backbone of marketing and has taken the bulk of
marketing budgets. Attitudes to representatives
vary from individual to individual. Pharmaceutical
sales representatives have incentives to be overly
positive when discussing their products with pre-
scribers as they are interested in selling drugs not
providing information (Rubin, forthcoming). It is
estimated that 30–60% of GPs in the United
Kingdom do not see representatives regularly or
frequently, and those who do see representatives
give them only a few minutes to promote their
products. However, while rep numbers increased
by 40% and their overall cost by 70%, face-to-face
contacts increased by only 13% between 1994 and
2002 in the United Kingdom (Pharmaceutical
Marketing Live, http://www.pmlivw.com)..) GPs in the
United Kingdom who do see drug representatives
perceive these visits as a good way of accessing
new drug information quickly, and many feel
they have the necessary skills to appraise the
information provided (Prosser and Walley,
2003).
AUS study found that pharmaceutical represen-
tatives thought certain services they offered were
valued more by target physicians than did the
physicians themselves, in particular product detail-
ing, provision of research details, expert consultant
role and recruiting physicians to participate in FDA
approval drug studies. Physicians only valued free
product samples and promotional meals as much as
drug representatives did (Gaedekeet al., 1999).
51.11 Free samples and gifts
Standard marketing practice internationally
includes samples, gifts, printed information and
invitations in contact with prescribers, based on
the principle of reciprocity to influence prescribing
(Rougheadet al., 1998). Giving prescribers free
samples of drugs for their own use or to pass on to
patients is a more common practice in the United
States, where more patients have to purchase their
medication at cost price than in the United
Kingdom. Free sample availability has been
shown to influence prescribing habits in the United
States (Boltriet al., 2002).
The practice of giving free gifts to prescribers
may also be viewed with suspicion by doctors and
patients, and is subjected to regulation. A survey
of psychiatrists in Canada in the 1990s found that
they had received a median of one personal meet-
ing, ten lunches, two promotional items and one
drug sample in the past year, with a median value
of gifts received of $20. Fewer than half of the
doctors thought they would maintain the current
contact levels with drug representatives if they did
not receive promotional gifts. The more money
and promotional items received, the more likely
they were to believe that this did not influence
their prescribing (Hodges, 1995). A survey of
hospital doctors in the United States found that
even those who thought that sponsored lunches
and pens were inappropriate gifts had accepted
such items. 61% of doctors thought that industry
promotions and contacts did not influence their
own prescribing, but only 16% thought that the
prescribing of others was equally unaffected
(Steimanet al., 2001).51.12 Direct-to-consumer
advertisingDTC advertising is the promotion of prescription
medicines to the general public. The United States
is now the only OECD countries which allow DTC
promotion (see below). However,de factoDTC
advertising may occur in other countries such as
in advertisements about a specific disease or con-
dition which does not include a drug name but
bears a pharmaceutical company logo or name
(Vitry, 2004).
DTC advertising of the modern type began in the
United States in 1981 with an ibuprofen product,
available at the time by prescription only, being
advertised in a consumer-oriented magazine. Other
manufacturers followed, leading to a moratorium
from 1983 to 1985 imposed by the FDA. It was
then decided that there was no evidence that DTC
advertising was endangering consumers and the
practice was allowed to continue without specific
focused regulation. The first television DTC adver-
tisement appeared in 1997 (Lee, 2001).51.12 DIRECT-TO-CONSUMER ADVERTISING 659