Attitudes and Beliefs Regarding Direct-to-Consumer Advertising of Pharmaceutical Drugs: An Exploratory Comparison of Physicians and Pharmaceutical Sales Representatives

Even with many changes in regulation in recent years, direct-to-consumer advertising (DTCA) of pharmaceutical drugs remains a complicated and contentious issue. Many in our society argue for increased legislation of DTCA while others believe that DTCA serves a useful purpose and should not be overregulated. This study was designed to compare attitudes and beliefs regarding DTCA held by two key stakeholder groups, physicians and pharmaceutical sales representatives. A questionnaire was created, pretested, and administered to 30 physicians and 30 pharmaceutical sales representatives to investigate these issues. Significant differences between these two groups were found and implications for DTCA are discussed.     

Managerial implications of medical sales representative perceptions of job duties, job qualifications, and other performance-related issues

This study examined the perceptions of medical sales representatives of job related duties, job qualifications needed, and motivating factors and tested for differences based on gender, age, years of experience and education using prior research as a base. This study also explored issues that may arise between sales people and physicians. The authors surveyed 132 medical sales representatives from pharmaceutical firms located in Ankara, Turkey. The authors' findings highlight the need in Turkey for developing in-service training programs for medical sales representatives, especially in the areas related to technical aspects of the product, effective marketing and personal selling strategies, and consumer relations. Training in these areas will help salespeople to better manage the problems typically encountered in physician-sales representative relations. While the study was conducted in Turkey, the results are similar to findings in prior research conducted in other countries and therefore may be of interest to all sales managers.     

The company we keep: why physicians should refuse to see pharmaceutical representatives

Whether physicians ought to interact with pharmaceutical sales representatives (reps) is a question worthy of careful ethical analysis. The issue presents a challenge to both professional integrity and time management. Empirical data suggest that interactions with pharmaceutical reps increase the chances that the physician will act contrary to duties owed to the patient. Ideally, a physician might both interact with reps and also do the research necessary to counteract the commercial bias in their messages. But a physician who actually did that research would, in turn, be devoting a good deal of time that might better be spent in other activities. The counterargument, that one is obligated to see representatives to obtain free samples to best serve one’s patients, can be shown in most practice settings not to be compelling. Physicians ought to refuse to visit with representatives as a matter of both professional integrity and sensible time management.     

Reconciling a “pleasant exchange” with evidence of information bias: A three-country study on pharmaceutical sales visits in primary care

ObjectivesTo examine and compare the experiences and attitudes of primary care physicians in three different regulatory environments (United States, Canada, and France) towards interactions with pharmaceutical sales representatives, particularly their perspectives on safety information provision and self-reported influences on prescribing.MethodsWe recruited primary care physicians for 12 focus groups in Montreal, Sacramento, Toulouse and Vancouver. A thematic analysis of the interview data followed a five-stage framework analysis approach.ResultsFifty-seven family physicians (19 women, 38 men) participated. Physicians expected a commercial bias and generally considered themselves to be immune from influence. They also appreciated the exchange and the information on new drugs. Across all sites, physicians expressed concern about missing harm information; however, attitudes to increased regulation of sales visits in France and the US were generally negative. A common solution to inadequate harm information was to seek further commercially sourced information. Physicians at all sites also expressed sensitivity to critiques from medical students and residents about promotional interactions.ConclusionsPhysicians have contradictory views on the inadequate harm information received from sales representatives, linked to their lack of awareness of the drugs’ safety profiles. Commonly used strategies to mitigate information bias are unlikely to be effective. Alternate information sources to inform prescribing decisions, and changes in the way that physicians and sales representatives interact are needed.     

Ethical dilemmas in fieldwork: forgotten issues in qualitative health research in Iberoamerica

This paper explores some ethical dilemmas faced while doing fieldwork. Ethical norms are not enough to appraise the relationship between researchers and participants; a reflexivity practice is needed to understand the dilemmas aroused during this process. Here four issues faced during fieldwork are presented. The academic social time usually defines the schedule of fieldwork; hence, the researcher may decide to follow the academic schedule or to arrange a different schedule with informants. Researchers usually decide which part of their identity will be disclosed for introducing themselves to the informants; but may also decide to hide who really he/she is. Researchers may cope with the dilemma to disclose their private life to informants during the fieldwork. Researchers also may decide to behave according to academic cultural norms of reciprocity or according to the cultural norms of participants. Finally, a reflexivity movement should be developed in Iberoamerica to define an agenda on ethical issues and to develop decolonizing strategies to debate these ethical dilemmas.     

C.A.R.E.: an approach for teaching ethics in medicine

Various societal factors have contributed to an increase in the ethical dilemmas faced by physicians, yet limited formal training in ethical decision-making is provided for those practitioners during their medical education. The pluralistic nature of contemporary medicine seems amenable to the development of common clinical and educational approaches to ethical dilemmas. The authors propose one such framework--a four question approach called C.A.R.E.--that encourages physicians at all levels of training to acknowledge individual and collective factors that enter into ethical decision-making. These questions are clearly described, and examples for use of the model in teaching settings are also provided. The authors believe that this approach can have significant utility in medical education and clinical settings, and advocate for its use and evaluation.     

Value of services provided by pharmaceutical companies: perceptions of physicians and pharmaceutical sales representatives

Pharmaceutical sales representatives (PSRs) are a key component of pharmaceutical companies' marketing strategies in that they are the link between the pharmaceutical company and the physician. PSRs provide various services in order to increase the physician's prescribing activity of their companies' products. Given the high cost of recruiting, training, and supporting a PSR, it is important for PSRs to understand the relative significance physicians ascribe to services provided. This study examined whether there is a gap in the perceptions of physicians and PSRs regarding the value of specific services provided by PSRs. Physicians and PSRs who attended medical meetings were surveyed. Results of the study indicated that there were significant differences in the perceived value between PSRs and physicians. Services which were perceived to be less important to physicians than to PSRs were new product detailing, old product detailing, providing product studies and research findings, PSRs serving as expert consultants, and recruiting physicians to participate in FDA approval drug studies. Services for which there were no significant differences of perceived value between the groups included free product samples and promotional luncheons and dinners.     

Relationships of Physicians with Pharmaceutical Sales Representatives and Pharmaceutical Companies:

Physicians were surveyed in Northwestern Pennsylvania to examine how they viewed their relationships with pharmaceutical sales representatives (PSR) and the pharmaceutical industry. Physicians viewed the PSR as an important source of information, but felt that they could get needed information from other sources without the PSR's assistance. Physicians also had friendly relationships with the PSRs and did not distrust them, but they did not view PSRs as a vital part of their practice. Samples and gifts provided by the pharmaceutical companies were not viewed as vital to gaining access to physicians. However, the financial support the companies provided for continuing medical education was seen as vital. The selling approaches used by PSRs was not considered manipulative, nor were PSRs thought to be perceived negatively by the medical community. A majority of the physicians said they would accept honoraria for delivering lectures to pharmaceutical companies. Twenty-five percent of the responding physicians also owned stock in pharmaceutical companies.     

Relationships of physicians with pharmaceutical sales representatives and pharmaceutical companies: an exploratory study

Physicians were surveyed in Northwestern Pennsylvania to examine how they viewed their relationships with pharmaceutical sales representatives (PSR) and the pharmaceutical industry. Physicians viewed the PSR as an important source of information, but felt that they could get needed information from other sources without the PSR's assistance. Physicians also had friendly relations with PSRs and did not distrust them, but they did not view PSRs as a vital part of their practice. Samples and gifts provided by the pharmaceutical companies were not viewed as vital to gaining access to physicians. However, the financial support the companies provided for continuing medical education was seen as vital. The selling approaches used by PSRs was not considered as manipulative, nor were PSRs thought to be perceived negatively by the medical community. A majority of the physicians said they would accept honoraria for delivering lectures to pharmaceutical companies. Twenty-five percent of the responding physicians also owned stock in pharmaceutical companies.     

Physicians' perceptions and uses of commercial drug information sources: an examination of pharmaceutical marketing to physicians.

Data were collected from physicians attending a medical conference. This exploratory study was primarily interested in two areas. First, the investigators were interested in better understanding physicians' responses to different promotional tactics typically used by the pharmaceutical industry. Pharmaceutical representatives were most useful, followed by drug samples and infomercials in medical journals. Direct mail, promotional faxes, and promotional products were used less by physicians. Second, the investigators were interested in learning what information sources influenced physicians' drug choices. Physicians were primarily influenced by their prior experience with a drug, then by drug compendiums, and journal articles. Physicians were also influenced by information provided by the industry and other factors, like the drug's price and their patients' financial situations. Managerial implications for marketing to physicians and ideas for future research are discussed.     

Involvement of pharmacy faculty in the development of policies for pharmaceutical sales representatives.

BACKGROUND. Few studies evaluating the impact of the pharmaceutical industry on postgraduate medical education have been done. Recently, position statements and professional guidelines have emerged to ensure the integrity of physician-industry relationships in the areas of clinical judgement, research, and medical education. METHODS. The present study surveyed directors of family practice residency programs in the United States to define the level of pharmacotherapy curriculum development and the existence of policies for pharmaceutical sales representatives. RESULTS. Of the 383 directors, 325 (85%) responded to a mailed survey. Nearly one third (32%) of the responding programs had pharmacist faculty, the majority of whom held a doctor of pharmacy degree. Approximately 30% of programs reported that they had printed guidelines for pharmaceutical sales representatives. CONCLUSIONS. Programs with pharmacist faculty are more likely to have a well-developed pharmacotherapy curriculum and printed guidelines for pharmaceutical sales representatives.     

A New Debate for Turkish Physicians: E-Detailing

The study presents an empirical analysis of the attitudes of Turkish physicians towards e-detailing practices compared to face-to-face detailing. The findings reveal that although physicians have positive attitudes toward e-detailing, on some points they are still undecided and/or have doubts. The structural model revealed that affect, convenience, and informative content influence their attitude in a positive manner, whereas the personal interaction was found to be a negative factor. Physicians' age and frequency of calls received from representatives are moderators. The present study can be seen as an addition to pharmaceutical marketing, an underresearched study field in Turkey, and e-detailing particularly.     

The ethics of managed care. An initial look at physicians' perspectives

The need for medical care in the United States had exceeded the financial resources required to pay for that care. To address this problem, managed care health insurance programs have become commonplace. With managed care programs, however, physicians are facing increasing ethical pressures. This article reviews the ethical dilemmas physicians face under a managed care system and conducts a national random sample of general practitioners and surgeons regarding four major ethical dilemmas: under treatment of patients due to overt pressures or financial incentives, breaches of patient confidentiality by the physician that are required by the managed care plan, lack of disclosure to the patient of the financial incentives or overt pressures under which the physician functions, and overuse of practice guidelines. The results of this survey suggest that physicians are more likely to compromise patients' confidentiality and not discuss financial arrangements with patients than they are to compromise actual patient care. Those physicians with more than 30 percent of their patient load coming from managed care are more likely to have faced the scenarios presented by the survey. There is, however, no statistically significant difference in the physicians' responses to these scenarios based on the percentage of the physicians' patient load coming from managed care.     

Drug advertising to the general public: conceptual parameters of a risk producer practice

This article analyzes some concepts relating to marketing, advertising, medications, regulation and manipulation. It discusses ethical and health surveillance parameters of drugs advertising for the general public. The focus of this work is the analysis of contradictions from a conceptual point of view between the practice of pharmaceutical advertising as a tool for the increase of sales and the conquest of markets versus the policy of rational use of medicines. Academic studies and monitoring of drugs advertising conducted by the National Health Surveillance Agency show that the contents of the advertising pieces oriented towards the general public overestimate the - sometimes dubious - qualities of their medication, focusing almost exclusively on the benefits and put them in a central position in the therapeutic process. They also fail to mention the risks inherent in their use. Rather than focusing on regulatory proposals aimed at creating constraints to this practice, this article discusses the impossibility, considering the interests of public health, of the coexistence of marketing with the policies for the correct, rational and safe use of drugs.