Differentiation of text messaging meta-data for critical clinical intervention purposes from marketing purposes

Background: Mobile text messaging provides an instant and asynchronous means of communication for which its ubiquitous adoption provides opportunities for more effective delivery of clinical and healthy behavior interventions. A literature review showed that there is emerging preliminary evidence that text messaging can be an effective tool in clinical and healthy behavior intervention delivery. Similarly, the omnipresent nature of the information technology leaves the population vulnerable for more targeted and intrusive marketing from pharmaceutical companies. The ethical implications of the logical progression of the use of text messaging by pharmaceutical companies are numerous. In the form of a clinical and healthy behavior intervention, text messaging seems fairly benign. However, in the context of pharmaceutical companies, text messaging teeters between serving a public health good and heading down the slippery slope of direct-to-consumer marketing. Objective: We aim to assess the ethical implications of exploiting secondary data usage for text message marketing. Methods: First, we conducted a literature review of academic, peer-reviewed literature on text messaging for clinical and behavioral health intervention. Next, we took that review a step further and have conducted a much broader review of the grey literature available on the use of text messaging by pharmaceutical companies and other private industry in the healthcare setting. Finally, we assessed these studies on text messaging and categorized them according to intervention or marketing. Lastly, we explored the ethical implications for potential exploitative uses of the data. Results: The academic literature review showed emerging preliminary evidence that text messaging can be an effective tool in clinical and healthy behavior intervention delivery. The results of the grey literature are inconclusive to date, but preliminary results show that these studies tend to be biased. Furthermore, we can identify potential ways in which data could be exploited.