Drugwatch. Rollins studied the use of celebrities in disease-specific advertisements.

Still, Big Pharma marketing is known for its ability to turn drugs with minor benefits — or even no benefits — over generics into multi-million dollar revenue generators. Celebrities have had a role in that marketing success for decades.

The History of Celebrity Drug Promotions

Advertisers developed increasingly sophisticated advertising strategies during the 20th century, but the tactics used by drug companies lagged behind other industries for decades.

Early on, companies tended to focus marketing tactics on doctors. They didn’t begin advertising directly to consumers until the second half of the century.

In 1958, Milton Berle became one of the first celebrities to promote a pharmaceutical drug, according to a review published in the American Journal of Public Health. Calling himself “Miltown Berle,” the comedian joked about his use of a depressant called Miltown, and the makers of the drug — Carter Products — promoted Berle’s jokes to gossip columnists.

Companies soon began hiring journalists to promote drugs in columns even as the writers presented themselves as objective, unbiased reporters, according to the AJPH review. And so began the rapid advancement of marketing tactics and promotion of pharmaceuticals by celebrities.

  • In the 1960s, Wyeth financed Dr. Robert A Wilson’s research institute and best-selling book titled Feminine Forever. The company funded cross-country promotions of the book and Wilson’s talks on hormone therapy. Wyeth was one of the largest producers of hormone therapy drugs, according to various sources.
  • Throughout the 60s, 70s and 80s, pharmaceutical companies paid popular writers like Lawrence Galton and Donald Cooley to write hundreds of articles promoting drugs, according to the AJPH review.
  • In 1985, the FDA lifted a ban on direct-to-consumer advertising, establishing standards that stated companies had to communicate a balance of benefits, risks and side effects of drugs in ads.
  • In 1997, the FDA relaxed its rules, allowing pharmaceutical companies to advertise to consumers by mentioning less information about side effects if they told consumers where they could find more information about the drugs. The gates opened for widespread use of TV advertisements by the pharmaceutical industry.
  • In 1998, drugmaker Schering hired actress, journalist and TV host Joan Lunden to promote Claritin. The FDA ordered Schering to remove one ad from a magazine because it failed to mention side effects and contraindications of the drug, according to FDA archives.
  • In 1999, Pfizer hired former U.S. senator and presidential candidate Bob Dole to talk about erectile dysfunction in public speaking engagements and advertisements. Pfizer had received FDA approval for Viagra months before.

Lunden and Dole were among the first celebrities to promote drugs or diseases for companies after the FDA relaxed the rules, but celebrity promotion of pharmaceuticals has become commonplace in today’s society. The practice has faced intense scrutiny, with some celebrities claiming they had no idea the drugs they were promoting could hurt people.

When Celebrity-Endorsed Drugs Hurt People

Almost 40 years after Feminine Forever was published, companies continued to promote hormone replacement therapy to women in the U.S.

Wyeth, a maker of estrogen drugs, hired supermodel Lauren Hutton to tell women Estrogen loss at menopause could lead to a number of diseases and uncomfortable symptoms. She encouraged women to talk to their doctor about hormonal therapies after menopause in commercials and magazine ads.

But studies in the 90s indicated hormone therapy could increase the risk of breast cancer, a fact mentioned in Wyeth’s commercial. A joint 2002 study by the National Heart, Lung and Blood Institute and the Women’s Health Initiative showed the risk of developing cancer was not worth the benefits of the therapy, and its use in postmenopausal women declined drastically.

A decade later, Wyeth’s parent company Pfizer paid almost $1 billion to settle lawsuits involving its hormone replacement drug Prempro. Hutton was one of the first celebrities to promote a treatment later found to be dangerous. She wasn’t the last.

When American Heroes Promoted a Deadly Drug

With the 2000 Olympic Games in Athens fresh in the minds of Americans, drugmaker Merck hired American Olympic gold medalists Dorothy Hamil and Bruce Jenner to promote the painkilling drug Vioxx.

In 1976, Jenner won the gold medal in the decathlon, and Hamill won gold in figure skating. Less than a month before the 2000 games began, Jenner and Hamil went on the Larry King Live show to talk about Vioxx.

Jenner talked about suffering pain from knee surgeries and shoulder problems after turning 50. A doctor prescribed Vioxx. Hamill suffered from chronic pain, and her doctor prescribed Vioxx too.

“My doctor prescribed Vioxx for me, and it’s as if I’ve been given a new life,” Hamill told King. “It’s just, it’s been amazing. I feel 20 years younger.”

Jenner and Hamill were open about being paid spokespersons for Merck, and both denied having experienced any side effects when asked by King. They deferred to Dr. John Klippel, then head of the Arthritis Foundation, who also appeared on the show.

“That’s one of the important things, Larry, Vioxx was developed to reduce side effects,” Klippel told King. “So if you will, one of the (instances) where it’s a real advance (case of pain), is that it’s a safer drug to use.”

Hamill and Jenner promoted the drug on talk shows, in TV commercials and magazines. Four years later, Merck recalled Vioxx worldwide after news broke that people taking it suffered heart attacks at an alarming rate.

According to a Wall Street Journal investigation, Merck knew of the high rate of heart attacks in March of 2000, five months before Jenner and Hamill appeared on Larry King’s show. Merck eventually settled more than 35,000 lawsuits claiming the drug caused heart attacks for more than $4 billion.

“Dorothy (Hamill) is not a scientist, and I’m not a scientist,” Jenner told ESPN in 2004. “We had no idea what was happening behind the scenes. They never told us. The bigger question is, should these things be on the air in the first place. The marketing has been effective, but whether it’s the right thing to do, maybe we should take another look at that.”

Raising Awareness for a Disease or Condition

One of the ways companies promote drugs is by paying a celebrity to raise awareness of a disease or condition.

Look at Bob Dole’s promotion of erectile dysfunction as an example. Although he was paid by Pfizer, he never promoted the company’s drug Viagra. He just raised awareness about erectile dysfunction shortly after the first drug approved by the FDA to treat erectile dysfunction hit the market.

Promoting a condition instead of a drug is a way companies can get around the rules on drug promotions. Drug advertisements must include the most dangerous side effects and information about where to find more information about a drug. Promoting disease awareness doesn’t carry the same requirements.

“If the campaign is unbranded, there is greater flexibility on securing the right spokesperson,” said Doner, who has worked with celebrities like Kelsey Grammer and Rob Lowe and companies like Johnson & Johnson and GlaxoSmithKline. “A personal connection through a family member or close friend will often be the anchor of the program.”

“If the campaign is branded, then the spokesperson must be taking or have taken the treatment being discussed so the messages are authentic and within the parameters of specific FDA guidelines.”

Early research showed celebrities raised awareness too.

In 2000, cameras for the Today Show followed journalist and TV show host Katie Couric as she underwent a colonoscopy. Her husband had died from colon cancer in 1998, and Couric was trying to raise awareness of screening methods for the disease. It worked.

In what researchers coined “The Katie Couric Effect,” colonoscopy rates jumped 20 percent across the U.S. in the following months.

Many advocates in the field praised Couric for raising awareness about colon cancer screening, but skeptics pointed out that prostate cancer is rarely identified solely by a colonoscopy, according to an ABC News report.

Couric’s promotion didn’t appear to be funded by a company, and few would question her motives in raising awareness for the disease that caused her husband’s death. In fact, most celebrities probably care very much about the causes they’re raising awareness for.

In 2002, Lowe appeared on talk shows to discuss febrile neutropenia, a type of infection common among patients undergoing chemotherapy. Lowe’s father suffered that type of infection in the 90s before recovering from cancer. Amgen funded Lowe’s appearances, but the actor didn’t mention the company’s drug Neulasta that treats the condition, according to media reports.

“When a celebrity is speaking out about a health issue and a person realizes this could be ‘happening to them,’ a sense of urgency may take place that would not have otherwise been there,” Doner said. “This often results in a new dialogue between doctor and patient and can sometimes make a significant impact on a patient’s quality of life.”

Even those with the best intentions might argue there’s no harm in making a buck while raising awareness.

Why Companies Hire Celebrities

Pharmaceutical companies are very, very good at advertising and marketing their drugs. The industry’s 10 highest grossing companies spent $98.3 billion on marketing in 2014. They brought in a combined $429.4 billion in sales that year.

“Celebrity spokespersons provide many advantages when working with a pharmaceutical company,” Doner said. “Most important, the right spokesperson with a personal genuine connection can help motivate people to sit up, take notice and take action when dealing with their own health or the health of loved ones.”

Although past research indicated celebrities could raise awareness, research doesn’t show clear proof that celebrity endorsements change consumer behavior.

A 2014 study published in the International Journal of Pharmaceutical and Healthcare Marketing found celebrity promotions of disease awareness did not affect consumer’s views of an advertisement or the company being advertised. The ads didn’t affect consumer behavior either. The study did find consumers paid more attention to ads with celebrities and found the ads to be more credible.

“So the overarching conclusion of that article was, manufacturers need to really evaluate whether the cost of celebrities is of benefit,” said Rollins, one of the authors of the paper.

A study published in 2015 by the same authors in the Research in Social & Administrative Pharmacy journal compared celebrities to expert endorsers (i.e. physicians) and non-celebrity endorsers. The study found similar results in addition to finding gender of the endorser had an insignificant influence on consumers.

“It’s the same overall premise,” Rollins said of the second study’s results. “The celebrity endorser attracted more ads. But in terms of effectiveness variables (behavioral intentions and information search behavior), both the celebrity and expert endorsers did not specifically differ from each other.

“The biggest significance of the second paper was that gender, from the consumer side or the endorser, had no effect on anything whatsoever.”

What’s in it for Celebrities

Make no mistake, there’s a lot of money to be made from the multi-billion dollar pharmaceutical industry. Whether they’re promoting drugs or diseases, there’s a lot for celebrities to gain.

In an essay published in PLOS Medicine, journalist and healthcare researcher Ray Moynihan wrote celebrities can make between $20,000 and $2 million for an endorsement.

That’s a good payday for someone who also feels like they’re helping people.

But when there’s money involved, it’s easy for critics to raise their eyebrows about a person’s motives.

Ethical Implications of Celebrity Drug Endorsements

When the Vioxx scandal made headlines, Jenner explained the Olympians had no idea the drug could cause negative side effects.

Does a lack of knowledge clear celebrities of any guilt, either legal or ethical? Should people learn as much as they can about a product before endorsing it?

“I don’t think that [the merits of a drug] is an athlete’s responsibility,” Mary Lou Retton told ESPN in 2004. The gymnast who won the gold at the 1984 Olympics endorsed Detrol, a drug made by Pfizer to treat overactive bladder.

“My job, and why I teamed up with Pfizer, is to help people,” Retton said. “And to get information out about this condition.”

Retton also suffered from hip dysplasia later in life. She had a Biomet hip replacement implanted in 2005, and then endorsed the company in ads and commercials.

But certain types of Biomet hip replacements caused enough complications that the company settled hundreds of lawsuits for $56 million. Although Retton’s implant was not included in the lawsuits, should she be responsible for promoting the company?

There are valid arguments to both answers to the question.

“There is nothing unethical about using your celebrity status to motivate people to see their doctor,” Doner said, speaking about the ethics of celebrity endorsements in general. “They are not claiming to be doctors nor are they offering medical advice. They are simply using their voice to reach as many people as they can with important health information that can save a life.”

In many situations, celebrities promote drugs that ease symptoms, save lives and rarely cause harmful side effects. They just have to play by the same rules that Big Pharma has to play by and make sure they aren’t breaking the law.

Celebrity Promotions and Social Media

When a celebrity promotes a drug in a commercial, it’s usually easy for consumers to tell that they’re being paid to do it. When they promote drugs on talk shows, the transparency isn’t as clear. But when celebrities promote products on social media, it can be almost impossible to tell if the endorsement is unsolicited or paid.

In the most publicized violation of FDA rules this year, Kim Kardashian West promoted an anti-nausea drug called Diclegis on her Instagram and Facebook accounts. In 60 words, the pregnant Kardashian described how the drug helped her with morning sickness with no risk to her baby.

But many doctors would argue there isn’t a drug in existence that doesn’t pose some risk to a baby.

The FDA warned the maker of Diclegis, Duchesnay, that the ad’s misleading claims and failure to communicate risks associated with the drug were against the law. Kardashian took the posts down but used the media coverage to promote a re-post less than a month later. The new post contained 321 words and full information about side effects, drug interactions and where to find new information.

Adweek declared the advertisement a “win” for Duchesnay after the controversy and media coverage led to increased awareness of the drug.

The FDA issued guidance on social media use for pharmaceutical companies, but the companies are still testing the waters on how to best use the new media.

Celebrity Drug and Disease Promotions Today

Janssen’s parent company Johnson & Johnson and its partner Bayer hope people buy into the testimonials from Palmer, Vickers, Nealon and Bosh. The companies hope people who see the commercials ask their doctor about taking Xarelto.

It’s unclear whether Palmer, Vickers, Nealon and Bosh know they’re advocating for a drug that faces thousands of lawsuits from people who claim they or a loved one suffered uncontrollable bleeding after taking it.

“Consumers should beware of medications promoted by celebrities in direct-to-consumer advertisements,” Carome of Public Citizen said. “A celebrity endorsement of a drug does not make the message any more valid from a health care perspective.”

That’s the lesson for consumers: Research and learn as much as possible about a drug before taking it. Celebrity endorsements do a great job of raising awareness, but celebrities aren’t doctors.

“Celebrities may be on the big screen or scoring that winning touchdown, but they are also regular people like you and me,” Doner said. “It is their willingness to share their real-life experiences through these important campaigns that can potentially reach millions of people and change lives for the better.”

It’s unlikely pharmaceutical companies will stop using celebrities in advertisements, but there’s a good chance they’ll continue to adapt the ways they use them.

Dr. Brent Rollins
Dr. Brent Rollins

“A lot of various papers that we’ve published lead into this idea of direct to consumer advertising fatigue,” Rollins said of consumers getting burnt out from seeing too many similar ads. “Gender isn’t going to matter, and celebrity versus non-celebrity doesn’t necessarily matter. What’s really showing in all of these studies that matters is involvement.”

Rollins believes all advertising should be targeted directly at people with certain diseases or who are highly involved with a certain disease.

“That is already going on,” Rollins said of targeted advertising. “It’s going to become more and more specific over time.”

When your favorite celebrity comes on TV and seems to be describing the exact symptoms you’re feeling, learn about the drug they’re promoting, have an honest conversation with your doctor and do what’s best for your health.

Additional Examples of Celebrities Raising Drug or Disease Awareness

Celebrity Related Disease or Condition Company Related Drug
Marcia Cross Migraines GlaxoSmithKline Imitrex
Kathleen Turner Rheumatoid arthritis Wyeth Enebrel
Lauren Bacall Macular Degeneration Novartis Visudyne
Kelsey Grammer IBS GlaxoSmithKline Lontronex
Cybill Shepherd IBS Novartis Zelnorm
Brooke Shields Thin eyelashes Allegran Latisse
Larry the Cable Guy Heartburn Proctor & Gamble Prilosec OTC
Sally Fields Postmenopausal osteoporosis Genetech Boniva
Barry Manilow Atrial Fibrillation Sanofi-Aventis Multaq
Phil Mickelson Arthritis Amgen Enbrel
Jon Bon Jovi Pain Reliever Pfizer Advil
Paula Deen Diabetes Novo Nordisk Victoza
Paul and Mira Sorvino Diabetes Sanofi-Aventis Lantus
Mike Ditka High Cholesterol Merck Zocor
Jack Nicklaus High Blood Pressure King Altace
Ricky Williams Social Anxiety GlaxoSmithKline Paxil