Beyond rhetoric in debates about the ethics of marketing prescription medicines to consumers: The importance of vulnerability in people, situations and relationships

Background This article examines community responses to the marketing of prescription medicines. Historically, debates about such marketing have focused on alleged unscrupulousness of pharmaceutical companies and on the quality of information provided. 2 Methods Six focus groups were conducted in Sydney, Australia, three with older and three with younger community members. Analysis examined interactions between group members, the positions participants took up, conflicting arguments, and explanations for variation. Results Participants argued specifically rather than generally about consumer marketing of medicines. Neither the moral purpose of corporations nor the quality of information in advertisements was particularly important. Instead, pharmaceutical marketing was assessed in relation to vulnerabilities that existed in individual consumers, in doctors, in the contexts of illness and as a result of medications being potentially dangerous. Conclusions The critical ethical issue in prescription medicine marketing may be the existence of vulnerabilities and the responsibilities they may generate. We outline three possible policy responses suggested by these participants. Key words: DTCA, direct-to-consumer advertising, marketing, vulnerability, doctor-patient relationship, drug industryAustralian National Health and Medical Research Council (NHMRC) Grant 457497

Bioethics as Engaged Activity

Whilst we applaud and support a call for “a proactive form of bioethics that actively resists and denounces injustice" we contend that the authors do not go far enough. The underlying theoretical issue is that the vision of bioethics itself is too constrained. Bioethics has been conceived of as an academic discipline in which the primary activity is free, open and reasoned discussion. What is missing is a conception of bioethics that (1) entails a broader practical repertoire and (2) gives effect to ethical values at clinical, organizational, community, and health system levels. We claim that bioethics should aim not merely to describe the world but should endeavor to change it

Bioethics and the Myth of Neutrality

There is currently a resurgence of interest in and debate on the role of bioethicists as advocates. However, it is also important that we discuss the appropriate role and responsibilities of bioethical associations. We must accept the responsibilities that attach to silence and inaction. Bioethics has always aimed to be practical, to make a difference to practice and policy, particularly when standing with those who are marginalised. Such actions are necessarily political. We call on the bioethics community to examine critically the myth of neutrality in bioethics

Increased rates of ENT surgery among young children: Have clinical guidelines made a difference?

Objectives: To examine the association between introduction of paediatric ear, nose and throat (ENT) surgery guidelines and population procedure rates. To determine changes in children's risk of undergoing ENT surgery. Methods: Trend analysis of incidence of myringotomy, tonsillectomy and adenoidectomy among New South Wales (NSW) children aged 0-14 between 1981 and mid 1999. Poisson regression models were used to estimate annual rates of change pre and postguidelines introduction and age/gender specific rates, and lifetable methods to determine risk of undergoing an ENT procedure by age 15. Results: ENT surgery rates increased by 21% over the study period. Children's risk of surgery increased from 17.9% in 1981 to 20.2% in 1998/99. Guideline introduction was associated with moderate short-term decreases in rates. For tonsillectomy, rates decreased between 1981 and 1983, but then rose continually until the introduction of myringotomy guidelines in 1993, when they fell, only to recommence rising until the end of the study period. For myringotomy, rates rose annually from 1981 to 1992/93 and fell in the 3 years following guideline introduction, after which they rose again. Increases were almost exclusively restricted to children aged 0-4 and correspond with increased use of formal childcare. The prevalence of myringotomy by the age of 5 years rose from 5.6% of children born in 1988/89 to 6.4% of those born in 1994/95, and the prevalence of tonsillectomy from 2.4% to 2.7%. Conclusions: The risk of young Australian children undergoing ENT surgery increased significantly over the last two decades despite the introduction of guidelines and no evidence of an increase in otitis media, one condition prompting surgery. Surgery increased most among the very young. We hypothesize this is related to increasing use of childcare