Pharmaceutical promotion is going undercover to a theater near you.
Starting next month, moviegoers in select cities will be able to see the heart-wrenching real stories of three people suffering from immune diseases - rheumatoid arthritis, psoriasis and Crohn's disease - in a new kind of documentary.
What viewers will not see, unless they wait for the last line of the ending credits, is that the film was produced by Centocor Inc., the Horsham-based biotechnology subsidiary of Johnson & Johnson and maker of the No. 1 treatment for those diseases.
Nor will they hear the name of Centocor's drug, Remicade, or about its high cost, even though the patients are shown getting the treatment and talking about their recoveries.
The film, titled Innerstate, is the drug industry's boldest foray into a form of indirect promotions called "patient education" or "disease awareness," as opposed to more explicit drug ads on TV, infomercials or pitches to doctors.
Centocor says no other drug company has undertaken such a campaign merging art with promotion. Some companies have underwritten outside film projects or produced patient testimonials about their drugs.
In this case, Centocor's director of public relations, Michael Parks, actually served as executive producer and personally sifted through the stories of 40 patients to pick the three for the documentary. He is overseeing its theatrical release.
"This is not about Remicade. It's about elevating public awareness of these conditions," said Parks, who declined to say how much the project is costing.
Alexander Sugerman-Brozan, director of the Boston-based Prescription Access Litigation Project, which opposes "ridiculous, questionable or manipulative" drug advertising, said the film represented a questionable trend in health information.
"We need to be skeptical of disease-awareness campaigns that come from a company with a vested interest," said Sugerman-Brozan, who has not yet seen the film. "The first out of the gate is not necessarily the problematic one."
Industry advocates call "patient education" a powerful way to push valid health information to a jaundiced public - even if it means omitting the sponsor and product name.
"It's about building trust in the message," said Barbara Pagano, a senior vice president at HealthEd Inc., a Clark, N.J., patient-education consulting firm, which had no role in the film.
"It's ironic, yes, but with the reputation that the pharma industry has, it makes a difference if the sponsor is identified. If Centocor's name was on top, people wouldn't watch it. People would think it's a commercial," Pagano said.
The producer defied anybody to watch the film and call it a veiled commercial. Directed by New York filmmaker Chris Valentino, it spends just six of its 58 minutes explicitly discussing the unnamed treatment, including the drug's risk of causing tuberculosis. Mostly the film shows the unpaid patients, relatives and doctors retelling tales of physical and emotional pain, diagnosis, recovery and redemption.
The film opens with Jason Knott, a Texan with psoriasis, a disease that causes painful, red skin lesions from the uncontrolled production of skin cells. He recounts a childhood trauma of jumping into a neighborhood pool, only to see others flee the water in groundless fear of contagion.
Years later, "I remember going and watching them tear the pool apart and being glad it was gone. It was like, that pool can't hurt anyone again," Jason says.
Ray Ciccarelli of Maryland suffers from Crohn's disease, a gastrointestinal condition that can cause severe pain, diarrhea, weight loss and organ damage.
He says, after discovering the biotech treatment, "I feel like I've started over. My life is back on track. It was derailed for four years."
Janie Feliz, a young Texan with rheumatoid arthritis, says, "I grew up in five hours" after the diagnosis. To cope while in the hospital, she sang in a children's talent show and now is a rising performer. "Now I would say I'm almost healthy. As someone with a crippling disease, I'm healthy," Janie says.
After viewing the film, retired rheumatologist George Ehrlich of Philadelphia, a onetime chairman of the FDA's arthritis advisory committee, called it balanced and "remarkably free of commercial content."
"More power to Centocor," said Ehrlich, who has never worked for the company or its competitors. "Yes, they'll sell more Remicade. But they went out of their way not to name any particular drug."
His only criticism: "Too long."
Even without naming Remicade, Centocor stands to gain from increased disease-awareness because, as the market leader, it tends to capture most new prescriptions.
"Anything that benefits the overall market tends to benefit the market leaders the most," Pagano said.
At the same time, omission of Remicade's name means Centocor does not have to meet strict federal rules on listing the drug's risks. Parks noted the film discusses them anyway.
Remicade earned $3 billion in worldwide sales last year, priced between $16,000 and $20,000 a year per patient. Centocor currently is the subject of a federal investigation and protest campaign over Remicade's price and reimbursements.
The drug is administered by infusion every six to eight weeks, usually in doctors' offices, and it has competition from three products administered by self-injection: Enbrel, marketed by Wyeth and Amgen Inc.; Humira, by Abbott Laboratories; and Kineret, also by Amgen.
Wyeth, of Collegeville, declined an invitation to view and critique the film.
Parks said Centocor had rented 14 theaters in major cities and would show the film in March and April, at no cost, to the public. It also will sponsor group discussions and distribution through video stores and nonprofit groups.
What: A movie, followed by discussions with physicians and groups.
When: Starting in mid-March.
Where: Select cities.
Showing locally: At 10 a.m. April 28 at the King of Prussia Stadium 16 theater, 300 Goddard Blvd.,
King of Prussia.
On the Web: The site for the film is www.MyInnerstate.com.