Shaping prescriptions, influencing doctors. The hard-to-grasp effects of Big Pharma's core business.

Summary In order to limit the regulation of its activity by the public authorities, the pharmaceutical industry leaves in the shadows, as much as possible, the extent of its promotional efforts. However, we show that drug promotion is one of its core activities. Spending in this area is considerable. It represents at least 20% of the sector's turnover, and the medical sales force accounts for up to 40% of the total workforce of large pharmaceutical companies, which have become marketing giants. But how can this be reconciled with the statements made by many doctors, who refute the influence of promotion on their practices, and the results of econometric studies, which highlight the weak effect of the medical visit? Do large pharmaceutical companies shape the demand in their markets, following the model of the reverse channel, or do they suffer from a rationality problem by investing massively in an activity that is not very profitable? As an alternative to the microeconomic studies whose results we discuss in the light of our ethnographic survey, we propose a macroeconomic approach to the question. The results obtained argue for a strong link between the intensity of the work of medical sales representatives and doctors' prescriptions, which takes the form of an incentive to prescribe the more expensive, newer drugs.