Ethics in Medical Practice Management – Practical Dermatology Magazine

Dermatology Practice Management

Beware of “Trojan Horse” Marketing by Pharmaceutical Companies

Learn how to identify potentially unfair marketing techniques, protect your practice and preserve your patient base. Original article

By Charles E. Crutchfield III, MD

In response to growing competition in the pharmaceutical industry, companies are rolling out new initiatives that benefit patients, the companies themselves, and ostensibly dermatologists. These include rebates and loyal-patient programs for medical and cosmetic products. However, some of these initiatives Practical Dermatology Articlegather patient demographic information that the companies can use to market directly to patients, bypassing or in some cases misrepresenting the physician.

Cautionary Tale

At our practice, we capture as much demographic and contact information as possible about patients, including e-mail addresses. We use our extensive database of e-mail addresses to send our practice e-newsletter and other electronic communications. So a few years back when a major pharmaceutical company approached us about a co-marketing/practice support Practical Dermatology Aritlceprogram that included a patient registry and data capture, we agreed to participate. My staff dutifully recorded patient information, including email addresses in the company’s system. We made no duplicate records of this data, expecting reports from the company. Several months into the program I learned that the pharmaceutical company had no intention of sharing recorded demographic and contact information with me. My staff’s time and resources were building a database for the company, but I did not have access to the information gathered. If I wanted the information, my staff would have had to duplicate efforts to enter this information in our own system, as well. Obviously I opted out of this program. Recently, however, I learned that the same company had sent an email to my registered patients announcing the company, in conjunction with me, was launching a new product. I had no advance notice of this mailing and obviously did not approve the use of my name. Worse still, this announcement included a discount coupon for the new intervention good at any provider.

Important Steps

pharmaceutical company discount or savings programs can offer tremendous benefits to patients and dermatologists. Enhanced affordability increases the accessibility of procedures, driving demand and increasing revenue opportunities for physicians. Of course every time their products are used, the pharmaceutical companies benefit, too. an ethical system allows all parties to share in the benefits. Problems arise if and when the dermatologist can be removed from the equation. Physician involvement helps to protect patients, helping to ensure that it is accurate and reliable. Furthermore, physician involvement ensures continuity of care and protects the patient from competitive (in many cases less qualified) providers. This also helps preserve the practice. A program in which the physician is not truly a co-marketer could actually promote competitive providers.

Protect Your Practice

“Trojan Horse Marketing” may become a very real, clear and present concern for all medical practices. After several thoughtful conversation with my friend and colleague, Dr. Barry Lycka, president of the Ethical Cosmetic Surgery Association, we both conclude and urge physicians to carefully protect their patient information. Your patient information is one of your most valuable resources.

Dermatologists can take steps to protect their patients and practice:

  1. Critically assess any program on the merits of the proposal, not simply the reputation of the company/products or your relationship with it. Look for specific details and ask questions about any points that are not explicitly described.
  2. establish your role in the program. Assure that you will have access to captured demographic/contact information. Ensure that the pharmaceutical company will send no communications to patients as if directly from you/your practice.
    Furthermore, you must have the opportunity to preview and/or reject any correspondence that may imply an endorsement by you or appears to be sent by the company in conjunction with you.
  3. Determine what types of value added bonuses patients will receive through the program. If you are allocating your time and resources to assist the pharmaceutical company’s marketing efforts, then they should not supply coupons or rebates that patients can use with another provider.

Fair & Ethical

Pharmaceutical companies invest millions of dollars in marketing. They also invest in programs to support our specialty, and they support us individually in our practices. They deserve to benefit from their investments.
However, when a company seeks to work with dermatologists as co-marketers the process must be fair and ethical, so that patients, physicians, and the company all benefit and no party contributes a disproportionate amount of effort in exchange for little or no benefit.

Companies have many opportunities to reach patients without active physician involvement (waiting room or exam room brochures, standard rebate/registry programs, communications via the pharmacy, etc.) If the company wishes to co-market with the dermatologist and expects the dermatologist and his/her staff to actively participate, then the rights of the practice and it’s patients should be protected. Be vigilant for “Trojan horse” schemes that allow a company to bypass the physician to gain access to his or her patients. Carefully review and evaluate any program prior to enrollment to ensure that it is fair and ethical. Keep tabs on communications sent to patients. Finally, assess patients satisfaction with marketing initiatives through direct questioning during follow-up visits. Address any concerns with the company immediately.


Beware of “Trojan Horse” Marketing by Pharmaceutical Companies Learn how…