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Abstract
Internal documents from the pharmaceutical industry provide a unique window for understanding
the structure and methods of pharmaceutical promotion. Such documents have become
available through litigation concerning the promotion of gabapentin (Neurontin, Pfizer,
Inc., New York, New York) for off-label uses.
To describe how gabapentin was promoted, focusing on the use of medical education,
research, and publication.
Court documents available to the public from United States ex. rel David Franklin
vs. Pfizer, Inc., and Parke-Davis, Division of Warner-Lambert Company, mostly from
1994-1998.
All documents were reviewed by 1 author, with selected review by coauthors. Marketing
strategies and tactics were identified by using an iterative process of review, discussion,
and re-review of selected documents.
The promotion of gabapentin was a comprehensive and multifaceted process. Advisory
boards, consultants meetings, and accredited continuing medical education events organized
by third-party vendors were used to deliver promotional messages. These tactics were
augmented by the recruitment of local champions and engagement of thought leaders,
who could be used to communicate favorable messages about gabapentin to their physician
colleagues. Research and scholarship were also used for marketing by encouraging "key
customers" to participate in research, using a large study to advance promotional
themes and build market share, paying medical communication companies to develop and
publish articles about gabapentin for the medical literature, and planning to suppress
unfavorable study results.
Most available documents were submitted by the plaintiff and may not represent a complete
picture of marketing practices.
Activities traditionally considered independent of promotional intent, including continuing
medical education and research, were extensively used to promote gabapentin. New strategies
are needed to ensure a clear separation between scientific and commercial activity.