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Merck & Co. and Pfizer Inc. have been criticized for their aggressive marketing campaigns for its COX-2 drugs, putting scrutiny on pharmaceutical advertising as a whole. Between December 2003 and November 2004, pharmaceutical ad spending increased 30 percent from the same period a year earlier, according to TNS Media Intelligence, to $4.35 billion.

The companies’ ads were partially responsible for the millions of patients requesting to be put on COX-2 drugs that may have benefited more with other drug therapies, according to many critics. The entire class of COX-2 drugs includes Pfizer’s Celebrex and Bextra and Merck’s Vioxx.

Vioxx was recalled last September after the drug was linked to an increased risk of heart attacks and stroke, prompting an investigation into the highly popular drug class. Last week, an FDA advisory panel voted to allow doctors to continue prescribing Celebrex and Bextra, recommending they carry warning that they could “significantly” increase the risk of cardiovascular problems. The panel also voted to allow Vioxx back on the market, and should it be reintroduced, a “black box” warning is likely, the strictest FDA issued drug warning.

There were a lot of people anticipating the outcome of the three-day meeting of the panel of government medical experts, and some were disappointed that an advertising ban on all COX-2 drugs was not recommended. Pfizer stopped advertising Celebrex prior to the meeting in response to an FDA request. Celebrex was the ninth most heavily advertised drug in the first 11 months of 2004 with $104.5 million in spending, based on TNS figures.

Should Celebrex include a black box warning, as the FDA panel recommended it carry, the serious caution restricts drug advertising. In response to the COX-2 backlash, ad executives and drug company officials predict changes in advertising strategies are likely. In 1997, federal regulators relaxed pharmaceutical advertising laws, allowing medicine to be promoted on television the way that it exists now.

Even though Celebrex and Bextra will remain on the market, and Vioxx could reemerge, the public is still trying to dig through all the information before deciding if the risks of the drugs are worth its potential benefits.