Ethical Issues in Pharmaceutical Marketing – Asrar Qureshi’s Blog Post #1005

Ethical Issues in Pharmaceutical Marketing – Asrar Qureshi’s Blog Post #1005

Dear Colleagues! This is Asrar Qureshi’s Blog Post #1005 for Pharma Veterans. Pharma Veterans Blogs are published by Asrar Qureshi on its dedicated site https://pharmaveterans.com. Please email to aq.pharmaveterans@gmail.com for publishing your contributions here.

Credit: Anna Shvets

Credit: Eva Bronzini

Pharmaceutical Marketing is a different type of marketing because the customer is not consumer. In all other commodities, such as food, appliances, textiles, shoes etc., customer and consumer are the same person, unless someone buys for someone else as a gift which is a fraction of total business. In Pharma marketing, customer is doctor and consumer is patient. Pharma companies are not allowed by law to approach patients directly for selling medicines. Nutritional supplements such as vitamins, health foods, probiotics, energy boosters etc., are not supposed to treat any disease and are therefore allowed to advertise to public.

Ministry of Health, Pakistan resisted to grant nutritional supplements the status of OTC – Over the Counter products which could be sold without prescription, and which could be advertised through media. After the Health & OTC Act promulgated few years ago, these products have been permitted to be sold without prescription and advertised on the media. As a result, Pakistan market has been flooded with thousands of these products. The manufacturers and marketers of these products were historically selling only these products. Seeing the potential of blossoming market, all major Pharma companies have jumped into this business. Given their huge resources and powerful marketing muscle, they have expanded the market and taken big shares also. 

For this post, I shall take up ethical issues of both segments, medicines and supplements.

Ethical Issues

Pharmaceutical marketing presents unique ethical challenges due to the nature of the products being promoted and their potential impact on public health. 

Misleading Advertising and Promotion

Pharmaceutical companies often, under the pressure to increase sales, resort to misleading or exaggerated claims about their products' benefits. There have been numerous examples where companies were fined heavily for making misleading claims. Several years ago, a French Pharma company made the claim that their pain drug had no adverse effect on stomach. The claim was found to be wrong and a fine of several thousand Euros. One of the largest American Pharma companies fabricated clinical trials favoring their neurological pain product and got them published also in a medical journal due to their clout. The case was caught, and the court slapped almost 250 million US dollars in fine. Advertising of supplements is even worse because the rules are softer. Claims made for supplements by the US companies are ludicrous and totally misleading. Pakistani companies are also trying to follow in their footsteps.

Government agencies can implement stricter regulations on pharmaceutical advertising, ensuring claims are accurate and backed by scientific evidence. Pharmaceutical industry associations can develop ethical guidelines and codes of conduct to promote responsible advertising. Companies should increase transparency by disclosing potential risks, side effects, and limitations of their products.

Promotion to Vulnerable Populations

Before advertising became digital, every wall in Pakistan was chalked with adverts for male weakness, impotence, lack of stamina, and fertility issues. It seemed that the entire country is partially or fully impotent. Going by the population growth, it seems Pakistani males have nothing else to do. 

Pharmaceutical companies may also target vulnerable populations, such as the elderly or those with chronic illnesses, who may be more susceptible to aggressive marketing tactics. Instant cure for diabetes, stomach, liver, gynecological issues, and even cancer is available with hakeems and quacks, which is not endorsed by Pharma companies, but supplements are trying to follow quacks.

Government should implement regulations that protect vulnerable populations from misleading or deceptive marketing practices. Public health campaigns can educate consumers about the risks of self-medication and the importance of consulting with healthcare professionals.

Off-Label Promotion

Off-label is a euphemism, a softer word for promoting a drug for disease(s) for which it is not approved by the regulating authority. Pharmaceutical companies may promote their drugs for unapproved uses, which can lead to unintended consequences and increased healthcare costs. This issue prevails worldwide but due to lack of regulatory oversight, it is quite common in Pakistan and other countries like us. Sometimes, doctors also find off-label use on the pretext of their own clinical experience. The case of an anticancer drug being used off-label in diabetic eye conditions is quite recent. Due to contaminated injections, many patients lost eyesight. Then the government went ahead and banned its off-label use. 

Government agencies should increase enforcement of off-label promotion regulations. Companies must clearly label their products with approved uses and warnings about off-label use.

Exaggerated Disease Prevalence

It is not uncommon for pharmaceutical companies to exaggerate the prevalence or severity of certain conditions to create a demand for their products. Hypes are created around certain conditions so that certain drugs could be sold. Statin class of drugs for lowering cholesterol is the biggest example. The negative effects of cholesterol were trumped up so much that everyone got scared. Dr. Malcolm Kendrick, who is among the most vocal opponents, claims that the entire story of benefits of statins taken regularly is entirely fabricated. The only proper indication may be patients who have already developed a heart condition. However, the pharma companies promotion has been forceful and relentless, and millions of people consume billions of dollars’ worth of statins every year. 

Healthcare professionals and independent organizations should conduct research to provide accurate information about disease prevalence and severity.

Public health campaigns can educate the public about the importance of consulting healthcare professionals for accurate diagnoses and treatment recommendations.

Influence on Healthcare Decision-Making

Pharmaceutical companies exert undue influence on healthcare professionals and policymakers, leading to biased decision-making. Most healthcare professionals are already willing to be influenced, and this is the easier part. Lobbying and various pressure tactics are used to get desired policies from the government.

Sum Up

Ethics are there and not there when it comes to marketing in general. Pharma industry is highly regulated and usually follows rules. However, it stays on the fringes of ethics with occasional trespassing into unethical areas.

Addressing these ethical issues requires a collaborative effort from pharmaceutical companies, healthcare professionals, policymakers, and consumers. By promoting transparency, accountability, and ethical practices, the pharmaceutical industry can ensure that its products are marketed responsibly and contribute positively to public health.

Concluded.

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For most blogs, I research from several sources which are open to public. Their links are mentioned under references. There is no intent to infringe upon anyone’s copyrights. If, however, it happens unintentionally, I offer my sincere regrets.