ethics, advertising andthe definition of aprofession · advertising, andthemercantileaspects...

Journal ofmedical ethics, 1985, 11, 72-78

Ethics, advertising and the definitionof a profession

Allen R Dyer Departments ofPsychiatty and Community and Family Medicine, Duke University Medical Center,Durham, North Carolina, USA

Author's abstractIn the climate ofconcern about high medical costs, therelationship between the trade and professional aspects ofmedical practice is receiving close scrutiny. In the UnitedKingdom there is talk ofincreasing privatisation of healthservices, and in the United States the Federal TradeCommission (FTC) has attempted to define medicine as atrade for the purposes ofcommercial regulation. TheSupreme Court recently upheld the FTC charge that theAmerican Medical Association (AMA) has been inrestraint oftrade because ofethical strictures againstadvertising. The concept ofprofession, as it has beenanalyzed in sociological, legal, philosophical, andhistorical perspectives, reveals the importance ofan ethic ofservice as well as technical expertise as definingcharacteristics ofprofessions. It is suggested that themedical profession should pay more attention to its serviceideal at this time when doctors are widely perceived to betechnically preoccupied.

The status of medicine as a profession has long goneunchallenged. If anything was a profession, it wasmedicine. Medicine, along with law and the clergy, theso-called 'learned professions', were defined by theknowledge held by their members and by theapplication of that knowledge to the needs of fellowcitizens. The relationship between the professional andthose served was considered of special importance, andsocieties have traditionally placed sanctions on thatrelationship, such as the protection of confidentiality,notable in English common law dating back tomedieval times. But the sanctity of relationships withprofessionals has always existed alongside anuneasiness about the mercantile aspects ofprofessionalpractice. In the contemporary era, the criticisms of themedical profession have become so widespread that theidea of a profession being defined primarily by an ethicof service shared by its members is no longer entirelyconvincing. More prominent is the idea of a professionbeing defined by technical services traded in themarket-place.

Key wordsEthics; medical ethics; advertising; profession; Federal TradeCommission; cost; monopoly.

This paper attempts to assess the meaning ofcontemporary challenges to the profession of medicineby looking at what it means for medicine to beconsidered a profession as distinct from a trade.Specifically it considers the role codes and traditionsof ethics play in defining medicine as a profession.

The definition of a professionOriginally the word profession meant 'to profess'religious vows. Medicine was a profession along withthe clergy because its members shared a common'calling,' and law was considered professional througha similar educational background in the medievaluniversity (1). University 'professors' (the masters atthe University of Paris) were first allowed toincorporate in the thirteenth century (2), and thedebate about whether guilds and guild-like groupsexert true monopoly power over prices has yet to besettled (3).What is considered professional might best be

understood in contrast with what is not. In athletics asin sexual activity, the designation 'professional' merelyimplies getting paid for what others do for free (4). Butthe professional is also distinguished from the amateurby a greater level of proficiency which merits themonetary compensation. Thus some level of skill orexpertise is generally held to be requisite forprofessional status. Reiser, Dyck and Curran extendthis consideration in a particularly useful definition ofprofession. They suggest that 'self-conscious reflectionon standards of conduct is one of the definingcharacteristics of a profession' (5).The dual themes relating professions to knowledge

on the one hand and its application to practice on theother place professions in an intermediate positionbetween sciences and trades with features in commonwith both, but also distinct from both (6). Theliterature distinguishing professions from trades isabundant, (7), (8), (9) but in the twentieth century, asknowledge has come to mean scientific knowledge, themedical profession is increasingly identified withtechnical expertise. But technical expertise is notsufficient to characterise a profession, as sociologists ofthe professions have demonstrated. The ethicaldimension is also required.

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Ethics, advertising and the definition ofa profession 73

The sociology of professionsA popular generalisation ofthe sociological literature isthat occupations are becoming 'professionalised'. Butspecialisation, technical skills and expertise do notsuffice to establish a work group as a profession. Whatdoes? According to Wilensky, any occupation wishingto exercise professional authority must find a technicalbasis for it, assert an exclusive jurisdiction, link bothskill and jurisdiction to standards of training andconvince the public that its services are uniquelytrustworthy (10).The theme of trustworthiness is the pivotal criterion

of professional status. The understanding of someoneas a 'professional' ultimately depends on the ability totrust that individual with personal matters. Thevarious articulated codes of ethics of professionalgroups all stress the maintenance' of thetrustworthiness of members of the professional groupthrough control of entry into and exit from theprofessional group and discipline of deviant membersif necessary (for example censure or removal frommembership of the group, or removal of licence).Table 1 (overleaf) illustrates the process ofprofessionalisation of a number of professions andwould-be professions in the United States. Itdemonstrates that the route to professional statusincludes the establishment of university trainingprogrammes, the formation of professionalassociations, and the presence of formal codes ofethics.Profession and monopolyOne of the most noticeable features of professionalorganisations, viewed in sociological perspective, istheir attempt to control markets and promote self-interest. The theory of professional monopoly wasdeveloped by Max Weber, who described the followingsteps by which the medical profession, as allcommercial classes, achieves monopoly power:creation of commodities, separation of theperformance of services from the satisfaction of theclient's interest (ie doctors get paid whether or not thetherapies work), creation of scarcity, monopolisationof supply, restriction of group membership,elimination of external competition, price fixationabove the theoretical competitive market value,unification of suppliers, elimination of internalcompetition, and development of group solidarity andco-operation (11). Such careful delineation of aneconomic component to human motivation was trulyradical in its time, but today it has becomecommonplace to reduce all human motivation toeconomic considerations. The problem with thisanalysis of professional monopoly is that it is one-dimensional; it considers only economic motives andoverlooks the benefit to the public which occurs fromsuch things as the promotion of scientific medicine andefforts to maintain professional standards.The basic issue is whether physicians can place

concern for the public good ahead of their own self-

interest. Trust or trustworthiness is the keystone ofmedical virtue in the traditional canons of medicalethics from the Hippocratic Oath to Percival's code tothe various versions of the AMA codes (see Table 2page 77). Trust is the basis of what it means to be aprofessional, what it means to be ethical. From theantitrust point of view, any trust, even basic humantrust is suspect as a form of monopoly.

Berlant, applying Weber's theory of monopoly tothe medical profession, states the case very cogently:

'[The] trust-inducing devices of the Percivalian codeincrease the market value of medical services and helpconvert them into commodities . . . It also creates apaternalistic relationship toward the patient, whichmay undermine consumer organization for mutualself-protection, thereby maintaining consumeratomization . . Through atomization of the publicinto vulnerable patients, paternalism results in theprofession's dealing with fragmented individualsrather than bargaining groups. Moreover, byappealing to patient salvation fantasies, trustinducement can stimulate interpatient competition byincreasing each patient's desire to see that nothingstand between doctor and himself. Much of theemotional power of the sentiment of the doctor-patientrelationship resides in this wish of the patient to savehimself at any cost to himself or others' (12).

Berlant offers a sharp attack on professional ethicsfrom a particular ideological perspective. But basicallythis attack is not just on professional ethics, it is also anattack on a kind ofcommunity in which people may notbe autonomous and independent, but in which peoplemay be dependent and in need of help which theywillingly seek. This argument introduces a note ofalmost cynical suspiciousness into a society whosemembers seem almost too willing to trust and to placethemselves in the care of others. This is a crisis ofconfidence - both for medicine and for our civic life ingeneral: to what extent is it possible and necessary totrust and rely on others and to what extent is it possibleto remain isolated, self-reliant and autonomous humanbeings?

It is because of such challenges to the medicalprofession's codes and traditions of ethics that a closerlook at the form and substance of those codes isnecessary.

The antitrust challenge to the professionsA profession's service ideal has several manifestations:a formal code of ethics, more personal ethical outlooks,and certain activities, such as licensure, specialtycertification and the accreditation of institutions andtraining programmes, undertaken by a professionalassociation to maintain standards of the group. It canbe argued that such professional gate-keeping is anessential aspect of professional responsibility, butthere is a widespread perception that the restrictionsthat the learned professions have placed on themselves



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under the aegis of professional ethics have beenmotivated not in fact by 'ethics' in the sense of a desireto achieve a higher plane of moral conduct, but ratherto serve the self-interest of the existing members of theprofession.

Perhaps because of the ambiguous relationship ofpublic interest and professional self-interest, thelearned professions were considered exempt from theantitrust laws from the time of the passing of theSherman Antitrust act in 1891 until the SupremeCourt's Goldfarb decision in 1975, in which Virginialawyers were found liable to charges of price-fixing ofthe fees charged for title searches. The Goldfarbdecision heralded a flurry of antitrust activity, mostnotably the suit by the Federal Trade Commissionagainst the American Medical Association, theConnecticut State Medical Society, and the NewHaven County Medical Association, charging thatthese professional organisations were in restraint oftrade because their code of ethics prohibitedadvertising. After a seven-year legal battle, this casewas settled on March 23, 1982, when the SupremeCourt split 4-4 leaving in place the lower court rulingthat barred the AMA from making any reference toadvertising and the solicitation of patients, and furtherprohibiting the AMA from 'formulating, adopting anddisseminating' any ethical guidelines without firstobtaining 'permission from and approval of theguidelines by the Federal Trade Commission' (13).Though advertising is the focal issue in this particularcase, the ethics of the profession both as explicitlyformulated in the AMA's Principles ofMedical Ethicsand as implicitly practised, as well as the right andpropriety of a professional association to formulate itsown code of ethics, are being called into question (14,(15).The FTC suit hinged on the questions of cost,

advertising, and the mercantile aspects of the medicalprofession. The position of the FTC is that the reasoncosts are high is because doctors have a monopoly onhealth care delivery and can thus maintain artificiallyhigh costs for their own profit. If doctors were notprohibited from advertising, it is argued, prices wouldcome down because patients could shop for the bestdeals. FTC chairman, Michael B Pertschuk, stated thecase as follows: 'One possible way to control theseemingly uncontrollable health sector could be totreat it as a business and make it respond to the samemarket-place influences as other American businessand industries' (16). In other words, medicine couldbetter be controlled if it were understood as a trade andnot as a profession.The categorisation of medicine as a trade is

obviously an oversimplification. The profession isinescapably concerned with the public well-being.Medicine is both a trade and a profession. It is certainlyappropriate for the commercial aspects of medicalpractice to be regulated (or de-regulated), but it wouldbe a catastrophic mistake to assume that medicine ismerely a trade and subject all aspects of professional

regulation either to market influences or to the crudetools of antitrust litigation.The courts have clearly recognised that professions

have trade aspects. They have not eliminated theresponsibility for professional self-regulation except insuch instances in which such self-regulation may be inrestraint of trade. For medicine the issue the SupremeCourt decided in FTC v AMA is that the AMA's codeof ethics cannot prohibit advertising. It remains forconscientious physicians to decide what constitutesethical advertising.

The ethics of advertisingMedical advertising is at the crossroads of two verydifferent philosophies about what medicine should beand how professions should be regulated. Thetraditional view opposes advertising in order to protectthe public from physicians who are too commerciallyoriented. The more prevalent contemporary viewholds that medicine is indeed commercially orientedand thus cannot be trusted to regulate itself. In order toreconcile the best aspects oftraditional professionalismwith the need for greater public accountability, it isnecessary to consider what might be ethical andunethical in advertising.Would advertising ofphysicians' fees and services be

a desirable and ethical thing? If increased competitionthrough advertising could reduce medical costs, then itwould be socially desirable unless lowered costs wereachieved through a lowering of the quality of service orunless increased advertising created a demand for moreservices further straining the economy beyond theapproximately ten per cent of the US Gross NationalProduct which currently goes to health care. The cost/quality equation is always a delicate balance, andalthough costs are easy to measure, the values by whichwe assess quality are impossible to quantify.

Advertising is a multi-faceted issue. It serves twovery distinct objectives: 1) the dissemination ofinformation and 2) product differentiation, whicheconomists define as public perception of differencesbetween two products, even though such differencesmay not in fact exist. The AMA has traditionally heldthat dissemination of information is acceptable, butthat product differentiation or solicitation ofpatients isnot (17). The physician was to be distinguished fromthe itinerant merchant of nostrums by de-emphasisingthe commercial aspects of practice and emphasisingprofessional ethics (actually standards whichminimised the difference between physicians similarlycredentialed and certified). Thus if someone were todevelop appendicitis while travelling in an unfamilarpart of the country, it would not be necessary to shopfor a physician who believed in the germ theory or ahospital that maintained antiseptic standards. Thisshopping would be taken care of by credentialingprocedures. The physician would obtain patients, notby direct appeal to the public but by building areputation in a community. Although the distinction



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76 Allen R Dyer

between dissemination of information and productdifferentiation was dropped in the 1980 revision of theAMA Principles of Medical Ethics it remains animportant distinction for physicians to keep in mindwhen contemplating the ethics of advertising.Advertising which provides information to consumersis ethical; creation ofthe illusion ofdifferences throughproduct differentiation is as unethical in medicine as itis in any business.

It could be debated whether advertising is everethical, but it is an accepted feature of capitalistsocieties. The ethical issue for advertising is whetheradvertising is truthful and whether there can beobjectively measurable standards for judging thetruthfulness of advertising claims. A moreproblematic concern is the way in which advertisingplays upon peoples' unconscious wishes and fantasies:sex, greed, the quest for power, status, and perfection.The scientific basis for advertising rests on the abilityto identify and manipulate such longings and fears.When we speak of 'the market' or 'market forces' or'demand', we are generally talking about human wantsand wishes.

Truthfulness in advertising was the concern whenthe field of advertising itself attempted to follow thecourse of professionalism in the early part of thetwentieth century (see Table 1.) At issue were thevalues which distinguished the professional advertisersfrom the retail-space merchants. The AmericanMarketing Association (another AMA) establisheduniversity training programmes and codes of ethicswhich promoted the scientific ideal of detachment andstatistical analysis. This scientific vision ofcommunityand definition ofman (as consumer) replaced the older,empathic, rural, and value-laden world in which amerchant had a feel for what his customers (notconsumers) wanted because he lived with them in thesame community (18, 19).The example of professional advertising is

illustrative for the medical profession, not only becauseadvertising promises (threatens?) to be such aconspicuous feature of contemporary medicine, butalso because medicine's traditions of professionalismderive from an era in which the physician participatedin the life of the community in which he practised.Knowledge of the patient as a person, the patient's lifehistory and social situation, have traditionally beendeemed essential to quality care. At issue today for theprofession of medicine is whether it will be possible topreserve the values of personal care whichcharacterised the ideals of an earlier era. The ethics ofmedicine derive from the time when medicine was acottage industry. Will it be possible to maintain suchethics if medicine is tranformed to assembly-lineefficiency?

interest. Ethical strictures against professionaladvertisement have a long and venerable tradition inthe Western world, which stems from a view ofprofessional life which cannot be easily reduced toeconomic analysis. The traditions represented byprofessional ethics stress the personal nature ofprofessional practice. In the traditional model, trust isessential, for the patient/client must trust theprofessional in order to reveal such confidences as maybe necessary to understand the problem. Theprofessional is worthy of that trust according to (i)knowledge possessed and (ii) such 'professional'attributes as ability to keep confidences, to refrainfrom taking advantage of vulnerable patients, to putthe patient's interests before his/her own, and torefrain from self-aggrandisement at the patient'sexpense. It is out of such a view of professionalism thatstrictures against advertising arose.The question ofwhether physicians should advertise

and how the profession should be regulated cannot besettled until the prior question of what it means to be aprofession is addressed. The economic analysis ofmarket forces addresses a different concern from theconcerns of professional ethics. The question is notwhether doctors should be allowed to advertise, butwhat are the trade-offs ofa strictly economic analysis ofprofessional activities.From the economic standpoint the question is this:

Are there any reasons not to allow market forces tosolve pricing and other problems? In other words,government regulation or professional self-regulationwould be warranted only if the market failed. This isnot the only question of interest, however. The ethicalconcern must also be addressed, namely can qualitycare be maintained if the economically most efficientmethods ofhealth care delivery are adopted? From thispoint of view, the FTC strategy of reforming themedical profession by treating it as a business fails atthe outset because it fails to consider the issues ofquality care which are so much the concern ofphysicians and patients alike.The message for the medical profession from the

current round of antitrust litigation is clear: Unfairtrade practices will not be tolerated. A more subtlemessage must also be recognised: The reputation oftheprofession and its ethics has become tarnished as thepublic has come to perceive professional ethics as aprotective mantle under which professionals cloak self-interest. This does not mean that the old ethics shouldbe abandoned, but rather that they should be takenmore seriously.The doctor-patient relationship, spoken of almost

religiously as the keystone of medical practice, hastraditionally been a dyad in which the doctor answereddirectly only to the patient and his own conscience:

Conclusion DOCTOR -* PATIENT

It is paradoxical that medical ethics should be at thecentre of controversy about what is in the public

In the modern era, financial considerations, even morethan changes in technology, have transformed all



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TABLE 2

THE CODES OF ETHICS ON ADVERTISING

The Hippocratic Oath: Nowhere in the surviving Hippocratic writings do we find anything about advertisingor self-promotion, but we do find a clearly established concept of the profession as a fraternity in the followingstatement: 'I swear . . . to regard my teacher in this art as equal to my parents; to make him partner in mylivelihood, and when he is in need of money to share mine with him; to consider his offspring equal to mybrothers; to teach them this art, if they require to learn it, without fee or indenture; and to impart precept, oralinstruction, and all the other learning, to my sons, to the sons of my teacher, and to pupils who have signedthe indenture and sworn obedience to the physicians' Law, but to none other.'

Percival's Medical Ethics: Percival apparently had no occasion to refer explicitly to advertising on the partof English physicians, though his code is concerned throughout with maintaining the dignity, honour, andreputation of the profession.American Medical Association, 1847 code: Duties of physicians for the support of professional character:

'It is derogatory to the dignity of the profession, to resort to public advertisements or private cards orhandbills, inviting the attention of individuals affected with particular diseases - publicly offering advice andmedicine to the poor gratis, or promising radical cures; or to publish cases and operations in the daily printsor suffer such publications to be made; - to invite laymen to be present at operations, - to boast of cures andremedies - to adduce certificates of skill and success, or to perform any other similar acts. These are theordinary practices of empirics, and are highly reprehensible in a regular physician.'AMA, 1903 revision: In this first revision after the Sherman Act the caption 'Principles of Medical Ethics'

is substituted for 'Code of Medical Ethics' leaving broader discretion to the State and territorial medicalsocieties. The strictures against advertising specify methods to be avoided: 'It is incompatible with honorablestanding in the profession to resort to public advertisement or private cards inviting the attention of personsaffected with particular diseases; to promise radical cures; to publish cases or operations in the daily prints,or to suffer such publication to be made; to invite laymen (other than relatives he may desire to be at hand) tobe present at operations; to boast ofcures and remedies; to adduce certificates of skill and success, or to employany of the other methods of charlatans.'AMA, 1912 revision: 'Solicitation of patients by circulars or advertisements, or by personal communications

or interviews, not warranted by personal relations, is unprofessional. It is equally unprofessional to procurepatients by indirection through solicitors or agents of any kind, or by indirect advertisement, or by furnishingor inspiring newspaper or magazine comments concerning cases in which the physician has been or isconcerned. All other like self-adulations defy the traditions and lower the tone of any profession and so areintolerable. The most worthy and effective advertisement possible, . . . is the establishment of a well-meritedreputation for professional ability and fidelity. This cannot be forced, but must be the outcome of characterand conduct.'AMA, 1957 revision: A physician 'shall not solicit patients.' (A physician shall not attempt to obtain patients

by deception.)AMA, 1980 revision: No comment on advertising in the Principles ofMedical Ethics, as per FTC order. TheCurrent Opinions ofthe_7udicial Council (1982) offers the following comment: 'Competition between and amongphysicians and other health care practitioners on the basis of competitive factors such as quality of services,skill, experience, miscellaneous conveniences offered to patients, credit terms, fees charged, etc, is not onlyethical but is encouraged.'

British Medical Association, Handbook ofMedical Ethics (1984): (Quoting the General Medical Councilbooklet Professional Conduct and Discipline: Fitness to Practise - 1983) 'The medical profession in this countryhas long accepted the tradition that doctors should refrain from self-advertisement. In the Council's opinionadvertising is not only incompatible with the principles which should govern relations between members butcould be a source of danger to the public. A doctor successful at achieving publicity may not be the mostappropriate doctor for a patient to consult. In extreme cases advertising may raise illusory hopes of a cure.'L'Ordre des Medecins, Code de Deontologie Medicale (Belgium, 1975): Publicity, direct or indirect, is

forbidden. The reputation of the physician is founded on his professional competence and on his integrity.Canadian Medical Association, Code of Ethics: An ethical physician . . . will build a professional

reputation based only on his ability and integrity, will avoid advertising in any form and make professionalannouncements according to local custom.World Medical Association, International Code ofMedical Ethics: Any self advertisement except such as is

expressly authorised by the national code of medical ethics [is deemed unethical].



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78 Allen R Dyer

parties in this relationship and added new ones:

PROVIDERS - CONSUMERS\ THIRD 7

PARTIES

Patients have become 'consumers'; doctors havebecome 'providers'; health care has become acommodity; and 'third parties', including insurancecompanies, social service agencies, and allied healthprofessionals, are very much part of the picture. Thepatient seldom appears privately (and confidentially)before the doctor for help. Likewise the physician doesnot answer only to the patient. The conscientiousphysician concerned about cost-containment may beput in the position of limiting the resources given to ademanding or anxious patient. Still, however, theappeal of a person in need of help and the response ofa concerned physician remain the essence of medicalpractice. Though some would suggest that medicineshould, in the interests of efficiency, be limited totreating just physical ailments, most responsiblephysicians still concern themselves with the impact ofdisease and illness on people's lives and not just withthe disease itself.

It is this broader concern of medical practice whichprofessional ethics attempts to address, and which isgenerally not understood to be an essential feature of atrade. The attempt to regulate the medical professionas a trade comes at a time when the activities ofphysicians are largely perceived as commercial andimpersonal. Physicians must bear the responsibility formaintaining a broader concern for the patient as aperson as part of their professional identity. To theextent that medicine fails in maintaining itsprofessional ethical standards of public service andpersonal care, it is vulnerable to the criticism of self-serving commercialism. To the extent that medicinerelies merely on technique and not on an ethic ofservice, it becomes merely a trade and not a profession.

AcknowledgementThis work is supported by fellowships from theKellogg Foundation and National Humanities Centerand by grants from the Roy A Hunt Foundation andthe Josiah Charles Trent Memorial Foundation.

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historical background. In: Dyer A R ed. The humanitiesand the profession of medicine. Research Triangle Park,NC: National Humanities Center, 1982.

(2) Post G. Parisian masters as a corporation, 1200-1246.Spectrum 1934; 9: 421-445.

(3) Thrupp S L. The guilds, Cambridge economic history ofEurope. Cambridge: Cambridge University Press, 1963.

(4) Moline J. On professionals and professions. Seereference (1):

(5) Reiser S J, Dyck A J, CurranW J, eds. Ethics in medicine.Cambridge: MIT Press, 1977: 1.

(6) Michels R. Professional ethics and social value.International review ofpsychoanalysis 1976; 3: 377-384.

(7) Friedson E. Profession ofmedicine: a study of the sociologyofapplied knowledge. New York: Dodd, Mead, 1970.

(8) Larson M S. The rise of professionalism: a sociologicalanalysis. Berkeley: University of California Press, 1977.

(9) Haskell T L. The emergence ofprofessional social science.Urbana: University of Illinois Press, 1977.

(10) Wilensky H. The professionalization of everyone? TheAmerican journal ofsociology 1964; 70: 137ff.

(11) Weber M. On the methodology of social sciences.Translated and edited by Shils E A, Finch H A. Glencoe:The Free Press, 1949.

(12) Berlant J. Profession and monopoly: a study ofmedicine inthe United States and Great Britain. Berkeley: Universityof California Press, 1975.

(13) Greenhouse J. Justices uphold right of doctors to solicittrade. New York Times 1982 Mar 24: 10.

(14) Lee R E. Application ofantitrust laws to the professions.Journal oflegal medicine 1979; 1(2): 143-153.

(15) Havighurst C. Antitrust enforcement in the medicalservices industry: what does it all mean? MilbankMemorial Fund quarterlylhealth and society 1980; 58(1):89-124.

(16) Pertshuk M. FTC Conference, 1977, Jun 1-2. Quotedin: Rosoff A J. Antitrust laws and the health careindustry: new warriors into an old battle. Saint LouisUniversity law journal 1979; 23: 478. Also quoted inBallentine T H, Jr. Annual discourse - the crisis inethics, anno domini 1979. New England journal ofmedicine 1979; 301: 634.

(17) Relman A S. Professional directories - but notcommercial advertising - as a public service. NewEnglandjournal ofmedicine 1978; 299: 476478.

(18) Christians C G, Schultze Q J, Simms N H. Community,epistemology, and mass media ethics. journalism history1978; 5: 38-41, 65-67.

(19) Schultze Q J. Professionalism in advertising: the originof ethical codes. J7ournal ofcommunication 198 1; 31: 64-71.



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