The drugs industry: a bad product well marketed
Authors: Kamran Abbasi
Journal: Journal of the Royal Society of Medicine (2012)

‘It will work,’ said Paris Hilton. ‘I'm a marketing genius.’ Ms Hilton, you might say, is all marketing—a bad product well marketed. But when does clever, even genius, marketing become sinister? Any company with a product to sell will put a marketing plan at the top of its agenda. But what if your product, your new wonder drug or medical device, doesn't work? What if you have invested billions of dollars in the product's research and development, does it make any commercial sense to crush it up and start again?

A decade ago a drug industry insider told me how naive medical journals were. Almost all the papers in top medical journals, he delighted in retelling, were written by industry and placed with precision in the journal of choice. Medical journals, according to our mole, were blind to industry's daylight robbery. It was a surprising statement that immediately rang true. Medical journals, if we take these insights to their logical conclusion, are little more than the marketing arm of pharmaceutical companies.1

Clearly, medical journals that publish research papers about drugs are closest to that description. Randomized controlled trials that evaluate me-too drugs, seek new indications for a waning product, and focus on the marketing speak of equivalence and non-inferiority, are straight from the Paris Hilton school of sexing up a bad product. Instead of perfume and mascara, medical journals are distracted by complex statistics and important sounding authors. The real marketing story behind any research is almost impossible for a journal to read. Journals can guess, infer, suspect, but can do little more without power or resources.

But none of these issues are new. The novelty comes with GlaxoSmithKlein's £2bn fine for aggressive marketing of its products in the United States. These were products that were marketed off-label for under-18s, promoted for treatment of conditions without FDA approval, negative trial data were withheld, and the labelling was ‘false and misleading’. Doctors were indulged to speak in favour of products at meetings, often at lavish resorts. Medical journals were used and abused, mere pawns in the marketing chess game.2

A further consequence of GSK's misbehaviour is that the US Department of Justice has persuaded the British company to sign a Corporate Integrity Agreement (CIA), an unfortunate acronym when the purpose is transparency. For the next five years, this CIA includes regular checks on GSK to ensure that it is marketing its products with honesty, isn't rewarding staff based on sales in territories, and includes penalties to claw back executive bonuses in the event of malpractice.

This a welcome turn of events but the effect of these measures will be unclear for years to come. Pharmaceutical companies have had slaps on the wrist in the past, regulations have been tightened, yet the whiff of Paris Hilton grows ever stronger. The US Department of Justice's introduction of an integrity agreement for GSK begs two questions. Why not introduce it for all pharmaceutical companies and device manufacturers? Why only five years? Until these measures are industry-wide and long term, the drugs industry will not shake its perception as a bad product well marketed.