In recent years, the relationship between the health-care industry and physicians has been questioned. In years past, industry representatives courted physicians with gifts, meals and trips to exotic destinations — all in the name of educating us on a new therapy, treatment or piece of equipment. Not surprisingly, many health-care professionals are concerned that such a courtship creates a conflict of interest.

It begs the question, "How much influence can the pharmaceutical industry have on a physician's practice?" As a consequence, most medical schools and community hospitals now closely regulate any contact with industry representatives. No more gifts and no more free lunches. Any services provided must have meticulous justification. For now, it is strictly education.

As the restrictions on physician education grew increasingly strict, the pharmaceutical industry shifted the attention directly to the public, using direct-to-consumer advertising in newspapers, magazines, radio and television. Through savvy marketing campaigns, Sally Field is now forever linked with Boniva, Dr. Jarvik with Lipitor and a yellow bumblebee with Nasonex.

What is the real impact of direct-to-consumer advertising? On the upside, this marketing has increased the public's awareness about new medications, as well as many diseases. An advertisement may prompt a visit to the physician that otherwise may not have occurred.

In the best-case scenario, this provides an opportunity for a comprehensive work-up to screen for medical problems such as cancer, high blood pressure, elevated cholesterol and other factors that may increase the risk of disease. It may also provide opportunities to counsel patients about the importance of smoking cessation, diet and exercise.

However, there is an obvious downside to the ads. First, patients are more likely to seek specific medications. They ask their doctor about the "new and improved medication," and frequently the physician gladly prescribes it. Patients with osteoporosis are happy to take a once-a-month Boniva rather than the weekly generic that provides the same effect. Often a new drug advertised to the general public is inappropriately prescribed as a first-line treatment, rather than using tried and true older medications as the initial therapy.

One of the biggest problems with requesting new drugs is simple: increased cost. Generic medications will never be marketed to the public, only the brand-name equivalent. Again, consider the case of heavily advertised, brand-name Boniva over the generic counterpart. A three-month supply of Alendronate (Fosamax) is now available for $10 at discount pharmacies. The cost savings of taking Alendronate once weekly far outweigh the convenience of taking Boniva once monthly.

In addition to concerns about cost, some pharmaceutical advertisements may not provide all the necessary information to educate consumers about the potential benefits and side effects.

A recent editorial published in the New England Journal of Medicine raised serious concerns about advertising a drug-coated stent used to open up a blocked coronary artery in patients with chest pain. In an advertisement titled "Life Wide Open," the advertisement shows a suffering man sitting with obvious chest pain, and then contrasts him with healthy-looking people exercising and having fun. The ad implies that opening up the artery by angioplasty and using this specific stent is the best way to treat chest pain. However, angioplasty for chest pain is no better than conservative treatment with medications.

Furthermore, the television advertisement downplays the side effects, indicating the angioplasty has only four side effects (allergy to blood thinners, heart attack, the need to repeat the procedure and blood clot in the stent), and the drug coating has none. The consumer Web site identifies 10 side effects from the procedure and four from the drug coating. The patient-education brochure identifies 24 side effects that the procedure may cause, including death, strokes, and the need for open-heart surgery, and 13 from the drug coating, including lymphoma and other cancers, severe lung disease, and bone marrow problems that can lead to infection and bleeding.

If you ever see an advertisement for a specific treatment that may seem appropriate for your condition, make sure you have all the facts before insisting that it be prescribed. Talk to your physician and insist on being told why one therapy may be better than another. It is critical that you be a truly educated consumer of health care.

Dr. David Lipschitz is the author of the book "Breaking the Rules of Aging." To find out more about Dr. David Lipschitz and read features by other Creators Syndicate writers and cartoonists, visit the Creators Syndicate Web page at www.creators.com. More information is available at www.drdavidhealth.com.

COPYRIGHT 2008 CREATORS SYNDICATE INC.