Evolution Of Marketing Techniques, Adoption in Pharmaceutical Industry And Related Issues

A Project Report Submitted In Partial Fulfillment of the Requirements

for the Award of Degree of

BACHELOR OF PHARMACY
MARKETING project

by

Suhaib
(2008520500051)

Under the Supervision of

Assist Prof. Ms Ramza Hashmi

Metro College of Health Sciences and Research, Greater Noida,
Uttar Pradesh, India.

to the

METRO COLLEGE OF HEALTH SCIENCES AND RESEARCH

(DR. A.P.J. ABDUL KALAM TECHNICAL UNIVERSITY)
December, 2023
 DECLARATION

I hereby declare that the work presented in this report entitled “ Evolution Of Marketing
Techniques, Adoption in Pharmaceutical Industry And Related
Issues”was carried out by me. I have not submitted the matter embodied in this report for the
award of any other degree or diploma of any other University or Institute. I have given due credit
to the original authors/sources for all the words, ideas, diagrams, graphics, computer programs,
experiments, results, that are not my original contribution. I have used quotation marks to
identify verbatim sentences and given credit to the original authors/sources.
I affirm that no portion of my work is plagiarized, and the experiments and results reported in the

report are not manipulated. In the event of a complaint of plagiarism and the manipulation of the

experiments and results, I shall be fully responsible and answerable.

Name: Suhaib

Roll No:- 2008520500051

…………………………………

(Candidate Signature)
 CERTIFICATE

Certified that Mr. Suhaib ( Roll No:-2008520500051) has carried out the project work presented

in this report entitled “Physicochemical properties in relation to biological action", for the award of

BACHELOR OF PHARMACY from Dr. A.P.J. Abdul Kalam Technical University (Formerly

Uttar Pradesh Technical University), Lucknow through affiliated institution METRO

COLLEGE OF HEALTH SCIENCES AND RESEARCH under our supervision. The thesis

embodies

results of original work, and studies carried out by the student himself and the contents of the

thesis do not form the basis for the award of any other degree to the candidate or to anybody else

from this or any other University/Institution.

Asst Prof. Ms Ramza Hashmi

SUPERVISOR
Metro College of Health Sciences
and Research, Greater Noida, Uttar
Pradesh, India.

Date:
Table of Content

1 Introduction

2 Marketing and its evolution

3 Pharmaceutical Marketing

4 Technique and Tools for Pharmaceutical Marketing and

Promotion

5 Regulation control and code of to control pharmaceutical

promotion
6 Abuse of Marketing technique in Pharmaceutical

7 Bribes

8 Conclusion

9 Reference
Abstract
The availability of life saving pharmaceutical products by their very nature plays a prominent
role in the well-being of a society. Within this context, the pharmaceutical industry plays a
prominent role especially in the process of discovery and development of new pharmaceutical
products, rapid and safe development of these products and finally the production and
distribution of safe and efficient products. Over the years with the advancement in global
marketing strategy and technologies, similar to other profit driven industry, pharmaceutical
industry also had joined the band wagon in the process of maximizing profits in the current era of
challenging global market.
The primary objective of this paper is to discuss the evolution of marketing techniques employed
by pharmaceutical industries in order to remain competitive in this highly regulated commodity.
Introduction

Marketing is the most commonly used tool to increase market share. Our aim to write this article
is to highlight marketing from the industry perspective regarding pharmaceutical marketing,
issues related to promotional practices and their impact on prescribing behavior of the physicians
from the published
and presented literature and research findings. Before starting discussion about pharmaceutical
marketing and related issues, it is much important to understand what the concept of "marketing"
is? How its evolution took place passing through the process of development.
Marketing And Its Evolution

The question "what is marketing" could be answered as, "it is a process by which one identifies
the needs and wants of the people, creates a product/service to meet the needs and wants,
develops a way of taking the product/service to the market place, determines the way of
communicating the product to the market place, determines the value for the product, targets the
people (segmentation), who have needs/ wants and then creating a transaction for exchanging the
product for a value and thus creating a satisfaction to the buyer's needs/wants".

business people to develop this way of retaining and increasing their business.
The evolution process can be in three eras; production, sales and marketing. The production
concept prevailed from the time of the industrial revolution until the early 1920's. It was early
industrialization when output was limited, no competition and high demand. Companies had no
interest in consumer preferences or demands.

They were only focused on 2 questions; can we produce the product? And can we produce it in
enough quantity? Production concept worked fairly well because the goods that were produced
were largely those of basic necessity and there was a relatively high level of unfulfilled demand.
Virtually everything that could be produced was sold easily at the price determined by the
producer.
Production concept prevailed into the late 1920's. By the early 1930's however, mass production
had become commonplace, competition had increased, and their demand was decreasing.

Now the firms began to practice the sales concept (or selling concept, which was focused to
convince customers to buy their products through advertising and personal selling. Now the key
questions were can we sell the product? And can we charge enough for it? The sales concept paid
little attention to whether the product actually was needed; the goal simply was to beat the
competition to the sale with little regard to customer satisfaction. Marketing was a function that
was performed after the product was developed and produced, and many people came to
associate marketing with hard selling.

Even today, many people use the word "marketing" when they really mean sales. After II World
War, the variety of products increased and hard selling no longer could be relied upon to
generate sales.
With increased discretionary income, customers could afford to be selective and buy only those
products that precisely met their changing needs, and these needs were not immediately obvious.
The key questions became; what do customers want, can we develop it while they still want it
and how can we keep our customers satisfied?
In response to these discerning customers, firms began to adopt the marketing concept, which
involves; focusing on customer needs before developing the product, aligning all functions of the
company to focus on those needs and realizing a profit by successfully satisfying customer needs
over the long-term A diagrammatic representation of marketing evolution is represented in Table.
(Table/fig 1) Flow of marketing evolution (the graphical presentation of marketing
evolution, priorities and challenges at diferent evolutionary stages)

It was some background about marketing and its evolution but it is just about marketing of the
products other than the controlled products and pharmaceuticals, which is not only largest but
also the most profitable industry of the world.
 Pharmaceutical Marketing

Pharmaceutical industries adopted marketing toll with some controlled practices initially. But
with passage of time, pharmaceutical marketing became like fast moving consumer goods
(FMCG) and all the concerns regarding patient safety and health were neglected. The definition
of pharmaceutical marketing is "activities focused on making physicians as well as the general
public aware of new and existing pharmaceutical brands, pharmaceutical marketing can include
giveaway samples, detailed product literature, disease management programs, and support
material for patients, internet
initiatives, and events/meetings for physicians". Pharmaceutical marketing can also be defined as
a management process that serves to identify and meet patients' needs in a profitable way.
Pharmaceutical business mainly adopts sales and promotion, the branches of marketing.
World Health Organization (WHO) defines promotion as "all
informational and persuasive activities by
manufacturers and distributors, the effect of which is to induce prescription, supply, purchase
and/or use of medicinal drugs".
International Federation of Pharmaceutical Manufacturers Association
(IFPMA) defines promotion as "any activity undertaken, organized or sponsored by a member
company (pharmaceutical company member of IFPMA) which is directed at healthcare
professionals to promote the prescription, recommendation, supply, administration or
consumption of its pharmaceutical products) through all media, including the internet".

Techniques and tools for pharmaceutical marketing

and promotion For ease of understanding, it can bedivided in
two sections:

o Traditional pharmaceuticalmarketing and promotion: techniques and

tools o Pharmaceutical marketing in 21st century: latest techniques and
tools in global village.
 Traditional pharmaceuticalmarketing and promotion techniques and tools: -
• Advertisement

Advertisement of drugs is done mainly by 2 ways: -

: Directed to cotin mers Advertisemay Alted only in two countries USA and New
Zealand) o Directed to
prescribers Advertisement.
o Through advertisement in professional publications, books, journals, conferences
electronic media and cyber space.
Continuous Medical Education (CME). These days this tool of pharmaceutical promotion is very
popular by which pharmaceutical companies use educational events for their marketing purpose
by investing on physicians or opinion leaders paid as speakers, education events, lectures
excursions i.e. national excursions for participation in conference/seminars and symposia,
foreign excursions for participation in conference/seminars and symposia. Industrygets double
benefit from CME programs. At one end they oblige their customers (prescribers) and as return
get increased prescription. On the other end they promote their image as a responsible
organization of the society to use corporate social responsibility (CSR) concept.
○ Sponsorships

Companies also try to make direct payments to the doctors by various indirect ways i.e.,
for clinical trials (entering patients in clinical trialsagainst payment), national and
international conferences and symposia sponsorships, free medical camps, and opinion
leaders (to deliver lectures) for health care professionals.

o Personal Selling

Personal selling is most important way of drug promotion. It adopts detailing in

combination with many other tools. Detailing is most commonly used technique
worldwide and by definition detailing is "the personal sampling and other promotional
work among doctors, dentists, and other professional persons done for pharmaceutical
concerns; in order to secure goodwill and possible distribution or prescription of the
product". Sales representatives are the focal resource for applying most of the techniques
of pharmaceutical marketing means relationship between prescribers and medical
representatives is supported by various gifts and materials. The adopted tools of
promotion for this technique are drug information brochures, literatures, drug samples,
giveaways, personalized gifts, sweepstakes in conferences and workshops and many other
tools.
Pharmaceutical Marketing in 21st century: Latest Techniques and Tools in Global
Village

Pharmaceutical marketing has also adopted modern techniques according to developments in

technology. Few of them are adopted independently and some are being used in combination or
to support traditional techniques

Internet Based Drug Promotion: Using Corporate Blogs, Social Network Webs
And Many Other Online Methods

Pharmaceutical industry is focusing on the advantages of the internet and the development of
new media forms to promote their products. Electronic detailing, interactive websites, email
prompts and viral marketing campaigns using social networking sites such as YouTube,
MySpace and Facebook are among the tools being used.
 ○ Electronic Detailing

With the technological development, many existing methods and practices has been either
replaced or modified in combination with technologically developed methods. Electronic
detailing (e-detailing) is one of the methods of drug promotion introduced few years back
as technologically develop tool. In pharmaceutical industry it has been introduced as a
new communication channel for the promotion of drugs among the physicians. For e-
detailing digital technologies like internet, video conferencing, and interactive voice
response are adopted to interact with physicians.

o Direct To Consumer Advertisement Of Prescription Drugs

o The pharmaceutical industry is one of the most advertising-intensive industries.

Promotional expenditures often amount to 20-30 percent of sales, sometimes well
exceeding expenditures on research and development (R&D).
 o • Direct-to-consumer advertising of prescription drugs (DTCA) is legal in 2 industrialized
countries, the United States and New Zealand. No new legislation was introduced to
allow this form of advertising; both countries' laws were silent with respect to the target
audience for prescription drug advertising. However, since the early 1990s when the US
pharmaceutical industry spent less than $100 million per year advertising prescription
drugs to the public, DTCA has grown enormously, with spending reaching $3.2 billion in
2003 and the proportion of advertising revenues devoted to DTCA growing from 9% in
1996 to 13% in 2003.

• Under the Federal Food, Drug, and Cosmetic Act, the Food and Drug Administration is
responsible for ensuring that the labeling and advertising of prescription drugs is truthful
and not misleading. Section 502 (n) of the act (21U.S.C. 352 (n)) prohibits the advertising
of drugs that is false or misleading or that fails to provide required information about
product's risks. Although in beginning, advertising of prescription drugs was primarily
addressed to health professionals, but over the period of time, consumers have became a
primary target audience. After the change target audience of advertisement, direct-to-
consumer advertising (DTCA) has become the favorite channel of the pharmaceutical
companies for marketing their products. Spending on DTCA for prescription drugs reached
$3.27 billion in 2003, almost 5 times the $695 million level seen in 1996, and over 25 times
the $130 million level seen in 1993. Part of this growth resulted from the Food and Drug
Administration's August 1997 Draft Guidance for Broadcast Advertising of Prescription
Medicines, which effectively opened the door for pharmaceutical companies to advertise
prescription drug products on television and radio.

Regulations and codes of conduct to control pharmaceutical promotion

o The issue in pharmaceutical marketing is not only the misuse or abuse of the drug
promotional techniques, but the absence and weak enforcement of the regulations and
self-regulatory codes could also be responsible for uncontrolled drug marketing.

o Malaysia has a comprehensive (Malaysian Laws on Poison and Sales of Drugs) law to
control pharmaceutical promotion and a well-defined self-regulatory code developed by
the
Pharmaceutical Association of Malaysia (PhAMA) which is an extension of IFPMA
(International Federation of Pharmaceutical Manufacturers Association) Code but The
effectiveness of the Pharmaceutical Association of Malaysia's (PhAMA) code of
conducts for prescription (ethical) products in controlling pharmaceutical
 promotion is questionable as no research has been done to examine if it is implemented
in practice.

• Many developing countries have no appropriate law to control the v

pharmaceutical promotion. In Pakistan the drug act

1976 governs the Pharma industry, but no appropriate control
on promotion.
In the chapter 4 of Drugs (Licensing, Registering and Advertising) Rules, Drug Act 1976
rule number 3 to 35 address the "advertisement" not promotion and even not enough to
control advertisement. Chapter Ill of Drug act
"prohibitio
ns" rule
number 24
and 25
addressin g
prohibition of advertisement of drugs direct to consumers and control on sampling in very
ambiguous way. It states that "no person shall distribute or cause to be distributed any
drug as a sample except in accordance with such conditions as may be prescribed" and no
details of "may be prescribed" are available.

o Schedule "G" is added by an SRO (Solicitor's Remuneration Order) 1362(1)/96, dated

28-11-1996, specifically to control pharmaceutical promotion but is in the same
ambiguous statements form and actually is only addition of few more papers
in the Drug Act. These legal provisions are much ambiguous and can easily be deceived/
violated.

Abuse of marketing techniques in pharmaceuticals

o The pharmaceutical industry has contributed more to the well-being of humanity than any
other. Arguably among other achievements, it has helped to remove tuberculosis,
gastroenteritis, and diphtheria from among the 10 leading causes of death in the western
world and also achieved a mile stone by playing basic role in removal of small pox,
plague and polio, the main causes of death and disability especially in the developing
countries few decades back. But despite these
achievements, yet the avoidable suffering caused by the pharmaceutical industry,
particularly to the poor of the world, seems at times beyond comprehension.

o Alliances between medical profession and pharmaceutical industry have become

increasingly widespread in recent years. While there are clearly benefits for doctors and
their patients derived from the medical profession working with the industry, concerns
have been arisen that commercial imperative of industry may
conflict with physicians' independence and professional integrity.
o It is fact that marketing and promotional activities may influence the physicians' decision
regarding prescribing medication. Little information is available about means of the
promotion of pharmaceuticals in all over the world especially in the
developing countries there is no documentation of the promotional practices, means and
tools influencing doctors prescribing behaviors. Even globally we can find few studies
that addressed the issue but on in a very narrow and specific area of the scene.
 Promotional Spending

o Gifts given by the pharmaceutical industry to physicians are common and controversial.
Their expenditure on marketing is increasing day by day. Only in USA, pharmaceutical
industry spends nearly twice as much on marketing as on R&D. In 1998 pharmaceutical
industry spent US$12724 million in United States
only on promoting its products. In 1998 expenditure were dominated by free drug
samples provided to physicians (equivalent retail cost of US$ 6602 million) and office
promotion (US$ 3537 million), followed by (DTCA) Direct to consumers advertisement
(US$ 1337 million) hospital promotion (US$ 705 million) and advertising in medical
journals (US$ 540 million). It has been estimated that on average, more than US$8000 is
spent per physician annually and this budget is increasing every year. According to IMS
International Medical Statistics) and CAM, spending for the promotion of prescription
drugs in US during the year of 2004 was more than 57.5 billion out of which 15.9
(27.7%) was spent on free samples, 20.4 (35.5%) on detailing 4 (7%) on Direct to
Consumers Advertisement (DTCA), 2(3.5%) on meetings, 0.3 (0.5%) on e- promotion,
mailing etc., 0.5(0.9%) on journal advertisement and 14.4 (25% were the monitored
promotional expenditures (estimate).

o IMS have not included the spending on phase IV "seeding" trials, trials which are
specifically designed for the promotion the prescription of new drugs and have no interest
in generation of scientific data. In 200413.2% (US$4.9 billion) of R&D expenditures by
Americanpharmaceutical firms was spent on phase IV trials.

o Out of these marketing budgets; focus of the companies shows increasing trend on the
budget allocation for detailing mode and direct to consumer advertisement. In 1996
budget spent on detailing mode of promotion was 3 billion which reached
4.8 billion in 2000 (only in 5 years). Similarly spending on direct-to-consumer
advertisement was 0.8 billion which in the 5 years reached 2.5 billion USD in United
States.

o Pharmaceutical industry has been the most profitable industry in the country for a decade.
According to an analysis of 2001 data, it was five times as profitable as the average
Fortune 500 companies. The industry deserves great credit for supplying miracle drugs,
but no responsible industry would engage in the price gouging and advertising abuses that
taint its reputation today.
 The game of patent and branding

o Since the early 1990s, the most drugs approved by FDA were "me too" and were as high
as 92% of the approvals. This sharp growth has produced many concerns regarding
marketing tactics because when we compare this growth with the launching of new
molecules, we will find no considerable addition in number of new molecules so easily.
Hence it can be concluded that this growth is based upon
generic drugs. Same drug is registered with different brand names, for example,
diclofenac sodium is registered in Pakistan with more then 170 brand names for different
companies. This type of growth is increasing with no ending of competition in the
market. Companies want to sale their products by any possible means either ethical or

The Food and Drug Administration (FDA) approved Neurontin in doses of 1800 mg per
day as adjunctive therapy for partial complex seizures, in 1993 which was patented in
1977. This drug became a surprise blockbuster for ParkeDavis, a division of Warner-
Lambert, which was purchased by Pfizer in 2000. U.S. sales reached to nearly $3 billion
in 2004 which was $98million only in 1995. Later Neurontin faced generic competition
and lost most U.S. sales

Drug information misinterpretation and manipulation

• It is accepted and well documented fact that pharmaceutical companies are the
biggest source of drug information for the prescribers. In Canada 66% doctors are
dependent on medical representatives for drug information. Other sources include detail
aids 41%, non-reviewed journals 44% company sponsored symposia 45%, association
meetings 51%, product monographs 51%, journal ads 53%, CME 59% and peer reviewed
journals 82%. If pharmaceutical industry provides healthcare professionals with exact
and accurate information to the doctors regarding medicine, it will be really a very big
contribution for the healthcare system and in large for the society because doctors are
very much dependent on the pharmaceutical companies for drug information especially in
developing countries. Using the fact of being main source of drug information,
companies are not hesitant even to deceive the health care providers and regulatory
authorities.

o Many studies have proved provision of drug information with the intentional
manipulation and misinterpretation.

o In 1997, for example, a study comparing the effects of brand-name and generic
formulations of levothyroxine led to an uproar over the discovery that the manufacturer
of the brand-name product suppressed publication of the result that the two formulations
were equivalent.
 Recently, lawsuits alleging damages from illegal marketing of another old drug,
gabapentin (Neurontin), have yielded remarkable discoveries about the structure and
function of pharmaceutical marketing.

o This is the picture of a developed country, where peer-reviewed journals are the biggest
source of information for doctors regarding drugs followed by medical representatives as
second biggest source for them, but in developing countries situation is different. There is
poor or no mechanism of monitoring drug promotion, medical representatives are the
main source of information even we can say the only source of drug information for the
doctors regarding drugs and to transfer the drug information, brochures are the main tool.
More than seventy-seven percent of the doctors rely on the medical representatives for
drug information in developing countries. A study conducted in 6 cities of NWFP and
Punjab (Pakistan) finds that 87% of the doctors think that they can face problems without
industry representatives out of which 92% (of the 87%) think that they will be unable to
get knowledge of new drugs, considering this fact, industry is increasing their sales force
day by day. According to IMS health, the sales force of top 30 US based pharmaceutical
companies was 52400 in 1998 which increased to more than 100000 only in 7 years
(2005).

o The accuracy and usefulness of the industry provided information/advertisement has been
a subject of debate since long time which generates the need to audit the mostly used
information transfer means i.e., medicine literature, wall mountings.

o In a recent study conducted in Pakistan, 18% claims made by pharmaceutical companies

were adjudged to be misleading or unjustifiable out of which 32% (of 18%) were
classified as "exaggerated", 21% ambiguous, 26% false and 21% as controversial
(percentage of the misleading or unjustifiable).

o It is not only in developing countries, if we observe the pharmaceutical industry is

heavily involved in aggressive drug promotion and due to this aggressiveness, many
cases of unfair ways of drug promotion have been identified in developed countries and
plead. For example, three current and former executives of the company that produce the
narcotic painkiller OxyContin pleaded guilty in federal
 court of ABINGDON, to criminal charges that they misled regulators, doctors and
patients about the drug's risk of addiction and its potential to.

o To resolve criminal and civil charges related to the drug's "misbranding," the parent of
Purdue Pharma, the company that markets OxyContin, agreed to pay some
$600 million in fines and other payments, one of the largest amounts ever paid by a drug
company in such a case Likewise, Bayer healthcare pharmaceutical agreed to spend $20m
(£14m; €15.6m) for correction of its misleading direct to consumer advertisement of birth
control pills.
 Bribes

o Any researcher, investigated the comparative evidence on bribery in international trade

has concluded that pharmaceutical is one of the most corrupt among the industries. Dr.
John Braithwaite in his article "The corrupt industry" says that his own research has
found evidences of substantial bribery by 19 of the 20 largest American pharmaceutical
companies.

o There is evidence of bribe being paid to every type of governmental official who could
conceivably affect the interest of pharmaceutical companies: bribes to cabinet members
to get drugs approval for marketing, bribes to social security bureaucrats who fix prices
for subsidized drugs; to health inspectors who check pharmaceutical manufacturing
plants; to customs officials, hospital administrators, tax assessors, political parties and
others. A practicing physician shared his experience saying that companies sponsored
lectures by specialists for family doctors were interesting and informative bit with only a
reference to a company product. Specialists are becoming little more than paid 'shill' for
pharmaceutical companies. Usually, the slides they use for their lectures are provided by
the host pharmaceutical company. Topics for these lectures are just repetition. Their
research figures are manipulated to turn a two percent improvement into a fifty percent
improvement. Graphs are doctored by altering the scales to show substantial
improvements where none exist.

o If the drug company didn't expect the gift to influence the doctor's decision, why would it
give the gift? According to a 1992 article published in The New England Journal of
Medicine written by Douglas Waud, M.D., the term gift should read bribe: A gift implies
that no strings are attached.

o It is now beyond dispute that retiring Rep. Nick Smith, R-Mich, was offered a
$100,000 bribe to vote for the Medicare pharmaceutical bill.

o Companies offer everything from free golf games to week-ends in resort hotels, from free
tickets for theatre festivals to dinner cruises. The evening invitations to the most
expensive local restaurants arrive once or twice a week, let alone the free lunches which
are mine for the asking.
The most a guest have is to do is to sit through a half hour presentation of a company's
product
 Abuse of sponsorship

Companies also try to make direct payments to the doctors by various indirect ways i.e.,
Enter patients in clinical trials against payment, National and International conferences
and symposia sponsorships, free medical camps, and foreign trips. Sponsorships also
involve "promotional research", use of opinion leaders by the way of calling them to
present company provided presentations among the health care professionals.

Abuse of internet sources of marketing

Such campaigns are targeting both health professionals and the general public. The internet
is helping to globalize and to change the nature of pharmaceutical marketing, and thus
raises some new challenges for regulators. There are no restrictions for consumers to access
the web-based drug information or through the advertisement mails they get in their e- mail
box from some unknown person offering to deliver at their doors. Now the question arises
who will monitor them how it can be controlled and after the start of internet based pharma
marketing, country regulation has become just a piece of paper because direct to consumers
advertisement of prescription drugs is legally allowed on in USA and New Zealand but by
internet who will stop the companies to direct their advertisements towards consumers and
who will stop consumers from accessing such advertisements and getting involved in self-
medication of prescription drugs.

Impact of marketing on prescribing behavior and behavioral changes

towards offers

A number of authors have commented paucity or lack of objective data on impact of

pharmaceutical marketing techniques on physician prescribing practices. The industry grew
very fastly during the last 2 decades. Simple example for observing this growth rate in a
developing country is the trend in number of drugs registration in Pakistan. The number of
total registered branded drugs in Pakistan was less than 20000 in early 1990s but it was
more than 35000 in 2004.
Ministry of health has registered more 30000 branded drugs during last 30 years.

Here a question arises, "Are the pharmaceutical promotional activities really able to
influence the behaviors of the physicians?" Many studies concluded that pharmaceutical
marketing is not only influential to the doctors' attitude also their prescribing behaviors.
Pharmaceutical companies give gifts to doctors as a part of promoting and marketing their
products. Although many doctors deny the potential for gifts to influence their judgment, it
has been found that medical practitioners' attitudes
to the pharmaceutical industry, their knowledge about pharmaceutical products, and
prescribing behavior are influenced by industry promotion and gift-giving.

As for as attitude change is concerned, it has been changed for example "Now" they
(prescribers) ask for or readily accept the offer for free travel and hotel accommodation,
give green cards against donations for building funds and refuse to see the medical
representatives if donation is not given.
Group of doctors have formed companies and prescribing their products. They have an
increasing liaison with chemists to prescribe a product which provides more discounts.
They ask for money per prescription particularly for prescribing more tonics and vitamins.
Request for renovation of clinics and hospitals.

Other studies also support the truth; that pharmaceutical promotion has clear impact on the
doctors' prescribing behavior. Here case is present for understanding the impact of drug
promotional activities on the sale of a drug (intravenous antibiotic used for hospitalized
patients) having 81+ 44 units' consumption per month over the period of last 22. The
consumption of the drug touches the peak at 476 units (maximum) per month after the
pharmaceutical company invited specialists of that hospital with one guest each for an "all-
expense paid" trip to a luxurious place.

Impact on healthcare spending

Spending on prescription drugs by different countries is increasing continuously by

significant sieh to nv ares which is an ou of inproming trause of ais increase s comining
expenditures in USA reached $1.6 trillion during the year 2002, which is 15 percent of that
year's gross domestic product (GDP).

Share of the pharmaceutical expenditures over the past decade, reached 10 percent of
overall healthcare spending which is highest during last forty years. Another indicator for
increase in pharmaceutical expenses is increasing sales of prescription USA which reached
at $228.8 billion in 2003.
 Conclusion

All the codes of conduct, self-regulations and laws developed to control pharmaceutical
promotion and marketing seem ineffective which is reflected by increasing marketing
expenditure of the companies. According to a report by IMS- health, spending on marketing in
USA shows continuous growth. In 1996, it was 9.164 billion, 10.990 in 1997,
12.473 in 1998, 13.867 in 1999 and in 2000 it reached 15.708 billion. Thus, increasing the need
of well define laws to be implemented by regulatory authorities only. There must not be any
reliance from industry for their self-regulation due to their clear and continuous reflection of pure
business mentality i.e., spokesperson for the British industry quoted "I would just be talking
rubbish if I were saying that the multinational companies were operating in the less developed
countries primarily for the welfare of thosecountries. They are not bishops, they are
businessmen". We must acceptthe fact that pharmaceutical industry in developing countries is
driven by "quest ofprofit" and they can practice anything to get their desired profit as medical
director of Squibb quoted "The incidence of disease cannot be manipulated and so increased
sales volume must depend at least in part on the use of drugs unrelated to their real utility or
need"
 Reference
1. Smith MC. Pharmaceutical marketing: principles, environment and practice. Binghamton,
NY13904-1580: Pharmaceutical product press; 2002.

2. Evens J, Berman B. Marketing. 4 ed. New York: McMillian 1990.

3. Marketing. International center forManagement and Business Administration, Inc;2002

cited2009 June 7 Available from:
http://www.netmba.com/marketing/.Phormaleutical Marketalan tromine: in
awpointimarketing. Com/pearmace cited)from:http://www.onpoint-
marketing.com/pharmaceutical marketing.htm.

4. Olszewska A. Strategic management in pharmaceutical marketing. Chemik 2006:591-4.

5. Doran E, Kerridge I, McNeill P, Henry D. Empirical uncertainty and moral contest: A

qualitative analysis of the relationship between medical specialists and the
pharmaceutical industry in Australia. Social Science & Medicine. 2006;62(6):1510- 9.

6. Ethical criteria for medicinal drugs promotion, endorsed by the 33rd world health
assembly, World Health Organisation. (1986).

7. IFPMA Code Of Pharmaceutical Marketing Practices. (2006).

8. Masood I, Anwar M. Common Promotional Materials and Medical Representatives: Are

they really useful for doctors? Pharmacy in new era, 1st national conference on
pharmaceutical sciences; 2007 2-4 March; Bahawalpur, Pakistan. Faculty of Pharmacy
and Alternative Medicine, The Islamia University of Bahawalpur; 2007. p.

9. Sweet M. Pharmaceutical marketing and the internet Australian Prescriber.2009;32(2):4.

10. Alkhateeb FM, Doucette WR. Electronic detailing (e-detailing) of pharmaceuticals to

physicians: a review. from ProQuest Central database. 2008;2(3):235-45.

11. Brekke KR, Kuhn M. Direct to consumer advertising in pharmaceutical markets. Journal
of Health Economics. 2006;25(1):102-30.
12. Mintzes B, Barer M, Lexchin J, Bassett KL. Introduction of direct-to-consumer
advertising of prescription drugs in Canada: An opinion survey on regulatory policy.
Research in Socialand Administrative Pharmacy. 2005;1(2):310- 30.

13. Schommer JC, Hansen RA. The study of direct-to-consumer advertising forprescription
drugs|star, open]. Research in Social and Administrative Pharmacy. 2005;1(2):348-68.

14. DCOMoH. Drugs (Licensing, Registering And Advertising) Rules, Drug Act
1976.Islamabad: Government of Pakistan; 1976[updated 1976; cited 2009 July 28,
2009];Drug Act]. Available from rules2.php.

15. Blackwell, R.D., Miniard, P.W. and Engel, J.F. (2001) "Consumer Behavior" 9th edi.
Mason, Or SouthWestern.2001.

16. Grant, R.M. (2002) "Contemporary Strategy Analysis: Concepts, Techniques, and
Application:Oxford: Blackwell Publishing.2002.

17. McNeill P, Kerridge I, Arciuli C, Henry D, Macdonald G, Day R, et al. Gifts, Drug
Samples, and other Items Given to MedicalSpecialists by Pharmaceutical Companies.
Journal of Bioethical Inquiry. 2006;3 (3):139-48.