Closing the Marketing Strategy-Tactics Gap: An Institutional Theory Analysis of Pharmaceutical Value Chain - Innovation and Marketing in the Pharmaceutical Industry - page 695

Grayson et al. ( 2008 ) note that in some industries (e.g., banking), professional
organizations codify expectations for members' actions that foster a “climate of trust”
to draw and reassure customers. Such rules are not instrumental, but essential to the
evoked role identity. A banker is rule-bound to limit exposure of consumer deposits to
risky investments, even though such practice may enhance payoffs, because doing so
without consumer consent violates the norms of a “trusted banker” who upholds con-
sumers' best interests no matter what . Here, the principle of trust is essential to the
identity of the banker; without trust one cannot claim to be a credible banker. Recent
Wall Street excesses that precipitated the worst fi nancial crisis that eroded the fi nan-
cial industry's legitimacy reaffi rm the role of trust in fi duciary relationships.
Institutionalized norms of fi duciary responsibility commit professionals to fol-
low codes of conduct or an oath of service (e.g., the Hippocratic Oath) that build
trust and curb opportunism. Consequently, an effective and stable system of market
relationships, here involving physicians and patients, emerges when market agents
(i.e., physicians) behave in accord with institutionalized norms of fi duciary respon-
sibility that are “socially constructed, publicly known, anticipated, and accepted”
(March and Olsen 1998 , p. 952).

24.2.3 Confl icted Logics in a Pharmaceutical Value Chain

Our preceding analysis suggests that different market actors (i.e., pharmaceutical
companies and physicians) in a pharmaceutical value chain are embedded in their
own distinct logic. Collectively, industry-physician and physician-patient exchanges
coexist as an interdependent market system. Viewing the logics of consequences and
appropriateness as coexistent requires theorizing their potential confl ict and its con-
sequences for the value chain (March and Olsen 1998 ). This potential for inherent
confl ict is centered on physicians who are engaged in consequential logic-based
exchanges with the pharmaceutical industry on one side of the value chain, and in
appropriateness logic-based relationships with patients on the other side.
Coexistent logics need not necessarily lead to confl icted logics. Many physicians'
actions that are guided by consequential logic, such as the pursuit of a reputation for
conducting controversial and infl uential studies, earning a decent income, and quality
of life commensurate with their status, need not compromise physicians' fi duciary
responsibility in patient relationships. Likewise, while it may be commonly under-
stood that detail salespeople work for pharmaceutical organizations that primarily
follow a consequential logic, they are not necessarily restrained from acting as a
trustworthy source of unbiased information. Only when actions implied by a particu-
lar logic directly or indirectly constrain or suppress possible actions that are implied
by the second logic does a problem of confl icted logics exist (Carson 2004 ).
The institutionalized frame of professionalized medicine holds that its members
give priority to fi duciary responsibility and forgo self-interested gains.
In other words, professions address confl ict of logics problems by legislating
norms that mandate the priority of the logic of appropriateness (e.g., American
Medical Association's Ethics Opinion at http://www.ama-assn.org/ama/pub/