Chain-smoker Cynthia Turnbull figured last year that she would finally kick the habit after 19 years. The 36-year-old Philadelphia secretary got a doctor's prescription for nicotine patches, which she wore faithfully. But within days, she started getting leg pains so severe that she ended up in a hospital emergency room. When the ache didn't subside with a lower-dose patch, she gave up. "I don't know how to live without smoking," she says now.
As Turnbull discovered, the nicotine patch is hardly the revolutionary antismoking weapon it once seemed to be. In last year's second quarter alone, doctors wrote some three million patch prescriptions. But since then, awareness of the product's modest effectiveness and occasional side effects are stubbing out demand. As a result, predictions early last year that the four patchmakers--the Lederle Laboratories unit of American Cyanamid, Ciba-Geigy, Marion Merrell Dow, and Warner-Lambert--would sell $1 billion worth of the devices annually are turning to ashes. U.S. sales came in at about $520 million in 1992, and analysts say the patchmakers may be lucky to reap $450 million this year.
Why such a quick turnabout in the patch's prospects? The devices are expensive, for one: A 6-to-20 week prescription goes for $168 to $660. And some studies show that as few as 22% of users were able to stay off smokes beyond six months. Many of those who failed had refused to join support groups--radically cutting the success rate.
FREEBIES. Moreover, other problems have flared up since the patch debuted in late 1991. First, heavy advertising stirred up far more demand than manufacturers could handle, creating shortages. Then, the companies riled the Food & Drug Administration and attorneys general in 11 states by failing to make clear in their ads that the patch is no cure-all but at best can help determined quitters slog through to the end.
Most damaging of all was last spring's news that a few Massachusetts patch users had suffered heart attacks. Even though the patch has not been conclusively linked to heart attacks, demand plunged. Now, only slightly more than one million patch prescriptions are being written each quarter, one-third the peak level. "We can't even give away the patch anymore," complains Dr. Gary B. Bernett of Drexel Hill, Pa.
Manufacturers are showing the strain. After announcing in late February that it would donate two million of its ProStep patches free to state health officials, mainly to be given to the poor, Lederle boosted the giveaway to three million in early March. Lederle denies the giveaway is linked to falling demand. But rivals say Lederle has recently fallen to last place in patch prescriptions. And the company has also started a rebate program that refunds about one-third of the normal $168 cost of six weeks of its patches to users who prove they have worn one that long.
A FAD? Legal and financial problems are also fouling the air at Ciba-Geigy Corp. and Marion Merrell Dow Inc. Ciba on Mar. 15 announced that it had settled a dispute with the 11 state attorneys general by agreeing to step up warnings in its ads and pay $550,000 toward legal fees. Ciba's ads now will note that its Habitrol is proven effective only when used in a behavior-modification program and will discourage use for more than three months at a time. "The ads were pitching the nicotine patch Habitrol as a magic bullet, a quick fix, and a panacea, without discussing adequately the potential risk and the limited effectiveness of the product," gripes David Woodward, a special assistant attorney general in Minnesota. Marion Merrell Dow, whose ads have also been targeted, is discussing a settlement.
Patch troubles are already filtering down to the companies' bottom lines. At Marion, for instance, disappointing Nicoderm sales are a major reason PaineWebber Inc. analyst Ronald M. Nordmann expects the Kansas City (Mo.) drugmaker's earnings for the first quarter of 1993 to fall to $57 million, down 66% from last year's first quarter. Nordmann also figures the company's revenues will fall 17%, to $650 million, thanks partly to poor patch sales.
Gregory Westerbeck, product director for Marion Merrell's Nicoderm, admits that "the elements of a fad" pumped up patch sales early on but contends that the market will see "consistent, moderate growth" from now on. But skeptics figure the patch eventually may be delegated to a modest therapeutic role. Smokers "have to be motivated to quit," says Dr. Donald S. Miller of Ardmore, Pa. Otherwise, the patch's shortcomings make it another excuse for lighting up.