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Darko PantelicInternet as a Medium ofPharmaceutical CompaniesPromotional ActivitiesArticle Info:Management Information Systems,Vol. 4 (2009), No. 1,pp. 029-037Received 12 Jun 2008Accepted 24 April 2009UDC 004.738.5:658.8]:615SummaryPharmaceuticals market is highly regulated, and it can be stated that prescription(legal or ethical) drugs have a status of substances in controlled circulation.Promotional activities are also under strict legislation, further burdened with ethicalconsideration and public scrutiny. Internet as liberal and hard to control medium bringsentirely new sets of solutions and/or problems to pharmaceuticals market(ers).Key wordsmarketing, pharmaceuticals, promotional mix, Internet promotion.Introduction‘Marketing… is communication andcommunication is marketing.’ (Czinkota et al..,2000, p. 418). This brief statement unequivocallyreflects the nature of promotion as an explicitmeans of communication between a company andits environment. Marketing science and marketingpractice developed immense specter ofpromotional mix tools to facilitate communicationprocess. During time continuum possibilities andusability of certain media expended or accordinglylost its ‘trendiness’. ‘Advertising frequentlygenerates controversy. Few industries, however,have so much strong feeling aroused by theirpromotional activities as pharmaceuticals.’ (Reekie,1970, p. 33). The issue of promotional activities inpharmaceutical industry is not new, and the samecontroversy and the same emotional charge are stillpresent after more than 35 years of practice.The controversy and strong emotion have alsoresulted in strictly regulated promotional activitiesof pharmaceutical companies. The sources of suchlegislation should also be sought in historical data,where unregulated promotion in this sphere oftrade resulted in the sale of pharmaceuticalproducts by the formula ‘ for man, two forbeast...’ Without strict legislation, ‘…often notlabeled with their ingredients, resulting in benignsubstances as well as dangerous chemicals beingtouted as cure-alls containing “secret” ingredients.’(Sterling, Ravich, 2002, p. 12). Although there is noprecise data, it was not uncommon for suchpreparations not only not to help patients, but alsoto exacerbate their condition, including the case ofsulfanilamide poisoning in 1937, leading to the lossof 100 lives. Another tragedy, 30 years later inEurope, taking the sedative Thalidomide inpregnancy resulted in the births of a large numberof children with deformities. These two isolatedcases contributed to a strict regulation ofpharmaceutical industry, with the requirement toprove the safety and effectiveness of a drug beforethe sale license is issued. Legislation defining thelabeling, packaging and promotion ofpharmaceuticals was developed simultaneously.Legislation determines what is permitted in thepromotion of pharmaceutical products, but itwould be wrong to conclude that this limits thecreativity in the promotion of pharmaceuticalproducts. Marketers in pharmaceutical industryhave all the instruments of promotional mix and alltheir combinations at their disposal, so as toconvey the intended message to the targetaudience. The nature of the product, legalregulations and ethical principles create anenvironment in which the marketers need aboveaveragecreativity and care of the target audience,message content and choice of appropriatecommunication channels for the message toproduce the desired effect.1. Pharmaceutical Products andFuture of Promotional ActivitiesRegarding method of sale, which directly translatesto restrictiveness of access and promotionalpractice, drugs are divided into two major groups:• Prescription drugs (ethical or Rx drugs)where the primary focus of marketingindustry’s promotional activities is onprescribing physicians. Ethicalpharmaceuticals correspond to situations

Darko Pantelicthat require expert medical opinion indiagnosis, seriousness of condition createsnecessity for medical supervision during thetreatment and inappropriate use ofmedication may represent serious healthhazard. In such circumstances limitingpromotional activities only towardsphysicians, in role of prescribers, is areasonable decision. As of 1997 (Draves etal., 2004), the USA has seen a significantgrowth in expenditure on promotionalmessages about ethical drugs aimed at finalconsumers/patients – a concept known asDTC (direct-to-consumer). Apart from thismarket, the practice of DTC promotion ofethical drugs is permitted only in NewZealand. According to Medwar (2002), thereis a pressure from pharmaceutical companiesfor DTC to be allowed in Europe as well,but apart from discussions, no steps havebeen made towards the legalization of suchpractices.• OTC drugs can be promoted to finalconsumers, which is a result of the fact thatthese are used for conditions where selftreatmentis possible, have comparativelyclear and brief package inserts, and asignificant amount of information and longexperience in the use of these drugsguarantee safety and effectiveness.Promoting OTC products is similar topromoting any other FMCG (fast movingconsumer goods), and the presence ofadvertising in print and electronic mediaproves that manufacturers actively utilizethis possibility. The key fact is that, on thismarket, the decision whether to purchase aproduct or not is ‘returned’ to the directconsumers, while physicians andpharmacists play an advisory role.Regarding prescription drugs pharmaceuticalindustry primarily engaged in personal selling(detailing), followed by mass use of samples, andalso investing in scientific conferences andpublications. Companies promoting their OTCproducts are more prone towards mass media andadvertising. True nature of promotingpharmaceuticals and its specific features is visibleon prescriptions drugs market, and in this papereffort is dedicated to understanding how Internetas a promotional medium is influencingpromotional practice regarding ethical drugs.Morris and Pines (2001) specifically state thatnew communication channels and new informationrequirements, among other factors, will lead to thegrowth of promotional activities. The promotionof pharmaceutical products ‘…operates in thecontext of a geometrically expanding universe ofhealth information available to individuals via theinternet as well as other, increasingly numerous andspecialized media channels.’ (Draves et al., 2004, p.54). This fragmentation of media, followed by theirexpanding number, facilitates communicationbetween industry and physicians/patients andgravitates towards personalized message –answering to new information requirements.Companies have to meet the differentiatedinformation requirements of patients, payers andprescribers. On the other hand, if number ofinformation and media channels is moving towards‘innumerable’ how hard it will be to controlsubstance and ethics of such communicationpractice. Furthermore, it has to be added thatmarket is facing increasing competition,development of new drugs/therapies, off-label useof pharmaceuticals and internationalization.2. Idea of Promoting PharmaceuticalsPharmaceutical promotion must not be primarilyguided by the motive of ‘selling a unit more of itsproduct’. What differentiates pharmaceuticalindustry from any other practice is that ‘its product,message, promotional channels, even the audienceare determined’ (Castagnoli, 2008, p. 82) bynational regulatory bodies. The primary purpose ofpharmaceutical promotion is conveying objectiveand balanced information to the target auditorium.The promotional message meets the needs ofprescribers (as well as other stakeholders) forappropriate information, and its content becomesthe basic element of understanding promotion inthis market.The objectivity of conveyed message is basedon clinical trials. The promotional message inpharmaceutical industry cannot be separated fromthe scientific context. Only the information provenand confirmed in clinical trials can be used inpromotional message. This information is derivedfrom documents submitted when applying for salelicenses. The balance of information requires that apromotional message for a pharmaceutical productmust contain an equal proportion of positive(affirmative) and negative information.Pharmaceutical industry is the only industryrequired by law to state the adverse features of itsproduct (Smith et al., 2002).The basic problem is that it is hard to separateeducation from promotion. Scientific (expert)30Management Information Systems1/2009

Darko Pantelicbut drug is also registered in Serbian market fortreatment of breast cancer patients. Thus in fullscale this example represents major issues ofpharmaceuticals promotion using Internet as amedium and answering on question how cancompany prevent patient from Serbia to accessinformation and promotional material intended toserve patient in US market?4. Illustration: Crestor – Branded WebPage for Specific ProductCrestor (rosuvastatin calcium) is AstraZeneca'smedication for the control of blood cholesterollevels. Crestor works by blocking an enzyme in theliver responsible for cholesterol synthesis, thusreducing levels of bad cholesterol (LDL) andsimultaneously raising the proportion of goodcholesterol, which, combined with appropriatedietary habits, can slow down arteriosclerosis.Using the drug's web site, the manufacturer directlyaddresses the patients, current and potentialmedication users. Some of the key elements of thisweb site include:Social responsibilityPage can be reached directly by entering nameof drug in any search engine (like Google orYahoo), or link can be provided by manufacturershome page (in case of Crestor and Arimidex it isAstraZeneca), or through various web pages withor without clear association with manufacturer. Ifyou analyze content of webpage for Arimidex(potent drug prescribed to patients with breastcancer) on the bottom of page you can noticedisclaimer that states: “This site is intended for USconsumers/patients. If you are a non-USconsumer/patient, click here [link].” Link will leadto branded site, sponsored by AstraZeneca that hasno direct association with company’s products, butspeaks about conditions – therapeutic areas inwhich AstraZeneca offers solutions – therapies.There is nothing to prevent non-US resident tobrowse brand based web page, and therefore beinfluenced by promotional material/message.Disclaimer mounted on bottom of page is moreformal than essential tool of managing consumer’saccess to promotional material. It could be arguedthat more sophisticated solution is available, lot ofcompanies uses rerouting to local web pagesautomatically detecting proxy address of computeraccessing web page, thus detecting precise locationof user. Applying this common and easy solutionwould prohibit consumers, other than ones fromUS and New Zealand (where direct to consumeradvertising of prescription pharmaceuticals isallowed), to access promotional materials legallyunacceptable on most world markets. Real questionmight be are pharmaceutical companies interestedin limiting this access? Furthermore, is betterunderstanding of disease, improving adherence totherapy, amassing information vital to enhancingquality of life delivered by branded web pages andif it is, should this access to information berestricted? Answers to these questions should belooked upon considering mentioned problem ofseparation of information and promotion regardingpharmaceutical products, and adding fact thatWorld Wide Web exists above national legislationboundaries. Devlin et al (2007) could argue thatpharmaceutical marketing is a question oflegislation, but Baumer et al (2007, p. 13) with agood reason ask “can regulation of distribution[and promotion] of pharmaceutical productscoexist with advances in information technology.”Serbian pharmaceutical companies developedweb pages that primarily would fit in to category ofinstitutional promotion, but only few mouse clicksaway, as user goes deeper trough site maps,information about specific products can easily befound. Most of producers in Big Five (Hemofarm,Vršac; Galenika, Beograd; Zdravlje-Actavis,Leskovac, Jugoremedija, Zrenjanin andHabitPharm, Ivanjica) have a detail package insert(PI) for every product in portfolio. Beforeconsumer/patient gets to data, he either needs toconfirm that he read or at least has opportunity toread warning info that states that available data isjust for educational purposes and that they do notsubstitute conversation with physician orpharmacist. Some of producers introduceddisclaimers of responsibility stating that each32Management Information Systems1/2009

Internet as a Medium of Pharmaceutical Companies Promotional Activitiesvisitor/patient is directly responsible for utilizationof available information. In a sense only differencebetween branded web pages is that there is noadditional information about condition, testimoniesof patients already using therapy, and there is nodirect promotional message stating that you shoulduse drug A if condition X occurs. It could beargued that information provided with product inPI and information provided on-line is redundant,and that available on-line information does notbring any additional benefit to end users. Could itbe use as quick reference guide for medicaldoctors? It could be, but then again National drugregistry already provides such information, both onprint and as e-resource. Searching for similarpractice in several EU member states countries, i.e.Stada, Germany (owner of Serbian pharmaceuticalcompany Hemofarm), Roche, Switzerland or Lek,Slovenia, none of them shares similar practiceconducted by Serbian pharmaceutical sector ofgiving extensive information on line availablethrough home page of company. Roche web sitehas list of available brands/products, but click onname of drug will provide just basic information ofintended indications and statement that regulatoryreasons prohibit company to provide further detailabout product.Some of web initiatives are intended to serveinformation needs of patients with primary focuson either specific condition, or on therapeutic area.From our previous example of Arimidex, non-USvisitor should redirect itself (sic!), web pagesponsored (and maintained) by AstraZeneca,leading user towards information about conditions,disease research and medical information.There are numerous examples of non brandedweb sites without association to pharmaceuticalsmanufacturers. Some of them are developed andmaintained by government as American HeartAssociation or SerbianInstitute for Public Health “Dr Milan JovanovicBatut” Entering name of certaincondition on any search engine will produceabundant results, some of them are specialized andsome cover broad range of health topics. Trackinginformation in health segment is equally burdenedwith issues of source and validity of data like anyother topic that can be found on-line. It iscommon to find out initiatives that are results ofpersonal efforts, i.e., webpaged posted and maintained by one health careprofessional, or web pages owned by patients inorganized or non-organized groups. Someinitiatives, like Katarina Rebraca Found( have intention to raiseawareness about certain condition, in this particularexample breast cancer, but also to collect fundsdestined to be invested in education, preventionand diagnosis. Some of these web initiatives can beutilized by pharmaceutical companies to invest inbuilding good image and reputation, but sometimesthese initiatives are ferocious opponents ofpharmaceutical companies and induce substantialpressure to business policies of industry.Most of discussion on web based promotion ofpharmaceuticals was dedicated to end users orpatients, and most of time physicians were notmentioned. Usually access to medical professional’spart of web site is available from page intended forpatients and vice versa, so there is no actualrestriction of access to neither group.Drummy (2006) points to several key featuresrendering the Internet as a medium of aboveaverage effectiveness in conveying a message to thetarget audience:1. Immediate segmentation. A Pharmaceuticalcompany’s web page should meet theinformation requirements of various targetgroups. Patients may seek information onhow to maximize the effects of a therapy, tolearn about the benefits of adherence totherapy or the dangers of discontinuing it;certain users may be interested ininformation on disease prevention ordiagnosis; prescribing physicians may seekinformation on the mechanism of action,contraindications or drug tolerance, takingtherapy in combination with food and/orother drugs etc. For this reason, a web pagemust enable intuitive, fast approach toinformation sought, with the reservationthat there is no way of ‘forcing’ the users tofollow information paths they do not requireor perhaps deem as inappropriate. Time isone of the key elements of keeping the user‘involved’ in the web page content; theuser’s attention is kept on the web page foronly a few seconds, and the inability of webpage’s infrastructure to lead the user todesired information in this extremely briefperiod of time results in his abandoning theinformation search, or turning to othersources (Sakal, 2007).2. Integration. Internet communicationchannel is only one in a complexcombination of communication channels ata company’s disposal within its promotionalManagement Information Systems1/200933

Darko Pantelicmix. Marketers should find a synergybetween ‘offline and online media’(Drummy, 2006, p. 89), integrating thedirection to the internet into thepromotional messages of the traditionalmedia (such as TV and print media), andvice versa. A pharmaceutical company’s webpage may be an excellent addition topersonal selling, so that some companies ‘…including Bristol and Merck, aresupplementing often brief physician visitswith „e-detailing“. They might, for example,point doctors to interactive Web sites thatteach them about new drugs and that can beupdated instantly with fresh clinical-trial datato support their sales pitches.’3. Immersion. Pharmaceutical companiesshould provide for a large enough targetgroup to be informed about the existence ifa web page. The amount of informationavailable to various stakeholders on a webpage acquires its full sense only when it hasproduced an effect in the expansion ofinformation and/or knowledge to a largeenough population. For this reason, in thevirtual space, attracting the target group touse the web page on a disease and/ortherapy is achieved either by buying keywords with major search engines (Google,Yahoo, MSN etc.) or ‘catching’ the users whoactively and intensively use the Internet butdo not primarily seek health information, i.e.their access to web pages sponsored bypharmaceutical companies results fromother stimulations (banners, advertisements,news etc.).4. Impact. The future development of Internetinfrastructure will provide for more audioand visually intensive, accompanied byanimations, video footage etc. Harrell (inDrummy, 2006, p. 94) warns of the dangerof marketing using all these new possibilities‘…just because they can, not because theyare serving a particular marketing goal oruser need.’5. Investment measurement. Measuring theeffect of investing in promotional activitiesis one of the typical marketing issues. Webbasedpromotion is comparatively easy tofollow (Iskowitz, 2008), especially in thecategory of the number of users whoaccessed different contents. However, theobjective result will only be manifested inthe changes of behavior among prescribersor consumers on the market, which requiresmore complex mechanisms of effectmeasurement. The existence of additionalchannels of communicating withstakeholders is also important instrengthening the connections between acompany and its environment.McGuire points out that the ‘shift’ of theindustry towards the Internet and interactivepromotional solutions for prescribers must be setin the context of the fact that the prescriberpopulation has also changed. Old physicians,hostile to information technology, are slowlyretiring from practice, and the younger generationof doctors, who grew up with computers, expect e-marketing solutions from the pharmaceuticalindustry. Catallo (2008, p. 24) predicts anexpansion in the use of the Internet for decisionmakingon health issues on the patient side as well,especially among the younger, educated population,facing ‘…a lifetime of healthcare decisionmaking…’Internet represents one of most importantcommunication channels in contemporary society.It has astonishing potential in emitting informationand knowledge, and can influence habits anddecisions trough diagnosis and treatment, but alsocan do a lot in prevention and rehabilitation ofpatients. Its influence can be tremendous ineducation (especially lifelong learning) for nextgeneration of medical doctors. Global nature ofindustry will require global regulation, and globalnature of World Wide Web is bringing newcommunication media that also requiresclarification and regulation in interest of publicsafety – regulating trade, distribution andpromotion of pharmaceuticals. Potential benefitswould be realized only if we are able to neutralizepotential perils.5. Internet and Direct-to-Consumer(DTC) Promotion of Ethical DrugsRelative novelty of Internet communicationregarding pharmaceuticals requires understandingof pros and cons of utilization of this media,especially stressing ease of access for enduser/patient.The problem of direct-to-consumer(DTC) promotion of ethical drugs gainedmomentum in 1997, with the exponential growthin the costs of communicating with finalconsumers/patients in the US. This form ofpromotion had legally existed before as well, butbecame effectively usable when the FDA, as the34Management Information Systems1/2009

Internet as a Medium of Pharmaceutical Companies Promotional Activitiesregulatory body of the largest pharmaceuticalmarket in the world – the USA – decided to loosenthe regulations on advertising on TV, radio and theInternet. Namely, the manufacturers of theseproduct got the permission ‘…to advertise in thebroadcast mass media without including detailed orsummary information on the use, indications andpotential adverse effects of a drug.’ (Findlay, 2001,p. 111). The manufacturers’ obligation was reducedto stating the most important adverse effects,referring to other media with detailed information(web page, patient hotlines or print media) andmandatory statement, i.e. instruction ‘to consulttheir doctors/pharmacists’ (Buckley, 2004, p. 94).The choice of an ethical drug for treating apatient’s symptom and/or disease is based on theassumption that the physician possesses therequired expertise enabling him/her to make aproper diagnosis and choose the best availabletherapy for the patient based on availableinformation. On the other hand, a patient who hasdecided that the ‘aberration from normal’ inhis/her case is such that it requires seeking experthelp in the domain of socially accepted medicalpractice will delegate the decision on the choice oftherapy best suited to his/her requirements to aphysician. The relationship between a physicianand a patient is based on mutual recognition ofrights and obligations arising from the doctorpatientrelationship and is based on trust. It mustbe pointed out that direct promotion to patients isin fact indirect (White et al., 2004), as themechanism of its functioning implies that a patientwill influence a physicians who has undoubtedultimate authority to prescribe a drug (or withholdit from the patient if it does not suit the patientscircumstances).Analyzing the opinions of various authors(Finlay, 2001; Smith et al., 2002; Shankland, 2003;Dubois, 2003; White et al., 2004; Buckley, 2004;Richardson, Luchsinger, 2005; Kavadas et al., 2007)we can define conclusions regarding the positiveand negative effects of DTC practices. In manyauthors’ opinion, the central beneficial effect israising information levels among patients,reflecting in:1. enhancing the role of patients as activeparticipants in their personal medical history(Shankland, 2003; White et al., 2004);2. raising the awareness of diseases, whichcontributes to the recognition of symptoms,more precise and timely diagnosis andtherapy (Dubois, 2003; Kavadas et al., 2007);3. raising the levels of knowledge on availabletherapeutic alternatives, includingprevention and lifestyle adjustment (Buckley,2004);4. faster dissemination of information on newavailable therapies, and developingpharmaceutical brands, and special expertisein particular therapeutic areas (Findlay, 2001;Richadson, Luchsinger, 2005);5. improving therapy outcomes, throughappropriate use of and adherence to therapy(Smith et al., 2002; White et al., 2004).According to Dick-Rath (2008, p. 74) thebest marketing practice in pharmaceuticalpromotion results from ‘…evolving adialogue with their patients to improveadoption, compliance and adherence.’;6. economizing with physicians’ time, as thepatient has numerous sources availablewhere (s)he can gather information on thedisease and therapies, and other desiredinformation (Richadson, Luchsinger, 2005).As for negative outcomes, the task ofpharmaceutical marketing to ‘harmonize the needsand wishes in an efficient and effective manner’ ischallenged when:1. the doctor-patient relationship is disruptedthrough undermining physician’s authority,where (s)he turns into a provider servicingpatients’ desires, while the diagnosis andchoice of therapy are transferred to thepatient. Self-diagnosis is a specific problemwhich, according to Shankland (2003), takesa significant amount of the physician’s time,who must dissuade a patient who has comewith his/her own, uncorroborated diagnosis.Smith et al. (2002), for instance, list fourdifferent producers who differentiate fourdifferent advantages of their hypertensiontherapies, so how can a patient make anappropriate decision?;2. there is a pressure on physician to prescribeunnecessary or inappropriate therapy, whichis based on influence without education(Kavadas et al., 2007);3. costs of therapy grow due to insistence onbranded drugs when there is an appropriategeneric parallel;4. there is a questionable ratio of positive andnegative information in DTC promotion,where the authors agree that advertisers tendto overemphasize positives and play downnegative effects (Dubois, 2003; Richardson,Luchsinger, 2005; Kavadas et al., 2007);Management Information Systems1/200935

Darko Pantelic5. the issue of ethicality of influencing‘vulnerable and suggestible’ audience israised (Richardson, Luchsinger, 2005) aswell as the danger of disease mongering(Buckely, 2004).Stakeholders, in widest notion, have to be awareof positive and negative aspects of direct toconsumer promotion of pharmaceuticals. Nationallegislations prevent DTC promotion on mostmarkets in the entire world, but contemporary usercan collect information and be influenced by mediathat surpass national legislation borders. In fact,part of the problem is that there are marketsallowing promotion to patients which withadvances in digital media become widely available,but even without that – would we be able toprevent patients accessing web pages intended onlyfor professionals.6. Further Issues Related to Use ofInternet as Promotional Medium forPharmaceuticalsPharmaceutical market is burdened with substantialcontroversy. Its source might be embodied in clashof specific use of pharmaceuticals and businesslogic of pharmaceuticals manufacturers. State ofbeing ill implies certain physical and biological, butmore important social and cultural phenomenonresulting in empathy and ethical attitude that ifsolution is available it should be accessible to all (orat least to wide population). On the other handpharmaceutical industry as any business enterpriseneeds to achieve business goals, often presented inform of profit. Simplified advertisers interest is toreach audience and convey message that will resultin increase of consumption/sales with intention toachieve business goals. A further complexity resultsfrom the fact that that theproduction/consumption of drugs functions in acombination of various (and often conflicting)interests of numerous stakeholders on thiscomplex market: prescribing physicians, legislators,payers, manufacturers, consumers/patients, varioussocial groups and society as a whole.To paraphrase Liebman (2003, p. 44)promotional activities in the pharmaceuticalindustry are in a delicate position balancingbetween education and promotion, betweenaffirmative and negative attitudes to its role in thesphere of healthcare, and marketers invest constanteffort ‘…to ensure that god intentions don’t bringbad results.’Utility and ethicality of pharmaceuticalspromotion will be always measured trough impacton attitudes and behavior of two key stakeholdersgroups: prescribers and patients. Without a doubt,it is necessary for prescribing physicians to haveaccess to up-to-date information on new therapiesand alternatives in the treatment of their patients.The physician’s freedom to choose a therapeuticalalternative that (s)he regards as the optimumsolution in a given situation should not bejeopardized by the ‘promotional pressure’ of thepharmaceutical industry. Alternatively, a physiciancould decide that the patient does not require drugtherapy, but rather an alteration of the lifestyle thatwill alleviate or neutralize the factor of risk of aperson developing a certain disease. One shouldnot neglect the need for all consumers to beinformed, within the limits of possibility, about theavailable alternatives and all aspects of choosingindividual therapies. The new - more significant -role of patients in treatment is based on the factthat the contemporary consumer is better educatedand informed than it was objectively possible in thepast. The abundance of research and existingattitudes for and against the promotional practicesin pharmaceutical industry aimed at practitionersand even more at final consumers i.e. patients,once again result from a very reasonable question –what is the interest of the source of information,how complete and accurate it is, and how muchfreedom of choice it leaves. With the strength of itsexpertise, pharmaceutical industry is the primarysource of information on pharmaceutical therapiesfor prescribers, and at the same time,pharmaceutical industry itself wants to provideinformation for the final consumers i.e. patients.Introducing Internet as promotional media hasopened new area of possibilities, but threatens withnew (or reappeared) issues, to name a few:• Potential of pharmaceuticals to harm was“restrained” by introducing strict regulationand giving exclusive right to prescribe drugto educated professional – physician. Asinternet becomes not just a promotionalmedium, but also a distribution channel,regulation becomes diluted in cyber spaceand possibility opens for end-users/patientsto make decisions without being properlydiagnosed and thus prescribed therapies thatfit circumstances and is in their best interest.• Losing control over distribution channelfurther meant losing control overproduction of pharmaceuticals and theirquality, opening route for trade with36Management Information Systems1/2009

Internet as a Medium of Pharmaceutical Companies Promotional Activitiescounterfeited or adulteratedpharmaceuticals.• Medicalization of mankind’s problems hasbeen given additional credibility bypromoting pharmaceutical solutions foralignments that are not necessarily illnessesper se.Internet should also be considered as evolvingor “alive” media. Regulators didn’t settled existingissues when new developments regarding Internetbrought new sets of advances in web basedsolutions i.e. Web 2.0 applications – blogs,podcasts, wikis, social network communities(Alkhateeb et. al, 2008, Dick-Rath, 2008). It iscertain that everything is not said, and at for sureeverything is not yet done regarding promotion ofpharmaceuticals on-line, so it will remain a hottopic to investigate.ReferencesBill Drummy, The Five “I”s of Internet Marketing; Pharmaceutical Executive,February 2006, p. 88 – 94.Charles Medwar, Promotion of Prescription Drugs: Trade Tactics?;Consumer Policy Review, Jan/Feb 2002, Vol. 12, No. 1, p. 18 – 30.Christopher Catallo, Reaching Customers in the Virtual World; MarketingHealth Services, Summer 2008, Vol. 28, p. 23 – 27.Constantina Kavadas, Lea Prevel Katsanis, Jordan LeBel, The effects ofrisk disclosure and ad involvement on consumers in DTC advertising;Journal of Consumer Marketing, 2007, Vol. 24, Issue 3, p. 171 – 179.David L. Baumer, J. C. Poindexter, Julie Earp, Can Regulation ofDistribution of Pharmaceutical products Coexist with Advances inInformation Technology; Journal of Internet Law, August 2007, Vol. 11, No.2, p. 13 – 24.Deborah Dick-Rath, Changing Channels; Medical Marketing and Media,August 2008, p. 74 – 79.Duncan W. Reekie, Some Problems Associated with the Marketing ofEthical Pharmaceutical Products, Journal of Industrial Economics,November 1970, Vol. 19, Issue 1, p. 33 – 49.Elinor Devlin, Gerard Hastings, Anne Smith, Laura McDermott, Gary Noble,Pharmaceutical Marketing: A Question of Regulation; Journal of PublicAffairs, May 2007, Vol. 7, p. 135 – 147.Fadi M. Akhateeb, Kevin A. Clauson, Nile M. Khanfar, David A. Latif, Legaland regulatory risk associated with Web 2.0 adoption by pharmaceuticalcompanies; Journal of Medical Marketing, 2008, Vol. 8, Issue 4, p. 311 –318.First Report in Pharmaceutical Sales and Marketing – Consumer, Patient,and Physician Oriented Web Initiatives; published by First ConsultingGroup, 2001.Hugh J. White, Lindsey P. Draves, Roland Soong, Chris Moore, ‘Ask YourDoctor!’ Measuring the Effect of DTC Communications in the World’sLargest Healthcare Market; International Journal of Advertising, 2004, Vol.23(1), p. 53 – 68.Hugh J. White, Lindsey P. Draves, Roland Soong, Chris Moore, ‘Ask YourDoctor!’ Measuring the Effect of DTC Communications in the World’sLargest Healthcare Market; International Journal of Advertising, 2004, Vol.23(1), p. 53 – 68.Joan Buckley, The Need to Develop Responsible Marketing Practice in thePharmaceutical Sector; Problems & Perspectives in Management, 2004,Issue 4, p. 92 – 110.Lee Richardson, Vince Luchsinger, DTC Advertising of PharmaceuticalProducts: Issue Analysis and DTC Promotion; The Journal of AmericanAcademy of Business, Cambridge, September 2005, Vol. 7, No. 2, p. 100 –104.Louis A. Morris, Wayne L. Pines, Future Promotion; Medical Marketing &Media, March 2001, p. 63 – 72.Marc Iskowitz, A Measure of Success; Medical Marketing & Media,February 2008, p. 8.Marton Sakal, Korisnički orijentisan dizajn interfejsa softverskih proizvoda;doktorska disertacija, Univerzitet u Novom Sadu, Ekonomski fakultetSubotica, 2007. godine.Michael R. Czinkota (editor), Marketing: Best Practice; The Dryden Press,Fort Worth, USA, 2000.Mickey C. Smith, E.M. Kolassa, Greg Perkins, Bruce Siecker,Pharmaceutical Marketing, Principles, Environment, and Practice;Pharmaceutical Products Press, New York, USA, 2002.Milton Liebman, Drawing a Line Between Education and Promotion;Medical Marketing & Media, August 2003, p. 44 – 49.Pierre Azoulay, Do Pharmaceutical Sales Respond to Scientific Evidence?;Journal of Economics and Management Strategy, Winter 2002, Vol. 11,Number 4, p. 551 – 594.Reinhard Angelmar, Sarah Angelmar, Liz Kane, Building Strong ConditionBrands; Journal of Medical Marketing, 2007, Vol. 7, Issue 4, p. 341 – 351.Robert W. Dubois, Pharmaceutical Promotion: Don’t Throw the Baby OutWith the Bathwater; Health Affairs, 26.02.2003, p. 96Sally Shankland, To DTC or Not to DTC?; Marketing Health Services,Winter2003, Vol. 23 Issue 4, p. 44.Steven D. Findlay, Direct-to-Customer Promotion of Prescription Drugs;Pharmacoeconomics, 2001, 19 (2), p. 109 – 119.Suzanne K. Sterling, Timothy M. Ravich, Resolving the Tension BetweenScientific Exchange and the Promotion of Drugs; Journal of Health CareCompliance, March – April 2002, Vol. 4 Issue 2, p. 12 – 17.William B. Lobb, E. M. Kolassa, Can Physicians Keep Up? A Quantificationof New Information on the Top 25 Drugs from 2000 to 2003; Journal ofPharmaceutical Marketing & Management, 2005, Vol. 17(1), p. 3 – 15.William Castagnoli, A Split on DTC is Coming; Medical Marketing & Media,May 2008, p. 82.Darko PantelicUniversity of Novi SadFaculty of Economics SuboticaSegedinski put 9-1124000 Information Systems1/200937

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