New guidelines limiting DTC on TV may mean that pharmaceutical marketers are likely to invest more effort reaching consumers via the Internet and other interactive media (see, for example, “Pharma eMarketing at Tipping Point?“).
As more money flows into DTC on the Internet, some ad agencies — especially those who previously specialized in TV ads — may pressure their pharma clients to “push the envelope” and engage in unethical online marketing practices. These “old dogs” need to learn new tricks (see “DTC in 2005: Old Dogs, New Tricks?“), but they also need to understand the unique ethical issues associated with online health information.

Sure, the old dogs may claim to know what’s ethical, but will they deliver?

One of the most important online ethical issues concerns the clear demarcation between editorial content and promotional content. It is legally permissible to disguise promotional content by making it look like just another editorial piece or by not labeling it as an advertisement. But is it ethical?

For example, according to the CAN-SPAM law, which is a federal law attempting to limit spam e-mail, and FTC regulations, an e-mail newsletter sent to opt-in subscribers of a disease information web site owned and run by a pharma company can legally contain a product ad without labeling it an “advertisement.” There are some hoops to go through to avoid breaking the law, which I won’t elaborate here, but it’s possible.

However, is it ethical?

No, according to the eHealth Code of Ethics developed in 2000 by the Internet Healthcare Coalition (IHHC). The IHHC, which I co-founded in 1997, is now disbanded, but the Code lives on and has been translated into at least 6 languages, including English.

According to the eHealth Code of Ethics:

“People who seek health information on the Internet need to know that products or services are described truthfully and that information they receive is not presented in a misleading way. Sites should be forthright

  • in all content used to promote the sale of health products or services
  • in any claims about the efficacy, performance, or benefits of products or services

“They should clearly distinguish content intended to promote or sell a product, service, or organization from educational or scientific content.”

The standard practice is to label promotional content as an “Advertisement.”

Ethics should not be regulated. The eHealth Code of Ethics was developed to help online marketers voluntarily “clean up Dodge” before the sheriffs (i.e., FDA, FTC, etc.) arrived and did it for them.

The FDA has cited a few errant online marketing practices of the drug and device industries, but it does not have the resources to monitor the vastness of the Internet. Nor does it intend to treat the Internet in any special way.

However, the Internet is different than TV. With TV you usually know what’s an ad and what’s not. The Internet is not linear like TV and it is more difficult to distinguish an ad from editorial content unless it is labeled.

There are some advertising practices being used on TV that attempt to disguise ads, such as product placements inside sitcoms or movies. I think these practices are unethical for the same reason that disgusing promotional content on the Internet is unethical. Obviously, however, the ad people do not have any qualms about it. These may be the same people developing prescription drug ads on the Internet in the future! Will they will develop new tricks and push the envelope on the Internet as effectively as they have on TV?