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Inappropriate promotion of products—be it food, financial products or medicines—can result in significant, and sometimes dangerous, problems for individuals, organisations and society. Examples include multibuy offers for unhealthy food products that can lead to overconsumption, aggressive selling of payment protection insurance and the widespread marketing of opioids to prescribers.1–3 The influence of the pharmaceutical industry on the promotion of drugs to prescribers and patient groups, as well as its impact on the compilation of clinical guidelines has long been recognised.4 One of the criticisms levelled at the pharmaceutical industry is that it has traditionally relied on aggressive marketing strategies to promote its products.5 A report published in 2009 suggested that pharmaceutical companies would need to move away from such an approach and develop expertise in the management of networks of external alliances, liaison with secondary-care specialists and communication with patients.5 While the direct marketing strategies may be easier to spot, it is also important to be able recognise the indirect mechanisms that are used to promote and increase the uptake of medicines.
In relation to medicines, marketing strategies may not be ‘owned’ and delivered solely by the pharmaceutical company. In his book, Ghost-managed medicine, Sergio Sismondo explores how the powerful influence of pharmaceutical companies is sustained through large networks that gather, create, control and disseminate information.6 Strategies include funded research, publication in medical journals, development of key opinion leaders, and the dissemination of information through sales representatives and patient support groups. He argues that such an approach can establish what medical knowledge is taken for granted or regarded as ‘common sense’. By applying its enormous resources, the pharmaceutical industry can influence medical practice, policies and regulations, as well as attitudes toward the industry itself and its contributions to health. For example, in the USA, …
Competing interests None declared. Refer to the online supplementary files to view the ICMJE form(s).
Provenance and peer review Commissioned; externally peer reviewed.
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