Biomedical Engineering Reference
In-Depth Information
appropriateness to appear as benevolence acts in the interest of enhancing physician
knowledge and public health. By ignoring strategies that underlie pharmaceutical
marketing tactics, most past research in marketing misses both the intricate interde-
pendencies among tactics and willful effort to obscure these interdependencies from
scrutiny by physicians and public. As a result, extant research in marketing is of
limited use to anticipate or explain the increasingly unfavorable response to phar-
maceutical marketing tactics, and regulatory effort to contain and constrain their
reach. Thus, a new direction is needed to break free from the myopia of past
research.
Second, our analysis indicates that an institutional theory perspective is well
suited for studying pharmaceutical marketing strategies within a broader, value
chain perspective. Our institutional theory-based development considers both the
logics of consequences that govern pharmaceutical marketing efforts and the log-
ics of appropriateness that frame physicians' medical decision making. Joint con-
sideration of industry and physician logics allows us to explicitly analyze the
confl ict that actions rooted in these disparate logics entail. Our analysis highlights
that confl icted logics become institutionalized and rationalized as normative rou-
tines making the system less fl exible and susceptible to market failure. More sig-
nifi cantly, our analysis shows that this confl ict is amplifi ed over time, perhaps
inadvertently, by self-centered actions of market actors who are narrowly focused
on their own logics and unable to grasp a system view—in a way,
missing the for-
est for the trees
. Past studies have generally given scant attention to the disparate
logics that characterize pharmaceutical industry-physician relationships, and
hesitated in adopting a value chain perspective. New frameworks for studying
pharmaceutical marketing strategies are needed that consider: (1) interdependen-
cies among pharmaceutical value chain partners motivated by disparate logics, (2)
embeddedness of market actors, and (3) temporal evolution of the nature and
intensity of system confl ict. Absent these considerations, we risk incomplete, if
not misleading, understanding of pharmaceutical marketing strategies and its
consequences.
We propose one such framework that draws from open system theories of orga-
nizational action (Stern and Barley
1996
; Katz and Kahn
1966
). Our proposed
framework has several distinct aspects that together constitute a theoretically use-
ful foundation including: (1) focus on a system of market relationships that char-
acterize the pharmaceutical value chain, (2) emphasis on organizational and
system legitimacy, and (3) linking
macro
-level system logics and
micro
-level
actions of individual market actors as they negotiate an order from emergent con-
tests of competing logics. Table
24.2
outlines the key elements of this proposed
framework—referred to as “open systems framework”—and compares it with
current economic framework that characterizes most studies of pharmaceutical
marketing. Specifi cally, the nine elements in Table
24.2
are organized around
three discussion points relating to foundations (what are the basic theoretical and
conceptual building blocks?), premises (what are its assumptions and axioms?)
and key questions and mechanisms (what are its proposed hypothesis and pro-
cesses?). These elements are best viewed as building blocks of a theory rather
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