1. Advertising and Marketing: A Practical Organizational Ethics Response Philip Boyle, Ph.D. Vice President, Mission & Ethics www.CHE.ORG/ETHICS

2. Etiquette Press * 6 to mute; Press # 6 to unmute Keep your phone on mute unless you are dialoging with the presenter Never place phone on hold If you do not want to be called on please check the red mood button on the lower left of screen

3. Advertising is constantly bombarded by criticism. Accused of encouraging materialism and consumption, causing us to purchase unneeded items, stereotyping, taking advantage of children and vulnerable, manipulating our behavior, and generally contributing to the downfall of the social system. Vance Packard’s The Hidden Persuaders

4. Goals for today’s class: What are the rules that you ought to use in evaluating advertising and marketing Explore how different moral theory analyze advertising and marketing and business communications Investigate whether advertising and marketing in health care is more problematic Identify practical means and organizational ethics committee could respond. Develop rules for engagement at your site

5. Questions Is there something inherently wronging in advertising or is it just some kinds of methods of advertising? Is there something inherently unethical about advertising in health care? And developing products to meet needs How can advertising be helpful or unhelpful in the mission of the organization? What is the best organizational response? Policy? Audits? Statements?

6. Definitions and distinctions Advertising Marketing—complex of commercial communications to create a favorable opinion and business communication Kinds –Commercial ads –Public service ads –Political ads

7. Cases: Lasik eye surgery Sex for Life ads Direct to consumer ads –Vioox Ad that tell you it can save your life—and take out your liver –Lamisil for the dematafite toes –Viagra and blindness Web ads –Unwarranted claims of surgery success –Denigrating the gold standard from peer-reviewed journals –Undocument claims of length of stay –Atypical patient testimony –Exaggeration fo physicians experience or credentials Propecia ad, bariatric surgery, tummy tucks Spending Medicare money on public service announcements Hospitals touting they are listed as one of the best hospitals based on the survey of the local patients Use of health data in Ads

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9. Practical options CEO, at prodding of Chief Ethics Officer, requests a review or development policy from Business Communications Board requests report special taskforce to review whether image and advertising fits mission Organizational ethics mechanisms adopts issue as priority education issue.

10. “Mission and the Bottom Line.” From Organizational Ethics in Health Care. The marketing director for PHC has developed and implemented a marketing plan that includes public advertising. This advertising is a mix of public service informational announcements as well as explicit advertising for PHC. At the end of the year, Medicaid sends PHC a form that allows it to bill Medicaid for certain public service informational announcements that so not include solicitations to contact PHC (such as a toll-free number for additional information). The marketing director decides not to file for these reimbursements for five reasons. First, complying with the restrictions on content is difficult and some what controversial. The regulations are complex, and any enforcement effort against an inappropriate claim is treated as an action for fraud. Second the amount of money at stake is relatively small, amounting to no more than $80,000. Third, the public health announcements benefit the entire organization because they help build public recognition of PHC within the community it serves. (They were in fact produced without considering whether Medicaid would pay for them.) Fourth, these announcements are consistent with the mission of PHC to provide public health care through information. Finally, the marketing director believes that it would be unethical to seek reimbursement because she believes that Medicaid funds, which are limited, are intended to meet the clinical needs of Medicaid patients and should not be diverted to general activities supporting the institutions. What would you do? Do you agree or disagree?

11. Legal arguments Commercial speech is protected under 1st amendment –Central Hudson Gas and Electric v Public Service Commission –Commercial speech can be regulated if: It is misleading or concerns an illegal product There is a substantial government interest The regulation directly advances gov’t interest Regulation is narrowly tailored

12. Moral Arguments Puffery and embellishment—what’s wrong with it? mere exaggerations or hyperbole The best and the greatest as sales talk—not regulated Everyone knows Wonder Bread or Greatest show on Earth is not greatest Form of opinion statement Coercion? Purchase unneeded item? Dealing with a vulnerable population Is where it advertised make a difference? Does the format make a moral difference? It is a matter of lying? Selling focuses on the need of the seller not the buyer? Goal of the ad—Public health or something else?

13. Moral Arguments Teleological Perspective: focus on the consequences of behavior –They focus on some utility—greatest good for greatest number –Does the advertising campaign bring about good for the corporation and its publics? –Who benefits and who suffers as a result of the ad campaign? –What information is most useful to society as part of an advertisement?

14. Deontological Perspective: based on rules or universalizability Is the advertising truthful? Does any group suffer life-threatening or dignity-debasing consequences as a result of the ad campaign? Does the product being advertised add genuine value? Are the rights of individuals being protected by the ad campaign? What duties to consumers and publics are being served in the ads?

15. Virtue Perspective Based on view that human communities require certain virtues or skills including honesty truthfulness, compassion, loyalty, and justice What kind of life/society is being promoted in the ads? Are the values being advertised the ones to which the organization subscribes? Does the advertising agency understand the central values of the hospital and why it holds them?

16. Natural law perspective: Values/goods to be positively promoted and protected from being acted against What goods will be promoted by advertising? A tool to inform people about the availability of rationally desirable new products A tool for sustaining honest and ethically responsible competition A tool to positively influence the media A tool to communicate a message of a religious nature—messages of faith, compassion, A tool in politics to create a democratic conversation

17. Natural law perspective: What goods will be risked by advertising? A tool to misrepresent and withhold relevant facts to make choices Brand ads promote similar products but to choose on loyalty (not rational) A tool for consumerism geared towards “having” not being better off. –Worse when they harm poor—Avon Products in Amazon Seeking wants that are artificial created A tool directed to meet the needs of those who can afford products and –Avoid those who cannot A tool for stereotyping/discrimination by placing other at a disadvantage A tool that can promote values such as envy, status seeking, and lust (ant-religious) A tool to undercut democratic participation by limiting voice to wealthy

18. Possible questions for an audit: Does embellishment occur in this ad/campaign? Does the ad accurately portray the situation in the hospital? Are there portions of the ad that may not be able to be substantiated? Is the message appropriate for the media to be used to convey it? Are there certain media/programs with which the hospital may not want to be associated? Are there consumer groups that may not understand the ad and its message?

19. Policy considerations Your ads should not be misleading to patients. Your ads should not lead patients to demand services they do not reasonably need. All your advertising claims should be based on facts. Your ad should present a fair and honest account of the service advertised. Hospitals are held to a higher standard in advertising than would generally be applied to other commercial enterprises.

20. SAMPLE POLICY All internal and external marketing communications are guided by the following principles: ○ fairness, honesty and accuracy; ○ respect for the individual; ○ sensitivity to the emotional, spiritual and physical needs of the people we serve; ○ determination to express the unique character of St. Elsewhere as a Catholic institution; ○ commitment to deliver all that we promise What’s missing from the policies?

21. Advertising Guidelines of the Council of Medical Specialty Societies TRUTH: Advertising shall tell the truth, and shall reveal significant facts, the omission of which would mislead the public. SUBSTANTIATION: Advertising claims shall be substantiated by evidence in possession of the advertiser and advertising agency, prior to making such claims. COMPARISONS: Advertising shall refrain from making false, misleading, or unsubstantiated statements or claims about a competitor or his products or services. BAIT ADVERTISING: Advertising shall not offer products or services for sale unless such offer constitutes a bona fide effort to sell the advertised products or services and is not a device to switch consumers to other goods or services, usually higher priced.

22. GUARANTEES AND WARRANTIES: Advertising of guarantees and warranties shall be explicit, with sufficient information to apprise consumers of their principal terms and limitations or, when space or time restrictions preclude such disclosures, the advertisement should clearly reveal where the full text of the guarantee or warranty can be examined before purchase. PRICE CLAIMS: Advertising shall avoid price claims which age false or misleading, or savings claims which do not offer provable savings. TESTIMONIALS: Advertising containing testimonials shall be limited to those of competent witnesses who are reflecting a real and honest opinion or experience. TASTE AND DECENCY: Advertising shall be free of statements, illustrations or implications which are offensive to good taste or public decency.

23. We, the members of the American Association of Advertising Agencies, in addition to supporting and obeying the laws and legal regulations pertaining to advertising, undertake to extend and broaden the application of high ethical standards. Specifically, we will not knowingly create advertising that contains: False or misleading statements or exaggerations, visual or verbal Testimonials that do not reflect the real opinion of the individual(s) involved Price claims that are misleading Claims insufficiently supported or that distort the true meaning or practicable application of statements made by professional or scientific authority Statements, suggestions, or pictures offensive to public decency or minority segments of the populations. We recognize that there are areas that are subject to honestly different interpretations and judgment. Nevertheless, we agree not to recommend to an advertiser, and to discourage the use of, advertising that is in poor or questionable taste or that is deliberately irritating through aural or visual content or presentation.

24. Website: http://advertising.utexas.edu/research/la w/catholic.html http://advertising.utexas.edu/research/la w/catholic.html