Closing the Marketing Strategy-Tactics Gap: An Institutional Theory Analysis of Pharmaceutical Value Chain - Innovation and Marketing in the Pharmaceutical Industry - page 702

reviewed medical journals, ghost writing was demonstrated in 13 % of research
articles, 10 % of review articles, 6 % of editorials, and 11 % of Cochrane reviews.
Guest authorship was even more prevalent, and found in 16 % of research articles,
26 % of review articles, 21 % of editorials, and 41 % of Cochrane reviews (Flanagin
et al. 1998 ; Mowatt et al. 2002 ).
The medical education strategy involved: (a) shaping standards of care; (b)
actively managing a Speakers' bureau; and (c) contracting with medical education
companies providing continuing medical education (CME) to physicians (third row
Table 24.1 ; Fig. 24.1 ). Parke-Davis marketing efforts focused on infl uencing stan-
dards of care to position Neurontin as a fi rst choice in treatment regimens. This goal
was achieved through scheduling presentations by infl uential thought leaders who
are favorable to Neurontin at various CME events. In some instances, Parke-Davis
paid physicians to attend these events, act as part of the audience, and plant leading
questions intended to portray Neurontin in a positive light (Exhibit 79). Parke Davis
managed a Speakers Bureau, a data base of key infl uencers and thought leaders who
were paid to present at educational symposia. Parke-Davis encouraged sales repre-
sentatives to “identify and train strong Neurontin advocates and users to speak
locally for Neurontin,” (Exhibit 19). Our review of Parke-Davis' documents sug-
gests that the company granted unrestricted educational grants to medical education
companies ostensibly for educational purposes; however, company managers
provided input in shaping conference content, suggesting thought leaders as speak-
ers, and in tracking participating physicians' pre- and post-seminar prescribing
behavior. Territory managers evaluated unrestricted educational grant proposals as
illustrated below:
I am forwarding two budget proposals… One is the satellite symposium alone and one
includes a highlights proceedings.. with the satellite. Please review.. so that we can move
forward with the grant request through Dannemiller[commercial provider], (Exhibit D).
Similar examples of industry efforts to leverage physician education efforts for
consequential gains abound in medical literature (Table 24.1 ). For instance, studies
show that industry sponsored CME programs “preferentially highlighted” the spon-
sors' drugs and positively affected physician prescription habits after attendance
(Bowman and Pearle 1988 ; Wazana 2000 ; Relman 2001 ). Drug companies provided
65 % of total revenue of CME programs organized by commercial providers, pro-
viding a fi nancial incentive to create educational programs that cast a favorable light
on the companies' products (Steinman and Baron 2007 ). Choudhry et al. ( 2002 )
found that 59 % of authors responsible for updating or developing clinical practice
guidelines had fi nancial relationships with companies whose products they
considered or included in the guidelines.
Finally, Parke-Davis used a surrogate selling strategy by (a) promoting conta-
gion effects through “Neurontin ® Champions,” (b) recruiting thought leaders; and
(c) managing disease-based advisory boards (last row Table 24.1 ; Fig. 24.1 ).
Promotion of contagion effects involved a “pyramid of infl uence,” where Neurontin ®
Champions, infl uential and favorably disposed epileptologists recruited from large