Pharmaceutical Marketing Practices Research Articles

Marketing projects of the pharmaceutical industry. Analysis and feature

The article presents the results of research into the essence and features of marketing projects (MP). It is shown that the pharmaceutical industry affects the properties of marketing projects. Analysis of marketing projects showed their dependence on the essence of marketing. Marketing is a complex and multi-component system, therefore, the marketing project will contain those components from the general aggregate of marketing that were chosen by the project owners to form the project product. The article analyzes the core of marketing, which can form the contours of a marketing project. The goal of marketing, formed by Peter Drucker, is accepted as the mission of marketing projects, namely the creation of such properties of the product, thanks to which "it will sell itself." Such a state of the project product can be achieved by meeting all the requirements and expectations of the project's main stakeholders, namely, its end users. The work shows that the pharmaceutical industry brings additional properties, assumptions and limitations to marketing projects. The product of the pharmaceutical production project is medicine, and the final consumers are patients. An additional constraint that the industry brings to marketing projects is the IFPMA Code of Pharmaceutical Marketing Practices, which should be taken into account when managing MPs. Achieving the specified mission of the MP is possible if the interests of all participants are taken into account. The work shows that there are three groups of participants: the manufacturer of medicinal products; pharmacies and medical institutions as intermediaries in promotion; the end users of medicines are patients. These three groups form the requirements for the future product (that is, for the medicinal product) that must be taken into account. Such a wide range of participants usually brings a conflict of interests and, accordingly, a conflict of requirements to the project. In this regard, the work analyzes the essence of project requirements, their collection, formation and management. Today, there is no single approach to considering the relevance of the requirements of marketing projects, which requires further analysis and research. The prospect of further research is the search for direction: management of MP stakeholders; management of requirements and conflict of requirements; MP market analysis.

Changes in opioid marketing practices after release of the CDC guidelines.

After the release of the CDC guidelines in March 2016, the rate of opioid prescriptions decreased. How or whether pharmaceutical companies changed their opioid marketing practices post release of the CDC guidelines is unknown. Our objectives were to (1) evaluate whether the release of the guidelines was associated with changes in total monthly marketing spending received per physician, monthly marketing encounter frequency per physician, and spending per encounter during opioid marketing; and (2) evaluate whether such changes in marketing differed between specialist physicians and primary care physicians (PCPs) and between urban and rural primary care service areas (PCSAs). Retrospective observational cross-sectional study using opioid marketing spending data from the CMS Open Payments database between August 2013 and December 2017. Single-group and multiple-group interrupted time series analyses were used to evaluate differences in the immediate changes in level and trend over time in opioid marketing practices post release of the CDC guidelines. Post release of the CDC guidelines, the monthly number of marketing encounters per physician and total monthly amount received per physician decreased. However, the amount spent at each marketing encounter increased. The release of the CDC guidelines was associated with an immediate increase in level of opioid marketing spending per encounter by $0.59 (95% CI, $0.51-$0.68; P < .001) and an over-time increase in rate of spending per encounter of $0.04 per month (95% CI, $0.03-$0.05; P < .001). These changes differed between specialists and PCPs and between urban and rural PCSAs. It is important to continue ongoing education for physicians on changes in pharmaceutical opioid marketing practices.

Patients Access to Medicines - A Critical Review of the Healthcare System in Kenya.

Access to affordable, safe, effective, and quality-assured medicines by a patient is important for good health outcomes. Unfortunately, there is sparse literature published on the pharmaceutical enablers that may increase the sale of a substandard and falsified (SF) medicine to a patient in Kenya. The review highlights some of the factors that may facilitate the entry of SF medicines into the legitimate pharmaceutical supply chain and discusses their impact on patient access to medicines. Lack of essential medicines in public health facilities is an important factor that may contribute to increased demand for medicine-related out-of-pocket expenses from private health facilities, thus a likelihood for a patient purchasing SF medicine from unlicensed and illegal medicine outlets or unregulated websites. The need to increase medicine availability in the public sector by the Ministry of Health (MOH) is emphasized in addition to the strengthening of public procurement to cushion it from corruption and mismanagement. In addition, the MOH should promote local pharmaceutical manufacturing and implement a medicine pricing containment policy to avoid abuse and prevent overexploitation of patients, increase medicine price transparency, and reduce pharmaceutical supply chain distortion. Recommended regulatory reviews include accreditation of unlicensed illegal medicine outlets to facilitate accountability, regulatory oversight, and active surveillance. The national post-market surveillance regulatory capacity should be strengthened to improve rational medicine use. A 3-year diploma course should be replaced with a shorter 1- or 2-year pharmaceutical support staff training not eligible to superintend a pharmacy. The recommended legislative review includes a mandatory clause to enforce generic prescribing and the implementation of generic substitution by health workers. Unethical manipulative pharmaceutical marketing practices should carry stiffer penalties to deter malpractice. Future research areas include investigation of medicine prescribing and dispensing practices, medicine consumption studies, medicine price differences within different health sub-sectors, and between licensed pharmacies and unlicensed illegal medicine outlets.

Ethical Evaluation of Pharmaceutical Marketing in Sana’a City, Yemen

Objectives: To evaluate the ethics of pharmaceutical marketing practices in Sana’a city, Yemen.&#x0D; Methods: A cross-sectional study was conducted among 400 physicians and 50 pharmaceutical companies in the period from March to August 2018. Data about pharmaceutical marketing ethics were collected from physicians and pharmaceutical companies using two types of self-administrated, structured questionnaires. Data were analyzed with appropriate statistical tests using IBM SPSS Statistics, version 21.0.&#x0D; Results: The majority of physicians (60.0%) agreed that medical samples had been used most frequently as a promotional tool for pharmaceutical marketing, followed by gifts (14.0%). More than half of physicians were satisfied with the way of pharmaceutical marketing in Yemen. Personal relationships and medical samples and gifts were the factors affecting their prescriptions, being reported by about a third of physicians each. Meanwhile, most physicians (44.0%) preferred medical conferences and exhibitions as a promotional benefit to be gotten for prescribing the company’s products. The majority of physicians (62.0%) agreed that the availability of medical samples affect their prescriptions, and about 28.2% of physicians reported that all medical samples are used by their patients. Most physicians (37.0%) perceived that only 50% of medical representatives respond well to their queries related to marketed drugs, and 41.5% of physicians agreed that global companies are more compliant with ethical marketing. About 60% of the physicians reported not facing unethical promotions, and the majority (54.0%) agreed that unethical pharmaceutical marketing is the responsibility of companies, physicians, and representatives. There was a statistically significant difference in the proportion of drug prescriptions affected by medical representative visits and availability of medical samples on prescription in relation to the work experience of physicians. On the other hand, there was a statistically significant difference in facing an unethical promotion offered by companies for prescribing their products and the attribution of unethical pharmaceutical marketing in relation to the type of medical profession of physicians.&#x0D; Conclusions: Pharmaceutical marketing in Yemen still depends on traditional tools, with the lack of ethical guidelines or codes for pharmaceutical marketing in the country. Work experience and medical profession of physicians can significantly affect pharmaceutical marketing. The spread of unethical marketing is the responsibility of pharmaceutical companies, physicians and medical representatives. Therefore, it is recommended to develop well-defined and updated ethical standards and national guidelines for pharmaceutical marketing by the Ministry of Public Health and Population. Furthermore, official campaigns should be regularly carried out to control and restrict unethical promotion. Further studies on the ethics of pharmaceutical marketing are also recommended. Pharmaceutical companies should continuously train their medical representatives and provide physicians with the latest medical knowledge about new drugs.&#x0D; Keywords: Pharmaceutical marketing, Ethics, IFPMA guidelines, Sana’a

Ethical Evaluation of Pharmaceutical Marketing in Sana’a City, Yemen

Objectives: To evaluate the ethics of pharmaceutical marketing practices in Sana’a city, Yemen.&#x0D; Methods: A cross-sectional study was conducted among 400 physicians and 50 pharmaceutical companies in the period from March to August 2018. Data about pharmaceutical marketing ethics were collected from physicians and pharmaceutical companies using two types of self-administrated, structured questionnaires. Data were analyzed with appropriate statistical tests using IBM SPSS Statistics, version 21.0.&#x0D; Results: The majority of physicians (60.0%) agreed that medical samples had been used most frequently as a promotional tool for pharmaceutical marketing, followed by gifts (14.0%). More than half of physicians were satisfied with the way of pharmaceutical marketing in Yemen. Personal relationships and medical samples and gifts were the factors affecting their prescriptions, being reported by about a third of physicians each. Meanwhile, most physicians (44.0%) preferred medical conferences and exhibitions as a promotional benefit to be gotten for prescribing the company’s products. The majority of physicians (62.0%) agreed that the availability of medical samples affect their prescriptions, and about 28.2% of physicians reported that all medical samples are used by their patients. Most physicians (37.0%) perceived that only 50% of medical representatives respond well to their queries related to marketed drugs, and 41.5% of physicians agreed that global companies are more compliant with ethical marketing. About 60% of the physicians reported not facing unethical promotions, and the majority (54.0%) agreed that unethical pharmaceutical marketing is the responsibility of companies, physicians, and representatives. There was a statistically significant difference in the proportion of drug prescriptions affected by medical representative visits and availability of medical samples on prescription in relation to the work experience of physicians. On the other hand, there was a statistically significant difference in facing an unethical promotion offered by companies for prescribing their products and the attribution of unethical pharmaceutical marketing in relation to the type of medical profession of physicians.&#x0D; Conclusions: Pharmaceutical marketing in Yemen still depends on traditional tools, with the lack of ethical guidelines or codes for pharmaceutical marketing in the country. Work experience and medical profession of physicians can significantly affect pharmaceutical marketing. The spread of unethical marketing is the responsibility of pharmaceutical companies, physicians and medical representatives. Therefore, it is recommended to develop well-defined and updated ethical standards and national guidelines for pharmaceutical marketing by the Ministry of Public Health and Population. Furthermore, official campaigns should be regularly carried out to control and restrict unethical promotion. Further studies on the ethics of pharmaceutical marketing are also recommended. Pharmaceutical companies should continuously train their medical representatives and provide physicians with the latest medical knowledge about new drugs.&#x0D; Keywords: Pharmaceutical marketing, Ethics, IFPMA guidelines, Sana’a

Pharmaceutical marketing strategies’ influence on physician’s prescription behavior

Introduction: Pharmaceutical marketing practices are one of the main reasons that massively influence the physician’s prescribing behavior. This issue has been hardly explored in very little studies that investigated the impact of pharmaceutical marketing strategies on prescribing patterns in developing countries and Middle Eastern countries. Objective: This paper aims to explore the impact of pharmaceutical marketing practices on the medication recommendation of physicians in Jordan. Methods: T

Exploring Ethics in Contemporary Pharmaceutical Marketing Practices: A Stakeholder Marketing Perspective

Exploring Ethics in Contemporary Pharmaceutical Marketing Practices: A Stakeholder Marketing Perspective

Pharmaceutical Promotion in Bangladesh: Assessing the Strength of Regulatory Documents

Pharmaceutical promotion is a negative influencing force for prescribing. However, very few regulatory initiatives are taken to overcome this unwarranted influence. The present research was conducted in such context with an attempt to review the regulatory documents related to pharmaceutical promotion in Bangladesh including Code of Pharmaceutical Marketing Practices (CPMP), and to compare CPMP with different global guidelines. The studied guidelines demonstrate effort to regulate promotion, though that varies to a great extent, particularly in enforcement aspects. Clearly defined ethical and legal prohibitions, provisions of punishment for violations and entrusted agency with defined authority are crucial.

Adaptation of pharmaceutical marketing and drug promotion practices in times of pandemic COVID-19

Pharmaceutical marketing is an essential societal activity that ensures the availability of medicines at the right time and place. Pharmaceutical marketers also provide timely information, perform after-sales service in the distribution chain, and organize medical conferences and seminars. Thus, therapy and product updating, ensuring availability, and usage of medications are catalyzed by pharmaceutical marketers; this also ensures access to medicines in society. Medical representatives are critical elements – they inform and persuade adoption of various products for patient welfare. To complement and supplement the ground-level pharmaceutical marketing activity, a host of digital marketing initiatives is also accoutering the pharmaceutical marketing process. During pandemics like the COVID-19 infection, face-to-face pharmaceutical marketing approach is thrown out of gear and digital marketing has gained increased adoption. This article reviews the adaptive response of pharmaceutical marketers during COVID-19 times.

Case Study: Competitive Advantage at All Costs - An Inside Look at Five Pharmaceutical Industry Practices Which Undermined Customer Relationships

This study attempts to answer the question: Over the past 35 years, what competitive business practices instituted by the pharmaceutical industry intended to drive increased competitiveness and business efficiencies had the unintended results of increasing the publics’ general distrust and dissatisfaction with the industry? This paper takes a unique perspective by analyzing five apparently disparate business practices designed to improve business performance but which also increased customer distrust and dissatisfaction of the industry. Specifically the five business practices were:Reliance on pharmaceutical marketers with MBAs but limited or no practical pharmaceutical selling experience.The loss of independent pharmacies and pharmacists as customers due to the rise in national pharmacy chains.Purchase and use of physician-specific prescribing dataUse of direct to consumer advertising for prescription drugsDelaying generic competition and providing industry support for the Affordable Healthcare Act in exchange for U. S. government prohibition against the importation of low cost prescription drugs into the U.S. and prohibiting negotiated Medicare drug prices.The paper uses a case study methodology. The results section details the practices reviewed in this case study and suggests they did improve competitiveness and efficiencies, but also contributed to erosion in customer confidence which includes key customer groups: physicians, pharmacists, patients and payers. Consumer groups such as American Association of Retired Persons (AARP) are focusing both financial resources and membership efforts to advocate for changes in pharmaceutical industry pricing and marketing practices. To see if this phenomenon has occurred in other industries, it was observed that the airlines, fast food and information technology industries also pursued greater business efficiencies. The discussion section suggests they too experienced and continue to experience significant customer relationship issues resulting from the drive for greater efficiencies, including government intervention to address customer concerns. The conclusions review some of the limitations of this study and suggest areas for additional research.

Critical analysis of drug promotional literature available to the medical practitioners

Background: To ascertain whether the pharmaceutical companies are following the WHO criteria for “Ethical medicinal drug promotion 1988” and “OPPI Code of pharmaceutical marketing practices, 2012” and to what extent. Also, to evaluate the therapeutic claims made by them in their drug promotional literature and other aspects.Methods: Drug Promotional Literature (DPL) from different pharmaceutical companies was collected from various Medical practitioners and analysed to see if they achieved objectives. Therapeutic claims made by them were classified as authentic, exaggerated, controversial, false, and misinterpreted.Results: Total 250 DPLs were collected and critically analysed for information content. Out of the 11 WHO criteria for ethical medicinal drug promotion (1988), Majority (30%) followed only 54.54% of the criteria while only 4% followed 100% of the criteria. The total number of claims in the 250 DPL were 354 of which 52.8% were authentic and 47.2% were misleading. From the misleading claims: 28.7% were exaggerated, 34.7% were controversial, 22.8% were false, 23% were ambiguous.Conclusions: This study enabled us to find out to what extent the pharmaceutical industries follow the standard criteria for DPL and evaluate the claims made by them. DPL is one of the important sources of drug information. Some of the pharmaceutical companies failed to follow the WHO criteria while advertising their products in order to make them look more lucrative having an underlying commercial motive. As they influence prescribing patterns of the clinicians, misleading promotional literature would result in irrational prescribing of drugs. To avoid this, DPL has to be critically evaluated.

Evaluation of first year student pharmacists’ perceptions of the pharmaceutical industry

Background and purposeThere are a limited number of pedagogical studies evaluating student pharmacists’ perceptions of the pharmaceutical industry. The objective of this two year prospective study was to evaluate changes in student pharmacists’ perceptions of the pharmaceutical industry during the first year of enrollment in the doctor of pharmacy curriculum. Educational activity and settingAn online survey was developed and offered to all first-year student pharmacists during the 2014 and 2015 Fall semesters prior to didactic instruction on the pharmaceutical industry and then again at the end of the respective academic years. Descriptive and inferential statistics were used to analyze the data. FindingsA majority of students had a positive impression of the pharmaceutical industry in both the fall (75%) and spring semesters (78%). Over the course of the year, significantly greater numbers of student pharmacists reported favorable impressions of the pharmaceutical industry with respect to research innovation, drug safety, and the provision of drug information. On the other hand, findings suggest that many students remain skeptical regarding the benefits of prescription medications relative to cost and there were significant increases in the number of students who perceived pharmaceutical industry-based marketing practices to have a negative impact on patients and society. Discussion and summaryDidactic education may influence student pharmacists’ perceptions of the pharmaceutical industry. Further research is warranted to evaluate the role of pharmacy curricula and extra-curricular activities in influencing changes in student pharmacists’ perceptions and the potential implications of these changes to pharmacy practice.

Evaluation of Scientific Advertisements of Pharmaceutical Products as Per UCPMP Guidelines

Background: Uniform Code for Pharmaceutical Marketing Practices (UCPMP), issued by the Department of Pharmaceuticals, introduced in India after several years of deliberations. The UCPMP is to be voluntarily adopted and implemented by pharmaceutical companies. The main aim of study was to evaluate the scientific advertisements of pharmaceutical products as per uniform code of pharmaceutical marketing practices (UCPMP) draft guidelines Methodology: Printed copies of the journals in Manipal University Health Sciences Library were scrutinised to identify Indian journals containing advertisements. All the selected journals published during the time period from Jan, 2012 to Dec, 2014 were further scrutinised to identify advertisements for evaluation. All the selected advertisements were evaluated for its content as per the UCPMP guidelines and the observations were recorded in the data collection sheet prepared for the study. The collected data was coded and entered into SPSS software. The results are presented in the form of descriptive statistic. Results: Some parameters such as claims-safe (85.9%), no side effect (98.9%), no toxic hazards (99.2%), word new (96.3%), brand name of competitors (99.6%), name and address of company (93.8%), method of administration (71%), method of use (88%), additional information on request (65.5%) and name and photo of healthcare professionals (97.9%) for full ads almost adhere to guidelines. Whereas some parameter such as claims without references (56.8%), date of advertisement (25.3%), adverse reaction, warnings, precaution for use and contraindications (50.2%), recommended dose (55.6%) for full ads do not follow guidelines. Conclusion: The present study has clearly shown the discrepancies in the usage of references for the substantiation of claims made and recommended dose. Key words: UCPMP Guidelines, India, Scientific Advertisements, Journal, Claims, Pharmaceutical Marketing.

Unhealthy marketing of pharmaceutical products: An international public health concern.

I consider the current state of pharmaceutical marketing vis-à-vis ethical and legal standards and advocate measures to improve it. There is abundant evidence of unethical or illicit marketing. It fuels growing concerns about undue corporate influence over pharmaceutical research, education, and consumption. The most extensive evidence of industry transgressions comes from the United States (US), where whistle-blowers are encouraged by financial rewards to help uncover illicit marketing and fraud. Outside the US increasing evidence of transgressions exists. Recently I have observed a range of new measures to align pharmaceutical marketing practices with ethical and legal standards. In the interest of public health, I highlight the need for additional and more profound reforms to ensure that information about medicines supports quality and resource-efficient care.

Target Locked: Nurse Practitioners and the Influence of Pharmaceutical Marketing Practices in Canada

The influence of marketing activities on prescribing practices of primary health care professionals represents a potential risk to patient health and the integrity of the health profession. Although Canadian nurse practitioners (NPs) identify similar concerns to their American counterparts, acknowledging potential influences of pharmaceutical marketing practices and some of the ethical issues arising from conflict of interest, challenges faced by NPs in Canada are confounded by the lack of authorization to dispense sample medications. NPs identify this as a barrier to effective practice. Work is needed to address educational deficiencies and to provide reliable information on new drugs that remains evidence based.

The rise of digital direct-to-consumer advertising?: Comparison of direct-to-consumer advertising expenditure trends from publicly available data sources and global policy implications

BackgroundPharmaceutical marketing is undergoing a major shift in the United States, in part due to new transparency regulations under the healthcare reform act. Changes in pharmaceutical marketing practices include a possible shift from more traditional forms of direct-to-consumer advertising towards emerging use of Internet-based DTCA (“eDTCA”) given the growing importance of digital health or “eHealth.” Though legally allowed only in the U.S. and New Zealand, eDTCA poses novel regulatory challenges, as it can cross geopolitical boundaries and impact health systems and populations outside of these countries.MethodsWe wished to assess whether changes in DTCA and eDTCA expenditure trends was occurring using publicly available pharmaceutical marketing data. DTCA data was analyzed to compare trends in aggregate marketing expenditures and to assess if there were statistically significant differences in trends and magnitudes for data sources and DTCA sub-categories (including eDTCA). This was accomplished using regression lines of DTCA trend data and conducting pairwise comparisons of regression coefficients using t-tests. Means testing was utilized for comparing magnitude of DTCA expenditure.ResultsData from multiple data sources indicate that aggregate DTCA expenditures have slightly declined during the period from 2005–2009 and are consistent with results from other studies. For DTCA sub-categories, television remained the most utilized form of DTCA, though experienced trends of declining expenditures (−13.2 %) similar to other traditional media platforms such as radio (−30.7 %) and outdoor ads (−12.1 %). The only DTCA sub-category that experienced substantial increased expenditures was eDTCA (+109.0 %) and it was the only medium that had statistically significant differences in its marketing expenditure trends compared to other DTCA sub-categories.ConclusionsOur study indicates that traditional DTCA marketing may be on the decline. Conversely, the only DTCA sub-category that experienced significant increases was eDTCA. However, to fully understand this possible shift to “digital” DTCA, improvements in publicly available DTCA data sources are necessary to confirm changing trends and validate existing data. Hence, utilizing the newly implemented U.S. physician-payment expenditure transparency requirements, we advocate for the mandatory disclosure of DTCA/eDTCA in order to inform future domestic and international health policy efforts regarding appropriate regulation of pharmaceutical promotion.

Emerging promotional and pricing approaches in the US pharmaceutical market

Purpose – This paper aims to review the progression of the pharmaceutical industry through the lens of government legislation in the USA. The goal of this paper is to provide a comprehensive review of pharmaceutical marketing practices while providing direction for emerging pricing and promotional approaches. Design/methodology/approach – This paper offers a comprehensive review of pharmaceutical marketing practices through an exhaustive review of the literature. Further, suggestions are made based on emerging marketing techniques found in the literature. Findings – Changes in government legislation will continue to play a significant role in promotional activities of the pharmaceutical industry. This study identifies specific pricing and promotional tools the pharmaceutical industry can use in response to these emerging changes. Specific actions such as enhancing public image, reconfiguring sales forces, outsourcing and optimizing the pricing mix are suggested. Practical implications – This paper presents clear guidelines for managers by affording applicable practical tools to offset changes posed by government legislation. Originality/value – This paper seeks to fill a gap in research surrounding pricing and promotion in the pharmaceutical industry. Further, this paper offers concrete pricing and promotional approaches for pharmaceutical management.

The False Claims Act: a review and policy recommendations

Purpose– The purpose of the study is to review The False Claims Act (FCA) settlements and challenges facing the industry to suggest the motivation behind firms’ alleged fraudulent activity. FCA has been applied against pharmaceutical companies by the US Government to combat marketing fraud including kickbacks, improper pricing and off-label promotion. The interests of the US Government and medical professionals are also considered. Changes to the law governing pharmaceutical marketing practices are recommended.Design/methodology/approach– Cases settled under the FCA between 2005 and 2012 were identified by accessing the US Department of Health and Human Services (DHHS) Corporate Integrity Agreements Web site and annual reports and thequitamhelp.comWeb site. Case details were collected from US Department of Justice press releases, DHHS annual reports, and case documents in the Public Access to Court Electronic Records database.Findings– Of the settled cases in the final sample, improper pricing practices were evident in 33 per cent of the cases; off-label promotion in 52 per cent; and both in 15 per cent of the cases. Forty-eight per cent of the alleged fraudulent marketing activity occurred within the brands’ first year and 68 per cent within the first two years on the market. Reported settlements ranged from US$4 million to US$4.3 billion.Originality/value– This research simultaneously considers business issues facing the pharmaceutical industry and alleged fraudulent marketing activity to recommend changes to the law governing drug promotion. Changes have the potential to improve the balance between the respective interests of industry, medicine and government and to improve compliance and patient care in the future.

Industry Influence Can Be Mediated by Understanding Theory Behind It

Back to table of contents Previous article Next article Professional NewsFull AccessIndustry Influence Can Be Mediated by Understanding Theory Behind ItAaron LevinAaron LevinSearch for more papers by this authorPublished Online:10 Sep 2013https://doi.org/10.1176/appi.pn.2013.9b15AbstractIf doctors can approach the food, flattery, and friendship that underlie pharmaceutical marketing with sufficient skepticism, its biasing effects may decrease.New norms within the medical profession that keep industry at arm’s length might lessen conflict of interest, said Adriane Fugh-Berman, M.D., of Georgetown University Medical Center.Aaron LevinSocial science research can help understand the marketing practices of pharmaceutical and medical device manufacturers, but might also plausibly be used to help doctors form independent judgments about therapies and diagnostic tools, according to two Georgetown University physicians.However, doctors must first understand the techniques used to influence their choices.“Industry uses principles of social psychology to manipulate prescribing behavior; physicians unaware of such subtle influences will not try to avoid the resulting conflicts of interest,” wrote Sunita Sah, M.D., M.B.A., Ph.D., an assistant professor of business ethics at Georgetown and a research fellow at the Ethics Center at Harvard University; and Adriane Fugh-Berman, M.D., an assistant professor of pharmacology and physiology and of family medicine at the Georgetown University Medical Center. Their article appears in the August issue of the Journal of Law, Medicine, and Ethics.Earlier studies showed that physicians believe they are not personally influenced by industry but their colleagues are. “Physicians think they are making their own independent choice of therapeutics for their patients and don’t realize the extent to which they are affected by drug reps,” said Fugh-Berman in an interview. She is also director of PharmedOut, a Georgetown University Medical Center project that advocates evidence-based prescribing and educates health care professionals about pharmaceutical marketing practices. “Overconfidence and naivetȳ are a dangerous combination.”One understanding of the industry’s techniques may lie in the principles of influence and persuasion set out by social psychologists like Robert Cialdini, Ph.D., a professor emeritus of psychology and marketing at Arizona State University, as cited by Sah and Fugh-Berman.For a start, reciprocity might be the tenet most familiar to medical professionals. That pizza or fancy dinner provided by the drug rep sets up an implicit obligation to return the favor.Commitment to even a small goal (like prescribing that new drug to just a few patients) is amplified by a desire later to justify that choice with future consistency.Conformity (or “social proof”) is doing what others do, especially those with more prestige or authority. Industry’s use of “high-status, respected, academic physicians” to act as “key opinion leaders” is such a time-tested tactic.“The effect on trainees of observing trusted mentors accepting hospitality and funds from industry may be more powerful than the influence of institutional policies or formal curricula,” said Sah and Fugh-Berman.However, Fugh-Berman said she has noticed a change in the last five years as attitudes toward speakers with heavy industry support have become less favorable, especially among medical students.Finally, there’s simple likeability. Drug reps are hired at least as much for their social skills as for their scientific knowledge. And flattery, whether it’s a pleasant conversation over that archetypal pizza or an invitation to speak at a prestigious meeting, gets them everywhere.“Some of that social science thinking might be turned around to help medical students and trainees think the way they have already learned to read the peer-reviewed literature,” said former APA President Carolyn Robinowitz, M.D., special associate provost for health science at George Washington University in Washington, D.C. “They could learn to recognize marketing techniques and begin to question more critically drug reps or speakers at those dinner meetings.”Like Sah and Fugh-Berman, Robinowitz believes that educating physicians, trainees, and medical students is the best way to minimize any biases in marketing messages.“We need to look to our leadership to help us learn this approach and help doctors make decisions based on the best evidence,” said Robinowitz.However, like it or not, the reality is that corporations exist to produce profits as well as products, she added. “Drug companies perform a useful function, and they must make money or they won’t invest in our field.”Somewhere out there between the bathwater and the babies lies a place where industry can make medicines and equipment while health professionals can find unbiased information about them.“Educational interventions have been able to move the needle on whether other physicians are affected by industry influence,” said Fugh-Berman. If enough physicians can learn to avoid the social obligations that industry cultivates and if academic medicine maintains its distance from industry, she said, “a new social norm may emerge that rejects transactions fraught with conflicts of interest.” ■An abstract of “Physicians Under the Influence: Social Psychology and Industry Marketing Strategies” is posted at http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1748-720X. Adriane Fugh-Berman’s PharmedOut site can be found at http://www.pharmedout.org/. ISSUES NewArchived

Ethics: the physician–pharma dyad in India

The study examines the attitudes among physicians regarding acceptance of gifts, sponsorships, and drug samples in response to marketing efforts of pharmaceutical companies in India. The research also attempts to study physicians’ perceptions of the Medical Council of India (MCI) guidelines on the code of conduct for pharmaceutical marketing practices and the influence of these guidelines on physicians’ actions. A structured questionnaire was developed for collecting primary data regarding exposure of physicians to promotional tools and physicians’ attitudes and practices with regard to various professional ethical issues. One thousand physicians from private and government hospitals located in a metropolitan area were approached personally or through email for getting the questionnaire filled. A total of 189 completed and usable questionnaires could be obtained which is a response rate of approximately 20 %. Respondents in the study indicate being offered samples, sponsorship, and gifts by pharmaceutical companies with a frequency of at least once a month. Thus, many pharmaceutical firms are not following the code of conduct issued by the Department of Pharmaceuticals, Govt. of India. Further, though almost all physicians report being aware of the guidelines issued by the MCI, yet as many as 69 % of the sample admitted to be accepting gifts and sponsorships offered by the pharmaceutical firms. Educational programs were found to be influencing physician prescription behavior to a greater extent when compared with gifts. Frequency of offers made for gifts and sponsorships were found to be dependent upon physicians’ practice (number of prescriptions written) and the type of hospital they are associated with (private or government). The study focuses on sensitive yet critical ethical issues related to the promotional practices of pharmaceutical firms in India and physicians’ responses with regard to these promotional practices in the context of the guidelines of the Medical Council of India and the Department of Pharmaceuticals.