MEDICAL MARKETING HAS NEW WRINKLE.

Byline: Lloyd M. Krieger Local View

A couple of months ago, the FDA approved Botox, purified bacterial poison, for cosmetic use as a treatment of facial wrinkles. Analysts predict the manufacturer, Allergan Inc., will unleash one of the largest advertising campaigns in pharmaceutical history.

The result will speak much about the current state of our health care system and the roles of information, money, doctors and patients within it.

I offer Botox treatments to my patients and have seen remarkable results. Still, I say: Let the buyer beware.

Botox is already commonly used for cosmetic purposes. Last year plastic surgeons did 1.6 million Botox treatments and about one-third of the drug's $309.5 million sales were for cosmetic use.

But with FDA approval comes the right to advertise and a likely sharp spike in usage.

There can be no doubt that selling medicines like soap suds works. Direct-to-consumer advertising has pushed drugs such as Claritin, Viagra and Prozac to superstar status.

As a physician I can say that advertising brings people into my office. If people see a drug ad in a magazine or on television, they ask about it.

The Botox media onslaught will doubtlessly entice many people to recapture their lost youth - just like the wrinkle-free faces of the male and female models in the ads.

Beyond advertising, the broader information economy has changed medicine. People research their questions before they ask their physician. They know about options, costs, benefits, and complications of medicines and treatments. They glean this information from television, magazines and the Internet.

This has changed the doctor-patient relationship.

Doctors used to be all-knowing directors of medical care. A patient had a problem, and the doctor diagnosed and treated it. Knowledge tended to remain with the physician.

Patients have been empowered by information. With educated patients, physicians function as something like patient facilitators within the health care system. The encounter is more of a dialogue where the doctor serves as a Sherpa to guide patients through the process, offer further education and make recommendations.

This all usually creates better patients who are more likely to benefit from treatments. But it also makes for some people who have made up their minds before they know all of the facts.

When I have a patient who wants a procedure for which he or she is not a good candidate, it usually takes more time and effort to explain why it's not for them than it would to simply go ahead and do it.

At the same time, doctors have seen their power limited by managed care plans. They have trouble doing the treatments they and their patients feel are best. Their incomes have fallen.

The result has been a shift toward disciplines where patients pay directly for services. Plastic surgery is booming, as are fertility medicine and Lasik surgery. This all puts pressure on patients.

When I go to a party in Los Angeles, I inevitably meet several other plastic surgeons. Many of these physicians have no formal training in the discipline. Some are gynecologists, internists or even dentists. They have turned to cosmetic procedures because they have trouble making a living in their original specialties. Some may be good at what they taught themselves to do. Others are not.

In New York and Los Angeles, Botox parties are all the rage.

A physician gathers patients at the office, or a restaurant, or a patient's home and describes the benefits of small doses of muscle poison. Sometimes champagne and brie are served. After a brief discussion, patients line up to receive injections.

Not exactly Marcus Welby, M.D.

All this means that health care has become more of a commodity than ever before.

In many ways, shopping for medical care has become like shopping for a car or a DVD player. That is both good and bad.

So when people start seeing the ads for Botox - which in the right situations offers great improvement in appearance with low cost and few risks - they should think before they inject. Read the fine print in those ads. Decide if the likely benefits are worth the risks. Search the Net and talk to medical societies.

Since many doctors offer procedures without full training in the discipline, investigate the doctor as well as the treatment. Look in the mirror. Since many physicians are looking to mass market their services, decide on expectations and goals before seeing the doctor.

And then ask lots of questions.

The modern health care system has empowered patients with information, convenience and access. In the age of Botox, they need to take steps to exercise that power appropriately.