Pharma Marketing Tactics

Pharmaceutical companies engage in multiple marketing tactics that have mixed or hidden promotional intent to encourage ‘off-label’ prescribing of specific drugs. In the case of gabapentin, pharmaceutical representatives provided funds for several activities in which promotional intent was unclear. These activities included: 1) Continuing medical education (CME), 2) Advisory boards and consultants meetings, and 3) Research and publication efforts.

Continuing Medical Education

Several different types of educational strategies were employed with the intent of influencing physician prescribing behavior. Strategies with unclear or hidden promotional intent included teleconferences directly and indirectly sponsored by pharmaceutical companies. In some cases, pharmaceutical representatives established the teleconference agenda and monitored teleconferences unbeknownst to attendees.

Other strategies included funding CME through medical education companies via “unrestricted educational grants.” This type of arrangement allowed the medical education company to organize programs discussing unapproved usages for gabapentin and grant CME credit, both of which are not permissible if the pharmaceutical company was directly sponsoring the events.

Advisory Boards and Consultants Meetings

Pharmaceutical companies held advisory board and consultants meetings with the stated purpose of soliciting physician feedback regarding clinical trial design, educational curriculum development and marketing strategies for gabapentin. However, a review of industry materials reveals that some aspects of these meetings were more suggestive of promotional intent. In some cases, attendees were invited due to their high rates of anticonvulsant prescribing. In other instances, the meetings were designed to resemble educational conferences and attendees were inundated with information about Neurontin.

Additionally, attendees of advisory board and consultant meetings received honoraria, paid travel and lodging in resorts and luxury hotels. Also, the faculty for meetings were carefully screened by medical education companies to ensure their support of gabapentin.

Research Strategy and Publication

In the case of gabapentin, a key marketing strategy blurred the lines between research and promotion. One such tactic was to employ a “publication strategy” to increase off-label prescribing. Pharmaceutical executives targeted publications which focused on expanding gabapentin use in neuropathic pain and bipolar disorder due to greater revenue potential. Another component of the publication strategy included the pharmaceutical company publishing own clinical trials. However, only research that was favorable to ‘off-label” use was published. Negative trial results were not released.

An additional strategy included expanding the existing literature on gabapentin by contracting with medical education companies to develop review papers, original articles and letters to the editor about the drug. These papers were heavily funded by the pharmaceutical company and included honorarium for a physician or pharmacist author. Medical education companies provided support to authors to ensure a consistent, positive message regarding the drug.

A final strategy included engaging the patients of amenable physicians in small scale studies. One such study which blurred the lines between promotion and research was an uncontrolled, open-label study in which physicians were to provide gabapentin to their patients with epilepsy and increase the dosage until they were seizure-free or until a maximum dosage level had been reached. While stated goals of the study were to examine the effectiveness of the drug, industry documents included stated goals such as increased market share and the use of higher doses of gabapentin.