Letters to the Editor
ETHICS OF THE MEDICAL PROFESSION RELATING TO ADVERTISING AND PROMOTION OF HEALTH-RELATED PRODUCTS - A CASE STUDY
In this time of increasing affluence and competition, it is natural for companies to have to work harder to increase their market share by creating any image that will appeal to the consumer. For example, some companies sell consumer products with pseudo-medical claims, ie. claims that impress the consumers with an image of authority and science, often beyond what is realistic, balanced or fair. To increase the credibility of these claims, medical professionals have sometimes been employed by such companies to assist in promoting their products to the general public, through talks and seminars organised by the companies. Such involvement is viewed as ethically improper. The following is a case study of one actual incident. By coincidence, the doctor involved was foreign, but her involvement in a public talk organised by a local company marketing a skin-care product illustrates the ethical difficulties very well.
In August 1996, the Singapore Medical Association was alerted to an advertisement in the Straits Times on Imedeen, a skin care product. The advertisement named a medical doctor, Dr Marianne Kieffer, a leading Dermatologist from Denmark in connection with this skin care product. Moreover, the advertisement was written in the form of an invitation to the general public to attend a promotional meeting later in the month, during which Dr Kieffer was to participate.
SMA immediately informed the Danish Medical Association (DMA), as SMA is concerned with any advertisement that features a doctor in the promotion of a product to the general public. This concern would have been identical had the doctor been a Singapore-registered medical practitioner. DMA was informed that SMA had always taken a firm stand against advertising by doctors, and considered the promotion of their names and particulars in the press, unethical. Furthermore, SMA also informed them that involvement with a promotional message is in contravention of the Singapore Medical Councils Ethical Code(1).
The DMA Ethical Council subsequently informed SMA that they concurred with SMAs opinion, and had written to Dr Kieffer to remind her about the ethical regulations on advertising, according to which doctors are not allowed to advertise medicinal products and other articles. This letter was sent to her prior to the sales meeting in Singapore.
Nonetheless, the meeting was conducted as scheduled in a local hotel. SMA sent a representative to the meeting, and an eyewitness report of the meeting was submitted to the DMA Ethical Council for their information. The report confirmed that the meeting was indeed a sales promotion meeting, and Dr Kieffer lectured on her clinical research supporting Imedeens claims.
Ferrosan, the manufacturer of Imedeen, informed the DMA Ethical Council in September 1996 that they had sponsored Dr Kieffers clinical research, the results of which were presented at the meeting in Singapore. However, they stated that Dr Keiffers name had been used in the Singapore advertisement without her knowledge. Dr Kieffer did not comment to the DMA Ethical Council on this issue.
On February 1997, the DMA informed SMA of the decision taken by its Ethical Council on Dr Kieffer. She had been informed that she had infringed the DMAs Ethical Regulations concerning advertising, by her participation in the sales promotion meeting on August 1996 in Singapore. In this respect, Dr Kieffer was informed that DMAs Ethical Council had attached importance to the fact that she had not commented or demented the sequence of events in this case. We were not informed of the action taken against her.
DMAs Ethical Council also found that the use of Dr Kieffers name in an advertisement infringed their Ethical Regulations concerning advertising. As Ferrosan had informed DMA that Dr Kieffer was not informed about the use of her name in the advertisement, she was not reprimanded on this incident. However, she was reminded to be more attentive to the fact that her name was not to be misused in connection co-operation with pharmaceutical companies in clinical trials.
SMAs main concern in this case was that a foreign doctor came to Singapore with the express purpose of advertising a commercial product to the general public, an activity that both the SMA and SMC considers unethical in the case of Singapore-registered doctors. Instances like this, where a doctor speaks openly about research work done with a named product, in a public forum conducted and sponsored by a company with commercial interests in the product, clearly constitute advertisement.
Should doctors distance themselves from pharmaceutical and similar companies? The relationship between the two is an important one. Pharmaceutical companies develop and introduce many new drugs and products into the world, and doctors are responsible for the safe and appropriate use of such products for the benefit of their patients. Bearing in mind both the importance of this synergistic relationship and the potential of misunderstanding and abuse, the way doctors relate to the pharmaceutical industry must be absolutely ethical and professional, and clearly seen to be so both by their peers and by the general public(2). Certainly, any invitation to speak in a public forum should be very carefully considered. In cases where there is any doubt, we urge caution, and we suggest that a brief conversation with the SMA might be helpful. Of course, speaking to an audience of doctors, in an event independently organised by a medical body, in which no obvious attempt to promote or advertise the product occurs, is a different matter entirely.
DR LEE PHENG SOON
DR TAN SZE WEE
1. SMC Ethical Code para 72 - It is improper for the practitioner to be involved in public talks to promote the products of a company and his name and clinic should not appear in the companys promotional materials.
2. Guideline on Pharmaceutical Companies and Doctors in Singapore (1997), Academy of Medicine, Singapore