– Dr. R. B. Smarta
Like every other profession, the medical profession as well as the pharmaceutical sales and
marketing profession, have undergone radical shifts in ethics. New technologies and discoveries
have changed the paradigms. The paradigms have modified the spectrum of practices and
activities in both professions. While building relationships with each other, tactics have taken
over strategies raising concern among professional and the community.
For prescription drugs, medical practitioners have great influence and are responsible for
balancing patients’ needs, self interests and public interests. They have the knowledge and
expertise to assess scientific evidence, and have access to the specific contextual details of
medical needs in particular cases.
For Pharma marketing, it is a difficult task to engage Prescribers in marketing campaigns, use all
methods of promotion from mass-media advertising to below the line spend on measures such
as the engagement of key opinion leaders (KOL) who have a challenge to balance the social,
medical, professional and moral ethics.
Millions of dollars are spent on developing and protecting patented products. Hence, it
becomes important to look at the strategies which are used for prescribers, influencers,
consumers and financiers. Much of the Pharma industry’s marketing budget is targeted towards
doctors and others, who effectively are the gatekeepers of medicine sales. Unfortunately, as
the environment is changing towards Take and Take relationships and quick gratification of
each interaction, the tactics have gained a momentum over any strategic move.
It is the duty of the Pharma Company to provide directly or indirectly “Accurate medical
information”. Information must be provided objectively, truthfully and by suitable methods.
The information used in drug marketing must not be equivocal and should evoke no inaccurate
or misleading perceptions. Medical information must meet rigorous ethical standards.
Pharmaceutical firms should also refrain from offering enormous financial advantages,
including excessive entertainment to physicians and other interested persons in efforts to
influence them in the prescription of pharmaceutical products.
However all over the world, the power and influence of the pharmaceutical industry on
Physicians has raised concerns among health professionals and the wider community, leading
to increased regulation. Evidence that advertising, contact with company representatives, gift
giving, samples, sponsorship of meetings and other forms of promotion, influence prescribing
behaviour, has drawn particular attention to drug promotion.
Marketing practice codes
The IFPMA code of Pharmaceutical Marketing Practices was updated in 1994 while in India too
the IDMA Marketing code was prepared more than 5 years prior. When OPPI prepared the code
which was based on the IFPMA code, IDMA also revisited the same. Having a code and adhering
to it are two different things. Issues are evident in India due to
Varying perceptions of different physicians for the companies
Number of quality medical representatives available (as they are made salesmen since
long and the medical component of their transaction is nearly zero)
Near zero to optimum training and retraining cost due to attrition
Companies taking a quick route to train their field force
Very less time available for final transaction with physicians
Fuzzy value propositions as there is little differentiation between two company products
Unknown value of prescriptions from the pharmacists
Absence of ideal forecasting mechanism
These issues are providing maximum deviation in every form of communication with the
Usually Pharma companies employ following different practices for raising awareness,
motivating and enabling change for getting prescriptions through innovative practices
Besides gifts, samples, academic practice oriented as well as commercial detailing,
educational visits, interactive educational workshops, paper and electronic
dissemination of summaries / information, didactic educational workshops and
Opinion leaders seminars
Peer / colleague discussion sponsorships for conferences
Manual / electronic reminders and others
In fact, if the purpose of all these activities and practices change its values they create the
conflicts and produce unacceptable behaviors on the part of both parties. This is the situation
today and it is imperative to take stock of these behaviors and realign them for the benefit of
This is a need of the society and cooperation of all stakeholders is essential to make them
useful for all who are afflicted. Physicians role is vital as they need to choose the right molecule
for their patients. For all new drugs it is important to provide Post Marketing feedback on all
aspects of the drug, if it is patented and make the drug useful for the community. On the basis
of the feedback companies can take a re-look at the drug and take necessary actions.
Over the counter medicines is an ill defined category in India. There is no clear definition
available so far, hence regulatory authorities should undertake the task of making the players
effective. Role of Physicians will take shape as the definition is carved out.
Both IDMA and OPPI conducted a common seminar a year before for the first time to resolve
the issues of Industry. The combined Associations wanted to form a committee to monitor the
code so that Industry is observed and directed.
No further step in this initiative is taken so far. Obliviously, the Medical Association, Industry,
Physicians, regulatory bodies, and patient forums must nominate a team to highlight the
deviations in practices to general public and make patients aware about severe deviations.
Influence of Pharma companies
Do Pharma marketing communications really influence and affect physician prescribing
Undoubtedly, “Patients Come First” should be the core of the solution, but they are often the
only ones who are forgotten in this influencing process. In my opinion, before any conclusions
are made, we need to consider the following questions:
Is medicine a business or a benevolent service?
Should the pharmaceutical industry consider medicine as a business?
Or is it a little of both?
Balancing self-interests and patient interests, is a delicate task for both Physicians and
Physicians usually participate in pharmaceutical industry research, marketing and
development. Similarly, Pharma industry invests in the research of new products for targeted
therapeutic areas. Both these activities have ‘patient’s benefits’ at the heart!
So both pharma companies and Physicians have “common” patient benefits as the core. Can
you segregate these three entities, physicians, pharma companies and patients? Are they not
mutually exclusive and collectively exhaustive for the benefit of patients?
Conflicts of interests
One of the key requirements of a health professional involved in interactions with industry is to
be able to distinguish dualities and conflicts of interests. A duality exists where there are two or
more social roles that overlap, each of which is associated with a moral imperative. A conflict
exists where these imperatives are contradictory and threaten to compromise the primary goal
of one of them.
Do Physicians need to learn to balance from Royal College of Psychiatrists?
Royal College of Psychiatrists has a copyright of following “stages of change model”, which
highlights how physicians and pharma industry have to take cognizance of the charge in the
behaviours of both and develop a delicate balance.
Balancing Act has to be followed by pharma companies, physicians and the society. It’s an
exchange which is taking place between industry, physicians and their business behaviors.
Balance should yield ethical behaviour and hence ethical marketing and sales practices need to
Balance can be accomplished by ensuring that Regulatory Authorities and physicians,
pharmaceutical companies, associations of medical professionals, pharmacists, industry work
together with monitoring systems in the beginning.
– Published in Pharmabiz
– Dr. R. B. Smarta