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.


DR. 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."