Everything a doctor should know about medicolegal aspects of advertising

Introduction:

In the climate of concern about high medical costs, the relationship between the trade and professional aspects of medical practice is receiving close scrutiny.  Marketing and advertising in the medical profession have been undergoing a transformation .For ages the relationship between doctors and advertising remained unambiguous all over the world, including India—advertising was forbidden and remains true even today. Over the four-and-a- half-year span of medical training, students are extensively grilled on how to diagnose diseases and treat patients. The rules of conduct, which should guide his behaviour with respect to advertising, are hardly ever touched upon in the medical curriculum. These rules and laws actually offer a framework of advertising within which the future doctor can act. Many students and practitioners are genuinely surprised to know that rules actually exist. Some know that some sort of ethical conduct is expected of them, but are not very clear on the subject. On the other hand in India, there is no central statutory agency or uniform legislation regulating the advertising industry. The Indian advertising market as a whole is regulated and controlled by a non-statutory body, the Advertising Standards Council of India (ASCI). In the absence of uniform integrated legislation, it is necessary for advertisers to ensure that an advertisement is in compliance will all local and national advertisement laws.

Concept of profession and advertising

The concept of profession, as it has been analyzed in sociological, legal, philosophical, and historical perspectives, reveals the importance of an ethic of service as well as medical scientific and technical expertise as defining characteristics of professions.

Word-of-mouth advertising

Since advertising and marketing by medical practitioners is regulated, the most effective way to drive patient traffic is word-of-mouth. “It is service quality that drives patient satisfaction, which leads to word-of-mouth referrals. Patient-to-patient referrals are the best form of advertising” According to marketing academics, doctors are better off perfecting their service delivery rather than spending money on ad campaigns. Word-of-mouth referral from both patients and colleagues is still recognized as the most effective medium for doctors who want to market themselves.  “For general practitioners in particular, professional advertising campaigns are not going to make a huge difference to the practice” Both experts acknowledged that doctors starting out in a practice or who have moved to a new area do need to do some form of advertising or marketing otherwise it shall result in other evils like cut practice/dichotomy, unnecessary referrals etc.

Show business all the way in indirect advertising:

However, for established practices in any specialty, the most important factors in “marketing” a practice are good interiors of clinic and hospital and happy, helpful and good looking staff. “Most people can’t judge if the quality of clinical care offered is good, so it is the peripheral things that become important”,

Five indirect ways to advertise quality of medical service are:

1. Reliability, which for doctors means providing efficient and effective diagnoses, investigations and treatment
2. Responsiveness, which means seeing patients on time but some time delay also becomes hallmark of busy doctor
3. Assurance, which involves a doctor’s expertise and ability to generate trust by communicating in proper language and non verbal content
4. Empathy with pain, disability and chronicity.
5. Tangibles, which cover the physical aspects interior designing of a office practice such as air-conditioning , cleanliness, facilities like TV, magazines and tea coffee in waiting room and the best reception environment

Advertising and websites

Websites have rapidly become the most common form of advertising and marketing in the medical profession

 “Many specialists now have their own websites where they market directly to patients”, The result is that the number of patients asking GPs for direct referrals to particular specialists has grown.

“Often requests are inappropriate, such as a dermatologist referral for routine skin checks or a gynaecologist for routine Pap tests in low-risk patients.”

There has been a noticeable increase in enquiries regarding legality of using website from doctors about their rights and obligations regarding the use of websites as advertising themselves. There is an increasing expectation for doctors to have a website so people can find information about them. Now question is what doctors can and can’t say on websites or when advertising are far from grey. “The rules are quite prescriptive”

medicolegal expert advice is to be pre-emptive. “Most doctors who contact medicolegal expert about precautions be followed regarding contents of website and do and don’t since they do not want to take any risks while setting up a their website” Since in many cases breaches related to law on advertising should not be  inadvertent requiring  correction and enquiry by authority.

As medical professionals engage online with patients and prospective patients, a logical question is whether and to what extent medical professionals may use these social networking platforms to boost practice

Advertisement and Mediclaim

“Some patients ignore the intellectual input of the GP and go to them only because they are covered under Mediclaim or some CGHS or some other government scheme and need a referral to be eligible for a cashless or reimbursement benefits”

Advertising and medical ethics

Advertisement was perhaps the most successful implement of quack doctors practicing medicine in India. Medical advertisements were especially potent in the self reliant, which touted health as a do it yourself venture commodified into tonics and health boosters. To assume that doctors anathematised advertising for purely ethical reasons would be naive. Advertisement has eroded medical professionalism by denying doctors the right to enforce ethical boundaries between themselves and the “let the buyer beware” world of business. And more is at stake than professional status, for the doctor/patient relationship, the cornerstone of medicine, is endangered. So it is no surprise that professional licensed doctors in grew up with a “distaste and discomfort for advertising”.  To distinguish themselves from the circus of healthcare providers, doctors not only instituted higher educational standards and licensure but also demanded that their members refrain from advertising to the masses. Thus, the early divorce of profession of medicine and advertisement has its roots in medical ethics.

Nevertheless, it was significant that the members of the medical profession framed their aversion to advertising as an ethical objection. According to the Code of Ethics, it was “derogatory to the dignity of the profession to resort to public advertisements”. Licensed doctors took a vow not to advertise because of a collective agreement that it was ethically incompatible with patient care. To promise cures or to publish testimonials violated medicine’s commandments, resulting in strict censure and ostracism from the profession. Abstinence from advertisement survived as an unchallenged criterion for medical professional so far.

Possible harms of advertising

Therefore, opening the doors to doctor advertising threatens the professional status of doctoring by denying doctors as a group the right to coalesce around a set of unifying ethical beliefs. Advertising is a divisive force that pits individual against individual, weakening the common ethical calling that is intrinsic to a profession.

Does Advertising diminish cost of health care?

 doctors were bullied to embrace advertising under the delusion that doctoring—like any trade—would become better and cheaper if incited by competition. Today few doctors engage in some form of paid advertising, yet it is doubtful that doctor advertising has either augmented the quality or diminished the cost of health care.

Why doctors want to advertise

Doctors are witnessing the relentless burgeoning of healthcare infrastructure expenditure as well as expenditure on consumable items for providing quality health care; doctors accepted the blame for immuring themselves from the natural forces of economics. Hence Doctors lately are in persuasive mood to seek legal permission for advertising not only amongst their own clan but also to public at large. Doctors guarded their profession from advertisement and their right to exert such internal control was not questioned.

Is Medicine trade or profession?

Medicine has in the past been regarded as the epitome of professions. Members of professions typically share specialized knowledge and possess certain technical expertise. Yet what separates a profession from a trade is codified ethics—professional behaviour is internally anchored by enforced ethical principles. Professionals in return procure from the public a special magnitude of trust.  A professional’s work is buttressed by considerable trust even during a first encounter because of the belief that this individual—by virtue of being a professional—is bound by ethical rules that prevent the exploitation of his or her knowledge and skill. A professional is one individual in society who is not trying to sell you anything; an individual who has at least sacrificed the semblance of profit making ambition in order to enjoy a private relationship with others that is free of consumer scepticism.  Unfettering doctors to advertise with impunity has propelled the metamorphosis of the medical profession into a trade

Advertising and doctor/patient relationship

The doctor/patient relationship is not simply theoretical in nature but rather exists as a truly unique and compassionate collaboration. Trust is the quintessential element of the ideal doctor/patient relationship. Although doctors certainly have financial interests in their work, advertising can make this interest so palpable and conspicuous that it may compromise the trust on which doctors and patients rely.  Advertising may transform the doctor/patient relationship “primarily into a means of making money rather than a means of serving and promoting the best interests of the patient as determined by the patient”.

Fault with advertisement of doctors

Doctor advertising is one‐way communication in which the patient does not participate. If a doctor tried to read an advertisement to a patient face to face, he or she would most likely not finish before the patient interrupted, wanting clarification and elucidation of the risks. Moreover, overwhelmingly demand the freedom to choose among possible treatment options as well as among primary care doctors and specialists. Doctor advertising manipulates choice by presenting limited and biased information that aims to entice rather than inform. Advertisements often fail to cite complications and rarely present treatment alternatives not offered by the doctor. The fleeting medium of advertisement—billboards, short radio segments, fliers, rapid television info-commercials—is not appropriate for initiating the informed and often complex decision making process that should underlie all health interventions. Finally, one is left to ponder how patients can make decisions in their best interest when exposed to the worst of doctor advertising, which associates certain interventions with luxury, beauty, or esteem. In addition, doctor advertising may increase the cost of health care and create unrealistic expectations that will further weaken the relations between doctor and patient. The price of advertising will augment doctor overheads and be transferred to the patient fees. “Additional hidden cost to doctor advertising” when misleading advertisements generate suits and force doctors to transfer higher malpractice indemnity insurance premiums to the patient fees.

Advertising leads to doctor shopping

One must remember that trust goes both ways. Doctors tend to trust that patients who are satisfied with the prescribed treatments will continue to return as they fall sick and feel necessary to get treated by doctor. Advertising encourages patients to frequently change doctors and shop around for the best deal; doctors may exert less effort to establish a strong doctor-patient interpersonal ethical trustworthy relationship with patients. An analysis of phonebook listings in “Yellow Pages” out of one hundreds of doctors, revealed that about 12% of “specialists” in the Yellow Pages were not qualified. Moreover, many doctors are listing themselves as specialists in fields—such as hypnosis and nutrition—for which no specialty qualification exists. Specialty advertising in the “Yellow Pages” is therefore frequently is deceptive; patients are being misled into believing that they are receiving expert care. Advertisements can too easily take advantage of the public’s ignorance regarding what confirmation of a doctor to be a true medical specialist. Even simple “Yellow Pages” words like “safe” and “effective” may prove to be legally debatable. Finally, a meaningful doctor/patient relationship requires that the doctor appreciate the delicate role of being a patient. Patients are not consumers in search of a commodity. One must realize that suffering teeming millions of patients have unique vulnerability breeding in the psyche which that comes to them for want of relief from disability and disease.

Gullible patients and advertisements

Hence gullible patients fall easy prey to the incredulousness forms of advertising falsely claiming to cure without injection and surgical operations. The word reliefs in advertisements make them vulnerable to subscribe to such advertisements. Advertisement becomes maximally seductive when priceless intangibles such as “feeling good” and pain relief are showcased to a suffering population. It is simply disrespectful to accost the medical ignorance, insecurities, and fears of patients with persuasion and titillation. There is simply no single variable parameter with which one can measure doctors in order to determine what the best remedy for a particular patient is. it will be unfortunate if the public begins to associate the quality of a doctor with the quality of his or her advertisements in media. The humility that should accompany the privilege of treating patients is lost when doctors invest in self aggrandizement detailed in advertisement spread across media.

Majority of doctors do not want to advertise

If medicine has lost some of its prestige is perhaps due to advertisement undertaken by doctors and they do not stick to ethical code saying “don’t to advertise”. Majority of doctors even today resent against minority of doctors advertise. Majority of doctors even today consider they were too noble to dirty their hands with advertising and business like behavior in practice of medicine. Majority of doctors recognized that medicine did not end with the distribution of a pill but required the formation of productive interpersonal doctor patient relationship buttressed by an indispensable trust. Hence the prohibition against advertising was not based on ethical superiority. Now that medical quackery has reached unprecedented sophistication, annually draining billions from the population with unproven treatments and supplements, some doctors are more tempted to advertise and secure some piece money lying in the of the healthcare pie. Yet no matter what the law permits, advertisement in medicine should remain a taboo that unifies most doctors.

Medical and health Industry-Specific Laws concerning doctors regulating advertising

1. The Drugs and Cosmetic Act, 1940
2. The Transplantation of Human Organs Act, 1994
3. The Drugs and Magical Remedies (Objectionable Advertisements) Act, 1954
4. The Prenatal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994
5. Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992
6. Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003
7. Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002
8. The Food Safety & Standards Act, 2006

Products and Services Banned From Advertising

Medical Devices

The authority principally responsible for regulating medical devices in India is the Central Drugs Standard Control Organization (“CDSCO“) under the provisions of the Drugs & Cosmetics Act, 1940. CDSCO’s functions include regulating the medical devices industry by approving for import, manufacture and sale of medical devices in India.

Medical Services

Individual doctors should not advertise. An institution run by a doctor for a particular purpose such as a maternity home, nursing home, private hospital, rehabilitation centre or any type of training institution etc. may be advertised in the lay press, but such advertisements should not contain anything more than the name of the institution, type of patients admitted, type of training and other facilities offered and the fees.

An institution run by a clinician for a particular purpose, such as a maternity home or sanatorium or home for the blind or aged, may be advertised in the lay press, but such advertisements should not contain anything more than the name of the institution, types of patients admitted, facilities offered and the residential fees. The names of the superintendent or the doctors attending should not appear in the advertisement.

Human Organs

The Transplantation of Human Organs Act, 1994: This law provides for the regulation of removal, storage and transplantation of human organs for therapeutic purposes and for the prevention of commercial dealings in human organs. This law prohibits any advertising inviting persons to supply, offering to supply, any human organ for payment.

Magical Remedies

The Drugs and Magical Remedies (Objectionable Advertisements) Act, 1954 prohibits advertisement of magical remedies of diseases and disorders.

These occult or psychic services are not legally recognized in India and are not permissible under the Drugs and Magical Remedies (Objectionable Advertisements) Act, 1954

Services for Pre-Natal Determination of Sex

The Prenatal Diagnostic Techniques (Regulation and Prevention of Misuse) Act, 1994 prohibits advertisements relating to pre-natal determination of sex.

Infant formula

Advertising forbidden in order to encourage natural feeding of infants. See details under Food.

Tobacco

The Cigarettes and other Tobacco Products (Prohibition of Advertisement and Regulation of Trade and Commerce, Production, Supply and Distribution) Act, 2003 (“Tobacco Prohibition Act“) prohibits all direct and indirect advertising of tobacco products in all media.

Doctors are not allowed to advertise except for specified reasons

Under the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, issued under the Indian Medical Council Act, 1956, doctors are not allowed to advertise their services in any form or manner of advertising through any mode, as soliciting of patients directly or indirectly, by a doctor, by a group of doctors, or by institutions or organizations is unethical. (A doctor refers to a doctor with a qualification of MBBS or MBBS with a postgraduate degree/diploma or with an equivalent qualification in any medical discipline.) However, medical practitioners are allowed to make a formal announcement in press regarding the following:

1. On starting practice
2. On change of type of practice
3. On changing address
4. On temporary absence from duty
5. On resumption of another practice
6. On succeeding to another practice
7. Public declaration of charges

Advertising pharmaceuticals (over-the-counter and prescription medications)

The phrase over-the-counter (OTC) has no legal recognition in India. All the drugs not included in the list of “prescription-only drugs” are considered to be non-prescription drugs (or OTC drugs). Prescription-only drugs are those medicines that are listed in Schedules H and X of the Drug and Cosmetics Rules, 1945.

Advertising Products Related to Sexuality (condoms, ED drugs, etc.)

Advertisements related to sexuality are allowed with the provision that there should not be any indecent representation of women under the Indecent Representation of Women (Prohibition) Act 1986. Products must comply with the Drugs and Cosmetic Act 1940 and other certification rules under the Cable Television Network Rules 1994. But Advertisement pertaining to sexual services is illegal in India.

Advertising to Children (advertising during and immediately before and after children’s programming)

The Young Persons (Harmful Publications) Act, 1956 prohibits advertisements relating to any harmful publication i.e., any publication that tends to corrupt a young person (person under the age of 18 years) by inciting or encouraging him or her to commit offenses or acts of violence or cruelty or in any other manner whatsoever.

According to the ASCI Code, advertisements addressed to minors shall not contain anything, whether in illustration or otherwise, which might result in their physical, mental, or moral harm or which exploits their vulnerability. For example, advertisements may not:

1. Encourage minors to enter strange places or to converse with strangers in an effort to collect coupons, wrappers, labels or the like
2. Feature dangerous or hazardous acts which are likely to encourage minors to emulate such acts in a manner which could cause harm or injury
3. Show minors using or playing with matches or any inflammable or explosive substance; or playing with or using sharp knives, guns, or mechanical or electrical appliances, the careless use of which could lead to their suffering cuts, burns, shocks, or other injury
4. Feature minors in promoting tobacco or alcohol-based products
5. Feature personalities from the field of sports, music, or cinema for products which, by law, either require a health warning in their advertising or cannot be purchased by minors.

Celebrity Endorsements

There is no restriction.

Comparative Advertising (ads that compare the advertiser’s product to that of a competitor)

The provisions pertaining to comparative representation were part of “Unfair Trade Practice” under the Monopolies and Restrictive Trade Practices Act, 1969 (MRTP Act). After repeal of the MRTP Act, the provisions relating to unfair trade practices were inserted in the Consumer Protection Act, 1986. However, a business entity cannot claim relief against unfair comparative advertising under the Consumer Protection Act, as a business entity is not a consumer. This can be taken up only by consumer associations, the central government, or state governments, and it does not provide protection to the business entity equal to the protection under the MRTP Act. Thus, under the existing law, a manufacturer whose goods are disparaged has no standing to seek a remedy. Presently, in the absence of any specific legislative regulating comparative advertising, disputes are decided by various courts on the basis of the facts in each case. However, ASCI code (which is made part of the Cable Television Network Rules, 1994 as well) permits advertisement containing comparisons including those where a competitor is named in the interests of vigorous competition and public enlightenment, provided:

1. It is clear what aspects of the advertiser’s product are being compared with what aspects of the competitor’s product.
2. The subject matter of comparison is not chosen in such a way as to confer an artificial advantage upon the advertiser or so as to suggest that a better bargain is offered than is truly the case.
3. The comparisons are factual, accurate and capable of substantiation.
4. There is no likelihood of the consumer being misled as a result of the comparison, whether about the product advertised or that with which it is compared.
5. The advertisement does not unfairly denigrate, attack or discredit other products, advertisers or advertisements directly or by implication.

Presently, ASCI is actively taking action against any advertisements making unsubstantiated claims, exaggeration, unfair denigration in violation of ASCI Code.

Deceptive or Misleading Advertising

Health services must not be advertised in a way that:

1. Is false, misleading or deceptive or is likely to be misleading or deceptive
2. Offers a gift, discount, or other inducement to attract a person to use the service or the business, unless the advertisement also sets out the terms and conditions of the offer
3. Uses testimonials or purported testimonials about the service or business
4. Creates an unreasonable expectation of beneficial treatment
5. Directly or indirectly encourages the indiscriminate or unnecessary use of regulated health services.

Misleading and deceptive conduct, misrepresentation and false representation of services and costs, and unconscionable conduct.

It lists the most common problems with medical advertising as:

1. Exaggerations or claims that cannot be substantiated
2. Advertisements requiring or suggesting self-diagnosis
3. Use of titles and qualifications
4. Claims about price and/or cost
5. Claims about time, eg. how quickly patients can expect results
6. Disclosure of conflicts of interest

Deceptive or misleading advertisements are restricted under the various legislations including the Consumer Protection Act, 1986; Cable Television Network Rules, 1994; Norms for Journalist Conduct issued by the Press Council of India Act and ASCI Code.

Surrogate Advertising

The ASCI Code provides that advertisements of services and products whose advertising is prohibited or restricted by law or medical ethics.

Surrogate advertising

The code of ethics forbids cheap exhibition by doctors in the form of interviews and articles published for the purpose of advertising themselves or soliciting practice.

The doctor is permitted to write to the press under his own name, on matters of public health or hygiene, or to deliver public lectures or give talks on the radio or television on subjects of public interest. He is also permitted to make a formal announcement in the press regarding the following:

1. starting practice
2. change of type of practice
3. change of address
4. temporary absence from duty
5. resumption of practice
6. succeeding to another practice

On a more pragmatic note, the Indian code of ethics categorically states that the ‘solicitation of patients directly or indirectly be a doctor, by groups of doctors or by institutions or organizations is unethical.’ The doctor who advertises his skills, achievements, qualifications lowers his own dignity and that of the profession.

No doctor should use touts or agents for procuring patients. He should neither pay, nor receive a commission for referring patients.

The Cable Television Networks Rules, 1994 has also imposed similar restrictions to curb surrogate advertising.

Advertorials and Disguised Ads

The Norms for Journalist Conduct issued by the Press Council of India, Cable Television Network Rules, 1994 and Advertising Code of Doordarshan requires that advertisements must be clearly distinguishable from news content carried in the newspaper.

False Advertising

False advertisements are restricted under the various legislations including the Consumer Protection Act, 1986; Cable Television Network Rules, 1994; Norms for Journalist Conduct issued by the Press Council of India Act and ASCI Code.

“Free” Gifts/Samples

The Consumer Protection Act 1986, Section 2 (3) (a) states that (i) the offering of gifts, prizes or other items with the intention of not providing them as offered or creating impression that something is being given or offered free of charge when it is fully or partly covered by the amount charged in the transaction as a whole, or (ii) the conduct of any contest, lottery, game of chance or skill, for the purpose of promoting, directly or indirectly, the sale, use or supply of any product or any business interest, is an unfair trade practice.

Summarizing Advertising

The doctor who sets up practice and announces his presence with an unusually large signboard is probably not breaking the law, but he is certainly acting unethically. A doctor’s signboard cannot have the status of a glossy hoarding. Both signboard and the doctor’s prescription pad should proclaim nothing more than the doctor’s name, qualifications, titles and specialty. It is improper to affix a signboard on a chemist’s shop or in places where he does not reside or work. Advertising lowers the dignity of the profession and entices or lures patients on the basis of glamour rather than competence. Advertising is growing menace of doctors who seek self-glorification and who market themselves in newspapers, magazines and on television. Doctors, surgeons and many quacks have been known to make tall claims of successful  and fantastic surgeries, guaranteed cures for obesity, cancer, AIDS and other diseases. Such individuals cannot wait for their work to speak for itself. Instead, they indulge in talk shows, consultancy columns in newspapers and advertisements of their arrivals and departures in various cities.

Doctors who advertise for various drugs, toothpaste products or remedies on TV and is also proceeding against doctors who place huge advertisements in newspapers for slimming programs and other quick money making programmes should be prosecuted. Self promotion in any form is a punishable offence under the rules laid down by the Medical Council of India and the state councils. There also bar on doctors from publishing their photographs in media and such conduct will debar doctors from medical practice. Ideally doctor cannot claim to be a specialist unless he has put in a number of years of study and experience in the speciality, or he has the appropriate University qualification. Once he becomes a specialist, he cannot and should not work outside his speciality even for his friends. The ramifications of this statement are far reaching. Cross practice of allopathy and other disciplines of medicine like Homeopathy, Unani or Ayurvedic Medicine is wrong and it behooves the clinician to restrict his practice to the discipline he is specifically trained for. Dabbling in other sciences is unethical and potentially dangerous. On a similar note, the anesthetist, for instance, should not do general practice nor should the neurosurgeon dabble in conditions that fall within the domain of the neurologist. There is, however, scope for debate on this issue when considering doctors who practice in rural areas, where they are forced to offer services on many fronts, because of the non-availability of qualified or specialist help.

 Advertising and legal implications

Even medical practitioners were subject to tight restrictions with respect to advertising. Any attempt to advertise special skills or services could result in a breach of the medical practice norms. Doctors who overstep the mark can face the ultimate penalty of deregistration .Indian Constitution in Article 19 protects Fundamental Right to speech and expression which includes Right to Advertisement also. Advertisement is a public notice offering or asking for goods, services etc. it includes any notice, circular, label, wrapper, or any other document including Advertisement through internet or any other media in electronic or print form and also includes any visible representation made by means of any hoarding, wall painting, signal, light, sound, smoke or gas. As per point 6.1, Chapter 6 of the Indian Medical Council (Professional Conducts, Ethics & Etiquette) Regulations 2002, advertisement has been defined under Unethical Acts. No medical Professional is allowed to advertise in any way which invites attention to his professional position, skill, associations, affiliations, honors or such character that would ordinarily result in his self aggrandizements. One cannot print his self photograph.

Examples of illegal advertising

1. The dug being illegally promoted was Disclowin Plus, which is a scheduled H drug that can only be sold on a doctor’s prescription. The advertisement promote Disclowin Plus as a cure for pain and head ache, even though its active ingredient Diclofenac Sodium is approved to treat only arthritis and gout. Disclowin Plus is a Non Steroidal Anti Inflammatory Drug (NSAID), with side effects and it is not recommended for asthmatic, pregnant women, people who are allergic for Aspirin and those at the risk of peptic ulcer or of gastro intestinal bleeding. “The advertisement is misleading and makes the people believe it is a safe pain killer for Head ache relief”. Side effect of Diclofenac include Headache, rash, flatulence, heart failure, blood disorders, diarhoea, nausea, abdominal pain, ulcers in stomach or intestine, decreased kidney function, inflammation of liver and severe blistering skin reaction affecting the tissues of the eyes, mouth, throat and genitals.
2. The Medical Council of India (MCI), the statutory body regulating medical education and practice, has found unethical the Indian Medical Association’s endorsement of two food products and barred such endorsements. The MCI would ask IMA, to stop endorsements. The issue is the IMA’s Rs 2.25-crore contract with Pepsico to allow Tropicana fruit juice and Quaker oats to use the IMA logo on their packs for three years ending 2011. The controversy has been raging for two years after Dr K V Babu, an IMA central committee member, complained to MCI on June 6, 2008, that the endorsement violated medical ethics. After protracted proceedings, the National Human Rights Commission served a notice on the association on June 30, 2010. After some confusion on its own powers over IMA, MCI on August 18 declared that IMA came under its jurisdiction and served a show-cause notice to the IMA ”for endorsing the product in violation of the provisions of the Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002.” In its reply of August 30, 2010 IMA argued it had not endorsed the products, but only entered into a MoU with Pepsico for a ‘nutritional awareness programme.’ MCI found this explanation unsatisfactory and summoned IMA Honorary Secretary- General for a personal hearing and inspection of the MoU. ”Now it is clear that IMA was at fault by endorsing the products. If the endorsements have not yet been stopped, they have to be, soon”. Stand of MCI: Board of Governors, presently in-charge of MCI‘s current affairs has decided to ask IMA to stop such endorsements forthwith. Penal action, if any, will be decided by the MCI ethics committee at its meeting. The decision will then have to be ratified by the Board of Directors within a week”. IMA‟s Stand: Earlier, IMA office bearers had said the decision to endorse the products was a mistake, but it was unable to get out of the contract as the settlement amount would be too big. Global Scenario:
3. in a similar case in 1988, the  Medical Association (AMA) had to pay $9.9 million (Rs 45 crore) to withdraw from a contract it signed with Sunbeam Corporation. While that was an endorsement of medical equipment, IMA became the first professional body of doctors in the world to endorse a food product. In fact, IMA has endorsement contracts with health and hygiene products including Dettol, Lizol (sanitizers), Aquaguard (water purifier), Pampers (napkins) and Odomos (mosquito repellent). Thus most prevalent unethical practice among medical profession in India, which can be easily proved as evidences are in record form, is related to issue of ―unethical advertisement.