ADS FOR DRUGS: 'HUCKSTERISM' OR A PUBLIC SERVICE?

Advertisers, Doctors Clash On The Merits Of Direct-To-Consumer Ads

They're everywhere -- on television, in magazines, in newspapers -- popping
up like spring weeds.

They're ads for prescription drugs -- about a billion dollars worth a year
in today's fastest-growing advertising category. And there seems to be no
limit to the aliments these drugs can cure: allergies, ailing hearts,
depression, herpes, high blood pressure, headaches, baldness and more.

But is the advertising of prescription drugs directly to consumers a form
of education or "snake oil hucksterism"?

Advertisers say pitching these products to the consumers provides a
valuable public service, but the practice is drawing criticism from medical
professionals. Some doctors say it interferes with the practice of
medicine, causing patients to ask for remedies that may be inappropriate.
Others fear advertising may exaggerate claims, and health insurance
executives say direct-to-consumer ads are raising health-care costs.

"Oh, yeah. Parents come in here and say, 'I want that for my kid,' " said
Dr. Thomas Kowalski, a Milwaukee pediatrician.

Parents want a drug they have seen on television or in a publication,
particularly now that allergy season has begun and the airways are filled
with commercials for Allegra or Claritin, he said.

"I spend a lot of time explaining that some particular advertised drug
won't be best for their kids," he said.

Kowalski said parents demand prescription antibiotics that keep them from
having to parcel out doses to their children at all hours of the night.

"For certain antibiotics, the ads say they need to be taken only once a
day," Kowalski said. "The problem is that any time there is convenience, it
costs you. The advertised antibiotic for your child's ear infection can
cost three times as much. There has to be a compelling (medical) reason for
me to write a more expensive prescription."

Doctors also face pressure from managed-care programs to prescribe less
expensive or generic drugs to hold down costs, he said.

"I could be de-selected by an HMO or managed care program. Is that a
conflict of interest? It could be. You always keep in mind that there is a
less costly way and aim for that," Kowalski said.

Health officials, including the American Medical Association, generally
agree they would prefer that the ads not target the general public, but
they have resigned themselves to the new practice.

An AMA survey of physicians found there can be a benefit if the ads involve
patients in their own care in such areas as smoking cessation, hypertension
or high cholesterol.

And, that's Richard McDonald's point.

"We know zip about the prescriptions we are taking," said McDonald,
managing officer with BVK / McDonald, a Milwaukee advertising firm, and one
of the early advocates for medical advertising.

He points to the 1977 U.S. Supreme Court decision that legalized such
advertising, saying the ruling found it informed the public and helped
decision-making by consumers.

Quoting Justice Blackmun's opinion, he said: "People will perceive their
own best interest if only they are well enough informed, and that the best
means to that end is to open the channels of communication rather than to
close them."

And McDonald agrees: "Educating people is a value to the public. The
consumer will be better able to challenge the physician, not in an
antagonistic way, but in an informed way. With more marketing and more
advertising, the consumer wins," McDonald said.

Even with recently relaxed Food and Drug Administration ad rules, McDonald
said protections are in place "to prevent a return to the snake oil days."

Eric Cohen isn't so certain. Ten years ago, he railed against
direct-to-consumer advertising in an article in The New England Journal of
Medicine, declaring prescription drug information "would be warped by
misleading commercials and hucksterism."

Today, the associate professor of medicine at the Medical College of
Wisconsin, hasn't changed his views.

"Advertising is snake oil hucksterism," Cohen said. "Advertisers are in the
business of not necessarily telling the truth. They are in the business of
selling products."

Cohen said direct marketing of prescription drugs to laymen confuses the
public and creates demand for drug use where drugs may not be appropriate.

"Advertising is not designed to educate, but to sell. A pill may not be
needed. A change in diet or lifestyle or even surgery may be more
appropriate," he said. "I don't think that advertising prescription
medicines is the right approach."

Cohen said the cost of direct advertising of prescription drugs has climbed
from $12 million 10 years ago to about $1 billion today. "Someone has to
pay for it," he said.

Greg Keuterman, a spokesman for Eli Lilly and Co., would not reveal how
much the drugmaker has spent on ads since July when it began a campaign for
the antidepressant Prozac.

But sales of Prozac, one of the most widely prescribed drugs in the world,
rose from $1.73 billion in 1996 to $2.02 billion last year.

"We are pleased with the campaign so far. We have received a lot of
positive feedback from patients and doctors who believe that the Prozac ads
are easy to read, understandable and help get patients into the doctor's
office.

"In the area of depression, there is a tremendous gap. Two-thirds of people
with depression are not receiving any treatment or appropriate treatment,"
he said.

"This campaign hopes to better the relationship between doctors and
patients and drive patients into doctors' offices if they recognize signs
of depression among themselves or friends," he said.

Keuterman said Lilly recognizes the company has a responsibility in
advertising directly to the public. He said Lilly makes sure depression is
properly depicted and the campaign is not aimed at children.

"Obviously, we are interested in selling products. That's why we are in the
business. But so many people are not receiving the treatment they need," he
said.

Thomas Hefty, chairman of Blue Cross & Blue Shield United of Wisconsin, and
Larry Rambo, president of Prime Care Health Care Inc., said they feel
direct-to-consumer advertising creates serious problems for patient and
physician alike.

Drug use is best decided by the treating physician, Rambo said.

Hefty said Blue Cross' pharmaceutical costs are the fastest rising part of
his company's expenses. Prescription drug use last year was up 5%, and drug
costs rose 13%.

"Often times, there are many alternative drugs that are appropriate within
any given class, and the consumer should not be misled into believing one
is superior to another without understanding all of the implications of
specific drugs," Rambo said.

"I do not believe that these are serving a positive purpose for the
American consumer. When people ask for these drugs, the doc has to justify
not doing something rather than justify doing something," Rambo said.

Said Hefty: "We are disappointed to see the pharmaceutical companies
engaging in these practices. It raises the costs and interferes in the
physician-patient relationship. They are trying to improve their profit
margins."