Commercial medicine: black doctors say drug ads may not be a bad thing. (Consumer Life).

"If you came into a physician's office with an ad for a drug you saw advertised," suggests Dr. Robert Seidman, chief pharmacy officer for WellPoint Health Networks, in Thousand Oaks, California, the country's fourth-largest health insurance company, "and the doctor says you don't need it, but you say I really want it, in most situations, the doctor's going to say OK let's try it barring no interaction with other drugs. And that's because physicians are very busy and it's very difficult to fight Madison Avenue."

Seidman is responding to a raging national concern that pharmaceutical companies, through glossy and clever direct-to-consumer advertising (DTC), are pressuring patients to ask their doctors about drugs they may not need. In fact, pharmaceutical companies hocking drugs for a sundry of ailments including diabetes, obesity, AIDS, herpes, heartburn, and erectile dysfunction have seen their bottom lines bolster through DTC advertising.

According to the National Institute for Health Care Management Foundation, a nonprofit health organization in Washington, D.C., pharmaceutical advertising has increased at double-digit rates since 1995. Between 1993 and 1998 there has been a $42.7 billion increase. In 2000, the industry spent $2.5 billion on DTC advertising while $86.2 billion worth of prescription drugs (65% of total retail sales) were sold in therapeutic categories where the top four drugs had a 50% or greater share of the market. Pharmaceutical manufacturers plainly see how their companies benefit. But what are these campaigns actually doing for the consumer?

The National Medical Association (NMA) in Washington D.C., the nation's oldest and largest African American medical organization, recently released a survey of 900 black physicians finding that DTC advertising, as it affects African American patients, poses no harm. In fact, they have concluded that effects of better marketing to minority communities could prove beneficial to black patients.

"We see DTC as a good thing. We believe the ads do no harm. They increase health awareness," asserts Dr. Sharon Allison-Ottey, author of the NMA survey. "We believe [the ads serve] as a tool in helping the nation look at healthcare and in helping patients [recognize] that potentially there is something that they are at risk for, or there is a disease that they should ask their doctor about. We, however, continue to ask for and support the Food and Drug Administration's efforts to make sure the ads are balanced."

The FDA mandated such efforts in a 1997 policy, which relaxed the rules governing broadcast advertising for prescription-based drugs. "Before that, if you were to run a branded television commercial, you were required to fulfill very detailed, very regimented requirements on disclosure," states Michael Guarini, managing director of the Ogilvy healthcare practice. His division handles the marketing and advertising concerns of a number of pharmaceutical clients. "It made it very prohibitive for advertisers to use broadcast. [Today], the restrictions are really simple" All branded commercials have to run, what Guarini calls fair balance or warning copy. They also have to provide four different ways for consumers to get information. DTC commercials must offer a toll-free number, encourage consumers to talk to their doctors, provide a Website, and direct viewers to a print ad.

It's that kind of prompting, Allison-Ottey argues, that encourages doctor visits, as well as doctor-patient dialogue, which has been a source of contention for African American patients. In fact, a report by the Commonwealth Fund, a private foundation that supports independent research on health and social issues, found African Americans lagging behind on healthcare quality measures and more likely to have communication problems with their doctors than whites. The Institute of Medicine shows that racial and ethnic minorities receive lower-quality healthcare even when their insurance and income are the same.

"Doctors are finding that these ads are helping our patients talk to us about medical conditions they're at risk for," says NMA President Dr. Lucille C. Perez. "When you consider that the majority of drugs advertised can treat diseases that disproportionately affect the African American community, there is incredible potential."

Allison-Ottey suggests that DTC advertising may also help black consumers overcome certain insecurities about health issues. "If my patient is sitting at home or at a hair salon and looks at a commercial for depression, and is watching someone acting out some of the hallmarks of depression and [recognizes] that's she's not alone, we believe that increases awareness of the problem."

Toney Means concurs. He is president of Imiren (www.imiren.com), an African American pharmaceutical company. Based in Decatur, Georgia, the company manufactures generic heart medications, analgesics and antibiotics, including doxycycline, one of the primary treatments for anthrax.

"At first I was a little surprised with the NMA's stance because traditionally doctors don't like pharmaceutical companies or [the media] telling them how to practice medicine," Means says. "When you look at the African American population, which is underserved and underrepresented in doctor visits and in the treatment of certain diseases, anything that gets the patient to think about going to the doctor to get a checkup makes sense, because it's a step toward improving health.

"It may be the one of the few times," he continues, "when a capitalistic objective really ends up benefiting some social goals."

The NMA would like to see changes in how the ads are targeted. "If this is a tool," Allison-Ottey asserts, "we want to make sure it is equally available to people of color in diverse media, in diverse outlets. We need to make sure that there's diversity in the advertisement so that cues such as hearing the symptoms and knowing that [consumers] need to talk to [their] doctor can be picked up."

TAKING CONTROL

The following suggestions will help consumers wade through the commercialism to make the best decisions for their health.

* Become involved in your healthcare decisions. Don't make demands to your doctor based on a commercial or advertisement, but ask questions and discuss your condition and the use of all drugs, generic or branded.

* Always ask your physician if there is a generic equivalent to a prescription brand for your condition. If you don't ask, the doctor may not offer it. In a recent study by the Henry J. Kaiser Family Foundation, a nonprofit independent national healthcare philanthropy based in Menlo Park, California, of the 30% of Americans who talked to their doctor about an advertised drug, only 25% received a recommendation for a different prescription drug and 15% were recommended to take an over-the-counter drug. "At our firm, there is a $7 co-pay for generic drugs and a $15 co-pay for brand names," offers Seidman. "The pain reliever Vioxx retails for approximately $80 a month for a 30-day supply. Generic ibuprofen is $40 retail."

* If you are encouraged to take a branded drug, ask for samples. Pharmaceutical sales agents often provide doctors with trial-size freebies.

* Do your homework. Dr. Ian Smith's Guide to Medical Websites (Random House, $12.95) rates Websites, including those devoted to pharmaceutical drugs. Among the listing are www.healthtouch.com, www.pdr.net, www.rxlist.com, www .nlm.nih.gov/medlineplus/druginformation.html, and www.safemedication.com.