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Ethics of Implicit Persuasion in Pharmaceutical Advertising

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Handbook of Neuroethics

Abstract

Direct to Consumer Advertising of Prescription Pharmaceuticals (DTCA) is a controversial practice permitted only in the United States and New Zealand. Central to why all other nations ban DTCA is concern about its capacity to impart complete, balanced, and accurate information that guides effective consumer decisions. Yet the debate has, thus far, paid scant attention to how implicit or unconscious persuasion in DTCA might influence consumer attitudes toward advertised drugs. In this chapter, one means of implicit persuasion, evaluative conditioning, is argued to have deleterious effects on the autonomous agency that DTCA viewers bring to medicine choices and on the wider doctor-patient relationship. These effects suggest implicit persuasion should be given much greater consideration in the development of public policy on the marketing of pharmaceuticals.

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Notes

  1. 1.

    Although DTCA of prescription pharmaceuticals is prohibited in Canada, there has nevertheless been a proliferation of “reminder” or “branded” advertisements on television by Canadian pharmaceutical companies. These ads mention a brand name of a drug without specifying what condition the drug treats (see Silversides 2001) and are tolerated by Canadian regulators. Canadians may also view DTCA via US-based cable TV and the Internet.

References

  • Australian Medical Association. (2006). AMA code of ethics. Retrieved August 12, 2013, from https://ama.com.au/codeofethics

  • Bargh, J., & Chartrand, T. L. (1999). The unbearable automaticity of being. American Psychologist, 54, 462–479.

    Article  Google Scholar 

  • Benkert, O., Graf-Morgenstern, M., Hillert, A., Sandmann, J., Ehmig, S. C., Weissbecker, H., . . . Sobota, K. (1997). Public opinion on psychotropic drugs: An analysis of the factors influencing acceptance or rejection. Journal of Nervous and Mental Disease, 185(3), 151–158.

    Article  Google Scholar 

  • Biegler, P., & Vargas, P. (2013). Ban the sunset? Nonpropositional content and regulation of pharmaceutical advertising. The American Journal of Bioethics, 13(5), 3–13.

    Article  Google Scholar 

  • Biegler, P. & Vargas, P. Feeling is believing: Evaluative conditioning and regulation of pharmaceutical advertising (in preparation).

    Google Scholar 

  • Biegler, P., Vargas, P., & Oakley, J. Persuasive effects of non-propositional content in a prescription sleeping pill commercial (Unpublished study).

    Google Scholar 

  • Bizer, G. Y., Barden, J. C., & Petty, R. E. (2003). Attitudes. In L. Nadel (Ed.), Encyclopedia of cognitive science (Vol. 1, pp. 247–253). Hampshire: Macmillan.

    Google Scholar 

  • Bortolotti, L. (2011). Does reflection lead to wise choices? Philosophical Explorations, 14(3), 297–313.

    Article  Google Scholar 

  • Bradley, M. M., & Lang, P. J. (2007). The international affective digitized sounds (2nd edition; IADS-2): Affective ratings of sounds and instruction manual. Gainesville: University of Florida.

    Google Scholar 

  • Brass, E. P. (2001). Changing the status of drugs from prescription to over-the-counter availability. New England Journal of Medicine, 345(11), 810–816.

    Article  Google Scholar 

  • Brunstrom, J. M., & Higgs, S. (2002). Exploring evaluative conditioning using a working memory task. Learning and Motivation, 33, 433–455.

    Article  Google Scholar 

  • Carruthers, P. (2005). Consciousness: Essays from a higher-order perspective. Oxford: Oxford University Press.

    Book  Google Scholar 

  • Chartrand, T. L. (2005). The role of conscious awareness in consumer behavior. Journal of Consumer Psychology, 15(3), 203–210.

    Article  Google Scholar 

  • Chartrand, T. L., Huber, J., Shiv, B., & Tanner, R. J. (2008). Nonconscious goals and consumer choice. Journal of Consumer Research, 35(2), 189–201.

    Article  Google Scholar 

  • Christman, J. (1991). Autonomy and personal history. Canadian Journal of Philosophy, 21(1), 1–24.

    Google Scholar 

  • De Houwer, J. (2009). Conditioning as a source of liking: There is nothing simple about it. In M. Wanke (Ed.), Social psychology of consumer behavior. New York: Taylor and Francis.

    Google Scholar 

  • De Houwer, J., Baeyens, F., & Eelen, P. (1994). Verbal evaluative conditioning with undetected US presentations. Behaviour Research and Therapy, 32(6), 629–633.

    Article  Google Scholar 

  • Dijksterhuis, A., & van Olden, Z. (2006). On the benefits of thinking unconsciously: Unconscious thought can increase post-choice satisfaction. Journal of Experimental Social Psychology, 42(5), 627–631.

    Article  Google Scholar 

  • Ditto, P. H., Jemmott, J. B., 3rd, & Darley, J. M. (1988). Appraising the threat of illness: A mental representational approach. Health Psychology, 7(2), 183–201.

    Article  Google Scholar 

  • Doris, J. M. (2009). Skepticism about persons. Philosophical Issues, 19, 57–91.

    Article  Google Scholar 

  • Drew, T., Vo, M. L., & Wolfe, J. M. (2013). The invisible gorilla strikes again: Sustained inattentional blindness in expert observers. Psychological Science, 24(9), 1848–53.

    Article  Google Scholar 

  • Dworkin, G. (1988). The theory and practice of autonomy. Cambridge/New York: Cambridge University Press.

    Book  Google Scholar 

  • Eifert, G. H., Craill, L., Carey, E., & O’Connor, C. (1988). Affect modification through evaluative conditioning with music. Behaviour Research and Therapy, 26(4), 321–330.

    Article  Google Scholar 

  • Faden, R. R., Beauchamp, T. L., & King, N. M. P. (1986). A history and theory of informed consent. New York: Oxford University Press.

    Google Scholar 

  • Fang, X., Singh, S., & Ahluwalia, R. (2007). An examination of different explanations for the mere exposure effect. Journal of Consumer Research, 34, 97–103.

    Article  Google Scholar 

  • Fischer, J. M., & Ravizza, M. (1998). Responsibility and control: A theory of moral responsibility. Cambridge/New York: Cambridge University Press.

    Book  Google Scholar 

  • Food and Drug Administration. (2012). Prescription drug advertising: Questions and answers. Retrieved April 23, 2013, from http://www.fda.gov/Drugs/ResourcesForYou/Consumers/PrescriptionDrugAdvertising/UCM076768.htm

  • Frankfurt, H. (1971). Freedom of the will and the concept of a person. Journal of Philosophy, 68, 5–20.

    Article  Google Scholar 

  • Gardner, W. L., Gabriel, S., & Lee, A. Y. (1999). “I” values freedom but “We” value relationships: Self-construal priming mirrors cultural differences in judgment’. Psychological Science, 10(4), 321–326.

    Article  Google Scholar 

  • Gilbody, S., Wilson, P., & Watt, I. (2005). Benefits and harms of direct to consumer advertising: A systematic review. Quality & Safety in Health Care, 14(4), 246–250.

    Article  Google Scholar 

  • GlaxoSmithKline. Commerical for Advair Diskus. Retrieved November 6, 2013, from https://www.youtube.com/watch?v=4uDtay8Mth8

  • Goldman, A. I., & Olsson, E. J. (2008). Reliabilism and the value of knowledge. In D. Pritchard, A. Millar, & A. Haddock (Eds.), Epistemic value. Oxford: Oxford University Press.

    Google Scholar 

  • Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. (1998). Measuring individual differences in implicit cognition: The implicit association test. Journal of Personality and Social Psychology, 74(6), 1464–1480.

    Article  Google Scholar 

  • Haidt, J. (2001). The emotional dog and its rational tail: A social intuitionist approach to moral judgment. Psychological Review, 108(4), 814–834.

    Article  Google Scholar 

  • Haidt, J. (2012). The righteous mind: Why good people are divided by politics and religion. London: Allen Lane.

    Google Scholar 

  • Haidt, J., & Bjorklund, F. (2008). Social intuitionists answer six questions about moral psychology. In W. Sinnott-Armstrong (Ed.), Moral psychology (The cognitive science of morality: Intuition and diversity, Vol. 2, pp. 181–217). Cambridge, MA: MIT Press.

    Google Scholar 

  • Hasman, A., & Holm, S. (2006). Direct-to-consumer advertising: Should there be a free market in healthcare information? Cambridge Quarterly of Healthcare Ethics, 15, 42–49.

    Article  Google Scholar 

  • Hofmann, W., De Houwer, J., Perugini, M., Baeyens, F., & Crombez, G. (2010). Evaluative conditioning in humans: A meta-analysis. Psychological Bulletin, 136(3), 390–421.

    Article  Google Scholar 

  • Hutton, R. J., & Klein, G. (1999). Expert decision making. Systems Engineering, 2(1), 32–45.

    Article  Google Scholar 

  • Jones, C. R., Olson, M. A., & Fazio, R. H. (2010). Evaluative conditioning: The “how” question. Advances in Experimental Social Psychology, 43, 205–255.

    Article  Google Scholar 

  • Kahneman, D. (2011). Thinking fast and slow. New York: Farrar, Straus and Giroux.

    Google Scholar 

  • Kahneman, D., Ritov, I., & Schkade, D. (2000). Economic preferences or attitude expressions? An analysis of dollar responses to public issues. In D. Kahneman & A. Tversky (Eds.), Choices, values, and frames. Cambridge: Cambridge University Press.

    Google Scholar 

  • Kravitz, R. L., Epstein, R. M., Feldman, M. D., Franz, C. E., Azari, R., Wilkes, M. S., . . . Franks, P. (2005). Influence of patients’ requests for direct-to-consumer advertised antidepressants: A randomized controlled trial. Journal of the American Medical Association, 293(16), 1995–2002.

    Google Scholar 

  • Krosnick, J. A., Jussim, L. J., & Lynn, A. R. (1992). Subliminal conditioning of attitudes. Personality and Social Psychology Bulletin, 18(2), 152–162.

    Article  Google Scholar 

  • Kunda, Z. (1987). Motivated inference: Self-serving generation and evaluation of causal theories. Journal of Personality and Social Psychology, 53(4), 636–647.

    Article  Google Scholar 

  • Kunda, Z. (1990). The case for motivated reasoning. Psychological Bulletin, 108(3), 480–498.

    Article  Google Scholar 

  • Kuran, T., & Sunstein, C. R. (1999). Availability cascades and risk regulation. Stanford Law Review, 5, 683–761.

    Article  Google Scholar 

  • Lang, P. J., Bradley, M. M., & Cuthbert, B. N. (2008). International affective picture system (IAPS): Affective ratings of pictures and instruction manual (Technical report A-8). Gainesville: University of Florida.

    Google Scholar 

  • Mackenzie, C., & Stoljar, N. (Eds.). (2000). Relational autonomy: Feminist perspectives on autonomy, agency, and the social self. New York: Oxford University Press.

    Google Scholar 

  • Mintzes, B. (2006). Direct-to-consumer advertising of prescription drugs in Canada: What are the public health implications? Retrieved April 23, 2013, from http://www.haiweb.org/15022006/DTCA%20of%20Prescription%20Drugs%20in%20Canada.pdf

  • Mintzes, B. (2009). Should Canada allow direct-to-consumer advertising of prescription drugs?: No. Canadian Family Physician, 55(2), 131–133.

    Google Scholar 

  • Mintzes, B., Barer, M. L., Kravitz, R. L., Kazanjian, A., Bassett, K., Lexchin, J., & Marion, S. A. (2002). Influence of direct to consumer pharmaceutical advertising and patients’ requests on prescribing decisions: Two site cross sectional survey. British Medical Journal, 324(7332), 278–279.

    Article  Google Scholar 

  • Mintzes, B., Barer, M. L., Kravitz, R. L., Bassett, K., Lexchin, J., Kazanjian, A., & Marion, S. A. (2003). How does direct-to-consumer advertising (DTCA) affect prescribing? A survey in primary care environments with and without legal DTCA. Canadian Medical Association Journal, 169(5), 405–412.

    Google Scholar 

  • Murray, E., Lo, B., Pollack, L., Donelan, K., & Lee, K. (2003). Direct-to-consumer advertising: physicians’ views of its effects on quality of care and the doctor-patient relationship. Journal of the American Board of Family Medicine, 16(6), 513–524.

    Article  Google Scholar 

  • Murray, E., Lo, B., Pollack, L., Donelan, K., & Lee, K. (2004). Direct-to-consumer advertising: Public perceptions of its effects on health behaviors, health care, and the doctor-patient relationship. Journal of the American Board of Family Medicine, 17(1), 6–18.

    Article  Google Scholar 

  • Nisbett, R., & Wilson, T. (1977). Telling more than we can know: Verbal reports on mental processes. Psychological Review, 84(3), 231–258.

    Article  Google Scholar 

  • Oakley, J. (2012, June). Virtue ethics, direct-to-consumer pharmaceutical advertising, and doctor-patient relationships. Paper presented at the 11th World Congress of Bioethics, Rotterdam.

    Google Scholar 

  • Oakley, J. (2014). A virtue ethics analysis of disclosure requirements and financial incentives as responses to conflicts of interest in physician prescribing. In A. Akabayashi (Ed.), The future of bioethics: International dialogues. Oxford: Oxford University Press.

    Google Scholar 

  • Pfizer. (2010). Lipitor medication 2010 commercial. Retrieved March 28, 2013, from http://www.youtube.com/watch?v=ogyC9rEjxDM

  • Pleyers, G., Corneille, O., Luminet, O., & Yzerbyt, V. (2007). Aware and (dis)liking: Item-based analyses reveal that valence acquisition via evaluative conditioning emerges only when there is contingency awareness. Journal of Experimental Psychology. Learning, Memory, and Cognition, 33(1), 130–144.

    Article  Google Scholar 

  • Priest, A. (2007). CanWest set to challenge ban on DTCA. Canadian Medical Association Journal, 176(1), 19–20.

    Article  Google Scholar 

  • Rogers v Whitaker. (1992). 67 Australian Law Journal Reports 47.

    Google Scholar 

  • Rozin, P., Wrzesniewski, A., & Byrnes, D. (1998). The elusiveness of evaluative conditioning. Learning and Motivation, 29, 397–415.

    Article  Google Scholar 

  • Schachtman, T. R., Walker, J., & Fowler, S. (2011). Effects of conditioning in advertising. In T. R. Schachtman & S. Reilly (Eds.), Associative learning and conditioning theory: Human and non-human applications. New York: Oxford University Press.

    Chapter  Google Scholar 

  • Schwarz, N., & Clore, G. L. (1983). Mood, misattribution, and judgments of well-being: Informative and directive functions of affective states. Journal of Personality and Social Psychology, 45(3), 513.

    Article  Google Scholar 

  • Silversides, A. (2001). Direct-to-consumer prescription drug ads getting bolder. Canadian Medical Association Journal, 165(4), 462.

    Google Scholar 

  • Smith, P. W., Feinberg, R. A., & Burns, D. J. (1998). An examination of classical conditioning principles in an ecologically valid advertising context. Journal of Marketing Theory and Practice, 6(1), 63–72.

    Google Scholar 

  • Spurgeon, D. (1999). Doctors feel pressurised by direct to consumer advertising. British Medical Journal, 319(7221), 1321.

    Article  Google Scholar 

  • Sweldens, S., Van Osselaer, S. M. J., & Janiszewski, C. (2010). Evaluative conditioning procedures and the resilience of conditioned brand attitudes. Journal of Consumer Research, 37, 473–489.

    Article  Google Scholar 

  • Thaler, R. H., & Sunstein, C. R. (2009). Nudge: Improving decisions about health, wealth, and happiness. New York: Penguin.

    Google Scholar 

  • Tversky, A., & Kahneman, D. (1981). The framing of decisions and the psychology of choice. Science, 211(4481), 455–458.

    Article  Google Scholar 

  • van Ravenzwaaij, D., van der Maas, H. L. J., & Wagenmakers, E.-J. (2011). Does the name-race implicit association test measure racial prejudice? Experimental Psychology, 58(4), 271–277.

    Article  Google Scholar 

  • Vansteenwegen, D., Francken, G., Vervliet, B., De Clercq, A., & Eelen, P. (2006). Resistance to extinction in evaluative conditioning. Journal of Experimental Psychology. Animal Behavior Processes, 32(1), 71–79.

    Article  Google Scholar 

  • Vargas, P. T. (2008). Implicit consumer cognition. In C. P. Haugtvedt, P. Herr, & F. R. Kardes (Eds.), Handbook of consumer psychology. New York: Lawrence Erlbaum Associates.

    Google Scholar 

  • Walther, E. (2002). Guilty by mere association: Evaluative conditioning and the spreading attitude effect. Journal of Personality and Social Psychology, 82(6), 919–934.

    Article  Google Scholar 

  • Wilson, T., & Schooler, J. (1991). Thinking too much: Introspection can reduce the quality of preferences and decisions. Journal of Personality and Social Psychology, 60(2), 181–192.

    Article  Google Scholar 

  • Wilson, T. D., Lindsey, S., & Schooler, T. Y. (2000). A model of dual attitudes. Psychological Review, 107(1), 101–126.

    Article  Google Scholar 

  • Young, R. (1986). Personal autonomy: Beyond negative and positive liberty. London: Croom Helm.

    Google Scholar 

  • Yuen, K. S. L., & Lee, T. M. C. (2003). Could mood state affect risk-taking decisions? Journal of Affective Disorders, 75, 11–18.

    Article  Google Scholar 

  • Zajonc, R. (1968). Attitudinal effects of mere exposure. Journal of Personality and Social Psychology, 9(2), 1–27.

    Article  Google Scholar 

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Authors and Affiliations

  1. Centre for Human Bioethics, School of Philosophical, Historical and International Studies Monash University Faculty of Arts, Building 11, Room E657, Clayton, VIC, 3800, Australia

    Paul Biegler & Justin Oakley

  2. Department of Philosophy, Macquarie University, Building W6A Room 736, Sydney, NSW, 2109, Australia

    Jeanette Kennett

  3. Department of Advertising, University of Illinois at Urbana-Champaign, 103 Gregory Hall, IL, USA

    Patrick Vargas

Authors
  1. Paul Biegler
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  2. Jeanette Kennett
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  3. Justin Oakley
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  4. Patrick Vargas
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Correspondence to Paul Biegler .

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Editors and Affiliations

  1. Institute for Ethics and History of Medicine, University of Tübingen, Tübingen, Germany

    Jens Clausen

  2. The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Parkville, Australia

    Neil Levy

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Biegler, P., Kennett, J., Oakley, J., Vargas, P. (2015). Ethics of Implicit Persuasion in Pharmaceutical Advertising. In: Clausen, J., Levy, N. (eds) Handbook of Neuroethics. Springer, Dordrecht. https://doi.org/10.1007/978-94-007-4707-4_1

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