Pertev Kokdemir & Sefik Gorkey
Marmara University Faculty of Medicine, Dept. Medical History & Ethics, Istanbul, Turkey
 

The Ethics of Advertisements and Use of Internet in Dentistry in Turkey

In the field of dentistry, the internet is emerging, as it is in many other professional fields. Many dentists start to introduce or promote themselves or their clinics to the public on the internet. A discussion has developed whether or not these publications count as advertisements.

The Commission of European Economics Community (EEC) declared that an advertisement is “an announcement aimed to increase sales of products and services”(article 2). According to this definition, the number of people to whom it is exposed is not a criterion for the announcement to be called advertisement (2). Therefore, it comprises announcements in all kinds of media including TV, radio, newspapers, magazines, and the internet.

Patients, so-called “consumers look for quality, trust, price advantage and healthiness”(5). In return, all physicians try their best to address these concerns. But emphasizing the service quality of a physician by means of an advertisement implies a comparison with his or her colleagues. This contradicts the fundamentals of our Dental Deontology (3).

According to article 8 of the Turkish Medical Deontology Amendment which was enacted in 1960, the medical and dental profession should not be a commercial venture. In their publications, physicians and dentists must protect their professional dignity. They cannot advertise themselves in their publications. They cannot allow patients to express their gratitude in the news media. Article 9 specifically states that “physicians and dentists cannot advertise in news media and in their prescriptions other than their names, address, specialty as defined by regulations, their academic title, days and hours of their work”(11). Since misleading advertisements constitute unfair competition according to Turkish Commerce Law (art. 56 etc.), suits of unfair competition can be brought against people who advertise in such a manner (3).

Dental advertising is restricted by rules and regulations in Turkey, like in many countries (9). These rules and regulations limit the number of advertisements on TV, radio, newspapers, and magazines, but they have nearly no impact on the fastest and largest communication medium, the internet. And yet, most advertisement in the virtual world contain misleading information (3). The reason for this is the lack of control over the internet.

According to the Turkish Amendment Pertaining to the Private Health Care Institutions Offering Mouth and Dental Care which was enacted in 1999, some restrictions and prohibitions are brought to advertising on the Internet through the following article: “Health institutions and workers are not allowed, either directly or indirectly, to make advertisements or representations using mass media tools, electronic environment, video and audio tools, written materials and such other materials aimed at people who are consumers, about the institution, their services, diagnostic and treatment methods applied or all kinds of devices and tools. They can not act as mediators in similar activities of other persons, agencies or institutions…”(1).

Internet is a mass medium like TV, radio or newspapers.  Hence, if an advertisement in the newspapers is forbidden then the same advertisement must be forbidden on the internet as well. The perspective of the Ethics Committee of Chamber of Dentists of Istanbul regarding web pages is as follows: “According to the laws and regulations with which  dentists are obliged to comply, web pages as well as all other communication tools should not be used for the purpose of advertising”. It is allowed to publish “scientific information for the purpose of improving the dental health awareness of society, knowledge and experience exchange between associates, name surname and e-mail address of the dentists”. But it is deemed inappropriate to list the “address of surgery and health care institution, photos and special information regarding the institution, use of scientific information by purpose of personal advertising, use of academic titles as specialty titles” (4).

The Turkish Amendment Pertaining to the Private Health Care Institutions Offering Mouth and Dental Care prohibits all kinds of presentations and advertisements. Article 32 says“…But they can prepare written or audio-video training materials which are to be fundamentally used for improvement and protection of health within the area of service of those particular health care institutions and containing information on health problems, protection against such problems or elimination or reduction of negative effects of health problems by taking personal measures, only for use by the patients applying to a private health care institution. It is necessary to obtain a written approval from the chamber of the profession before producing such materials stating that information contained in the material complies with the rules of the regulation and date and number of this approval should be stated on the material produced. Only the name, address and the telephone number of the institution can be included in this training material. Apart from this information, advertisement or introductory information regarding services of any institution, methods of diagnostics or treatment applied by them or all kinds of devices or similar equipment used by them, as well as the name of the issuing person, cannot be included in the material”. Evidently, this highly comprehensive article entails certain restrictions for advertising in dentistry (1).

Another way in which the internet is used is by agencies or brokerages offering medical or dental treatment of better quality and quantity in the foreign countries. This kind of advertisement may have misleading information since no one can guarantee complete health (8). According to the Law of the Turkish Dentists Association, such brokerage is absolutely forbidden with the article stating that “Persons acting as brokers between patients and dentists for their own profit or dentists using brokers shall be sentenced to one to twelve months and will be fined to pay one hundred to three hundred liras (article 45)”(12).

As the internet becomes widespread, we come across more and more ‘netcamera’ and ‘online treatment’ links on the web pages of the clinics or hospitals. Internet enables exchange of visual or written materials about patients, such that the physician or dentist can immediately obtain the results of diagnostic tests or other relevant documentation, and initiate treatment by writing a prescription. In this case the correctness of the diagnosis depends on the quality and the quantity of the information and documents sent by the patient. This requires a highly technological infrastructure.  But it is not clear that many of these sites offering online treatment have such an infrastructure. Hence, links to such services, in other words advertisements of these sites, are potentially misleading (7).

The applicability of the laws and conformity of the society to the laws can only be possible with a strict control mechanism and heavy penalties. In the area of dental care, dentists should conform to the ethical rules (6). There is an obvious need for a committee within the chambers of dentists that will handle contentious situations, assess allegations received, and enforce the law by imposing the required penalties. One of the decisions made during the 8^th General Assembly of the Turkish Dentists Association is to establish “…workshops at the Turkish Dentists Association and Chambers in order to follow the Internet publications regarding the dental care area, improve the benefits of such publications and adapt them to comply with the ethical values and the rules of deontology”(10). Thus control mechanism will be built on a more reliable foundation and continuous control will be assured. 

Undoubtedly, technological developments and the spread of internet have brought advantages to the medical field. But publications and advertisements on the internet containing information against the laws and medical-ethical principles should be avoided. In order to prepare contemporary dentists for the proper use of the internet, this issue should be added to the curricula of dental schools.

References:

1.   Ağız ve Diş Sağlığı Hizmeti Sunulan Özel Sağlık Kuruluşları Hakkında Yönetmelik (Turkish Amendment Pertaining to the Private Health Care Institutions Offering Mouth and Dental Care), Resmi Gazete October 14^th, 1999

2.   Gök, C:Aldatıcı Reklamlara Karşı Tüketicinin Korunması (Protecting the Consumers Against Misleading Advertisements). Banka ve Ticaret Hukuku Araştırma Enstitüsü, Ankara, 1983

3.   Görkey, Ş:Dişhekimliği Deontolojisi ve Reklamlar (Dental Deontology and Advertisements), Dergi, İDO sayı 23

4.   http://www.ido.org.tr/web.asp

5.   http://www.tdb.org.tr/mevzuat/bilinc.html

6.   Kökdemir, P., Görkey, Ş.: Diş Hekimliğinde Reklamın Etik Boyutu ve İnternet Kullanımı (Ethics of Advertisements on Internet in Dentistry), TDB Dergisi, June 2001

7.   Kökdemir, P., Görkey, Ş.: İnternet Üzerinden Yapılan Sağlık Hizmetlerinin Etik Açıdan İncelenmesi (Ethics of the Health Services on Internet), in print

8.   Scheirton, L.S., Boerschinger, T.H.: Advertising. Dental Ethics. Ed. B.D. Weinstein., Lea & Febige., Philadelphia 1993, 143-163

9.   Seear, J.: Law and Ethics in Dentistry., John Wright & Sons Ltd. Bristol 1975 p 8,112

10.  TDB 8. Olağan Genel Kurul Kararları (8^th General Assembly of the Turkish Dentists Association madde 17, TDB Dergisi 12/2000

11.  Tıbbi Deontoloji Tüzüğü (Turkish Medical Deontology Amendment), Resmi Gazete February 19^th,1960

12.  Türk Diş Hekimleri Birliği Kanunu (Law of Turkish Dentists Association), Resmi Gazete 25.06.1985

Contact address: