The Ethics and Goals of Advertising

Advertising serves two very distinct and divergent objectives: (1) dissemination of information, and (2) product differentiation, which economists define as public perception of differences between two products, even though such differences may not in fact exist.

Dissemination of information provides the facts on which rational consumers can make informed choices. In healthcare, information about the services provided, location, hours of service, fees charged, and languages spoken are examples of services that might be advertised. Arguments in favor of advertising in healthcare are based on an understanding of advertising as dissemination of information.

Advertising also serves to differentiate products, and the methods for doing so are more ethically problematic. How can the claim be made and justified that one product is better than another? The FTC requires that any claims of product differentiation be empirically measurable. For example, in order to claim that a particular mouthwash "kills germs on contact by millions," it is necessary to be able to count killed germs. Usually advertisers attempt to differentiate products not on the basis of objective criteria about the product but by manipulating unconscious wishes and fantasies (such as youth, power, beauty, sex, and affluence), associating the product with images of attractive people in beautiful surroundings. The consumer is left to feel tremendous anxiety about the possible consequences of making the wrong choice of detergent, antiperspirant, or health plan.

Though many physicians have shown reluctance (or an aversion) to advertising their services, healthcare institutions have readily accepted the imperative to advertise in an attempt to create markets, capture market share, and find niches in the marketplace. Notable in this regard is advertising directed at target populations, for example, women, cancer patients, and those needing psychiatric and substance abuse services.

Truth in advertising was the concern when the field of advertising itself attempted to follow the course of professionalism in the early part of the twentieth century. At issue were the values that distinguished professional advertisers from retail-space merchants. The American Marketing Association established university training programs and codes of ethics that promoted the scientific ideal of detachment and statistical analysis. The scientific vision of community and definition of people as consumers replaced the older, em-pathic, and value-laden world in which a merchant understood what customers (not consumers) wanted and needed based on living in the same community (Christians, Schultze, and Simms; Schultze).

Professional advertising is illustrative because medicine's traditions of professionalism are derived from an era in which physicians participated in the life of the community in which they practiced. Knowledge of the patient as a person, as well as the patient's life history and social situation, has traditionally been deemed essential to quality care. At issue in 2003 for medicine is whether it will be possible to preserve the values of personal care that characterized the ideals of an earlier era.

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