Doctor-directed Marketing

Sales Representatives

Much of the promotional expenditure of pharmaceutical companies goes towards perks, such as all-expense-paid conferences and gifts, for doctors who prescribe the company's products. Evidence suggests that the most important source of information about drugs for doctors is the pharmaceutical industry itself. Techniques the pharmaceutical industry may use to influence doctors to prescribe their medications include the use of sales representatives, promotional material in the mail, journal advertisements, meetings, and cocktail parties organized by the industry. Of these techniques, sales representatives from the pharmaceutical company have the most influence over doctors. For example, some studies have shown that doctors who get more visits from sales reps write more prescriptions.

The responsibilities of sales reps are twofold. They must sell and promote the advantages of the product, but they must also educate doctors as to the risks and limitations of the medication. However, a rep's success, and therefore how much he or she gets paid, depends on the volume of sales, not on improvements in the knowledge of the physicians they work with. Under these pressures, it is hard to imagine that a sales representative can objectively portray their product to doctors. Further, sales reps are themselves trained to accept the belief that their products are decidedly beneficial to patients, making it even more difficult for them to act as an objective party.

Medical Journals

Doctors may also rely on medical journals for information about prescription drugs. However, even these sources are not free from industry bias. In terms of medical journal advertisements, ad agencies are skilled at designing layouts that highlight the positive aspects of a drug while overlooking the bad. Moreover, medical journals historically have not rigorously restrained misleading drug ads. This lack of restraint can be traced in part to the financial relationship between these journals and pharmaceutical companies. The money pharmaceutical companies pay in order to advertise in medical journals constitutes a major source of revenue for the journals.

In order to advertise their products, pharmaceutical companies need to be able to cite scientific research that proves the efficacy and safety of these products. Such research is typically reported in medical journals. Although biomedical research incorporates rigorous scientific rules and is often critically reviewed by peer scientists, the information can nevertheless be biased. This bias results from the financial relationship that researchers often have with wealthy corporations that pay them to conduct research on their product. Most biomedical research funding comes from government and foundations, but the amount contributed by private companies has grown in recent years. The increasingly important financial relationship with industry produces a conflict of interest for the researcher. Researchers undoubtedly try to be objective, but if the result the industry desires is not produced, the funding for the research may be discontinued. In order to avoid termination of funding, and of their jobs, researchers may introduce bias into their results. They can do so by ending a study that gives negative results, trying not to publish negative results, publicizing preliminary results, and de-emphasizing drawbacks.