Virtue ethics, direct-to-consumer pharmaceutical advertising, and doctor-patient relationships

Justin Oakley (Monash University)

A number of empirical studies have shown that direct-to consumer advertising (DTCA) of prescription pharmaceuticals significantly increases clinically inappropriate prescribing by doctors. This seems largely because doctors working in DTCA environments face greater demands from patients for clinically inappropriate medication than do other doctors, and because doctors often seem to find such demands difficult to resist. These effects seem to be magnified in cases where DTCA uses implicit persuasion techniques such as evaluative conditioning, where patients are led to develop preferences for particular medications but are unaware of the persuasive processes involved. Pharmaceutical DTCA has also been criticised for its tendency to undermine therapeutic doctor-patient relationships.
          In this paper I present a new analysis of why the kinds of influence that pharmaceutical DTCA have on doctor-patient relationships makes such advertising ethically problematic. I argue that pharmaceutical DTCA tends to significantly undermine the proper governing conditions of doctor-patient relationships, thereby redefining them as consumer relationships rather than therapeutic relationships, and I suggest that the use of implicit persuasion techniques like evaluative conditioning in such advertising heightens this tendency. I also argue that because of its impact on doctor-patient relationships, pharmaceutical DTCA would be opposed by a plausible virtue ethics regulatory model, as this model would reject policies that undermine doctors’ commitments to uphold the priorities they committed themselves to maintain when joining the profession, such as a commitment to act in their patients’ best interests.