A Pharmaceutical Marketing Strategy: Gifts to Physicians or Burdens to Patients? by LAN HUYNH In the business world, the term “marketing” is generally understood as the activity of advertising and selling products or services from a company directly to the consumer. In the Big Pharma world, however, the consumer is usually not the main marketing target of pharmaceutical companies. A study estimated that about 84% of pharmaceutical marketing is directed towards medical doctors, who have the power to prescribe and determine the sale of drugs.1 Most people wonder what magic drug companies use to be able to persuade these experts of the medical field. Unfortunately, physicians are just normal humans like anyone else. They are not immune to behavioral manipulation, and the Big Pharma knows it. Pharmaceutical sale representatives meet with doctors for an average of four times a month and offer them a variety of gifts.2 The gift, regardless of value, makes the recipient feel indebted to the giver. In this case, gifts from the pharmaceutical industry can make doctors feel like they need to return the favor by starting to prescribe the company’s products. This biased decision making can lead to an increase in financial burden on patients, compromise doctors’ professionalism, and weaken patients’ trust in their physicians. In recent years, the issue has gained more attention from a segment of the medical community who is against the pharmaceutical industry’s effort to influence physicians. A number of policies and guidelines were enacted to restrict or ban pharmaceutical representatives’ visits and set limits for gifts’ price. Although these solutions can be helpful as the first step to prevent bias in treatment decisions and lower overall cost for indigent patients, individual physicians must carry a great responsibility to make ethical decisions
about accepting gifts from pharmaceutical industry. In 2012, the pharmaceutical industry spent about $24 billion in marketing its branded products to health-care professionals.3 This number is eight times the amount spent on direct-to-consumer advertising. The gifts offered to medical doctors by pharmaceutical companies and sale representatives range from inexpensive items such as pens and notepads to expensive ones such as meals, trips, and drug samples.2 Furthermore, some types of gift can have unclear intent by targeting independent continuing medical education, peer-to-peer selling by physicians, resident programs, and sponsored studies.1 The practice of giving and accepting any kind of gifts between pharmaceutical companies and physicians has been raising ethical concerns over two decades. One of the main arguments focuses on the quality of treatments provided to the patient. Gifts may result in inappropriate changes in doctors’ prescribing habit, thus compromise the objectivity of treatments. An analytical study conducted in the District of Columbia found that prescribers who received gifts from the pharmaceutical industry generated more prescriptions per prescriber, and an average of two more prescriptions per patient, compared to non-gift recipients.4 This changing in physicians’ prescribing behavior is more likely a result of trust in biased and inaccurate information from the pharmaceutical sale representatives, who might or might not have a sufficient medical knowledge. Consequently, doctor’s practices can become neither evidencebased, nor clinically safe, nor cost-efficient, which is another main argument against the widespread acceptance of pharmaceutical gifts. According to the same study in STETOTHOSCOPE MAGAZINE
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Washington, D.C.,4 physicians who received any gifts from pharmaceutical companies were two to three times more likely to prescribe branded drugs than those who did not receive gifts. These branded drugs are often much more expensive than available generic drugs but offer minimal, if any, benefit over generic formulations. High drug prices may diminish patients’ ability to afford the therapy, thus putting their health in serious danger. If a patient finds out that the drug he or she received was not chosen based on the medical condition solely but also was influenced by gifts from the drug company, he or she may lose trust in the physician, which can affect the patient compliance to the treatment.1 Therefore, receiving gifts from the industry can compromise physicians’ professionalism and their main duty, which is putting the patient’s best interest before personal benefits. Although the acceptance of gifts from the pharmaceutical industry has been criticized by a growing segment of the medical community, defenders of this practice view it as morally permissible and provide several counter-arguments to the critique. They argue that gifts from the industry may offer various benefits directly or indirectly to patients. According to the “pro-gifts” group, free drug samples are actually gifts for patients as they allow patients to start the therapy immediately and help them overcome financial obstacles.1 Moreover, physicians believe that to provide the best services to their patients, it is important for them to be informed and updated with newly approved medication or medical devices. This also means that financial support from pharmaceutical companies is ethically acceptable if it is directed toward professional continuing education activities