Is brand endorsement by medical associations ethical?
A recent news item reported on the Indian Medical Association’s decision to endorse the Tropicana brand of fruit juices and Quaker brand of oats. The director of the Centre for Science and Environment, Sunita Narain, has objected to the association’s actions, calling them “advertisement tricks” (1).
The Indian Medical Association (IMA), the national organisation of “doctors of modern scientific system of medicine”, was set up in 1928 (2). Its major objectives include: promotion and advancement of medical and all related sciences, improving public health and medical education in India, and maintaining the honour and dignity of the medical profession.
Actually, the IMA and other medical associations have endorsed a number of commercial products over the years. The IMA has endorsed Eureka products and products like Lifebuoy soap. It recently agreed to endorse hygiene products and is currently negotiating an endorsement with Dabur (1). The Federation of Family Physicians’ Associations of India certified Kinley, a packaged drinking water, though it withdrew this certification following public pressure (3, 4). The Indian Dental Association endorses Colgate toothpaste and Pfizer’s Listerine mouthwash (5).
The manufacturers of Tropicana juice received the IMA’s endorsement in return for Rs 5 million. IMA sources state that the amount received will be used to conduct scientific activities, seminars and conferences (1). For endorsing products of Eureka Forbes, the IMA received Rs 30 million (6).
If we look at the world scenario, the logo of the British Heart Association appears on Tetley tea and the World Heart Federation logo appears on Kellogg’s bran flakes. Muller Crunch Corner yoghurt carries the logo of the National Osteoporosis Society. Ribena Tooth Kind states that its drink is “the only drink accredited by British Dental Association”. These exclusive endorsements are made even though equivalent (and even cheaper) brands are available (7). The United Kingdom’s market has over 40 food products that have logos or endorsements from health charities or medical associations (8).
The American Medical Association (AMA) paid Sunbeam Corporation US$ 9.9 million to avoid a suit for breach of contract when the company pulled out of a five-year, multi-million-dollar endorsement deal. The AMA was to endorse Sunbeam’s blood pressure monitors, humidifiers and other products, but the association withdrew from the deal after being criticised because it had no plans to test the products. The chief executive of the AMA resigned following protest over this case (9, 10). Supporters of fluoridation have endorsements from the AMA and the American Dental Association (ADA) to promote their products, one of which is Crest toothpaste (11). The ADA has also approved Wrigley’s sugar-free chewing gum products after accepting US$ 36,000. The American Cancer Society receives US$ 300,000 a year from Neutrogena to approve its products (12).
The ability of endorsements to affect consumer behaviour has been discussed in the past (13). Advertisements and promotional strategies are based on consumer psychology and even the best informed consumer cannot escape their influence. Their impact is heightened when medical associations endorse brands (14). Consumers look for credible sources and opinions that cut through the advertising hype, so they are receptive to endorsements by health organisations, and such endorsements have an effect on their behaviour and the companies’ sales go up (15).
Ethics for doctors
When medical associations endorse a product, they violate the Medical Council of India’s 2002 regulations (16) regarding professional conduct, etiquette and ethics for registered medical practitioners. The regulations specify that a physician shall not give to any person, whether for compensation or otherwise, any approval, recommendation, endorsement, certificate, report or statement with respect to any drug, medicine or any commercial product for use in connection with his name, signature or photograph in any form or manner of advertising through any mode.
The basic objectives of clinical associations are to promote medical science, and improve public health and medical education. Are the honour and dignity of the association not being tarnished when it accepts money to endorse a particular brand? If the brands are medicines, their efficacy should be proved by clinical trials and the results published. Advertisements for products with endorsements contain a line to the effect that results are not “100 per cent proven”. Many of these products are cosmetics or food supplements that are being sold under the garb of medicine to escape heavy taxes – the so-called “nutraceuticals” and “cosmeceuticals”, which have no meaning in the Drugs and Cosmetics Act or in the Food and Drugs Administration.
A medical association’s name and emblem are its pride. Using them for monetary gain is like selling the association for a price. Medical associations do not have the authority to dispense seals of endorsement, recognition or approval. It is not acceptable them to sell these even if it is argued that the amount received is put to good use. We should have a ban on all medical association endorsements and action should be taken against those who violate medical ethics. Let the glory of medical associations shine through their work on promoting health and not as commercial advertisers.
I thank the members of Network for Rational Use of Medicines (NetRUM) for their help in preparing this article.
- Times News Network. IMA faces ire for endorsing juice brand. The Times of India 2008 May 8. [cited 2008 Jun 13]. Available from: http://timesofindia.indiatimes.com/India/IMA_faces_ire_for_endorsing_juice_brand/articleshow/3019870.cms.
- Indian Medical Association. Panipat branch. Objectives.[cited 2008 Jun 13]. Available from: http://imapanipat.com/objectives.html.
- Bhandare D. Advertisement approved by the IMA? Letters. Indian J Med Ethics 1999 Apr-Jun; 7(2): 36. [cited 2008 Jun 13]. Available from: http://www.issuesinmedicalethics.org/072mi036.html
- Datta PTJ. Coca Cola to dump doctors’ endorsement in Kinley ad. Hindu 2001 Mar 23. [cited 2008 Jun 13].Available from: http://www.hinduonnet.com/businessline/2001/03/23/stories/14233426.htm.
- Pfizer India. Consumer health. [cited 2008 Jun 13]. Available from: http://www.pfizerindia.com/pindia_cb_phar.html.
- Datta PTJ. Drawing the line on medical endorsements. Hindu Business Line 2003 Jun 30. [cited 2008 Jun 13]. Available from: http://www.thehindubusinessline.com/2003/06/30/stories/2003063001470100.htm.
- Health charities boost food company profits. Food Magazine 2002 Apr 23. [cited 2008 Jun 13]. Available from: http://www.foodcomm.org.uk/press%20images/linkups.pdf.
- Foodnavigator.com. The rise of endorsement marketing. [cited 2008 Jun 13]. Available from: http://www.foodnavigator.com/news/ng.asp?id=44848-the-rise-of.
- SoRelle R. Report on the American Medical Association meeting. Circulation1998; 97:516-17. [cited 2008 Jun 13]. Available from: http://circ.ahajournals.org/cgi/content/full/97/6/516.
- Anonymous. What the American Medical Association hopes you never learn about its true history. [monograph on the Internet; cited 2008 Jun 13]. Available from: http://www.docjeff.com/index.php?file=american_medical_assoc.html.
- Halford B. Fluoride. Chemical & Engineering News 2005; 83(25) [cited 2008 Jun 13]. Available from: http://pubs.acs.org/cen/coverstory/83/8325/8325fluoride.html.
- CNN.com. Paying for product approvals. [cited 2008 Jun 13]. Available from: http://www.cnn.com/HEALTH/blogs/paging.dr.gupta/2007/09/paying-for-product-approvals.html
- Dean Hal D. Brand endorsement, popularity and event sponsorship as advertisement cues affecting consumer. J of Advertising 1999 Sep 22. [cited 2008 Jun 13]. Available from: http://www.allbusiness.com/management/382063-1.html.
- Murlidharan YG. Endorsement by docs: consumer interest at stake. 2008 May 27. [cited 2008 Jun 13]. Available from: http://www.newindpress.com/NewsItems.asp?ID=IE120080526222213&Page=1&Title=Bangalore&Topic=0&.
- Freitag M. The media business: advertising-the value of a seal of approval. Health 1989 Jul 14 [cited 2008 Jun 13]. Available from: http://query.nytimes.com/gst/fullpage.html?res=950DE5DD123CF937A25754C0A96F948260&sec=&spon=&pagewanted=all
- The Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002 and MCI notification 2002 Apr 06. [cited 2008 Jun 13]. Available from: http://www.expresshealthcaremgmt.com/20020531/focus1.shtml.