PHILADELPHIA — As pharmaceutical marketing activities in recent years have shifted away from traditional face-to-face methods towards more digital interactions, physicians may not be aware of the new ways they’re being marketed to, necessitating greater transparency and reporting. A new perspective piece in The New England Journal of Medicine, written by health policy researchers at the University of Pennsylvania’s Perelman School of Medicine and Leonard Davis Institute of Health Economics, describes various digital marketing tactics targeting physicians, outlines concerns about their influence over physician decisions, and makes recommendations about how to adapt policies to keep up with the changing nature of pharmaceutical marketing.
“Pharmaceutical companies currently spend 25 percent of their marketing budgets on digital technologies, such as websites and social media,” wrote the authors, including lead author Christopher Manz, MD, and senior author David Grande, MD, MPA, from Penn Medicine. “Electronic health records (EHRs), social media and mobile applications represent new ways for pharmaceutical companies to conduct market research and to market directly to physicians.”
For example, anonymized EHRs provide pharmaceutical companies with clinical and demographic information about patients and insight about the circumstances under which physicians choose specific treatments. Therefore, EHRs can also be used for direct marketing to physicians through banner ads, industry-sponsored clinical resources and other tactics. “Unlike traditional forms of advertising, digital technologies enable tailoring of advertisements to individual physicians on the basis of data from clinical encounters,” according to the authors.
Social media sites that are restricted to physicians are another way for companies to reach out, using stealth marketing tactics ranging from sponsored discussion forums to games. Mobile smartphone applications also allow companies to market to physicians, using data that tracks what kind of clinical information physicians are looking up and then targeting sponsored alerts accordingly.
“Traditional marketing, including visits by sales representatives, gifts to physicians and lectures by opinion leaders, influences treatment decisions even though it mostly occurs outside of patient care settings. Although marketing can lead to reductions in under-treatment of some conditions, it has more often been associated with over-diagnosis, overtreatment and overuse of brand-name medications,” wrote the authors. “Digital advertising creates new pathways for reaching physicians, allowing delivery of marketing messages at the point of care, when clinical decisions are being made. Physicians may also be less aware of when they’re encountering digital marketing than they are with traditional marketing.”
The authors recommend a three-pronged approach to amend current policies “to address the insidious nature of digital marketing tools that are seamlessly integrated into electronic resources used for patient care, but are not as easily recognized as marketing devices.” Their first recommendation is greater transparency from EHRs, social media sites and mobile applications about what personal and prescribing data are collected and how they are used. The second recommendation is for physicians to recognize the issue and exercise the same caution with regard to online interactions as with in-person interactions with sales representatives. And lastly, the authors suggest that professional societies issue guidelines “calling for firewalls to keep marketing out of patent visits, as they did with free pens and other traditional marketing tools.”
“Digital technology is changing the nature of marketing, and policies intended to limit its influence are lagging behind,” the authors conclude. “But the medical profession can enact policies to ensure that patients, not advertising, remain the focus of care.”
Disclosure: Manz reports receiving travel and conference support from the American Medical Student Association.
Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, excellence in patient care, and community service. The organization consists of the University of Pennsylvania Health System and Penn’s Raymond and Ruth Perelman School of Medicine, founded in 1765 as the nation’s first medical school.
The Perelman School of Medicine is consistently among the nation's top recipients of funding from the National Institutes of Health, with $550 million awarded in the 2022 fiscal year. Home to a proud history of “firsts” in medicine, Penn Medicine teams have pioneered discoveries and innovations that have shaped modern medicine, including recent breakthroughs such as CAR T cell therapy for cancer and the mRNA technology used in COVID-19 vaccines.
The University of Pennsylvania Health System’s patient care facilities stretch from the Susquehanna River in Pennsylvania to the New Jersey shore. These include the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, Chester County Hospital, Lancaster General Health, Penn Medicine Princeton Health, and Pennsylvania Hospital—the nation’s first hospital, founded in 1751. Additional facilities and enterprises include Good Shepherd Penn Partners, Penn Medicine at Home, Lancaster Behavioral Health Hospital, and Princeton House Behavioral Health, among others.
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