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  Research - Los Angeles Times Article

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Sealed With a Catch; Those stamps of approval on health products may be key marketing tools, but they're not cheap. And critics wonder if they are even necessary.

Doheny, K.

The Los Angeles Times (Pre-1997 Fulltext); Los Angeles, Calif.; Sep 12, 1995

Take a good look at your tube of toothpaste. Chances are, it has a "seal of acceptance" from the American Dental Assn.

Same goes for your dental floss, mouthwash and toothbrush, as well as the dental chair, the drill and the X-ray equipment that your dentist uses because you haven't been flossing, brushing or rinsing like you should.

These imprimaturs aren't limited to oral hygiene. Sunscreens, pain relievers, even boots are among the countless products and equipment that have the blessings of professional health organizations.

Why is this approval so important to some manufacturers, especially after the Food and Drug Administration--the granddaddy of approval--has already given its nod in many cases?

Marketing experts say the added approval is a smart marketing tool, especially in these times of increased competition for consumers.

But smaller companies and some ethicists complain that the reality is often "to the wealthiest go the seals." Others wonder if consumers really notice the seals.

Despite that debate, manufacturers know that enticing customers to buy a new product is one of their biggest challenges, says Roy D. Adler, a psychologist and a professor of marketing at Pepperdine University. "That's a hurdle even for something as mundane as toothpaste."

But getting the blessing of a respected organization, he says, "tells you someone else has tried it and has found it effective. It takes away the risk."

Debbie Lowman, a Los Angeles office manager, agrees. Before she switches to a new brand of toothpaste or mouthwash, she inspects the package to see if the product has earned any seals of approval. If the product is expensive and lacks a seal, Lowman, 34, thinks twice.

"I don't want to waste money," she says.

But Arthur L. Caplan, director of the Center for Bioethics at the University of Pennsylvania Medical Center, says that the practice of charging for seals of approval "is ethically dubious."

He worries that smaller companies can't compete with corporate giants.

"People expect objective information from nonprofits," Caplan adds. "I would want to know if six or seven figures changed hands before I got excited about a seal."

Professional organizations that issue seals argue that the programs are costly to oversee.

Until July, there was never a charge for the American Dental Assn. seal of acceptance, which tells you that your toothpaste or other dental product "has been shown to be an effective decay-preventive dentifrice that can be of significant value when used as directed in a conscientiously applied program of oral hygiene and regular professional care."

But since the program began in 1934, costs have escalated. And the fee is now crucial to offset the annual program operating costs of more than $1 million, says Kenneth Burrell, director of the ADA's Council on Scientific Affairs. So, manufacturers of over-the-counter products seeking the seal now pay a one-time $9,000 administrative fee and an annual fee of $1,500, he says. More than 500 manufacturers participate in the program, says the ADA, the Chicago-based organization of 140,000 dentists.

Before a seal is awarded, a manufacturer must give the ADA data on clinical and laboratory studies to support the claims of safety and effectiveness, submit advertising and other promotional materials and ingredients lists. Claims are reviewed by a bank of 100 consultants.

Other seal-approval programs vary. Some examples:

When seeking the American Podiatric Medical Assn.'s seal, manufacturers pay a $750 processing fee for a single product. The "seal of acceptance" is found on Thor-Lo athletic socks, Tony Lama boots, Acme and Dingo boots, among other products; the "seal of approval," reserved for pharmaceuticals, is on such products as Dr. Scholl's Original Foot Powder and Desenex anti-fungal products.

Next, the committee on podiatric seals reviews claims and may also use an independent lab to confirm them, charging the research costs back to the applicant, says spokesman Dean Wakefield.

"We don't do the testing," he says, "except wear testing {of shoes}, which is done by members."

Once approved, the company agrees to give a grant to fund APMA's foot health education programs, helping to support a toll-free consumer telephone service line, audiovisual materials, public service announcements and other components. This grant ranges from $2,500 to $10,000, the association says.

Sunscreen manufacturers wishing to obtain the Skin Cancer Foundation Seal of Recommendation must first be a member of the foundation's corporate council, which costs $10,000 per year, a representative says. (The money covers lab testing fees and benefits including free advertising in the foundation's journal.)

Manufacturers then submit proof of claims for the sun protection factor, safety and effectiveness, which are checked by an independent committee.

Soon, the foundation, a New York-based nonprofit group that conducts public education programs and funds research to reduce skin cancer, plans to evaluate sunglasses.

The Good Housekeeping Seal, the stamp that started it all, is more accurately a limited warranty, says Susanne Williams, director of consumer services of the Good Housekeeping Institute, which began the program 110 years ago. If any product bearing the seal proves defective within a year of purchase Good Housekeeping will replace it or refund the price.

When a company applies for the seal, institute officials look at the product and review ads and claims. If applicable, they determine if it meets Food and Drug Administration regulations. Among products with the seal are Kmart toothpaste, Maalox Caplets and Liquid, Fibercon Laxative and a host of other drugs and remedies, foods and household supplies.

A company then signs a licensing agreement, promising to run at least a two-thirds-page black-and-white advertisement in Good Housekeeping magazine, which costs $86,780.

The ultimate seal of approval came last year when the Arthritis Foundation agreed to put its name on a line of four over-the-counter drugs manufactured by McNeil Consumer Products Co., a Johnson & Johnson company.

As part of the agreement, McNeil gives the foundation a minimum of $1 million per year for research from the sale of Arthritis Foundation Pain Relievers, says Roy Scott, spokesman for the foundation. He says it's a natural extension of previous cooperative efforts in which the manufacturers would supply funding for educational brochures and other projects. There are no strings attached to the type of research funded, he says.

Now, he predicts the Arthritis Foundation will be a trendsetter. Other organizations, he says, "are waiting to see how it goes."

Putting its name on the pain reliever line is also a way for the foundation to beef up its membership. In each package is an invitation to join the Arthritis Foundation for a year and to get a year's issues of the bimonthly magazine, Arthritis Today, free. Normal cost is $20.

Some consumers, of course, pay no heed to these seals. And others may notice them selectively, contends Dennis Rook, USC professor of clinical marketing, depending on individual health concerns and problems.

The less risk a consumer associates with a product, the less weight a seal is likely to have, he adds. "If there's no risk, who cares {about a seal}?" he asks.

In addition, "there may be a negative attribution," he says, citing sunscreens as an example. Many people are already aware of the need to use sunscreens and the various sun protection factors, he points out. "Then they see 'cancer' {on the Skin Cancer Foundation's seal} and say 'Never mind.' "

(Consumer Reports on Health--a publication of Consumers Union--which does not accept advertising, takes no stand on whether consumers should look for seals of acceptance on health products, a representative says.)

Despite Rook's misgivings and the costs of getting a seal, many businesses try for it, but plenty are turned down.

About 20% of applicants for the American Podiatric Medical Assn.'s approval are declined each year, says spokesman Wakefield. "It varies year by year." One manufacturer was refused the seal because there was rough sewing on the inside of the shoe; when the defect was corrected the seal was awarded.

About 30% of products don't make it on the first try with the American Dental Assn., Burrell says. "We try to work with companies so they are eventually accepted," says Burrell, who notes that the approval process can take two years or longer.

At Good Housekeeping, 2% of applicants a year are turned down, estimates spokeswoman Williams.

Seals are often awarded for a specific time period. The ADA, for instance, usually awards the seal for a three-year period. And it requires manufacturers to reapply if a formula changes.

Of course, many products have done quite well without anyone's blessing. Neutrogena, for instance, markets a line of sun care products and has chosen not to feature the Skin Cancer Foundation seal, a representative says. Instead, the Los Angeles-based company markets via advertising and educational messages on a toll-free number.

Nike Inc., the footwear and apparel manufacturer, sees no need for a seal either. "It's inconsequential to us," says Robin Carr of Nike. "We prefer to rely on our own marketing."

Sometimes, seeking a seal is beyond the resources of smaller companies, says Nancy Rosenzweig, spokeswoman for Tom's of Maine, which recently earned the ADA seal for three flavors of its natural toothpaste. Administrative fees charged by the group, she knows now, can be just the beginning. Tom's, for instance, spent about $100,000 over seven years, Rosenzweig says, to conduct needed tests and help establish a definition for the term natural when it comes to toothpaste.

"Consumers should be aware that sometimes if smaller companies don't have seals, it doesn't mean the product is not worthy," she says.

But no matter how good their products or unlimited their budgets, some manufacturers will never win the nod of some professional health organizations. Among the holdouts: the American Medical Assn. and the American Dietetic Assn.

The AMA had a seal program for cosmetics and other products, but disbanded it in the mid-'50s. The American Dietetic Assn., says a representative, has "a longstanding policy of not endorsing products."


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