Dangerous Liaisons

Pharmaceutical ads abound in publications about cancer and AIDS—but they may be hazardous to your health

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Weight-lifting magazines bulk up on ads for supplements. Beauty magazines keep up their looks with messages from makeup manufacturers. Cooking magazines gorge on ads for the choicest ingredients. Whatever their subject matter, special-interest magazines are often financially dependent on advertisers from the very industries they aim to cover.

It's no secret that this chumminess can affect a magazine's editorial content. Questionable claims about the best brand of eye shadow or olive oil may not be such a big deal, but what happens when a magazine focuses on much more complicated, life-and-death issues? Take the case of a publication targeted toward people with AIDS—and full of pharmaceutical ads for AIDS-fighting drugs. How well are readers served when advertisers have a vested interest in seeing the illness treated in a specific way?

The question is not an idle one: The number of large-circulation, disease-specific magazines is on the rise. The trend began less than a decade ago with POZ, A&U, and later HIV Plus—national magazines that set out to serve the HIV-AIDS community by profiling activists, sharing personal stories, and providing news on the latest medical treatments. Several cancer-specific titles can now be found on the newsstand as well.

The earliest ventures were not designed to rely solely on drug ads. Publishers first tried promoting the affluent “gay demographic,” hoping to secure long-term contracts with high-profile general-interest advertisers; but mainstream clients quickly faded away when the audience proved more diverse—and less prosperous—than predicted.

The magazines survived in part by featuring more direct-to-consumer (DTC) ads placed by drug companies, promotions touting the health benefits of certain drug therapies. You've seen them: high-gloss shots of active, beaming patients followed by a page of government-mandated microscopic “mouse print” that details, among other things, the drug's potentially nasty side effects. At first, the models featured in the ads were more somber and thoughtful, but as public understanding of HIV and AIDS has increased, so has the vitality of the people the ads depict.

Today, the vast majority of the ads in leading HIV-AIDS publications come from pharmaceutical manufacturers. From a financial standpoint, the switchover has been positive—one-to- three-page ads now plump up the magazines—but many readers wonder if these publications can continue to provide unbiased health information.

“I view POZ as a commercial venture,” says Bob Tracy, director of community affairs and education for the Minnesota AIDS Project. “It's more about entertaining than informing me. If I'm looking for news, I'll go to one of the few publications that don't take advertising. I'm not saying I'll never look at POZ, because I do on a regular basis, but I do so with an understanding of the way publishing works. Sure, most of the advertising has no effect on content, but it may have an effect on 5 percent—and I don't know which 5 percent. It might be information that could affect my health.”

Sean Strub, founder of New York–based POZ, allows that the majority of his magazine's advertising revenue comes from drug companies; but he underscores his long involvement with such AIDS activist organizations as ACT-UP in defending his magazine against charges that advertisers may be influencing editorial content.

“If anything, the fact that most of our advertising comes from drug companies only increases our desire to maintain our credibility, to look critically at the drug companies and the products they are producing,” Strub says. “Because we were created by activists, we cater to activists. We expect to be held to a higher standard than other consumer magazines.”

John James, editor of the San Francisco–based nonprofit newsletter AIDS Treatment News, says that early on he made the decision to keep all advertising—including DTC campaigns—out of his publication. For people with AIDS and HIV, drugs and their side effects are potentially life-threatening issues, and he won't risk even the appearance of advertiser influence.

“Over the years, POZ has been able to remain remarkably independent, despite page after page of glossy ads,” James says. “Still, the concern I have is that there isn't any significant presence in the media that is not dependent on the drug industry for survival. In order for people to feel like they're really getting the whole story, there needs to be a clear group of publications that are independent, whose motivations you can't call into question, publishers who keep their hands clean.”

Easier said than done. Michael Wilke, a New York–based freelance reporter covering the DTC market, notes that when early promises of highbrow advertisers didn't pan out for AIDS magazines, the drug companies' siren song was hard to ignore. By the mid-1990s, the U.S. Food and Drug Administration had removed nearly all significant roadblocks to DTC advertising, which led to a major shift in how—and to whom—prescription drugs were marketed. Many magazines dropped their early reservations and went calling at the major pharmaceutical companies, pitching sales packages and even offering to critique ad content.

“Who can blame them? Over $1 billion in advertising revenue is available for prescription drugs alone,” Wilke says. “Though the boom has slowed a bit in recent years, it's still a very big segment of the industry, with lots of profits to be made.”

Companies that produce drugs to fight AIDS and HIV aren't the only ones looking to advertise. In recent years, the pharmaceutical industry has created DTC campaigns promoting a host of prescription drugs, including therapies for chemotherapy-related nausea, white blood cell loss, and many other cancer-related health concerns. Perhaps noting that fact, POZ Publishing in 1997 launched MAMM, a publication focused on breast cancer and other cancers that affect women. Two other new magazines, Coping and In Touch, also focus on the topic of cancer.

POZ has had a long-standing policy of a strong fire wall between advertising and editorial, and we've done the same thing here,” says Gwen Darien, editor of MAMM. “While the number of drug ads obviously affects the way people look at the magazine, I can honestly say it has no effect on our editorial content. A lot of readers say they turn to our advertising for information; for them it adds value.”

Strub acknowledges that the fire wall needs to be even sturdier now that his company publishes two titles dependent on drug manufacturers for their advertising revenue. “We've had more pressure from drug companies in the last year than we had in the previous four years combined,” he says. “But there never has been and never will be a party line around treatments in these magazines.”

James adds that over the years, POZ and MAMM have published several articles critical of drugs and drug companies, including a recent two-part series by Australian cancer activist Helen Caldicott, founder of Physicians for Social Responsibility.

“In the articles, Caldicott clearly explained that many of the companies that make the major cancer drugs are also the companies that produce the major cancer-causing chemicals,” James says. The series can be seen as a direct challenge to many of MAMM's big advertisers, he explains.

POZ recently published a two-part series by Martin Delaney, founder of the San Francisco-based AIDS activist organization Project Inform, in which Delaney suggested, against advice included in several of the same issues' pharmaceutical ads, that some people with HIV take structured “drug holidays” or stop taking AIDS treatment drugs altogether.

It's that kind of defiant attitude Strub hopes his readers will continue to look for in his magazine. It's a delicate balance, he knows, walking the tight-rope between editorial independence and financial viability.

Still, for Bob Tracy, it's important that the major disease-specific magazines find ways to wean their dependence on DTC advertising. It would be a difficult transition, he admits, but one that's definitely worth considering.

“I'm HIV-positive,” he says. “I've had experience with these drugs just like anybody else. But I've always realized in my personal relationships with the pharmaceutical companies that above all, they're self-interested. I hope the magazines continue to remember that, too.”