092898Antiacne Campaign Propels Sales
Of Popular Birth-Control Pill

By ANNE MARIE CHAKER
THE WALL STREET JOURNAL INTERACTIVE EDITION September 28, 1998

NEW YORK -- Columbia University sophomore Lindsay Rachelefsky was flipping through some of her favorite fashion magazines a few months ago when she noticed an ad for a birth-control pill that also prevents pimples.

The 19-year-old student didn't have acne. But she asked her doctor to switch her pill prescription anyway, to "prevent me from ever breaking out."

The acne-fighting pill is Ortho Tri-Cyclen. It is made by Johnson & Johnson's Ortho-McNeil unit, and it is a hit among teenagers and 20-somethings nationwide. But its success poses a dilemma for health professionals, who say that many young women are being distracted from making the best birth-control choices because of their obsession with clear skin.

Ortho Tri-Cyclen is the only birth-control brand with Food and Drug Administration permission to advertise skin-clearing side effects. It won that approval in January 1997 after submitting clinical-test results of a six-month study involving 250 women. Ads in women's magazines such as Glamour, Marie Claire and Jane show a close-up of a young woman's face and pose a question riveting to teenagers: "Can a birth-control pill help clear up your skin?"

Popular Campaign

Since Ortho launched the campaign a year ago, the acne-clearing pill has surged past rivals, including other Ortho pills, to rank No. 1 among U.S. oral contraceptives, a $1.6 billion-a-year market. At the Chautauqua County Health Department in New York state, counselors say, teens ranging from 14 to 17 years old arrive clutching the ad or scraps of paper scribbled with the Ortho Tri-Cyclen brand name. Adds Barbara Blizzard, a nurse practitioner at the University of Texas campus health center in Austin: Students "ask for it by name more than any other pill I've ever had."

Many health workers say anything that prompts teens to use birth control is a good thing. But some medical professionals are worried that the ad campaign is coaxing teens to use birth-control pills even though condoms can prevent sexually transmitted diseases. Each year 25% of sexually active teens contract such diseases, according to the Alan Guttmacher Institute, a New York research center on reproductive health.

"I'm really sick of this," says Martha Saez, a family-planning counselor at the Chautauqua health department. "Nine times out of 10 there's nothing wrong with their skin. I try to explain that this may not be the method they want" for birth-control, "but they don't want to hear the rest of it."

Ortho says its ad campaign serves a broader public-health purpose. Marc Monseau, manager of corporate communications, says it "is designed to encourage a dialogue between women and their health-care providers" and to "help adult women make informed decisions about the pill as well as Ortho Tri-Cyclen." He also notes that the company's ads say the drug doesn't prevent sexually transmitted diseases. The company declined to respond in greater depth, saying that it doesn't comment on its marketing strategy.

Birth-control pills have lost market share to condoms and other forms of contraception in recent years. In addition to concern about sexually transmitted diseases, health worries about the pill are also driving some women away. A study by the National Center for Health Statistics in Hyattsville, Md., found that 27% of U.S. women used the pill in 1995, down from 31% seven years earlier. The decline was even more pronounced for teens. Forty-four percent were using the pill, down from 59%. In the same period, condom use among women overall increased to 20% from 15%.

But Ortho's ad campaign has helped boost the number of Ortho Tri-Cyclen prescriptions, which surged 73% to 3.8 million in the first half, compared with a year earlier. The number of rival pill prescriptions filled edged up less than 2%. And Ortho Tri-Cyclen now has a 12.1% market share, up from 8.5% a year earlier, says IMS Health, a health-care information company in Plymouth Meeting, Pa.

Some Losses

Some of Ortho's other top brands lost market share, but the company's combined share of those brands climbed from 28.5% in 1996 to 31.9% in the 1998 first half. Those numbers don't even include pills dispensed on college campuses and in public-health clinics, where many teens seek contraception.

At the University of Texas, Austin, where advertising inserts for Ortho Tri-Cyclen appeared in the Daily Texan campus newspaper, the number of packages distributed to students more than doubled in the 1997-98 academic year from a year earlier, to 13,592. During the same period, college pharmacists say, Ortho Tri-Cyclen prescriptions tripled at Harvard University, Cambridge, Mass., and at the University of Michigan, Ann Arbor. Stanford University, Stanford, Calif., started stocking the pill this year because of high demand.

The ad campaign touting Ortho Tri-Cyclen as an acne treatment began in September 1997, with inserts in college publications and ads in beauty magazines. "Introducing a birth-control pill that's also a beauty aid," said the ads. But the pitch ran afoul of the FDA, which called the beauty claim "misleading." A month later, the company adopted its current slogan.

Magazine-ad spending for Ortho Tri-Cyclen nearly doubled to $18.1 million in 1997 from $9.6 million a year earlier, according to Competitive Media Reporting. Mr. Monseau says the CMR figures are "substantially higher" than the actual figures but declines to elaborate because the company "can't comment on financial matters." The ads were developed by Omnicom Group's DDB Needham, but Interpublic Group's Ammirati Puris Lintas has since taken over the account.

Ortho is currently the only pill company allowed to plug acne benefits, but doctors have been prescribing birth-control pills to improve skin for years. That is because the estrogen in the pills lowers natural levels of "free" testosterone, which can cause acne. "We spend a lot of time trying to explain to students that it doesn't mean that other contraceptive [pills] won't clear your skin," says Robyn Tepper, chief of medical services at Stanford's student-health services. "It's difficult to try to fight the kind of marketing that they see in print."

Ortho says its pill is different because it contains Norgestimate, a patented brand of progestin. Progestin is the other hormone in birth-control pills, and it can interfere with the acne-clearing benefits of estrogen. But Norgestimate doesn't have that effect, says Geoffrey Redmond, the lead investigator in the clinical trials that resulted in Ortho Tri-Cyclen's acne-treatment approval.

The success of the Ortho ad campaign may trigger some copycat ads from other pill makers. American Home Products Corp.'s Wyeth-Ayerst Laboratories says it plans to seek approval in Canada and the U.S. for use of its Alesse birth-control pill as an acne treatment. "Everybody in the category is looking at Ortho Tri-Cyclen and looking at its success," says David Rebey, group product director for female health care at Berlex Laboratories Inc., a unit of Schering AG of Germany.