New wrinkle in anti-aging cosmetics

When a 73-year-old patient recently asked Dr. Jeffrey Dover how she could look more youthful, the prominent Chestnut Hill dermatologist had a ready answer. He suggested she visit a CVS drugstore across the street to shop for a specific brand of anti-aging, wrinkle-fighting, and lip-plumping creams.

The products were part of the doctor's own line of cosmetics, Skin Effects by Dr. Jeffrey Dover, sold exclusively at CVS.

''You will be able to afford this and you will love it," Dover said he told the patient.

Dover -- an author, frequent guest on television talk shows, and a part-time faculty member at the Yale University and Dartmouth College medical schools -- is among an increasing number of high-profile dermatologists profiting from selling over-the-counter skin treatments.

Doctor-branded lines of ''cosmeceuticals," as they have been come to be known in the industry, are rapidly moving from spas and physicians' offices into retail markets, and have become the fastest-growing segment of the $2.1 billion cosmetics market at prestige department stores, according to market research firm NPD Group. Now they are heading for even greater growth by infiltrating mid-level department stores and chain drugstores.

''This whole sector is exploding," said Dr. Bruce Katz, a New York dermatologist who sells an extensive line of products from his office. ''Cosmetic companies are rushing to get on board. They know this is the next big thing."

It also is pushing the boundaries of medical ethics, according to some doctors and academics who worry about dermatologists using their prestige to profit by selling glorified makeup to a trusting audience.

''You can only hope that the ethics of the doctor will prevail, and if they believe a product is good for someone, that is the only reason they will recommend it," said Dr. Robyn Gmyrek, a dermatologist at Columbia University's College of Physicians and Surgeons.

Over-the-counter wrinkle creams often contain an inflammatory agent or compound that stimulates collagen production, to temporarily reduce wrinkles and plump lips by puffing up the skin. Many also contain sunscreen, moisturizer, fragrances, and a variety of neutralizers and thickeners to make them feel good and minimize stinging.

Unlike the rigorous scientific testing it requires for prescription skin treatments, the US Food and Drug Administration does not require clinical trials to prove the effectiveness of over-the-counter cosmetics. In fact, they are not even reviewed by the FDA, which does not recognize the term ''cosmeceutical."

Despite the loose regulatory environment and lack of proof that they work, Madison Avenue is increasingly infusing these cosmetic lines with an aura of medical science.

Doctors on websites and in TV infomercials appear dressed in white lab coats. The products often have technical-sounding names; StriVectin-SD, a stretch-mark cream marketed to treat facial wrinkles, is a well-known, heavily advertised example. The packaging is typically spartan, giving them a technical, medicinal appearance.

One established brand, N.V. Perricone M.D. Ltd., offers a starter pack of cleansers, face creams, and eye ointments that come in what its website describes as a ''handy doctor's bag."

Wrinkle creams have been marketed to American women since the early 19th century, and some have earned doctors' endorsements. But there has been a new proliferation of ''celebrity dermatologists" who write books with popular appeal, dispense advice on TV, and also attach their names to mass-marketed products, said Kathy Peiss, a history professor at the University of Pennsylvania who has studied the cosmetic industry's evolution.

Some national firms have enlisted physician-marketers with academic affiliations. For example, Estee Lauder has tapped a doctor associated with Stanford University School of Medicine; and Bath & Body Works, a division of Limited Brands, has signed up a physician who teaches at Albert Einstein College of Medicine of Yeshiva University in New York.

CVS Corp. decided to jump into the fray with products that will cost about 75 percent less than some of the high-end products sold at department stores. Executives from the Rhode Island company approached Dover -- a former chairman of dermatology at the former New England Deaconess Hospital -- to develop a branded line to be sold exclusively in its 5,000 stores and, beginning this fall, in Dover's office.

A dermatologist who agreed at the Globe's request to review ingredients listed on Dover's product labels, Dr. Deborah Scott, director of the dermatology department in the women's health program at Brigham and Women's Hospital, said the products do contain active ingredients that are likely to provide some short-term cosmetic benefit. But the same ingredients are also contained in many products already on the market, Scott said.

Dover said he worked with CVS and a team of pharmaceutical chemists for months to develop the products' active ingredients, fragrance, and packaging. Dover and CVS would not discuss terms of his contract. Typically, doctors receive a percentage of revenue.

Getting a doctor to co-develop and sponsor the product was a critical element of the launch for CVS, said Eileen Howard Dunn, the company's vice president for corporate communications, who participated in the search for a dermatologist.

Dover ''brings integrity and credibility to the product," she said.

There is more to the trend than simply leveraging physicians' credibility, said Meg Walsh, managing director of Faith Popcorn's BrainReserve, a marketing firm in New York. It is part of a major shift toward giving consumers the power to diagnose and treat themselves for a variety of afflictions by mass-marketing over-the-counter treatments, some of which were formerly only available by prescription.

''We're like a nation of first-year medical students," Walsh said.

But a physician who profits from selling a product may place his financial interests ahead of a patient's health, said Arthur Caplan, director of the University of Pennsylvania Center for Bioethics.

Lucrative commercial agreements also tend to encourage more research into minor but marketable areas like wrinkles instead of serious diseases, he said.

''You're going where the money is and that distorts medicine," Caplan said. ''If my doctor is an entrepreneur, maybe I don't want that guy to be my dermatologist."

A spokeswoman for the American Academy of Dermatology said the academy's ethics committee has not reviewed the issued involved in physicians acting as entrepreneurs and marketers. In the late 1990s, it issued guidelines in response to the widespread practice of dermatologists selling any skin product to patients in their offices. The guidelines say doctors should ''do so in a manner with the best interest of their patient as their highest priority."

The American Medical Association, which represents doctors across all specialties, has a tighter set of guidelines. It says physicians who sell products in their offices must take measures to minimize conflicts of interest, including disclosing to their patients the nature of their financial arrangements with manufacturers.

''The risk is that patients will be exploited and that doctors will profit from that," said Dr. Priscilla Ray, chairwoman of the AMA ethics council.

Physicians being paid to market these products said they do not consider it an ethical problem. Dover said he typically prescribes stronger, prescription anti-aging treatments, and additionally suggests his own or other over-the-counter products.

''I'm a physician first. They are never told, 'This is what you have to have,' " he said.

He said he also takes care not to oversell the results his products can produce. ''They are not magic, but they help," said.

Dr. Katie Rodan, an associate clinical professor of dermatology at Stanford University School of Medicine, and a pioneer of over-the-counter cosmeceuticals, vigorously defended her marketing and retail role.

Rodan and a business partner, Dr. Kathy Fields, who is also a dermatologist, in the mid-1990s introduced a brand of acne treatment called Proactiv Solution and marketed it through infomercials in the mid-1990s. Estee Lauder jumped on the concept, and this year enlisted the doctors to market a line of wrinkle creams under the name Rodan + Fields. A website shows the two physicians standing back-to-back, smiling at the camera, wearing lab coats.

''Who is better than a dermatologist to come up with these ideas?" Rodan said in a telephone interview. ''The only reason we were able to create a product to treat acne the way we did was because of our training and experience. We're not making pizza sauce and claiming that it is going to treat cancer."

Christopher Rowland can be reached at crowland@globe.com.