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Changing Their Role

TIMES HEALTH WRITER

Not that long ago, doctors who advertised their services risked ridicule in the conservative profession.

Even in this age of self-promoting cosmetic surgeons and laser eye doctors, many physicians still consider such behavior beneath them. But a new breed of high-profile doctors is combining celebrity with cyberspace to change the way medicine is practiced and promoted.

Known as “celebrity e-docs,” these physicians are using their fame--built through bestselling books, TV shows and the lecture circuit--to launch Internet sites that are part online clinic and part marketing tool.

“This is a major and important trend in health care,” says Tom Ferguson, a Harvard Medical School lecturer who has written frequently on the convergence of medicine and the Internet. “I call it the unbundling of the physician’s role.”

Instead of keeping within the traditional confines of the clinic and, perhaps, the pages of a book, celebrity e-docs, says Ferguson, are putting themselves “out there” for patients in a bold--and experimental--way.

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Former Surgeon General C. Everett Koop and alternative health pioneers Drs. Andrew Weil and Deepak Chopra were among the first to establish Web sites in their names. But more physicians are flocking to the medium. Within the last few months, Dr. Susan Love, the breast cancer expert, and Dr. Drew Pinsky, co-host of the popular “Love-line” talk show on MTV and KROQ-FM (106.7), have launched their own Web sites. Dr. Barry Sears, author of the bestselling “Zone” diet book series, plans to launch his own site soon.

Other well-known doctors have captured spots on Web sites sponsored by others. Nancy Snyderman, a medical correspondent for ABC and an otolaryngologist at UC San Francisco, is featured on Koop’s page. Dr. Bernie Siegel, a popular author and lecturer on mind-body medicine, and sex expert Ruth Westheimer have a presence on Weil’s page. Dr. Dean Edell, the syndicated radio host and TV medical reporter, can be found at Healthcentral.com (https://www.healthcentral.com).

These e-docs are exploring new ways to dispense medical advice and information that is timely and allows for direct communication between patient and doctor. Many observers believe the development has great potential to educate patients and enhance medical care.

But doctors with Web sites bearing their names must balance the delicate issues of professional responsibility and personal aggrandizement. As they aim to develop successful Internet businesses--and, potentially, create enormous personal wealth--they must strive to maintain their reputations as responsible advocates for health.

The cost of starting up a Web site capable of handling a respectable 1 million hits a day can reach $5 million to $10 million or more, according to Ferguson. Thus, it is necessary for these doctors to seek out corporate or private investors willing to cover most of the expense in hopes of a handsome profit down the road.

DrWeil.com (https://www.drweil.com), for example, is owned and operated by publishing giant Time Inc., which pays Weil a flat fee, said Steven Petrow, the site’s executive editor. Koop launched his site with investors, and when the company went public in 1999, Koop’s stake in the venture was valued at more than $55 million. (The Internet company’s stock price--and the value of Koop’s holdings--have since fallen.) But the headlines generated by the public offering no doubt caught the attention of other celebrity docs who were mulling their prospects on the Web.

Some Raise Money; Others, Just Visibility

While some physicians may view their Web sites as potentially lucrative investments, their motives vary. Chopra’s site, for example, is largely used as a promotional vehicle for his ever-expanding empire of books, tapes and seminars. He earns no income from advertisements or sponsors on the site.

Other doctors say they merely hope to break even with their Web sites but see the Internet as a way to enhance their authority and visibility in their respective fields.

“I think some doctors would like to be able to [make millions, as Koop did],” Ferguson says. “But it’s not easy to do that. Whether you can make money is very uncertain.”

To pay the bills, however, some of these medical Web sites accept advertising, sponsorships or sell products--activities not usually associated with the practice of medicine.

“I think physicians need to be part of this [Internet] world,” said Pinsky, a Los Angeles internist who inaugurated his site in October after a friend convinced him that he could continue to reach his target audience--young adults--via the Web.

“But I also think physicians need to be careful to be in the driver’s seat,” he added. “I don’t think they can let businesspeople be in the driver’s seat.”

The potential pitfalls of doctor dot-coms became clear last fall when Koop, the dean of U.S. medicine, was stung by criticism for blurring the lines between content and advertising on his site, DrKoop.com (https://www.drkoop.com) and for not disclosing his ties to businesses that advertised there. For example, Koop’s site used to list hospitals that it claimed were among the most innovative and advanced in the country. The site did not disclose that each of the 14 hospitals had paid a reported fee of $40,000 to be listed.

In response to the criticism, DrKoop.com announced changes intended to better separate the site’s editorial and informational content from its advertising. And Koop severed a financial arrangement in which he earned a percentage of revenue from some of the products and services advertised on his site.

Dr. Joshua Hauser, a University of Chicago ethicist who has studied physician Web sites, says the separation between advertising and content remains a sticky issue for these sites. “When you read . . . the New England Journal of Medicine or the Journal of the American Medical Assn.,” he says, “it’s usually very obvious. That’s not necessarily the case on the Web.”

Criticism Was an Eye-Opener

To be sure, other celebrity e-docs and wannabes took note of Koop’s blunder.

“Dr. Koop was singled out for some practices that are fairly prevalent in the health online community,” Petrow says. “But because he is the former surgeon general and wears that crown of integrity, they dinged him.”

Doctors who launch ambitious sites, Petrow says, may be stunned “by the huge amounts of revenue needed to run these Web sites.”

“There are a number of [ways] for making money on the Internet, none of them familiar to doctors,” says Ferguson, who writes the Ferguson Report, a newsletter on Internet health content.

Indeed, how to generate income to operate a site is “the million-dollar question” for dot-com docs, says Love, whose site for breast cancer patients and women with midlife health concerns was launched last month.

“I don’t want to put ads in the middle of content because I think that puts you in a conflict of interest--or the perception of a conflict of interest,” says Love, who is exploring raising revenue through sponsorships by biotechnology and pharmaceutical companies or through an “exhibit hall,” an online store that would sell medical-related products for consumers.

Sears, too, says he has decided against advertising.

“Web sites cost money. So you have to advertise egregiously or have products that are germane to your philosophy that you can sell to help pay for the site,” he says. “I think that is a more upfront way than advertising.”

While doctors like Koop and Dr. Julian Whitaker, a proponent of vitamin therapy who runs a clinic in Newport Beach and is the author of “Reversing Heart Disease” and several other books, post prominent advertisements on their sites, Pinsky argues that doctors shouldn’t do anything that might raise questions about the impartiality or integrity that they earn by taking the Hippocratic oath.

“We have to be more Catholic than the pope,” he says. “When we started out, we called the American Medical Assn. to see what their advertising policy is. And then we made ours tighter.” The AMA, like many other medical societies, adheres to a conservative policy in which only mainstream medical products--usually pharmaceuticals--are advertised.

Pinsky says his Web site will sell ad space but will accept ads only for proven products.

“For example, if we advertise a medication, it is either the only one in that class [of drugs] and is a good product, or we will discuss and educate people about all the other drugs in that class,” he says.

Pinsky says he is also exploring raising money through the syndication of material on his site.

How and where to run ads, sell products or tout sponsors is just one of the areas that celebrity e-docs must ponder. The other is how to ensure that the site will post accurate medical information. That may be easier said than done, given the need to feed an around-the-clock Web site with timely information, says ethicist Hauser.

“Unfortunately, we don’t have standards, or haven’t come to a consensus yet, about how to regulate or ensure high-quality, trustworthy information,” he says.

This issue is crucial in medicine, he says, “because the asymmetry of health care and information is tremendous. Doctors have a lot of information, and patients don’t have a lot. Patients rely on doctors to give it to them.”

Recognizing the problem, a nonprofit group called the Health on the Net Foundation has established a code of conduct for medical and health Web sites. The code includes eight principles that Web doctors agree to follow, including the vow that advice will be given only by a physician, unless otherwise stated, and policies on advertising.

Site operators that agree to the code can carry the foundation’s code emblem, as Love’s site does.

Doctor’s Presence Proves to Be a Crucial Point

To ensure that information is medically sound, however, some celebrity e-docs have found they need to be intimately involved in the day-to-day operations of the site--such as by reading and approving all content--or have employees trained in medicine or medical journalism to run the show.

“I think there is some real question about how often they are involved,” Hauser says. “I do think there is some responsibility, if your name is on the site, to be closely involved.”

The largest and most popular sites, Koop’s and Weil’s, are run largely by staff, although Petrow says that Weil spends six to nine hours a week on the site and “nothing goes up that he hasn’t read.”

Other Web docs say they will guard their reputations fastidiously by running their own sites.

“I intend to be very involved because it’s got my name on it,” Sears says. “The Web site will be my No. 1 priority each day.”

With strict policies on business ethics and strong physician oversight, e-docs have great potential to alter health care, Ferguson and others suggest.

“Celebrity doctors are doing this because it works,” he says. “Consumers want a feeling of connection with a person. The Internet provides doctors with a way to have a one-to-many relationship.”

“The Internet is a better and more efficient way to get information out,” Love says. “When you have questions, it may be at 2 a.m. when you can’t sleep. With the Internet, you can get on at any time and get information.”

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Dr. C. Everett Koop, https://wwww.DrKoop.com

Who: former U.S. surgeon general and leading national health authority.

Launched: 1998

Focus: general personal and public health topics

Revenue: advertising, sponsorships.

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Dr. Susan Love, https://www.SusanLoveMD.com

Who: surgeon; co-founder of the National Breast Cancer Coalition; author of “Dr. Susan Love’s Breast Book” and “Dr. Susan Love’s Hormone Book.”

Launched: December 1999

Focus: breast cancer and women’s midlife health issues

Revenue: possible pharmaceutical and biotech company sponsorship, “exhibit hall” of consumer products.

***

Dr. Drew Pinsky, https://www.drDrew.com

Who: Los Angeles-based internist and expert in addictions who co-hosts popular “Loveline” TV and radio show.

Launched: October 1999

Focuses: similar to “Loveline”; younger people interested in health, sex and relationships.

Revenue: advertising, sale of packaged material, possible syndication of content.

***

Dr. Andrew Weil, https://www.drweil.com

Who: Harvard-trained proponent of alternative and integrative medicine; author of seven books including the bestselling “8 Weeks to Optimum Health.”

Launched: 1996

Focuses on: integrative and alternative health practices.

Revenue: paid a flat fee (no commission) for links to vitamin company, also promotes his videos, books and newsletter.

***

Dr. Deepak Chopra

https://www.chopra.com

Who: New Age guru and author who emphasizes mind-body healing and ayurvedic medicine.

Launched: 1997

Focus: mind-body medicine and ayurveda.

Revenue: no income, however site promotes his products and seminars.

***

Dr. Julian Whitaker, https://www.DrWhitaker.com

Who: longtime advocate of alternative medicine who advocates power of diet and exercise.

Launched: 1999

Focus: alternative medicine and vitamins.

Revenue: consultant to vitamin companies who have links to his site.

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Dr. Barry Sears, https://www.drsears.com

Who: creator of the “Zone” diet named after his 1995 bestselling book advocating the link between nutrition and hormones; operates Sears Laboratories, a nutrition research institute.

Expected Launch: March 2000

Focus: nutrition and the role of hormones, such as insulin.

Revenue: will sell nutritional products.


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