Enjeux éthiques des communications directes aux patients par les compagnies pharmaceutiques

It is widely accepted that patients should be provided with balanced and credible information so that they can make informed decisions about how best to manage their health. However, the sources are not always reliable and the search for balanced, impartial and comprehensible information can be particularly difficult. With a wealth of marketing experience and significant financial resources (far in excess of national regulators), the pharmaceutical industry is one of the major players in direct-to-consumer communications (DTCC). However, pharmaceutical marketing is often seen as a vehicle for transmitting biased information to increase drug consumption, to the extent that in recent years there have been many calls for more government regulation and for industry to better self-regulate its practices.  Although DTCC are generally presented in an accessible and comprehensible way, pharmaceutical company practices raise (and are influenced by) a significant tension between two conflicting imperatives: 1) social expectations for information and consumer empowerment; and 2) commercial expectations that marketing stimulate the sale of drugs and serve as a reference for evaluating the practice of pharmaceutical marketers. These two requirements simultaneously justify pharmaceutical practices, each with different stakeholders: the first for regulators and patient advocates, and the second for industry stakeholders and shareholders. Without these two imperatives, the promotion of medicines would simply not happen: the industry would not invest time, money and energy if there were no financial gains, and practices would not have social and regulatory legitimacy if they did not possess informational qualities.  The social value given to the DTCC, and the regulatory response, varies greatly between jurisdictions. Only two countries in the Organisation for Economic Co-operation and Development (OECD), the United States and New Zealand, have a permissive approach and are more inclined to recognize the informational quality in DTCC. Most other OECD countries (including Canada) have a rather prohibitive approach and only allow for disease awareness, help seeking and other communications not directly related to the sale of a drug. Although they must coexist, the two imperatives are nevertheless often difficult to reconcile given the very high marketing targets, arising from the expectations of the financial markets, that pharmaceutical marketers must attain. It is therefore not surprising that marketing activities present one of the most controversial and challenging ethical issues in the contemporary business world.  This, of course, raises many questions regarding the proper management and resolution of ethical issues related to marketing. In the context of this thesis, these considerations are analyzed through the study of four paradigmatic cases as a means of explaining the ethical and regulatory issues raised by DTCC. Each case is targeted at a particular communication device and aims to provide a more accurate picture of the impact of DTCC, its social considerations and regulatory and ethical implications. The objective of each case study, and more generally that of the thesis, is to make recommendations concerning the responsibility of the main actors in order to better oversee marketing practices and to layout an ethics for DTCC.  Ultimately, the analysis of the cases highlights the ethical dimensions that are the most conducive to systemic change in the practice of pharmaceutical marketing. The cases are therefore focused on the practices of industry employees, for whom benchmarks are proposed, in the form of an ethical engagement and a preliminary ethical framework. The idea is to directly target the actors who, on a daily basis, play a major role in the deployment of DTCC, but who have never received training in ethics to enable them to understand the implications of their practice. The objective is to align the practice of pharmaceutical marketing with pro-social expectations and equip marketers with clear ethical benchmarks to support an appropriate and moral practice of pharmaceutical marketing.

Keyphrases: marketing, bioethics, drugs, medicine, pharmaceutical industry, self-regulation