August 11th, 2002
Heartfelt Advice, Hefty Fees
By Melody Peterson
New York Times
In a rare interview, Lauren Bacall appeared on the NBC "Today" program
in March, telling Matt Lauer about a good friend who had gone blind from an
eye disease and urging the audience to see their doctors to be tested for it.
"It’s just—it’s frightening because it—it can happen very suddenly,"
she said. Ms. Bacall then mentioned a drug called Visudyne, a new treatment
for the disease known as macular degeneration. She never revealed that she was
being paid to tell the story, and neither did the network, NBC.
"We compensated her for her time," said Dr. Yvonne Johnson, medical
affairs director for the ophthalmics division of Novartis, the Swiss drug maker
that sells Visudyne. Novartis chose Ms. Bacall for its marketing campaign, Dr.
Johnson said, because she appeals to many people over 50, the primary market
for the drug.
"We realized people would accept what she was telling them," said
Dr. Johnson, who declined to say how much Ms. Bacall had been paid. "Our
whole intent is to let people know they don’t have to go blind."
The pharmaceutical industry is going Hollywood—and getting a warm embrace.
In the last year or so, dozens of celebrities, from Ms. Bacall to Kathleen
Turner to Rob Lowe, have been paid hefty fees to appear on television talk shows
and morning news programs and to disclose intimate details of ailments that
afflict them or people close to them. Often, they mention brand-name drugs without
disclosing their financial ties to the medicine’s maker.
And even when drug companies say they pay nothing, Hollywood producers have
given their brand-name prescription drug products starring roles on prime-time
television programs.
Last winter, for example, an episode of "Law & Order" on NBC
revolved around Gleevec, a cancer drug sold by Novartis. On "West Wing,"
also on NBC, President Bartlet, played by Martin Sheen, suffers from multiple
sclerosis and takes Betaseron, a drug made by Berlex Laboratories. Both companies
say they did not pay for those prominent placements.
In the last few years, in their quest to wring more profit out of their drugs
before the patents expire, pharmaceutical companies have poured billions of
dollars into marketing their products—fielding armies of sales representatives,
entertaining doctors, nurses and pharmacists, and taking their pitches directly
to consumers in glitzy television commercials and glossy magazine ads. Now,
despite criticism that those tactics raise the price of drugs, some companies
are also trying these more subtle sales pitches.
Consumer product companies like Coca-Cola and BMW have been using celebrity
endorsers and placing their products in film and television scripts for decades.
But doing so with prescription drugs raises a host of issues, experts say—
especially when celebrities fail to disclose their financial links to the companies.
"It is highly problematic and maybe even unethical," said Dr. Joseph
Turow, a professor at the Annenberg School for Communication at the University
of Pennsylvania.
"We admire these people and that is why drug companies pay for their time
and services," Dr. Turow said. "But when it comes to issues of health,
particularly medicines, transparency is an ethical concern. People should be
clear about the reasons they are making certain recommendations."
Allison Gollust, a spokeswoman for the "Today" program, said NBC
may have made a mistake in handling the interview. At the time of Ms. Bacall’s
interview, NBC executives did not consider her comments about Visudyne to be
a problem, she said.
"In hindsight, and with more information about celebrities and their connection
to drug companies, we may have handled that differently," Ms. Gollust said.
Terry Barnett, president of Novartis’s operations in the United States, said
the company did not intend for Ms. Bacall to promote Visadyne. But he said in
the future, even if a celebrity is talking only about a disease, the company
will be more careful at making sure the audience knows the star is working on
the company’s behalf. "I think we would look at that more closely in the
future," Mr. Barnett said.
None of the drug companies would disclose how much they have paid stars for
these services. But the case of Larry King provides an indication. After Mr.
King talked publicly about his heart disease in a public awareness campaign,
the company that put together that effort convinced the Guidant Corporation,
which makes stents, to contribute medical equipment valued at $1 million to
Mr. King’s charitable foundation, which helps poor people.
DRUG companies have also wielded the might they gain from their spending on
consumer ads, which came to $2.7 billion last year alone, to stop scripts that
might put a brand-name medicine in an unfavorable light. In December 2000, USA
Network canceled the production of a television film called "Who Killed
Sue Snow?"—a film about the deaths of two Seattle-area residents who
took cyanide-laced pain relievers—after complaints from Johnson & Johnson,
a major advertiser and the maker of Tylenol. (Tylenol, of course, weathered
just such an incident in 1982.)
Jeffrey J. Leebaw, a spokesman for Johnson & Johnson, said the company
had become aware of the movie and let the network know that it did not feel
it was appropriate. "We did not threaten to pull our ads," he said.
Other health care companies, lacking that clout, have not fared as well in
Hollywood. The nation’s health insurers have grown so tired of their repeated
portrayal by Hollywood as the corporate villains of the health care system that
in June they hired the William Morris agency to improve their image.
Mark Merritt, senior vice president at the American Association of Health Plans,
a trade group that represents 1,000 insurers, said a recent movie, "John
Q," was the last straw for the companies. In it, an insurance company refuses
to cover the cost of a heart transplant for a dying boy, and the boy’s father,
played by Denzel Washington, grows desperate as his son’s condition worsens.
As tension builds, he pulls out his gun and holds hostages in the emergency
room until the hospital agrees to put the boy on the heart transplant list.
In other scripts, insurers are shown as profit-hungry companies that deny patients
prescription drugs, which are almost always depicted as essential for health
and life. In the "Law & Order" episode on Gleevec, the father
of a young girl with leukemia kills an insurance executive after the insurer
refuses to pay for the drug, which on the show and in real life costs $25,000
a year. After his lawyers argue that the killing was justified, the jury is
unable to reach a verdict.
Mr. Merritt said the William Morris agency was helping the insurers set up
meetings with Hollywood executives. "We want to sit down with writers and
producers of shows with health-care content and get a fair hearing for our side
of the story," Mr. Merritt said. "Hollywood is too big to ignore."
There are many advantages to getting Hollywood on your side.
"When a celebrity talks about something, everyone stands up and takes
notice," said Dr. Jonathan Sackier, the founder of Spotlight Health in
Los Angeles, a company that creates star-studded medical education campaigns
for health care concerns. Spotlight handled the deal between Mr. King and Guidant,
for example, and rival firms like Premier Entertainment Consulting of Essex
Fells, N.J., also match celebrities with drug and health-oriented campaigns.
Prime-time shows like "E.R." have twice the viewers as the evening
news. More than 22 million viewers on average tuned into each episode of "E.R."
last season, according to Nielsen Media Research, while 10.8 million watched
Tom Brokaw on the "NBC Nightly News."
And even though the programs are fictional, viewers take them seriously. According
to a study sponsored by the Kaiser Family Foundation, 53 percent of viewers
of "E.R." said they learned about "important health issues"
from the show.
At the same time, drug companies can avoid federal drug advertising regulations
by hiring celebrities for what they describe as campaigns to raise awareness
about a disease. The regulations require that all prescription drug ads disclose
the medicine’s adverse effects and refrain from overstating its effectiveness.
As long as the celebrity does not mention a prescription drug by name, the
Food and Drug Administration considers the event educational, not promotional,
and does not regulate it, an agency official said.
But some recent appearances, including Ms. Bacall’s interview on "Today,"
appear to be very close to going over the line. Ms. Bacall mentioned Visudyne
by name, but she did not talk about the drug’s side effects.
"We’re aware that she said the word Visudyne once or twice," said
Dr. Johnson at Novartis, "but she was not hyping the product."
Johnnie Planco, Ms. Bacall’s manager, said she was never asked whether she
was being compensated. "She felt this could help people," he added.
Amgen is another drug company, that has recently hired celebrities to help
promote its products. It pays Danny Glover to help market Aranesp by raising
awareness about anemia. The company, which sells Enbrel, for rheumatoid arthritis,
also pays Kathleen Turner to discuss how she is coping with that disease. And
it pays Rob Lowe to raise awareness about neutropia, a side effect of chemotherapy
that is treated by its drug, Neulasta.
Ms. Gollust, at NBC, said "Today" declined an interview with Rob
Lowe after learning of his Amgen ties.
Jeff Richardson, a spokesman for Amgen, said doctors had told the company they
liked the celebrity campaigns. "Patients will see this and go to their
physicians," he said.
Dr. Alan M. Langlieb, an assistant professor at the Johns Hopkins School of
Medicine, said he learned just how much pressure Hollywood producers feel from
health care companies when he helped create a series of news segments based
on the content and story lines in "E.R." The news feature, which began
in the late 1990’s and ran through last season, was called "Following E.R."
and appeared after each episode on local NBC stations. Dr. Langlieb said he
had often been approached by companies that wanted their products mentioned,
and that they had sometimes offered to pay for placements.
"They wanted the names of Hopkins and ‘E.R.’ to be tied to whatever they
were doing," he said.
One drug company, American Home Products, now known as Wyeth, sent him a box
of its products after it began paying NBC to sponsor the "Following E.R."
reports.
"Some ad agencies for pharmaceutical companies approached me, asking me
to be a consultant for their product lines," Dr. Langlieb said. "I
turned them down because I thought it would be a conflict of interest."
DR. LANGLIEB said he and other academics at Johns Hopkins who created the news
segments refused the companies’ requests.
"I realized early on, that in Hollywood, you were either in or out,"
said Dr. Langlieb. "To stay in, it required a strong resistance to selling
out."
A similar news feature, also created by experts at Johns Hopkins, ran on CBS
after the medical drama "Chicago Hope." In 1998, the Pharmaceutical
Research and Manufacturers Association, the trade group representing drug companies,
paid CBS about $1 million to sponsor the program and the news report, which
was called "Living with Hope," Dr. Langlieb said.
Dr. Langlieb said the trade group did not approve the news report’s content,
suggest topics or ask that any medicines be mentioned.
But the pharmaceutical trade group’s contract with CBS raised questions among
some breast-feeding advocates when a Chicago Hope episode focused on the risks
of breast feeding. The episode featured an infant dying after a mother refused
to give the baby manufactured formula even though her own milk supply was not
enough. The pharmaceutical trade group’s members include some of the biggest
baby formula suppliers in the country, like Bristol-Myers Squibb, Abbott Laboratories
and Wyeth.
"It just seemed too coincidental," said Kimberly Cavaliero, the public
relations director at La Leche League International, a group that promotes breast
feeding. "A lot of people believe what they see on television, even though
it is fictional."
Jeff Trewhitt, a spokesman for the trade group, said the association did not
talk to the producers of "Chicago Hope" or have any input into the
show’s story line.
A CBS spokeswoman referred questions to David E. Kelly, the producer of Chicago
Hope. Mr. Kelly’s spokeswoman said he was not available to comment.
Dr. Langlieb said that, in his work with writers and producers of "E.R.,"
he had been told that some companies had negotiated with the show to get products
placed in episodes in exchange for money or free medical equipment to use on
the set.
But Dr. Neal Baer, the former executive producer of "E.R.," said
that he did not meet or talk to drug companies that may have wanted to get favorable
depictions of their products or coverage of health conditions that their products
treat.
"We’re not in the business of promoting products," said Dr. Baer,
now executive producer of "Law & Order: Special Victims Unit."
Even so, Dr. Baer said, "E.R." episodes frequently include the brand
names of drugs—if the product was featured in a positive way. In one episode,
he said, a girl overdosed on Tylenol, which seriously damaged her liver. Instead
of using the Johnson & Johnson brand name, Tylenol, Dr. Baer said, the network’s
policy required him to use its generic name, acetaminophen. "The companies
spend a lot on promotion," he said. "They would have sued us."
Some episodes from television shows have later been used by drug companies
in their own promotional efforts. For example, after an "E.R." episode
featured Dr. John Carter finding skin cancer on a patient, Schering-Plough hired
Noah Wyle, the actor who plays Dr. Carter, for a campaign to raise awareness
of the disease. Schering-Plough sells Intron A, used to treat melanoma.
Pfizer also hired Mr. Wyle to raise awareness of post-traumatic stress disorder.
When Pfizer’s campaign began in January 2001, the fictional Dr. John Carter
was dealing with psychological trauma as he recovered from a stabbing. Mr. Wyle
kicked off the campaign by appearing on "Today." He appeared again
on the NBC morning program in November 2001, about two months after terrorists
struck the World Trade Center on Sept. 11. Both times, the program disclosed
that Mr. Wyle was working with Pfizer.
Pfizer makes Zoloft, an antidepressant that is approved to treat post-traumatic
stress disorder. During the November interview, Mr. Lauer asked Mr. Wyle questions
as if he were the doctor he plays on television.
"Noah, trauma is trauma, and we all react to trauma in different ways,
so how do you kind of give people a guideline as to what’s normal reaction and
what steps over the line and gets into something serious?" Mr. Lauer asked.
MR. WYLE gave reasonable advice. "The first thing that you should do is
just get it off your chest, just talk about what it is you’re feeling, what
it is that you’ve seen and are reacting to," Mr. Wyle said. If the problem
persists, Mr. Wyle said, the person may want to see a professional.
Eddie Michaels, Mr. Wyle’s agent, said the actor wanted to help raise awareness
about the syndrome after traveling to Macedonia, where he talked with war refugees.
"Most actors are not interested in promoting a drug," Mr. Michaels
said. "The message has to be one that will bring awareness and not one
to sell.
"Sure, the pharmaceutical company gets some return," he added, "but
it is much more educational than an advertisement."
In April, Montel Williams, who suffers from multiple sclerosis, devoted an
entire show to a discussion of the disease. On the show, Mr. Williams said that
he takes Copaxone.
"Copaxone has been what has kept me running," Mr. Williams told the
audience. He never discussed the drug’s possible side effects or his financial
ties to Teva Pharmaceuticals, which sells Copaxone.
In a deal put together with the help of Spotlight Health, Teva paid Spotlight
Health, which then paid Mr. Williams’s charity, The Montel Williams MS Foundation,
according to Dr. Sackier at Spotlight Health. The Web site describing Mr. Williams’
charity says its goals are to raise money for research on multiple sclerosis
and educate the public. Dr. Sackier said he could not reveal how much money
Teva had paid or Mr. William’s foundation had received.
Greg Westbrook, a spokesman for Teva, said the company felt its marketing campaign
was appropriate. "We did not tell Mr. Williams what to say," he said.
Mr. Williams said he received no money personally from his foundation and was
not misleading anyone. "I have deliberately and repeatedly stated that
my treatment is not appropriate for all MS sufferers," he added.
Even when no drug is mentioned, the message often gets across. In February,
Kathleen Turner appeared on "Good Morning America" on ABC to talk
about her rheumatoid arthritis. Ms. Turner did not disclose that she was actually
being paid by Wyeth and a company that became part of Amgen, which sell Enbrel,
a new treatment.
BUT without saying the word Enbrel, Ms. Turner told Diane Sawyer that the "new
medications" were "extraordinarily effective" and did not have
any side effects. She also referred viewers to more information at a Web site
maintained by the companies, without saying their names.
Douglas Petkus, a spokesman for Wyeth, said a producer of the news program
had been given material that clearly showed it had been prepared by the companies.
"The responsibility to disclose was not Kathleen’s," Mr. Petkus said.
Lisa Finkel, a spokeswoman for "Good Morning America," said the news
program was troubled by how the interview had been handled and had become much
more careful. "We always want to disclose any pertinent information,"
Ms. Finkel said. "No one is more bothered by this than us."