Biomedical Engineering Reference
In-Depth Information
teaching hospitals, reassured their peers about Neurontin's effi cacy. The company
invited these champions to disease-based advisory boards for discussing diagnostic
criteria and appropriate treatment plans for specifi c diseases (e.g., neuropathy,
migraine) that promoted Neurontin as a fi rst choice in standard treatment plans. The
key goal of the surrogate selling strategy was to “increase Neurontin new prescrip-
tions by convincing non-prescribers to begin prescribing and current prescribers to
increase their prescription behavior” (Exhibits 78 and 79). Medical liaisons encour-
aged Neurontin champions to publicize their feelings:
In fact, John had met with somebody… who had asked about restless leg… told her exactly
what he's doing. And, she's using it like crazy now. That zip code that Dr. X is in like up to
a fi fteen percent curve on the market share, (Exhibit A).
The medical literature provides corroborating evidence on surrogate selling. For
instance, Henry et al. ( 2005 ) report in their study involving Australian physicians
that 23 % of their sample was on industry advisory panels and 16 % acted as expert
speakers for specifi c pharmaceutical products. Surrogate selling infl uence has been
examined in seeding trials where the pharmaceutical company awards drug-trial
grants to physician investigators with the intent to encourage the physicians to advo-
cate the drug to their colleagues. For instance, internal documents pertaining to
Merck's ADVANTAGE (Assessment of Differences between Vioxx and Naproxen
to Ascertain Gastrointestinal Tolerability and Effectiveness) seeding trial revealed
that Merck designed the study with a quest to engage future prescribers with Vioxx
(Hill et al. 2008 ). Additionally, the appropriateness of physician membership in
speakers' bureau and advisory boards and their role in surrogate selling have been
questioned by a number of medical researchers (Brennan et al. 2006 ; Angell 2008 ;
Jampol et al. 2009 ; Insel 2010 ). In a national survey of department chairs in the 125
accredited medical schools and 15 largest independent teaching hospitals, Campbell
et al. ( 2007 ) found that 27 % of department chairs surveyed had a consulting rela-
tionship with the industry and 14 % served on the speakers' bureau.
24.4.2
Strategic Interdependencies
Our analysis indicates that Parke-Davis structured deliberate interdependencies
among the four strategies outlined above, which we broadly classify as expertise or
promotion based interdependencies. The goal of these interdependencies was to link
strategies so that they collectively exert a synergistic infl uence on a physician's
decision to write prescriptions that favor the company's products. Expertise based
interdependencies focus on leveraging knowledge (e.g., scientifi c evidence) and
knowledgeable physicians (e.g., thought leaders) to support Parke Davis' objectives
for Neurontin. Promotion based interdependencies focus on leveraging data (e.g.,
prescription writing) and networks (e.g., Neurontin champions) to bolster the sales
efforts in direct interactions with targeted physicians. These interdependencies are
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