In most recessions, drugs are usually considered a bright spot for marketers. Consumers may skimp on food, fuel and clothes, but the business of health often benefits from "nondiscretionary" spending. But that is not the case this time round.

Marketers are predicting an overall decline through 2011, which would be the first setback the business has ever seen.

The decline is unrelated to the economic woes of the rest of the country. Instead, it is caused by an unusual confluence of events:

• Many patents have expired or are about to expire
• The FDA has become more skittish about approving new drugs
• Drug companies' R&D pipelines won't have any major new launches until 2011
• The growing number of uninsured Americans is impacting the total number of prescriptions written

Analysts expect to see more drug marketing money go online or into CRM programs, which are cheaper than commercials.