Did GlaxoSmithKline Just Create a New Opportunity for Healthcare?

GlaxoSmithKline recently announced that it will discontinue the practice of paying physicians to promote its pharmaceuticals and medical devices.It will also no longer pay its sales staff based on the number of prescriptions a doctor writes. It s certainly a bold move. Pay-for-promotion, so-to-speak, has been a common tactic in the pharmaceutical and medical device industries education, marketing, and outreach strategies. The practice has been controversial due to the perception -- and not infrequent reality -- of conscious (or unconscious) influence on prescribing behavior. For many consumers, healthcare providers, and medical ethicists, Glaxo s announcement is a welcome development. Were life and healthcare nothing but black-and-white affairs, then the ethical implications of halting any form of compensation for education, marketing, and medical leadership resources would be fairly clear: physicians would be free of undue influence and informational contamination. In such a world, physicians would stand as informational ascetics -- medical gnostics independently seeking out the safest and most effective products available without concern for the time value of money or opportunity costs. In this life of ours, however, prescribers face worsening bouts of attention-obesity. They're surrounded by conflicting study after conflicting study, product after product, insurance form after insurance form. Where do they start? How are they to plan and organize their assaults against the fierce data-brigade in their efforts to find the best matches for their patients? Putting aside the pay-to-promote matter, physicians clearly have needs to be met - and they cannot meet all of their needs by themselves. They do need help. Their individual pursuit for information has to be complemented by other informed parties. That is to say, their workflows of information-gathering and education need to be more than just unilateral. There has to be bilateral, or even multi-channel input as well. The question then is: What kind of relationship between manufacturers and prescribers can achieve the optimal osmosis of vetted clinical data, experiential information, and practical feedback while also cultivating an ethical ecology where practitioners aren t suspect to even the appearance of impropriety? This is where there's an opportunity to re-think modern medicine. So let s take a simple view of a complex problem. The Medical-Marketing Conundrum A drug or medical device is a widget that is administered or applied to a living creature in order to halt or slow a pathological process, to enhance a natural mechanism of physiology or anatomy, or to prevent the springs of life from going haywire. It is hoped that this widget is safe and effective (in both its consumption and production). Now, in one part of the world there is a physician who needs a certain kind of widget for the people whom s/he attends. In another part of the world is a manufacturer of such a widget. As you can see, we have between the physician and the manufacturer a gap --an informational problem. This is also a marketing problem. How does each party go about finding the other? This is not just about widgets either -- it s also about learning the latest clinical research, comparative effectiveness, patient experiences and stories, post-marketing surveillance, general advancements in healthcare technology and modalities, etc. The physician s resources include: other physicians, journals, patient experiences, hospitals, academies...maybe even Twitter hashtags. The manufacturers resources include: physicians, journal advertisements, patients (pull-demand from TV ads, stories), sales representatives...maybe even Twitter hashtags. It is precisely in the meeting point between physicians and manufacturers where the ethics of transactions comes to play in its fullest. The conundrum is that the right and relevant information about products need to be marketed where impropriety and its appearance are vigorously excommunicated from the market s religion. (There s always a religion.) Manufacturers who decide to abandon the tradition of pay-for-promotion will need to work-out new marketing strategies that meet the needs of physicians acting on behalf of patients and the needs of investors. This is crucial: for marketing is often torn between the temptation to churn short-term profit and the intelligence to accumulate long-term capital. Given pharma s blockbuster successes of the last few decades, adopting a novel marketing approach based more on information than on selling will likely be as hard as getting off of heroin. A New Direction for Pharma On one hand, none of us want to live in a world where we consume widgets that don t work, or worsen our problems, or kill us -- especially in long, painful and undignified ways. On the other hand, manufacturers are in the position to offer physicians the information and education that can enable the best decisions concerning the widgets they re investors expect them to sell. The question, then, is ultimately about objectivity and influence. Now, we can have a postmodernist debate about objectivism and argue that no human is purely objective. More practically, however, we can argue that humans are influenced not only by information but also the context and presentation of that information and the motivation for it. So in sense, it isn t compensation for promotion per se that is at the heart of ethical marketing. Rather, it s the motivation of both parties (sometimes opposing) that merits our close inspection. Most physicians and other healthcare providers are motivated to access the intellectual and practical resources that improve the lives of their patients. But when might pay-to-promote be ethical? Maybe never. Maybe only under certain conditions. Regardless, what has to be understood is that everything has opportunity costs. For physicians, nurses, and other healthcare providers the opportunity costs of their time could include: time spent attending patients, time spent inventing a breakthrough therapy, time spent speaking to young medical and nursing students, or time meditating to keep from going insane. That is to say: any conditions of information-exchange between healthcare providers and manufacturers aught to provide value that ultimately benefits patients (as well as students and the public). There's eating and then there's gluttony. Gluttony is forcing us to starve now. Neither extreme is helpful to healthcare. Healthcare professionals are people too. If we could have a healthcare system wherein physicians and manufacturers can meet in markets where ethical values are exchanged, then healthcare can stand to gain improved support for physicians who want the best for their patients. The opportunity for pharma is to envision itself as a source of trustworthy information rather than as a seller of widgets. Selling widgets is tough business -- you either spend enormous amounts on advertising and pay-to-promote, or you hope for eternal word-of-mouth, or employ mass-brainwashing techniques developed by the CIA in the 1950s and 1960s. If there is hope in an information-based marketing model, it may partially lie in digital technology. I ll publish thoughts where digital media may best serve all stakeholders in a unifying way. (It's trickier than many who have already speculated realize.) The other area of hope is in the area of Ideology. I'll also share thoughts on that tough nail in another post. For now, the widget-makers have a lot of creative re-thinking to do. Heroin addiction is violently tenacious. The-widget makers will have to work-up the cou