Suddenly, celebrities who want to raise awareness about health
problems are becoming as inescapable as, well, health problems.
They're on talk shows, in news stories, on Web sites, at
fund-raisers, even testifying before Congress.
Rob Lowe talks passionately about chemotherapy side effects.
Michael J. Fox, about Parkinson's disease. Lauren Bacall, macular
degeneration. Lynda Carter, irritable bowel syndrome. Dan Quayle,
deep vein thrombosis. Camilla Parker Bowles, Jill Eikenberry,
Michael Tucker, Meredith Viera, osteoporosis. Wynnona Judd, asthma.
Noah Wyle, post-traumatic stress disorder, melanoma, and uninsured
Americans - although not all together.
While some of these stars have embraced a health cause because
they have the disease or for strictly altruistic reasons, most have
an additional motive: They're getting paid by a pharmaceutical or
health-care company that, not coincidentally, makes money diagnosing
or treating the health problem.
This fact tends to get lost in the fine print of press releases,
if it gets mentioned at all. Often, the celebrity is presented as
the "spokesperson" for an awareness-raising campaign led by a
nonprofit such as the National Osteoporosis Foundation or the
American Lung Association. The celebrity may not even mention the
company's product by name - just a campaign Web site or toll-free
number sponsored by the company.
Relatively new but increasingly common, celebrity-driven
health-awareness campaigns are defended by medical companies,
nonprofits, celebrity brokers, and, of course, celebrities. They say
it can empower consumers, improve health care, and save lives.
But critics are appalled. Stealth health-product marketing, they
say, is blurring the distinction between advertising and education,
giving celebrities undue medical influence, and contributing to
soaring health-care costs.
"Often, there is a legitimate reason to try to raise awareness
about a disease," said Ray Moynihan, a British Medical Journal
editor who has researched drug-marketing practices. "The question
is: Who is raising awareness, and why?"
Until recently, few thought to ask that question. Traditionally,
big-name disease champions were easy to peg as humanitarians, shills, or confessors.
But last summer, after Moynihan and a few others began writing
about the new breed of celebrity pitch people, CNN announced a new
policy: Do ask, do tell. CNN had just broadcast an interview with
actress Kathleen Turner, who talked candidly about her struggle with
rheumatoid arthritis - without mentioning the arthritis drug makers
who hired her.
The growing number of agencies that connect celebrities with
health causes say they advocate full disclosure. One agency,
Spotlight Health in Los Angeles, even posts an ethics statement to
that effect on its Web site.
Yet the brokers acknowledge that, by contract, they cannot
disclose how much their clients are paid. Nor do brokers have
control over the sprawling network of publicists and promoters who
may not be as forthcoming as the brokers would like.
Case in point: A New York City public relations agent recently
sent a pitch letter offering interviews with Viera, cohost of a TV
talk show, who is "spearheading" a National Osteoporosis Foundation
campaign to encourage bone density testing. It gave no hint that
Merck & Co., maker of an osteoporosis drug, is paying for Viera
and the campaign.
(Asked through the public relations agent for an interview for
this story, Viera, a former journalist, said she was too busy.)
Barry Greenberg, founder of 22-year-old Celebrity Connection in
Los Angeles, is one of the few people making money from awareness
campaigns who seems to have no illusions: "The world... wants to
believe all this stuff happens spontaneously, without any combustion
on the part of pharmaceutical companies... . What you need to
understand about this [celebrity] community is that not everybody is
rich, and a lot of this is motivated by income."
Greenberg told Variety magazine that compensation typically can
range from $30,000 to $300,000, and sometimes go all the way up to
$1 million and stock options.
Amy Doner Schachtel, president of Premier Entertainment
Consulting in Essex Fells, N.J., thinks celebrities are "compensated
"Someone could take this in a cynical way," she said, "but our
goal is to get these celebrities out there to say 'See your
doctor'... and 'Go to this Web site for more information.'... I
forget which celebrity it was, but a celebrity said to me: 'If I can
help one person, good for me.' "
Merck spokesman Tony Plohoros said the company "always tries to
make [financial ties] clear." "The pure purpose," he said, "is to
Robert Bonow, president of the American Heart Association - which
has a campaign with actress Rita Moreno underwritten by Takeda
Pharmaceuticals and Eli Lilly - said it is "a purely educational
program to raise awareness and understanding of the connection
between cardiovascular disease, diabetes and insulin resistance. We
are grateful to our corporate sponsors."
In Europe, where drug advertising aimed at consumers is illegal,
educational information about diseases and treatments is published
by independent drug bulletin groups that do not depend on industry
In the United States, direct-to-consumer drug advertising surged
in 1997 when the Food and Drug Administration allowed TV ads, paving
the way for a parade of drug endorsers including Bob Dole (Viagra),
Dorothy Hamill (Vioxx), Joan Lunden (Claritin), and Lauren Hutton
Still, the FDA can stop a drug ad campaign if it contains false
or misleading information.
Not so with a disease-awareness campaign.
"If you're talking about diseases and conditions, we don't
regulate it," said Melissa Moncavage, director of the FDA's
direct-to-consumer advertising review group.
Awareness campaign sponsors and creators say disease information
is vetted by medical experts and often updated.
Even so, European authorities consider such material suspect.
Last year, they rejected a drug industry proposal to provide
consumers with information about treatments just for HIV/AIDS,
asthma and diabetes.
The consumer advocacy group Health Action International cheered:
"While [drug] industry representatives... have argued that the
proposal was about providing information, public health groups...
have emphasized that the proposal would actually allow promotion
disguised as information to reach consumers."
Such promotion can change the doctor-patient relationship, said
Barbara Mintzes, an epidemiologist at the University of British
Columbia. In a study of family doctors in Sacramento, Calif., and
Vancouver, British Columbia, she found they usually obliged when
patients asked for a specific drug. In Sacramento, 7 percent of
patients requested specific drugs, compared with 3 percent in
Vancouver. (Canada has a ban on consumer-aimed drug ads, but it
can't keep U.S. ads out.)
Studies show a strong correlation between prescription drug
spending - growing at four or five times the rate of inflation - and
increased sales of heavily advertised drugs.
Awareness campaigners see such trends as evidence that patients
are being empowered to take charge of their health care.
Merck spokesman Plohoros said more than 5,700 people in
Cleveland, Dallas and Atlanta took advantage of free bone density
tests offered through the new osteoporosis campaign.
Whatever the merits of such campaigns, Moynihan believes the
trend raises a more basic question: "Is it appropriate that
companies shape the way we think about illness?"
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