By Patty Sposato
A 28-year-old Ohio O.D. launched the idea. See all the ripples he caused.
While the Federal Trade Commission makes up its mind about whether to permit price advertising of ophthalmic goods, some firms have deliberately been testing state controls by advertising mail-order contact lens spares and replacements in prominent national publications. In pursuit of advertising freedom, they have alienated themselves from those in the ophthalmic community who traditionally regard advertising as unethical.
What impact has national advertising had on the services and operations of those individuals and firms? Quite a bit, judging by the experience of 28-year-old Joseph Serian, a Columbus, Ohio, O.D. who operates both a private practice and a mail-order firm (20/20 Contact Lens Service, Inc.). He launched an extensive advertising campaign in Cosmopolitan and Playgirl to sell replacement contact lenses and spare lenses at advertised low prices, delivered by mail. Shortly after, Contact Specialists inc., of Marshall, Texas, began a similar campaign, but smaller in scope.
Economically speaking, 20/20′s campaign was an overwhelming success. After only one week’s operation, it reportedly had received thousands of inquiries over its national toll-tree telephone. A 20/20 spokesman declines to quote figures on consumer response to subsequent ads. He does say, though, that the ads unleashed such a torrent of public response that it was necessary to revamp the firm’s operations to accommodate demand.
How has the profession reacted to all this? Not very happily. Lawsuits have been threatened by those challenging the legality of the advertising. But as of press time, no actual litigation has taken place. Apparently a “wait and see” attitude prevails in all ranks of the profession.
The ophthalmic community’s reaction to 20/20′s operations went on record at recent F.T.C. hearings in Washington, DC. It was anything but friendly. Loudest opposition to price advertising came from the bastions of professional optometry and opticianry. Generally, those supporting it are consumers, economists, retail commercial establishments (both optometry and opticianry), drug store chains, and the F.T.C. Little has been heard publicly from ophthalmology, but its voice may be heard in a companion article appearing elsewhere in this issue.
Dr. Serian and 20/20 Contact Lens Service have apparently not endeared themselves to many ophthalmic groups. That became evident when the Ohioan testified at the F.T.C. hearings, particularly while being questioned by Hugh Stanley, representative of the National Association of Optometrists and Opticians. The testimony:
Mr. Stanley: “In conducting 20/20 Contact Lens Service, have you had difficulty from the American Optometric Association?”
Dr. Serian: “We have had harassment. Some national magazines have been skeptical about accepting our advertising; Bausch & Lomb cut off my soft lens supply because they thought l was, in turn, selling to 20/20 Contact Lens. That is the effect that the Association has had there.”
Dr. Serian’s counsel, Attorney Laurence E. Sturtz, then took the stand:
Mr. Stanley: “Has the American Optometric Association attempted to prevent 20/20 Contact Lens Service from conveying information to consumers through advertising?”
Attorney Sturtz: “We have received no formal document from any association. We have received phone calls from persons who later refused to identify themselves. We have asked for written documents and have been unable to get them. The only association that has put anything in writing is the State of New York. After we clarified some items to them, they indicated there would be no action taken.”
What legal research, if any, had taken place prior to the advertising campaign? Had Attorney Sturtz checked regulations and/or received clearance from states in which the national ads were to run?
Laws were checked in all 50 states prior to the advertising campaign, says Attorney Sturtz. And in so doing, he found “no ability to run the ad without potential interference.” This threat of resistance did not thwart 20/20 however, and while testifying Sturtz explained why:
“We were cognizant of the Supreme Court cases that were then pending, involving the regulation of drugs and drug advertising, and made the legal determination that filling a contact lens prescription would fall under the same rules. Therefore, we took a flyer. And fortunately, the Supreme Court agreed with us.”
Treatment at home base
What kind of treatment is being received by Dr. Serian and his company in his home state of Ohio? Judge from the testimony:
Dr. Serian: “I called the State Board and asked what was being done about 20/20 Contact Lens, without telling them I was Dr. Serian. They said: ‘We don’t like it, either,’ But as far as the State of Ohio is concerned, we were violating no law. It was very unethical what we did there, in their definition.”
Mr. Stanley: “How was it unethical? Could you explain that?”
Dr. Serian: “The commercial optometrist has been called ‘unethical’ because he advertises. But ethics is between the doctor and the patient, not how big the ad is in the Yellow Pages.”
Mr. Stanley: “Has Bausch & Lomb brought suit against you?”
Mr. Sturtz: “Bausch & Lomb has not brought any action against 20/20. But due to pressure, they did not feel they could fill the prescriptions forwarded by 20/20 at this time.”
Mr. Stanley: “Is there any identity as to the source of this pressure?”
Mr. Sturtz: “We have, in writing, a letter from the General Counsel who has indicated that, hopefully, through further discussions they can lift the ban and once again fill the prescriptions. They have said that they have been getting complaints from many optometrists who also buy from Bausch & Lomb, but did not list the names of the individuals and/or associations.”
Obviously there were motivating factors that influenced Dr. Serian to put his professional reputation on the line. He testified that he wanted to offer ophthalmic goods at an attractive price within the reach of many. Asked if he thought that consumers were being overcharged for ophthalmic goods and material, he replied:
“Let’s make a distinction between the doctor’s services and filling the prescription. I am not in a position to judge a doctor, whether he thinks that $40 for an examination is right, or if he thinks his time is worth $15.
It is the consumer’s right to choose the doctor he wants. But if the consumer is then forced to go to the same doctor and buy glasses only that doctor can prescribe and sell at a profit, yes, I feel that the consumer is paying too much.”
[CAPTION: "It disappoints me to see a medical problem being relegated to advertising and placing the unknowing patient in a position of potential danger," says Dr. Franle Weinstock, a clinical assistant professor of ophthalmology at Ohio State University, with a private practice of ophthalmology in Canton, Ohio.]
How 20/20 began
Explaining before the F.T.C. how 20/20 came into being, Serian says that the replacement service grew out of his own private practice, specializing in contact lenses. Many of his patients, although happy wearing contact lenses, had been neglecting to replace damaged or scratched lenses, presumably because of a cost factor.
Dr. Serian says that he could never justify selling materials at a profit because patients already had paid him as a doctor for the time taken to determine the prescription. So he decided to conduct a study to determine what was being charged across the country for contact lens fittings, as opposed to material or the replacement of lenses. His testimony:
Dr. Serian: “Prices varied anywhere from $100 to $300 for a hard, single vision lens fit; and the soft lens fee was $195 to $500 for the fitting. Fees for replacement of hard lenses ranged from $30 to $100.”
It was after this study that Dr. Serian said that he decided to begin 20/20 and that advertising was the only vehicle for reaching the people. How is it possible to advertise one uniform price if there are millions of variations in prescriptions?
He answers, “Expensive variations are about one in a hundred.” In cases of special complex designs, like bifocals, etc., which he expects to be available in five or six months, a larger amount, perhaps $25 more, would be charged.”
["This is the sort of thinking which led to the now defunct discount house craze of the 1950s. The whole idea is a generation behind the times." So says Dr. R.A. Koetting, St. Louis, Missouri, chairman ot the Contact Lens Committee of the American Academy of Optometry.]
The possibility of medical problems resulting from improperly curved lenses was introduced with this response:
Dr. Serian: “To my knowledge, there has never been permanent damage to vision or to the welfare of the patient if a contact lens didn’t fit properly. I believe there would be evident problems if the patient wasn’t wearing the right fit, but a fit is only determined by the doctor who specifies the relationship of the lens on the eye.”
Serian contends it is the responsibility of the examining doctor to write an exacting prescription as the first step in preventing improperly fit lenses. Careful verification of the manufactured lens with the doctor’s prescription is the follow up step to assure proper fit.
Exact wording of 20/20′s ads was pursued at length at the F.T.C. hearings. Dr. Serian was closely questioned on whether his ads explicitly recommend that patients return to their own eye practitioner for checkups.
Dr. Serian: “Our advertisement says: ‘Your eye doctor cannot be replaced. He is an integral part of the team. We merely fill the prescription.’ So obviously, if we say he can’t be replaced, we suggest that the patient continue his usual treatment, to have frequent eye check ups. Yes, we encourage regular checkups with the eye doctor. In fact, we are spending thousands of dollars in our advertising and brochures and papers to inform the consumer to go back to the eye doctor; only he can determine the correct fit of your glasses or contact lenses, although we do verify the lab’s lenses for accuracy.”
Dr. Serian says he sends a verification form to each doctor who provides him with a patient’s prescription by telephone, asking that specifications received by phone be confirmed as correct. If an error in specifications appears on the form, the doctor is asked to note the error and return the corrected prescription to him immediately.
Economical or not?
20/20 advertises spare and replacement hard contact lenses at $39.90 a pair and soft lenses for $99 a pair, with a 100 per cent money-back guarantee. F.T.C. interrogators wanted to know if the service, touted as an alternative to expensive contact lens insurance, was as economical as implied, and whether the doctor would levy an extra charge for checking the fit.
Dr. Serian: “Remember, this patient has already been examined. That is the largest expense for the doctor’s time. His obligation now is to take care of the patient, to make sure that the patient has the right fit. I think a doctor has every right to charge for this office visit, but only the office visit.
We can’t provide an examination. We don’t intend to. We just want to establish ourselves as an alternative so that the patient has a choice. A patient can go back to the eye doctor and buy a spare or replacement from him, or he can use this contact lens service.”
Dr. Serian, a graduate of Ohio State University is not a member of the A.O.A. or the Ohio Optometric Association because, “To be a member of the Association, you must belong to the state association. When I asked the state association if they would permit my listing in the yellow pages of the telephone directory that I specialize in contact lenses, they said no. It would be considered unethical. I felt if I joined, I would be thrown out. So I did not join.”
Dr. Serian has since told Forum that he has applied for membership in the Ohio and American Optometric Associations.