Document Type : Original Article
Authors
DBA Programs, College of Management and Technology, Walden University, Minneapolis, MN, USA
Abstract
BACKGROUND: Some pharmaceutical company sales representatives are using bribes to encourage
increasing medication prescriptions. In 2012, GlaxoSmithKline paid $3 billion on a felony charge
related to bribing doctors to prescribe the company’s medications. Using Hunt and Vitell’s general
theory of marketing ethics, the purpose of this qualitative multiple case study was to explore strategies
some sales managers in the pharmaceutical industry used to improve marketing training to reduce
unethical sales representative behavior.
MATERIALS AND METHODS: Data were collected from company reports and documents provided
by sales managers and semistructured interviews with five sales managers of different pharmaceutical
companies in the northeast region of the United States. Data were analyzed using thematic analysis
and Yin’s 5‑step process of compiling, disassembling, reassembling, interpreting, and concluding
thematic data analysis.
RESULTS: Three themes emerged from data analysis: developing ethical standards, developing
organizational policy, and implementing training and development programs. A key recommendation is
that pharmaceutical sales managers identify ethical standards to inculcate in their business practices
to achieve ethical marketing training that can result in sales representatives’ ethical behavior. The
implications for positive social change include the potential for sales managers to develop strategies
to reduce unethical behavior in the pharmaceutical industry.
CONCLUSION: Reducing unethical behavior may lead to more trust between patients and physicians,
improving patient satisfaction and promoting prosperity for the community through enhancing the
quality of health care.
Keywords
1. Munoz L, Mallin M. Unethical sales behavior neutralization: The
impact of salesperson role variables and moderating effects of role
relationship orientation. J Bus Ind Mark 2019;34:62‑79.
2. Peltier‑Rivest D. The prevention and detection of corruption in
pharmaceutical companies. Pharm Policy Law 2017;19:17‑31.
3. Cacciolatti L, Lee SH. Revisiting the relationship between
marketing capabilities and firm performance: The moderating
role of market orientation, marketing strategy and organizational
power. J Bus Res 2016;69:5597‑610.
4. ShawB, WhitneyP. Ethics and compliance in global pharmaceutical
industry marketing and promotion: The role of the IFPMA and
self‑regulation. Pharm Policy Law 2016;18:199‑206.
5. Khazzaka M. Pharmaceutical marketing strategies’ influence
on physicians’ prescribing pattern in Lebanon: Ethics, gifts, and
samples. BMC Health Serv Res 2019;19:80.
6. Ameer I, Halinen A. Moving beyond ethical decision‑making:
A practice‑based view to study unethical sales behavior. J Pers
Selling Sales Manage 2019;39:103‑22.
7. Badrinarayanan V, Ramachandran I, Madhavaram S. Mirroring
the boss: Ethical leadership, emulation intentions, and salesperson
performance. J Bus Ethics 2019;159:897‑912.
8. Sasirekha V. Ethically practiced unethical strategies in pharma
industry – Whom to be blamed. Int J Res Grathaalayah
2018;6:32‑45.
9. Schipani CA, Lui J, Xu H. Doing business in a connected society:
The GSK bribery scandal in China. Univ Ill Law Rev 2016;1:63‑102.
10. Hunt SD, Vitell S. A general theory of marketing ethics.
J Macromarketing 1986;6:5‑16.
11. Khaldi K. Quantitative, qualitative or mixed research: Which
research paradigm to use? J Educ Soc Res 2017;7:15‑24.
12. Yin R. Case Study Research and Applications: Design and
Methods. 6th ed. Thousand Oaks, CA: SAGE Publications; 2018.
13. Sridhar G, Lyngdoh T. Flow and information sharing as predictors
of ethical selling behavior. J Bus Ethics 2017;158:807‑23.
14. Miska C, Stahl GK, Fuchs M. The moderating role of context in
determining unethical managerial behavior: A case survey. J Bus
Ethics 2016;153:793‑812.
15. Malik F, Junaid M, Sharif I. Exploring the role of pharmaceutical
marketing on physician ethical behaviors: A grounded theory
study. City Univ Res J 2019;9:245‑63.
16. Katamba D, Nkiko CM, Ademson C. Managing stakeholders’
influence on embracing business code of conduct and ethics
in a local pharmaceutical company. Rev Int Bus Strategy
2016;26:261‑90.
17. MinM, Desmoulins‑LebeaultF, EspositoM. Should pharmaceutical
companies engage in corporate social responsibility? J Manage
Dev 2017;36:58‑70.
18. Kazadi K, Lievens A, Mahr D. Stakeholder co‑creation during
the innovation process: Identifying capabilities for knowledge
creation among multiple stakeholders. J Bus Res 2016;69:525‑40.
19. Franco‑Trigo L, Marqués‑Sánchez P, Tudball J, Benrimoj SI,
Martínez‑Martínez F, Sabater‑Hernández D. Collaborative health
service planning: A stakeholder analysis with social network
analysis to develop a community pharmacy service. Res Social
Adm Pharm 2020;16:216‑29.
20. LorenziniGC, MostaghelR, Hellström D. Drivers of pharmaceutical
packaging innovation: A customer‑supplier relationship case
study. J Bus Res 2017;88:363‑70.
21. Skandrani H, Sghaier M. The dark side of the pharmaceutical
industry. Mark Intell Plann 2016;34:905‑26.
22. HaqueA, KabirSM, AnwarAK, YasminF, Mhm N. Pharmaceutical
marketing ethics in healthcare quality for patient satisfaction: An
Islamic approach. J Pharm Res Int 2019;11:1696‑705.
23. Javed SA, Ilyas F. Service quality and satisfaction in healthcare
sector of Pakistan – The patients’ expectations. Int J Health Care
Qual Assur 2018;31:1‑13.
24. Fatima Z. Salesforce ethical behaviour: A control system
perspective. J Mark Vistas 2017;7:68‑75.
25. Kadic‑Maglajlic S, Micevski M, Lee N, Boso N, Vida I. Three
levels of ethical influences on selling behavior and performance:
Synergies and tensions. J Bus Ethics 2019;156:377‑97.
26. Mehralian G, Nazari JA, Ghasemzadeh P. The effects of
knowledge creation process on organizational performance using
the BSC approach: The mediating role of intellectual capital.
J Knowl Manage 2018;22:802‑23.
27. Huang GD, Altemose JK, O’Leary TJ. Public access to clinical
trials: Lessons from an organizational implementation of policy.
Contemp Clin Trials 2017;57:87‑9.
28. Beck‑Krala E, Klimkiewicz K. Reward programs supporting
environmental organizational policy. Cent Eur J Soc Sci Humanit
2017;6:41‑54.
29. Mackey TK, Vian T, KohlerJ. The sustainable development goals
as a framework to combat health‑sector corruption. Bull World
Health Organ 2018;96:634‑43.
30. David‑Barrett E, Yakis‑Douglas B, Moss‑Cowan A, Nguyen Y.
A bitter pill? Institutional corruption and the challenge of
antibribery compliance in the pharmaceutical sector. J Manage
Inq 2017;26:326‑47.
31. Witchey NJ, inventor; Nant Holdings IP LLC, assignee. Healthcare
transaction validation via blockchain, systems and methods.
United States patent US 10,340,038. 2019 Jul 2.
32. Nunoo JC. Sales and Revenue Optimization in Pharmaceutical
Companies: The Role of an ERP System. A Case Study of Ayrton
Drug Manufacturing Limited (Doctoral dissertation, University
of Ghana). 2019. http://197.255.68.205/handle/123456789/32695.
33. Hassan H, Daud S. Fostering corporate sustainability performance
through integrated knowledge management strategy and
eco‑innovation in halal pharmaceutical companies: A Malaysia
case. World J Islam Hist Civiliz 2017;7:23‑9.
34. Lotfi T, Morsi RZ, Rajabbik MH, Alkhaled L, Kahale L, Nass H,et al. Knowledge, beliefs and attitudes of physicians in low
and middle‑income countries regarding interacting with
pharmaceutical companies: A systematic review. BMC Health
Serv Res 2016;16:57.
35. Alowi M, Kani Y. Impact of pharmaceutical companies’
promotional tools on physicians’ prescription patterns:
A systematic review. J Appl Pharm 2018;10:e1000268.
36. Gupta SK, Nayak RP, Sivaranjani R. A study on the interactions
of doctors with medical representatives of pharmaceutical
companies in a Tertiary Care Teaching Hospital of South India.
J Pharm Bioallied Sci 2016;8:47‑51.
37. Muddukrishna BS, Kumar L, Girish KP. Importance of
competency level and its assessment in pharmaceutical industry.
Res J Pharm Technol 2018;11:139‑42.
38. Babapour J, Gholipourb A, Mehralian G. Human resource
management challenges to develop pharmaceutical industry:
Evidence from developing countries. Iran J Pharm Res
2018;17:224‑38.
39. Dhainaut JF, Blin O, Herry F; Participants of Giens XXXV Round
Table News; Benito S, Bilbault P, et al. Health research and
innovation: Can we optimize the interface between startups/
pharmaceutical companies and academic health care institutions
or not? Therapie 2020;75:113‑23.
40. Setia S, Ryan NJ, Nair PS, Ching E, Subramaniam K. Evolving role
of pharmaceutical physicians in medical evidence and education.
Adv Med Educ Pract 2018;9:777‑90.
41. Villalba L. Pharmaceutical companies and medical practitioners
or “the beast and the beauty”? Clin Dermatol 2019;37:16‑20.
42. Chisholm O. Curriculum transformation: From didactic to
competency‑based programs in pharmaceutical medicine. Front
Pharmacol 2019;10:1‑7.
43. Sharma P. An analytical study of quality management in
pharmaceutical industries. Int J Manage Res Rev 2017;7:482‑9.
44. Yaseen MM, Sweis RJ, Abdallah AB, Obeidat BY, Sweis NJ.
Benchmarking of TQM practices in the Jordanian pharmaceutical
industry (a comparative study). Benchmarking Int J
2018;25:4058‑83.
45. Shanley A. Good laboratory practices: Getting on the same page.
PharmTech 2019;47-48. Available from: https://www.pharmtech.
com/view/good-laboratory-practices-getting-same-page. [Last
accessed on 2022 Feb 24].
46. Pai DR, Kamath K, Subramanyam EV, Shabaraya AR. Personnel
training for pharmaceutical industry. Int J Pharm Qual Assur
2016;7:55‑61.
47. Yusuff KB. Patients’, consumers’, and healthcare professionals’
perceptions, beliefs, knowledge, attitudes, and practices toward
the use of medicines. In: Social and Administrative Aspects of
Pharmacy in Low‑and Middle‑Income Countries. Cambridge,
MA: Academic Press; 2018. p. 35‑52.
48. Green L, Gray BJ, Edmonds N, Parry‑Williams L. Development
of a quality assurance review framework for health impact
assessments. Impact Assess Proj Appraisal 2018;37:107‑13.
49. Duan N, BhaumikDK, Palinkas LA, Hoagwood K. Optimal design
and purposeful sampling: Complementary methodologies for
implementation research. Adm Policy Ment Health 2015;42:524‑32.
50. Ames H, Glenton C, Lewin S. Purposive sampling in a qualitative
evidence synthesis: A worked example from a synthesis on
parental perceptions of vaccination communication. BMC Med
Res Methodol 2019;19:26.
51. Available from: https://www.crunchbase.com/hub/
northeastern‑us‑pharmaceutical‑companies#section
‑overview. [Last accessed on 2021 Jul 27].
impact of salesperson role variables and moderating effects of role
relationship orientation. J Bus Ind Mark 2019;34:62‑79.
2. Peltier‑Rivest D. The prevention and detection of corruption in
pharmaceutical companies. Pharm Policy Law 2017;19:17‑31.
3. Cacciolatti L, Lee SH. Revisiting the relationship between
marketing capabilities and firm performance: The moderating
role of market orientation, marketing strategy and organizational
power. J Bus Res 2016;69:5597‑610.
4. ShawB, WhitneyP. Ethics and compliance in global pharmaceutical
industry marketing and promotion: The role of the IFPMA and
self‑regulation. Pharm Policy Law 2016;18:199‑206.
5. Khazzaka M. Pharmaceutical marketing strategies’ influence
on physicians’ prescribing pattern in Lebanon: Ethics, gifts, and
samples. BMC Health Serv Res 2019;19:80.
6. Ameer I, Halinen A. Moving beyond ethical decision‑making:
A practice‑based view to study unethical sales behavior. J Pers
Selling Sales Manage 2019;39:103‑22.
7. Badrinarayanan V, Ramachandran I, Madhavaram S. Mirroring
the boss: Ethical leadership, emulation intentions, and salesperson
performance. J Bus Ethics 2019;159:897‑912.
8. Sasirekha V. Ethically practiced unethical strategies in pharma
industry – Whom to be blamed. Int J Res Grathaalayah
2018;6:32‑45.
9. Schipani CA, Lui J, Xu H. Doing business in a connected society:
The GSK bribery scandal in China. Univ Ill Law Rev 2016;1:63‑102.
10. Hunt SD, Vitell S. A general theory of marketing ethics.
J Macromarketing 1986;6:5‑16.
11. Khaldi K. Quantitative, qualitative or mixed research: Which
research paradigm to use? J Educ Soc Res 2017;7:15‑24.
12. Yin R. Case Study Research and Applications: Design and
Methods. 6th ed. Thousand Oaks, CA: SAGE Publications; 2018.
13. Sridhar G, Lyngdoh T. Flow and information sharing as predictors
of ethical selling behavior. J Bus Ethics 2017;158:807‑23.
14. Miska C, Stahl GK, Fuchs M. The moderating role of context in
determining unethical managerial behavior: A case survey. J Bus
Ethics 2016;153:793‑812.
15. Malik F, Junaid M, Sharif I. Exploring the role of pharmaceutical
marketing on physician ethical behaviors: A grounded theory
study. City Univ Res J 2019;9:245‑63.
16. Katamba D, Nkiko CM, Ademson C. Managing stakeholders’
influence on embracing business code of conduct and ethics
in a local pharmaceutical company. Rev Int Bus Strategy
2016;26:261‑90.
17. MinM, Desmoulins‑LebeaultF, EspositoM. Should pharmaceutical
companies engage in corporate social responsibility? J Manage
Dev 2017;36:58‑70.
18. Kazadi K, Lievens A, Mahr D. Stakeholder co‑creation during
the innovation process: Identifying capabilities for knowledge
creation among multiple stakeholders. J Bus Res 2016;69:525‑40.
19. Franco‑Trigo L, Marqués‑Sánchez P, Tudball J, Benrimoj SI,
Martínez‑Martínez F, Sabater‑Hernández D. Collaborative health
service planning: A stakeholder analysis with social network
analysis to develop a community pharmacy service. Res Social
Adm Pharm 2020;16:216‑29.
20. LorenziniGC, MostaghelR, Hellström D. Drivers of pharmaceutical
packaging innovation: A customer‑supplier relationship case
study. J Bus Res 2017;88:363‑70.
21. Skandrani H, Sghaier M. The dark side of the pharmaceutical
industry. Mark Intell Plann 2016;34:905‑26.
22. HaqueA, KabirSM, AnwarAK, YasminF, Mhm N. Pharmaceutical
marketing ethics in healthcare quality for patient satisfaction: An
Islamic approach. J Pharm Res Int 2019;11:1696‑705.
23. Javed SA, Ilyas F. Service quality and satisfaction in healthcare
sector of Pakistan – The patients’ expectations. Int J Health Care
Qual Assur 2018;31:1‑13.
24. Fatima Z. Salesforce ethical behaviour: A control system
perspective. J Mark Vistas 2017;7:68‑75.
25. Kadic‑Maglajlic S, Micevski M, Lee N, Boso N, Vida I. Three
levels of ethical influences on selling behavior and performance:
Synergies and tensions. J Bus Ethics 2019;156:377‑97.
26. Mehralian G, Nazari JA, Ghasemzadeh P. The effects of
knowledge creation process on organizational performance using
the BSC approach: The mediating role of intellectual capital.
J Knowl Manage 2018;22:802‑23.
27. Huang GD, Altemose JK, O’Leary TJ. Public access to clinical
trials: Lessons from an organizational implementation of policy.
Contemp Clin Trials 2017;57:87‑9.
28. Beck‑Krala E, Klimkiewicz K. Reward programs supporting
environmental organizational policy. Cent Eur J Soc Sci Humanit
2017;6:41‑54.
29. Mackey TK, Vian T, KohlerJ. The sustainable development goals
as a framework to combat health‑sector corruption. Bull World
Health Organ 2018;96:634‑43.
30. David‑Barrett E, Yakis‑Douglas B, Moss‑Cowan A, Nguyen Y.
A bitter pill? Institutional corruption and the challenge of
antibribery compliance in the pharmaceutical sector. J Manage
Inq 2017;26:326‑47.
31. Witchey NJ, inventor; Nant Holdings IP LLC, assignee. Healthcare
transaction validation via blockchain, systems and methods.
United States patent US 10,340,038. 2019 Jul 2.
32. Nunoo JC. Sales and Revenue Optimization in Pharmaceutical
Companies: The Role of an ERP System. A Case Study of Ayrton
Drug Manufacturing Limited (Doctoral dissertation, University
of Ghana). 2019. http://197.255.68.205/handle/123456789/32695.
33. Hassan H, Daud S. Fostering corporate sustainability performance
through integrated knowledge management strategy and
eco‑innovation in halal pharmaceutical companies: A Malaysia
case. World J Islam Hist Civiliz 2017;7:23‑9.
34. Lotfi T, Morsi RZ, Rajabbik MH, Alkhaled L, Kahale L, Nass H,et al. Knowledge, beliefs and attitudes of physicians in low
and middle‑income countries regarding interacting with
pharmaceutical companies: A systematic review. BMC Health
Serv Res 2016;16:57.
35. Alowi M, Kani Y. Impact of pharmaceutical companies’
promotional tools on physicians’ prescription patterns:
A systematic review. J Appl Pharm 2018;10:e1000268.
36. Gupta SK, Nayak RP, Sivaranjani R. A study on the interactions
of doctors with medical representatives of pharmaceutical
companies in a Tertiary Care Teaching Hospital of South India.
J Pharm Bioallied Sci 2016;8:47‑51.
37. Muddukrishna BS, Kumar L, Girish KP. Importance of
competency level and its assessment in pharmaceutical industry.
Res J Pharm Technol 2018;11:139‑42.
38. Babapour J, Gholipourb A, Mehralian G. Human resource
management challenges to develop pharmaceutical industry:
Evidence from developing countries. Iran J Pharm Res
2018;17:224‑38.
39. Dhainaut JF, Blin O, Herry F; Participants of Giens XXXV Round
Table News; Benito S, Bilbault P, et al. Health research and
innovation: Can we optimize the interface between startups/
pharmaceutical companies and academic health care institutions
or not? Therapie 2020;75:113‑23.
40. Setia S, Ryan NJ, Nair PS, Ching E, Subramaniam K. Evolving role
of pharmaceutical physicians in medical evidence and education.
Adv Med Educ Pract 2018;9:777‑90.
41. Villalba L. Pharmaceutical companies and medical practitioners
or “the beast and the beauty”? Clin Dermatol 2019;37:16‑20.
42. Chisholm O. Curriculum transformation: From didactic to
competency‑based programs in pharmaceutical medicine. Front
Pharmacol 2019;10:1‑7.
43. Sharma P. An analytical study of quality management in
pharmaceutical industries. Int J Manage Res Rev 2017;7:482‑9.
44. Yaseen MM, Sweis RJ, Abdallah AB, Obeidat BY, Sweis NJ.
Benchmarking of TQM practices in the Jordanian pharmaceutical
industry (a comparative study). Benchmarking Int J
2018;25:4058‑83.
45. Shanley A. Good laboratory practices: Getting on the same page.
PharmTech 2019;47-48. Available from: https://www.pharmtech.
com/view/good-laboratory-practices-getting-same-page. [Last
accessed on 2022 Feb 24].
46. Pai DR, Kamath K, Subramanyam EV, Shabaraya AR. Personnel
training for pharmaceutical industry. Int J Pharm Qual Assur
2016;7:55‑61.
47. Yusuff KB. Patients’, consumers’, and healthcare professionals’
perceptions, beliefs, knowledge, attitudes, and practices toward
the use of medicines. In: Social and Administrative Aspects of
Pharmacy in Low‑and Middle‑Income Countries. Cambridge,
MA: Academic Press; 2018. p. 35‑52.
48. Green L, Gray BJ, Edmonds N, Parry‑Williams L. Development
of a quality assurance review framework for health impact
assessments. Impact Assess Proj Appraisal 2018;37:107‑13.
49. Duan N, BhaumikDK, Palinkas LA, Hoagwood K. Optimal design
and purposeful sampling: Complementary methodologies for
implementation research. Adm Policy Ment Health 2015;42:524‑32.
50. Ames H, Glenton C, Lewin S. Purposive sampling in a qualitative
evidence synthesis: A worked example from a synthesis on
parental perceptions of vaccination communication. BMC Med
Res Methodol 2019;19:26.
51. Available from: https://www.crunchbase.com/hub/
northeastern‑us‑pharmaceutical‑companies#section
‑overview. [Last accessed on 2021 Jul 27].
)