The Dangers of Detailing: How Pharmaceutical Marketing Threatens Health Care

This master’s thesis examines the issues that surround the practice of Direct to Physician (DTP) marketing by pharmaceutical companies. The thesis begins by looking at the normative foundations that ground objections to DTP marketing. Developments that have recently emerged in contemporary Kantian ethics are utilized in order to defend a Kantian moral framework. The first and second formulations of the categorical imperative are then utilized in order to derive four mid level principles that serve to guide the discussion through the following chapters.

Chapter 3 criticizes DTP marketing as deceptive and manipulative and argues that is strongly correlated to negative affects on prescribing behavior, both harming patient care and undermining the fiduciary duties physicians owe their patients. As such, DTP marketing does not show the proper respect patients and physicians are owed as moral agents.

Chapter 4 considers the economic impact of DTP marketing. Indications suggest that DTP marketing is primarily utilized to create an artificial market for “me-too” drugs. As these drugs are often very expensive and offer little to no therapeutic benefit over existing alternatives they drive up health care spending. When understood within the context of a failing health care system it becomes a self defeating business strategy and harms patients through rising health care costs.

Finally, Chapter 5 concludes with a discussion of the potential for the industry to regulate itself and examines the likely impact regulation of DTP marketing will have on the industry. While a voluntary ban is called for, financial incentives make it unlikely that self regulation will be sufficient. In which case, it will be the responsibility of state or federal governments to regulate the practices. While regulation of DTP marketing may threaten profitability of the industry it is claimed that the current reliance on “me-too” drugs entails that the primary affect of regulation will be to force pharmaceutical companies to concentrate on truly innovative drugs. As such, contrary to the claims of critics, regulation will likely encourage innovation as opposed to stifling it.