Impact of pharmaceutical industry

promotion mix on doctor's prescribing

behaviour

Introduction

Pharmaceutical marketing is unique as the decision making of buying the medicine lies in
the hand of intermediate customer (doctor) rather than final consumer (patient). Thus
pharmaceutical companies try to influence the customer (doctor) rather than final
consumer (Patient). Thus doctors are the most important players in pharmaceutical
marketing system. Doctors write the prescriptions that determine which drugs (brands)
will be used by the consumer (patient). Thus influencing the doctor is a key to the
pharmaceutical sales. Pharmaceutical companies try to influence prescription pattern of
doctors in favor of their brands by offering various kinds of promotional inputs like
samples, gifts and sponsorships etc. (Arora and Taneja, 2006). Usual marketing practices
followed by most of the large and mid-sized companies include valuable gifts, arranging
foreign trips with family and complimentary tickets and memberships for social activities
to doctors (Jayakumar, 2008). Interaction of the medical professional with the
pharmaceutical industry starts as early as in medical school. The doctor and sales
representative meet about 4 times a month (Ziegler et al, 1995). In Canada, on an average
6 gifts are received per year by doctors with average value of $60. Eighty per cent of
residents take pharmaceutical industry paid meals about 14 times in a year in Canada
(Hodges, 1995). The expenses for travel, stay and even local sight seeing are paid directly
to the tour operator by the pharmaceutical company or travel ticket and hotel
accommodation are booked by the company in the name of the doctor. The expenses of
not only the doctor but also of their spouse and family are borne by the pharmaceutical
companies (Mehta, 2000). The policies adopted by the pharmaceutical firms may include
extravagant marketing practices like offering vacation/travel expenses; gifts of substantial
value; lavish meals and entertainment; offering cash/ commission for prescribing a
particular brand/drug; offering money for drug trial; samples and promotional material;
and CME (continuous medical education) funding and honoraria (Wazana, 2000). One
study involving about one hundred doctors, conducted to determine the roles of various
information sources in influencing the prescribing behaviour of doctors, revealed that
promotional information by pharmaceutical companies (commercial sources) plays a
greater role in the decision process of the doctors to prescribe the drugs than even
scienfic sources of the information (Chaganti, 2005). Social scientists describe and the
pharmaceutical industry follows the, "norm of reciprocity" i.e., the obligation to help
those who have helped you, as one of the fundamental guiding principle of human
interactions. It is not surprising, therefore, that pharmaceutical companies rely on this
principle of human nature by giving gifts to doctors in hope that they will prescribe their
firm's product in return (Verma, 2004).

The act of receiving gifts and other benefits from the pharmaceutical firm by doctors
establish relationship with the giver and assumes certain social duties such as: grateful
conduct, grateful use, and reciprocation. It is bound to compromise the doctor's decision
making. Further, it is also unrealistic to expect the pharmaceutical industry that contribute
large sums of money in different manner to doctors, will not influence their attitude and
behavior towards them. Since no profit minded company would distribute gifts and other
freebies out of disinterested generosity. In the context of medicine, however, many feel
that the act of accepting a gift has far reaching ethical consequences that put the "gift" at
too great a price (Randell, 1991). Doctors have regular contact with the pharmaceutical
industry and its sales representatives, who spend a large sum of money each year
promoting to them by way of gifts, free meals, travel subsidies, sponsored teachings, and
symposia. Attending sponsored CME events and accepting funding for travel or lodging
for educational symposia was associated with increased prescription rates of the sponsor's
medication. Attending presentations given by pharmaceutical representative speakers was
also associated with non-rational prescribing (Wazana, 2000). Researchers explored in a
cross section of survey that doctors who are frequently in contact with drug
representatives are more willing to prescribe newer drug. Such doctors do not like ending
consultations with advice only and are more likely to prescribe a drug that is not
clinically indicated (Chris et al, 2003). A study conducted in Haryana state of India
explored that doctors considered regular visits by good personality medical representative
as best tool of promotion. Good quality literature, journals and sponsorship for
conferences or personal tours were considered preferable promotional tools by doctors in
comparison to organization of free camps, personal gifts, medicine samples or any other
incentive (Arora and Taneja, 2006). A study conducted in West Virginia reported that the
most commonly received gifts reported by the study doctors were trinkets (77 * 4%),
followed by books (41 * 7%) and meals (41%). The mean ratings of the constructs
indicated that the doctors slightly agreed that pharmaceutical companies give gifts to
doctors to influence their prescribing, moderately disagreed that they do so as a form of
professional recognition of doctors, and strongly disagreed that their prescribing
behaviour could be influenced by the gifts they receive (Madhavan et al, 1997). Evidence
supports that drug company sponsorship of travel expenses change the prescribing
behavior of doctors. These doctors who avail the travel expense are 4.5-10 times more
likely to prescribe the company's product after such sponsorship than before (Orlowski,
1992).

Thus regular, continuous study of the prescribing behaviour of doctors is essential for
pharmaceutical marketer. The intense competition in Indian pharmaceutical industry
implies that practicing doctors are exposed constantly to various competing stimuli. The
present study is an attempt to develop a simple framework for finding out the impact of
the different kinds of promotional tools offered by pharmaceutical industry on the
prescribing behavior of doctors.

Research Methodology

The purpose of the study is to develop a simple framework for finding out the impact of
the different kind of promotional tools offered by pharmaceutical industry on the
prescribing behavior of doctors. Moreover the study also focused on whether the
perception of doctors towards various promotional tools is different with respect to
demographic variables. Pharmaceutical companies are spending lot of money on
promotion of their products to doctors. Now the questions in the mind of marketing
managers of the pharmaceutical companies are: Which promotional tools are more
effective in obtaining prescription from doctors?, Whether the perception of doctors
towards various promotional tools offered by pharmaceutical companies differs
according to demographic variables?

Various studies and standard textbooks elaborate that demographic variables influence
individual buying behavior. An …