This article was downloaded by: [University of Utah] On: 02 December 2014, At: 23:37 Publisher: Routledge Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK
The American Journal of Bioethics Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/uajb20
Capitalism Works for Health Care Too a
Ari Z. Zivotofsky & Naomi T. S. Zivotofsky a
b
Bar-Ilan University
b
Maccabi Health Services and Sackler Medical School, Tel Aviv University Published online: 04 Mar 2014.
To cite this article: Ari Z. Zivotofsky & Naomi T. S. Zivotofsky (2014) Capitalism Works for Health Care Too, The American Journal of Bioethics, 14:3, 56-58, DOI: 10.1080/15265161.2013.879956 To link to this article: http://dx.doi.org/10.1080/15265161.2013.879956
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Downloaded by [University of Utah] at 23:37 02 December 2014
The American Journal of Bioethics
know what health care they need. Any patient, regardless of his or her financial means or type of insurance, bears this same vulnerability to health care advertisements. Likewise, any patient might suffer the complications, side effects, and other ill consequences that result. Though I agree with Schenker and colleagues regarding the risks associated with health care advertisements that encourage unnecessary care, I add that when they specifically target wealthier patients, disadvantaged patients may be prevented from obtaining necessary care. As the authors note, health care advertisements consume limited health care resources and thereby harm the greater community. Yet through their efforts to lure wealthier patients, health care advertisements risk diverting health care resources away from the disadvantaged and toward the wealthy. When wealthier patients seek unnecessary care at the prompting of advertisements directed specifically at them, they fill appointment slots and hospital beds. A bed taken by a wealthier patient admitted for unnecessary care may be a bed taken away from a disadvantaged patient in want of necessary care. Certainly, the wealthier patient receiving unnecessary care is at risk for unnecessary complications and side effects. However, when health care resources are consumed by providing unnecessary care for the wealthy, they are also siphoned away from providing necessary care for the disadvantaged. This renders health care advertisements even more problematic.
Clearly, hospitals must achieve some degree of financial success in order to keep their doors open. Yet in pursuit of profits, health care advertisements endanger patients. By specifically inviting wealthier patients to undergo unnecessary care, health care advertisements also direct resources away from disadvantaged patients, further eroding their access to care. Therefore, health care advertisements are even more ethically problematic because they risk exacerbating existing health care disparities. Though disadvantaged patients might be spared some of the risks and burdens of unnecessary care, they will ultimately suffer when hospitals have no room for them to obtain the care they need.
REFERENCES Centers for Disease Control and Prevention. 2013. Data 2020. Healthy People 2020. Available at: http://www.healthypeople. gov/2020/data/default.aspx (accessed December 11, 2013). Larson, R. J., L. M. Schwartz, S. Woloshin, and H. G. Welch. 2005. Advertising by academic medical centers. Archives of Internal Medicine 165: 645–651. Schenker, Y., R. M. Arnold, and A. London. 2014. The ethics of advertising for health care services. American Journal of Bioethics 14(3): 34–43.
Capitalism Works for Health Care Too Ari Z. Zivotofsky, Bar-Ilan University Naomi T. S. Zivotofsky, Maccabi Health Services and Sackler Medical School, Tel Aviv University Capitalism has been shown to be the most successful economic system, one that creates more prosperity than any other and benefits the consumer in many ways. A mainstay of capitalism is the free market, in which multiple entities compete for the consumer’s business in order to boost profits. This profit motive helps ensure that companies are responsive to the desires of the consumer and strive to enhance their product. One aspect of this competition is that businesses try to influence consumers through marketing and advertising. In a regulated system in which advertisements are held to certain minimal standards of truth, they play an important role in educating consumers, providing options, and forcing businesses to enhance a product or service in order to compete. Schenker, Arnold, and London (2014) summarize the legal development of advertising for medical services, illustrating that up until recent decades it was frowned upon
by medical societies and was illegal in the United States. In 1980 the U.S. judiciary determined that such advertising was legal, and the last few years have seen a surge in advertising by drug companies, medical centers, specialty clinics, and even individual physicians. Schenker and colleagues (2014) then suggest that any and all advertising related to medicine and medical care is ethically problematic. While agreeing that the physician–patient relationship and health care provision differ substantially from other goods and services, we propose that regulated advertising for many aspects of health care actually benefits patients and society. Before addressing the specifics of health care advertising, it should be noted that it is easy to criticize medical advertising in light of the fact that general advertising is frequently viewed with suspicion. Jerry Kirkpatrick (1986) in a defense of advertising quotes several examples of how
Address correspondence to Ari Z. Zivotofsky, Gonda Brain Science Center, Bar-Ilan University, Ramat-Gan 52900, Israel. E-mail: [email protected]
56 ajob
March, Volume 14, Number 3, 2014
Advertising for Health Care Services
Downloaded by [University of Utah] at 23:37 02 December 2014
advertising is perceived. He quotes historian Arnold Toynbee as saying that he “cannot think of any circumstances in which advertising would not be an evil,” and cites John Kenneth Galbraith as accusing advertising of creating desires that otherwise would not exist and of manipulating consumers into buying unneeded new brands of breakfast cereal and laundry detergent. Despite the rhetoric of its detractors, advertising is simply not a superpowerful entity. Capitalism assumes a certain degree of intelligence, knowledge, and free choice on the part of the average citizen, and to quote Kirkpatrick (1986): Speaking precisely and technically, advertising cannot change tastes, create needs or wants, or even create demand. Advertising can make consumers aware of needs, it can stimulate their wants, it can stimulate demand, and it can make it possible for consumers to enjoy a greater and wider range of tastes. But tastes, needs, wants and demand all originate within the consumer. (47)
Various types of health care advertising exist. Some are indirect and implicit, such as a local news report highlighting recent successes or a health clinic’s website, while others are direct and explicit, such as billboards touting a specific hospital or department. Such advertising should certainly not be a free-for-all, and external control, as exists for all advertising, as well as internal self-regulation, should be instituted. This process would be not dissimilar to that used by institutional review boards and ethics committees. Nelson and Taylor (2012) suggest that in order for health care advertising to reflect the mission, vision, and values of the health care facility, a formal process should be established to guarantee that the marketing is ethically grounded and responsible. Such a process could begin with the marketing department following established guidelines regarding accuracy and values, with the advertisement then being reviewed by clinicians or other professionals knowledgeable about the topic, and then being reviewed by “outside” reviewers. The self-promotion of a hospital website can be very useful, for example, for a patient in a major metropolitan area requiring a surgical procedure who needs to choose a hospital. Physicians and hospitals are licensed by regulatory agencies, thus guaranteeing for the consumer a minimum acceptable standard. Consumers will thus need to make a decision based on other factors, many of which will impact not only on their comfort but potentially on the medical outcome as well. Muhlestein, Wilks, and Richter (2013) conducted a recent survey of hospitals advertising via their own websites. The first thing the surgical patient needs to determine is which hospital offers the required procedure. Muhlestein and colleagues found that more than half of hospitals included information about service lines. Nearly half had some quality outcome data available and one-third featured outside awards. But the hospitals did not stop at that, and in order to attract “customers” almost one-third include information about amenities, including information about parking, cafeterias, gift shops, chaplains, and support
March, Volume 14, Number 3, 2014
groups. Including items such as wait time in a physician office or number of patients sharing a hospital room may seem like unfair advertising techniques, but while seemingly nonmedical, they can be important to patient comfort and can be medically significant, for instance, in terms of reducing nosocomial infection, a major health concern. This advertising is beneficial for both the potential patient and his loved ones. Thus, hospital advertising can be beneficial in making an informed decision and in improving service. Hospital advertising is not limited to the subtle and implicit; hospitals today make use of such bold methods as highway billboards, a medium that generates significant attention. These, by definition, contain much less information than a website and need to be more creative. Fortenberry and McGoldrick (2010) report that billboard advertisements are both noticed by patients and favorably viewed by patients. The billboards in the study were efficacious in bringing in new and returning patients, who reported that they found that the billboards increased awareness and provided information. Billboards and other modalities may describe services available. This serves two important functions: It informs the consumer where he can receive said service, and it educates that this service exists. While it may appear to convince others of an unnecessary service, the provider should refuse to offer that service when approached. A physician offering unnecessary vaccinations or a clinic performing superfluous operations should be censured by the appropriate licensing agency. In the United States and many Western countries the health care system is primarily a free market. Even if the trend in recent years is toward more centralized and government-controlled health care, access to physicians, hospitals, and clinics still maintains an element of competition—both for the individual and for the government or health care funds’ contract decisions. How is the average consumer to even know, for example, the most basic of facts, such as which hospitals in her metropolitan area offer which services? Clearly, advertising, in all its forms, serves to inform the consumer. A most rudimentary form of advertising is the organization’s website. Every health care facility has a website whose content is determined by that facility. That is clearly a form of legal and beneficial advertising, albeit perhaps implicit. Schenker and colleagues (2014) approvingly cite the motto of Cancer Treatment Centers of America and the “vision” of the University of Pittsburgh Medical Center as found on their websites without recognizing that those are in effect advertisements! Advertising by individual physicians may raise some different ethical and marketing concerns than those for hospitals. Lim and Zallocco (1997) highlight that consumers have positive attitudes toward health care institution advertising but view such activities by hospitals to be more appropriate than similar activities by individual physicians. Ethically as well, such activities are often viewed as more controversial for individual providers and have led to the continued existence of bans on physician advertising in many jurisdictions including most of Europe, Asia, and
ajob 57
Downloaded by [University of Utah] at 23:37 02 December 2014
The American Journal of Bioethics
South America. Zwier (2014) has raised important concerns about the negative repercussions of such bans. She has pointed out that in a society inundated with advertising, such a ban contributes to the perceived character of the product or service concerned and thereby the public’s position in relation to that product or service. In general, advertising sends a signal of an interest on the part of the provider, implies that there is a variety in the services offered, and implies that there is some level of nonexclusiveness. All of these are important messages in today’s physician–patient relationship. None of this in any way minimizes the priority that physicians place on proper patient care. As Naidoo (2012) expressed it regarding dental advertising: “It is the professional and ethical responsibility of dentists to educate their patients about their condition and to advise and offer them the best possible options for care.” As we noted, there may be differences in advertising between health care facilities and individual physicians; so too the ethics of pharmaceutical direct consumer advertising has its own issues. Patients are often not able to evaluate risks and benefits, and often fail to read drug inserts and other information provided. This can lead to misuse of even relatively benign over-the-counter medications. For example, Archontaki and colleagues (2009) attributed a significant increase in rhinitis medicamentosa (RM), rebound nasal congestion caused by extended use of topical nasal decongestants, in a region of Greece to an intensive media advertising campaign for nasal topical decongestants. Amazingly, 80% of their RM patients had made their purchasing decision solely on the basis of the information supplied by the drug advertisement without consulting their doctor or pharmacist. Such examples do not demand an absolute ban on such advertising, but rather point to the need for tighter regulation. We are surely not naive to the point of believing that every citizen is an expert in all matters. Government oversight and regulation by experts is certainly required (see Zivotofsky and Zivotofsky 2011). But supervision is a far cry from banning. Medical care and patients are not what they once were. Chronic diseases increase the palliative role of physicians, impersonal, high-tech testing is replacing the physical exam, insurance companies play an ever-increasing role in care choices, and Internet access and direct-to-consumer advertising are changing the knowledge base of patients and
58 ajob
thereby the doctor–patient relationship. Schenker and colleagues (2014) are correct—the stakes are high and health care decisions are important, nay, life altering—and therefore patients are entitled to as much accurate information as they can glean. One of the methods of knowledge dissemination in modern society is advertising. Each player in the panoply of health care providers should be encouraged to responsibly strut its wares in order to continually improve the health and well-being of society.
REFERENCES Archontaki, M., E. K. Symvoulakis, J. K. Hajiioannou, et al. 2009. Increased frequency of rhinitis medicamentosa due to media advertising for nasal topical decongestants. B-ENT 5(3): 159– 162. Fortenberry, J. L., Jr., and P. J. McGoldrick. 2010. Is billboard advertising beneficial for healthcare organizations? An investigation of efficacy and acceptability to patients. Journal of Healthcare Management 55(2): 81–95. Kirkpatrick, J. 1986. A philosophic defense of advertising. Journal of Advertising 15:2, 42–48, 64. Lim, J.-S., and R. Zallocco. 1997. Consumer attitudes toward healthcare marketing practices: A comparison of hospitals vs. physicians. Journal of Hospital Marketing 12(1): 91–108. Muhlestein, D. B., C. E. Wilks, and J. P. Richter. 2013. Limited use of price and quality advertising among American hospitals. Journal of Medical Internet Research 15(8): e185. Naidoo, S. 2012. Dental ethics case 23. The ethics of advertising in dentistry. SADJ Journal of the South African Dental Association 67(6): 284–286. Nelson, W. A., and E. C. Taylor. 2012. Ethics and advertising. Healthcare organizations must have an ethical framework in place for advertising. Healthcare Executive 27(2): 52, 54–55. Schenker, Y., R. M. Arnold, and A. London. 2014. The ethics of advertising for health care services. American Journal of Bioethics 14(3): 34–43. Zivotofsky, A. Z., and N. T. Zivotofsky. 2011. Withholding or necessary filtering of information? American Journal of Bioethics 11(12): 70–72. Zwier, S. 2014. The neglected repercussions of a physician advertising ban. Journal of Medical Ethics, in press.
March, Volume 14, Number 3, 2014
The American Journal of Bioethics Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/uajb20
Capitalism Works for Health Care Too a
Ari Z. Zivotofsky & Naomi T. S. Zivotofsky a
b
Bar-Ilan University
b
Maccabi Health Services and Sackler Medical School, Tel Aviv University Published online: 04 Mar 2014.
To cite this article: Ari Z. Zivotofsky & Naomi T. S. Zivotofsky (2014) Capitalism Works for Health Care Too, The American Journal of Bioethics, 14:3, 56-58, DOI: 10.1080/15265161.2013.879956 To link to this article: http://dx.doi.org/10.1080/15265161.2013.879956
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Downloaded by [University of Utah] at 23:37 02 December 2014
The American Journal of Bioethics
know what health care they need. Any patient, regardless of his or her financial means or type of insurance, bears this same vulnerability to health care advertisements. Likewise, any patient might suffer the complications, side effects, and other ill consequences that result. Though I agree with Schenker and colleagues regarding the risks associated with health care advertisements that encourage unnecessary care, I add that when they specifically target wealthier patients, disadvantaged patients may be prevented from obtaining necessary care. As the authors note, health care advertisements consume limited health care resources and thereby harm the greater community. Yet through their efforts to lure wealthier patients, health care advertisements risk diverting health care resources away from the disadvantaged and toward the wealthy. When wealthier patients seek unnecessary care at the prompting of advertisements directed specifically at them, they fill appointment slots and hospital beds. A bed taken by a wealthier patient admitted for unnecessary care may be a bed taken away from a disadvantaged patient in want of necessary care. Certainly, the wealthier patient receiving unnecessary care is at risk for unnecessary complications and side effects. However, when health care resources are consumed by providing unnecessary care for the wealthy, they are also siphoned away from providing necessary care for the disadvantaged. This renders health care advertisements even more problematic.
Clearly, hospitals must achieve some degree of financial success in order to keep their doors open. Yet in pursuit of profits, health care advertisements endanger patients. By specifically inviting wealthier patients to undergo unnecessary care, health care advertisements also direct resources away from disadvantaged patients, further eroding their access to care. Therefore, health care advertisements are even more ethically problematic because they risk exacerbating existing health care disparities. Though disadvantaged patients might be spared some of the risks and burdens of unnecessary care, they will ultimately suffer when hospitals have no room for them to obtain the care they need.
REFERENCES Centers for Disease Control and Prevention. 2013. Data 2020. Healthy People 2020. Available at: http://www.healthypeople. gov/2020/data/default.aspx (accessed December 11, 2013). Larson, R. J., L. M. Schwartz, S. Woloshin, and H. G. Welch. 2005. Advertising by academic medical centers. Archives of Internal Medicine 165: 645–651. Schenker, Y., R. M. Arnold, and A. London. 2014. The ethics of advertising for health care services. American Journal of Bioethics 14(3): 34–43.
Capitalism Works for Health Care Too Ari Z. Zivotofsky, Bar-Ilan University Naomi T. S. Zivotofsky, Maccabi Health Services and Sackler Medical School, Tel Aviv University Capitalism has been shown to be the most successful economic system, one that creates more prosperity than any other and benefits the consumer in many ways. A mainstay of capitalism is the free market, in which multiple entities compete for the consumer’s business in order to boost profits. This profit motive helps ensure that companies are responsive to the desires of the consumer and strive to enhance their product. One aspect of this competition is that businesses try to influence consumers through marketing and advertising. In a regulated system in which advertisements are held to certain minimal standards of truth, they play an important role in educating consumers, providing options, and forcing businesses to enhance a product or service in order to compete. Schenker, Arnold, and London (2014) summarize the legal development of advertising for medical services, illustrating that up until recent decades it was frowned upon
by medical societies and was illegal in the United States. In 1980 the U.S. judiciary determined that such advertising was legal, and the last few years have seen a surge in advertising by drug companies, medical centers, specialty clinics, and even individual physicians. Schenker and colleagues (2014) then suggest that any and all advertising related to medicine and medical care is ethically problematic. While agreeing that the physician–patient relationship and health care provision differ substantially from other goods and services, we propose that regulated advertising for many aspects of health care actually benefits patients and society. Before addressing the specifics of health care advertising, it should be noted that it is easy to criticize medical advertising in light of the fact that general advertising is frequently viewed with suspicion. Jerry Kirkpatrick (1986) in a defense of advertising quotes several examples of how
Address correspondence to Ari Z. Zivotofsky, Gonda Brain Science Center, Bar-Ilan University, Ramat-Gan 52900, Israel. E-mail: [email protected]
56 ajob
March, Volume 14, Number 3, 2014
Advertising for Health Care Services
Downloaded by [University of Utah] at 23:37 02 December 2014
advertising is perceived. He quotes historian Arnold Toynbee as saying that he “cannot think of any circumstances in which advertising would not be an evil,” and cites John Kenneth Galbraith as accusing advertising of creating desires that otherwise would not exist and of manipulating consumers into buying unneeded new brands of breakfast cereal and laundry detergent. Despite the rhetoric of its detractors, advertising is simply not a superpowerful entity. Capitalism assumes a certain degree of intelligence, knowledge, and free choice on the part of the average citizen, and to quote Kirkpatrick (1986): Speaking precisely and technically, advertising cannot change tastes, create needs or wants, or even create demand. Advertising can make consumers aware of needs, it can stimulate their wants, it can stimulate demand, and it can make it possible for consumers to enjoy a greater and wider range of tastes. But tastes, needs, wants and demand all originate within the consumer. (47)
Various types of health care advertising exist. Some are indirect and implicit, such as a local news report highlighting recent successes or a health clinic’s website, while others are direct and explicit, such as billboards touting a specific hospital or department. Such advertising should certainly not be a free-for-all, and external control, as exists for all advertising, as well as internal self-regulation, should be instituted. This process would be not dissimilar to that used by institutional review boards and ethics committees. Nelson and Taylor (2012) suggest that in order for health care advertising to reflect the mission, vision, and values of the health care facility, a formal process should be established to guarantee that the marketing is ethically grounded and responsible. Such a process could begin with the marketing department following established guidelines regarding accuracy and values, with the advertisement then being reviewed by clinicians or other professionals knowledgeable about the topic, and then being reviewed by “outside” reviewers. The self-promotion of a hospital website can be very useful, for example, for a patient in a major metropolitan area requiring a surgical procedure who needs to choose a hospital. Physicians and hospitals are licensed by regulatory agencies, thus guaranteeing for the consumer a minimum acceptable standard. Consumers will thus need to make a decision based on other factors, many of which will impact not only on their comfort but potentially on the medical outcome as well. Muhlestein, Wilks, and Richter (2013) conducted a recent survey of hospitals advertising via their own websites. The first thing the surgical patient needs to determine is which hospital offers the required procedure. Muhlestein and colleagues found that more than half of hospitals included information about service lines. Nearly half had some quality outcome data available and one-third featured outside awards. But the hospitals did not stop at that, and in order to attract “customers” almost one-third include information about amenities, including information about parking, cafeterias, gift shops, chaplains, and support
March, Volume 14, Number 3, 2014
groups. Including items such as wait time in a physician office or number of patients sharing a hospital room may seem like unfair advertising techniques, but while seemingly nonmedical, they can be important to patient comfort and can be medically significant, for instance, in terms of reducing nosocomial infection, a major health concern. This advertising is beneficial for both the potential patient and his loved ones. Thus, hospital advertising can be beneficial in making an informed decision and in improving service. Hospital advertising is not limited to the subtle and implicit; hospitals today make use of such bold methods as highway billboards, a medium that generates significant attention. These, by definition, contain much less information than a website and need to be more creative. Fortenberry and McGoldrick (2010) report that billboard advertisements are both noticed by patients and favorably viewed by patients. The billboards in the study were efficacious in bringing in new and returning patients, who reported that they found that the billboards increased awareness and provided information. Billboards and other modalities may describe services available. This serves two important functions: It informs the consumer where he can receive said service, and it educates that this service exists. While it may appear to convince others of an unnecessary service, the provider should refuse to offer that service when approached. A physician offering unnecessary vaccinations or a clinic performing superfluous operations should be censured by the appropriate licensing agency. In the United States and many Western countries the health care system is primarily a free market. Even if the trend in recent years is toward more centralized and government-controlled health care, access to physicians, hospitals, and clinics still maintains an element of competition—both for the individual and for the government or health care funds’ contract decisions. How is the average consumer to even know, for example, the most basic of facts, such as which hospitals in her metropolitan area offer which services? Clearly, advertising, in all its forms, serves to inform the consumer. A most rudimentary form of advertising is the organization’s website. Every health care facility has a website whose content is determined by that facility. That is clearly a form of legal and beneficial advertising, albeit perhaps implicit. Schenker and colleagues (2014) approvingly cite the motto of Cancer Treatment Centers of America and the “vision” of the University of Pittsburgh Medical Center as found on their websites without recognizing that those are in effect advertisements! Advertising by individual physicians may raise some different ethical and marketing concerns than those for hospitals. Lim and Zallocco (1997) highlight that consumers have positive attitudes toward health care institution advertising but view such activities by hospitals to be more appropriate than similar activities by individual physicians. Ethically as well, such activities are often viewed as more controversial for individual providers and have led to the continued existence of bans on physician advertising in many jurisdictions including most of Europe, Asia, and
ajob 57
Downloaded by [University of Utah] at 23:37 02 December 2014
The American Journal of Bioethics
South America. Zwier (2014) has raised important concerns about the negative repercussions of such bans. She has pointed out that in a society inundated with advertising, such a ban contributes to the perceived character of the product or service concerned and thereby the public’s position in relation to that product or service. In general, advertising sends a signal of an interest on the part of the provider, implies that there is a variety in the services offered, and implies that there is some level of nonexclusiveness. All of these are important messages in today’s physician–patient relationship. None of this in any way minimizes the priority that physicians place on proper patient care. As Naidoo (2012) expressed it regarding dental advertising: “It is the professional and ethical responsibility of dentists to educate their patients about their condition and to advise and offer them the best possible options for care.” As we noted, there may be differences in advertising between health care facilities and individual physicians; so too the ethics of pharmaceutical direct consumer advertising has its own issues. Patients are often not able to evaluate risks and benefits, and often fail to read drug inserts and other information provided. This can lead to misuse of even relatively benign over-the-counter medications. For example, Archontaki and colleagues (2009) attributed a significant increase in rhinitis medicamentosa (RM), rebound nasal congestion caused by extended use of topical nasal decongestants, in a region of Greece to an intensive media advertising campaign for nasal topical decongestants. Amazingly, 80% of their RM patients had made their purchasing decision solely on the basis of the information supplied by the drug advertisement without consulting their doctor or pharmacist. Such examples do not demand an absolute ban on such advertising, but rather point to the need for tighter regulation. We are surely not naive to the point of believing that every citizen is an expert in all matters. Government oversight and regulation by experts is certainly required (see Zivotofsky and Zivotofsky 2011). But supervision is a far cry from banning. Medical care and patients are not what they once were. Chronic diseases increase the palliative role of physicians, impersonal, high-tech testing is replacing the physical exam, insurance companies play an ever-increasing role in care choices, and Internet access and direct-to-consumer advertising are changing the knowledge base of patients and
58 ajob
thereby the doctor–patient relationship. Schenker and colleagues (2014) are correct—the stakes are high and health care decisions are important, nay, life altering—and therefore patients are entitled to as much accurate information as they can glean. One of the methods of knowledge dissemination in modern society is advertising. Each player in the panoply of health care providers should be encouraged to responsibly strut its wares in order to continually improve the health and well-being of society.
REFERENCES Archontaki, M., E. K. Symvoulakis, J. K. Hajiioannou, et al. 2009. Increased frequency of rhinitis medicamentosa due to media advertising for nasal topical decongestants. B-ENT 5(3): 159– 162. Fortenberry, J. L., Jr., and P. J. McGoldrick. 2010. Is billboard advertising beneficial for healthcare organizations? An investigation of efficacy and acceptability to patients. Journal of Healthcare Management 55(2): 81–95. Kirkpatrick, J. 1986. A philosophic defense of advertising. Journal of Advertising 15:2, 42–48, 64. Lim, J.-S., and R. Zallocco. 1997. Consumer attitudes toward healthcare marketing practices: A comparison of hospitals vs. physicians. Journal of Hospital Marketing 12(1): 91–108. Muhlestein, D. B., C. E. Wilks, and J. P. Richter. 2013. Limited use of price and quality advertising among American hospitals. Journal of Medical Internet Research 15(8): e185. Naidoo, S. 2012. Dental ethics case 23. The ethics of advertising in dentistry. SADJ Journal of the South African Dental Association 67(6): 284–286. Nelson, W. A., and E. C. Taylor. 2012. Ethics and advertising. Healthcare organizations must have an ethical framework in place for advertising. Healthcare Executive 27(2): 52, 54–55. Schenker, Y., R. M. Arnold, and A. London. 2014. The ethics of advertising for health care services. American Journal of Bioethics 14(3): 34–43. Zivotofsky, A. Z., and N. T. Zivotofsky. 2011. Withholding or necessary filtering of information? American Journal of Bioethics 11(12): 70–72. Zwier, S. 2014. The neglected repercussions of a physician advertising ban. Journal of Medical Ethics, in press.
March, Volume 14, Number 3, 2014
