Business ethics 88.
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A controversy emerged this week over US ads for pain-killer Cerebrex after Pfizer Corporation recently aired an unusually long TV ad for the drug and critics complained that the ads were misleading and should be banned.
The ad for Cerebrex is unusually informative - it is far from mere "image advertising" and included significant concrete patient information. Critics aver that by repeatedly emphasizing that over-the-counter pain relievers have the same types of dangers as Cerebrex, the ad gives the impression that they have the same extent of danger, whereas current studies show more danger for the prescription drug. Pfizer claims that the ad never compares the safety of Cerebrex with that of non-prescription equivalents.
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I have mixed emotions regarding this complaint. On the one hand, I personally did feel the ad was cleverly constructed to give the impression that the extent of risks was being compared. (Ultimately regulators will have to judge whether the average viewer would be misled.) On the other hand, I have written before that I believe risks are over-regulated in our society, and pain-killers are a classic example. Pain killers make a revolutionary difference in quality of life for arthritics and others, and many patients feel they are well-worth the risks. In my opinion, the risks from medicines like Cerebrex are small enough that requiring a prescription is an adequate safeguard against reckless neglect of the risk. Perhaps the ad does hint that the difference in risk is not great, but perhaps this claim is justified for many consumers.
But the more interesting business ethics conundrum is, what role does consumer advertising have in the prescription drug market at all? Most countries, including Israel, rigidly restrict such advertising. There are two quite distinct ethical concerns involved.
One concern is that the consumer is just not sufficiently informed to exercise judgment regarding medicines. Once it has been established that a patient is in need of medication, only an expert - a physician - is in a position to adequately weigh various considerations such as efficacy vs. dangers and side effects. I strongly disagree with this position. On the contrary, only the patient is in a position to adequately weigh the medical considerations (which the physician must explain to him) against personal considerations like quality of life in terms of the drug's benefits and side effects, which differ from person to person, as well as cost and convenience, which have greatly varying importance for different patients. This is particularly true in the Internet age when patients are often enormously well informed. As the book of Proverbs tells us, "The heart knows its own bitterness."
The other concern is that mass advertising enables the pharmaceutical companies to market their products to people who are not really sick. They are, in effect, expanding their markets beyond "ethical drugs" (prescription drugs) to recreational drugs.
A leading pharmaceutical executive was quoted decades ago as stating that he wished his company could sell to everyone, like consumer products manufacturers. Deregulation of drug advertising has played a key role in making this wish come true. Critics point out that pharmaceutical companies brand not only medicines but also disorders. A classic example is "erectile dysfunction," a previously obscure term for impotence, which was aggressively branded for mass marketing of various medicines (which we are all familiar with from reams of spam).
This is indeed a weighty ethical concern. The problem is endemic to a consumerist society: a happy person is the enemy of industry. If "man wants but little nor that little long," then huge swathes of industry will become bankrupt. So advertisers of all ilk have to undermine the esteem of consumers and suggest that they are somehow lacking, in a way which can only be remedied by buying the seller's wares.
The problem here is that this concern is so weighty and universal in our culture that there seems to be no fair basis to apply it selectively to pharmaceutical companies. As long as apparel manufacturers can tell you you'll be a wallflower if you wear last year's fashions, pharmaceutical companies should be able to tell you you suffer from "social anxiety disorder" when really you're only shy.
Banning consumer-directed pharmaceutical advertising because "doctor knows best" is patronizing; banning it because it is consumerist is discriminatory. The best solution is to make sure that pharmaceuticals with meaningful risks are prescription-only so that an expert has the last word, and to regulate ads to prevent misleading claims. Drug companies sell valuable products that can bring at least as much benefit to an informed public as other consumer goods, and they deserve the opportunity to bring their message directly to their audience.
The writer is research director at the Business Ethics Center of Jerusalem (www.besr.org), an independent institute in the Jerusalem College of Technology.