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The pharma rep with the free lunch is gone. What replaced it is harder to see, and aimed at you and your doctor. Martha Rosenberg is an investigative reporter who has worked at two medical schools and two medical ad agencies, seeing drug marketing from the inside. This episode is based on her article “3 new pharma marketing tactics every physician should know,” published on KevinMD. Reporting from a pharma conference, Martha breaks down three tactics drug makers no longer hide. You will hear how AI apps track where a prescriber sits on the “prescription journey,” how disease mongering and TikTok influencers turn everyday worries into conditions worth medicating, and how the industry is shifting from “ask your doctor” ads to pop-up and online practices that sell straight to patients and sidestep the FDA. She also flags a Maryland bill that would force disclosure of pharma funding behind patient advocacy groups. Press play to learn how to spot the marketing dressed up as medicine, and why your skepticism is the best defense you have.

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Transcript

Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Martha Rosenberg. She’s an investigative reporter and writer. Today’s KevinMD article is “Three new pharma marketing tactics every physician should know.” Martha, welcome back to the show.

Martha Rosenberg: Thank you, Dr. Pho. I love to be on your podcast, and I’d like to talk about this recent article.

Kevin Pho: Absolutely. So why did you decide to write it in the first place? And then talk about the article itself for those who didn’t get a chance to read it yet.

Martha Rosenberg: Sure. OK. So in May there was a big conference in San Diego called Fierce Pharma Engage, and it’s unabashedly designed to connect health care providers with big pharma. There were 700 participants, 56 sponsors, and there’s no attempt to hide the agenda of engaging. So I wrote about three revelations from that conference, which was last month.

Kevin Pho: When you said that there was no hiding what their agenda was, what exactly was their agenda?

Martha Rosenberg: Well, they’re getting health care providers to sell drugs. I’ve been a reporter on these issues for a long time, and I can remember when doctors would be given tickets to playoffs or sent to Bermuda. Now there are different tactics used, but the idea is monetizing the drugs through buying sales.

It is not hidden. This conference was built for it. You’d see all these people, pardon the sirens here, you’d see all the people shaking hands and sharing agendas, and it was just very overt.

Kevin Pho: Now, from your perspective, over the years, how has direct pharma marketing to physicians changed? Because, like you said, back when I was a medical student and resident, there were all these lunches and dinners and being taken out to baseball games and stuff like that. But from what I understand, that has changed since then, right?

Martha Rosenberg: Well, it totally has, Dr. Pho. I might add here, for anybody watching this, that I’ve worked at two medical schools, studied at a medical school, and worked at two top medical ad agencies, so my orientation is drug marketing. I see it from both sides.

I can remember when what we used to call detail men, men and women, would come in to see the doctor with their tote bags that would mention the drug they wanted to sell. And they’d have their own room, with a water cooler and swivel chairs, and that was too overt. Now the partnerships are really different, as we see in this conference.

There’s really no attempt to hide affiliations anymore, which is one of the things I discovered at the conference: the very strong agenda of drug makers to directly market. We’ve heard about telehealth. We’ve heard about direct-to-patient advertising, but it’s really not hidden.

The plan of drug makers is to really bypass the doctors and just go direct. They want not only to engage and sell, but also to ship the drugs to the patients. So you see a lot of this online now: Talk to a doctor directly. That’s a move to hijack what used to be a system of controls.

Kevin Pho: Now, what did you see at this conference? What are some of the new tactics that drug makers are using to market to physicians?

Martha Rosenberg: OK, well the first one, of course, is AI. They have new apps which are called agentic, meaning agent-like. They bypass a lot of the slow approval rules as far as getting a new drug on the market.

But secondly, they very much perceive how a health care provider feels about a certain drug. For example, at the conference they talked about how health care providers were annoyed when they had met with a rep and then they get introduced to the drug information. And it’s like, “Don’t you know where I am on the journey?”

They call it the journey, the prescription journey. So the AI apps would perceive where this prescriber might be in terms of the goal of getting them to prescribe. That was the use of AI.

Drug makers have very much changed the language, and every time you hear “journey,” it’s big pharma. They talk about your health care journey if you’re the patient. But they also talk about the prescription journey for the health care provider. So there’s a lot of machinations over how these drugs are marketed.

One other thing I wrote about right before this was that increasingly they’re targeting lab workers to market drugs, because they want to reach a patient or a practitioner early in the prescription journey.

Kevin Pho: All right, so AI, of course, using these agentic tools. So as a physician, how would they know that they’re the target of an agentic marketing tool? What would that look like to them?

Martha Rosenberg: Wow, I love that question, and I don’t really know. I’ve personally received phone calls from AI, so I don’t know if it’s phone-based. It’s certainly clear that we’re being spied upon, including me as a reporter. But how would it look? I would guess it would be a very tailored message.

“We know that you wrote this article last week,” or “We know that you pulled these side effects,” so it would be very precise in terms of what the prescriber has done or is doing. Certainly if the prescriber is involved in clinical trials, that would be, “We know that you’re researching this.” But it would be just very targeted to specific facts that are going on.

Kevin Pho: And as far as you know, and I know that we’re really early into this agentic era, in terms of the effectiveness of this, do you have any data or any insight in terms of how effective AI or agentic marketing is?

Martha Rosenberg: Not from the standpoint of the prescribers, but certainly when you look at Wall Street and you look at drug prices, you look at GLP-1 agonists, it’s obvious that this kind of AI marketing is larger than life, and so we know it’s very effective. And one thing that I write about is how health care costs and tax dollars are affected by this.

Kevin Pho: All right. So in your article you wrote about three new pharma marketing tactics, and we talked about AI, so what are the other new pharma marketing tactics we should be aware of?

Martha Rosenberg: Sure. Well, this is not necessarily new, but it was confirmed at the conference, and as a reporter it irritates me a lot, and this would be disease mongering. We make a joke in my area about, you know, do you fall asleep at night and wake up in the morning? You might be suffering from something. So this whole idea of, whoever you are, you might be sick.

They had a seminar at this conference about new disease marketing, and they literally said, they’re not even hiding it, quote, “It creates new markets. We’re redefining education. We’re rewriting the playbook of engagement with prescribers.” So they admit that they’re using disease fears to make money.

Kevin Pho: So what does that look like, disease mongering? Would it just be bringing awareness to a relatively rare disease, or simply talking about it? What does that look like?

Martha Rosenberg: Well, that’s a great question. Disease mongering began with symptom checkers and websites for “Do you have EPI?” or “Do you have depression?” or “Do you have pain?” How could somebody not know if they had pain or depression? But anyway, it began with what they would call awareness.

Then it segued to what we now see, which is influencers sharing their story. One thing we’ve seen a lot in reporting is, quote unquote, “My story really sells.” Somebody says, “Well, I had diabetes.” There are more than 3 million health influencers on TikTok, and so that’s another form of disease mongering that we see.

Another thing, Dr. Pho, is that even general interest magazines, old-fashioned glossy magazines in the bookstore, now monger. “Are you on the spectrum? Are you an adult with ADHD?” So what I’ve seen as a reporter for 20 years is that there’s some kind of sales magic that happens when people self-diagnose with an elusive disease that doesn’t really have parameters.

There are so many of these self-diagnosed conditions. So disease mongering is literally selling a disease. It’s an excuse. Maybe you were late to work, but you might have this mental illness. It’s an excuse, it’s an identity, and it’s certainly a path to sell drugs.

Kevin Pho: Now, you mentioned the role of health care influencers, especially on social media sites like TikTok. Now, as a patient, how would they know that these influencers are sometimes sponsored or paid for by pharma? Are they required to do any disclosures?

Martha Rosenberg: I can’t answer that one, because I don’t watch them. I give them wide berth. I would guess no. But a lot of people have a personality as a podcaster, and of course we know they have a lot of advertisers, and I don’t think they really say, “Well, I’m paid by so-and-so.” I don’t think they do, but I really can’t answer that, because I just avoid them.

I will say this: When I’m here in Evanston, on the Northwestern campus, and you go into the medical waiting rooms, you see what look like magazines that are actually pharma communications designed to look like magazines. So that’s influencing. But as far as the podcasters, I can’t tell you that.

One thing I do know from being in this field for a while is that the ultimate sales energy is from friends, and social media figured this out a long time ago. If your friends are eating this or wearing this or saying this, that will influence people. So certainly with social influencers, if you look a certain way, you want to be like her. I would guess that the social influencers are more effective than even what they do with the prescribers, because you relate to them.

Kevin Pho: Now, you wrote in your article that in Maryland, for instance, there’s a bill that would force disclosure of pharma funding for some of these disease awareness campaigns. Now, tell us more about that.

Martha Rosenberg: OK, so now I don’t know the fate of this bill, but last month a bill was introduced in Maryland to force disclosure of pharma funding. The part that I’m intrigued with is that a lot of so-called patient advocacy groups are funded by big pharma. So they would be forced to say, “Well, 70 percent of our funding comes in from pharma.” The bill would try to separate what’s really medicine from what’s hype and marketing.

I feel naturally there’s going to be antipathy against that, because so many of our lawmakers federally are funded by big pharma, including their reelection campaigns.

Kevin Pho: The other distinction that you made in your article that I found interesting was a shift from direct-to-consumer advertising to direct-to-patient marketing. So give us a sense of what exactly that distinction is and why that’s important going forward.

Martha Rosenberg: Well, that’s a very important point in the article and at the conference, because we’ve seen direct-to-consumer ads for more than 20 years, the ones that say “ask your doctor.” The move from drug makers in that sector is to direct-to-patient, which would be, as we talked about, pharma-funded practices. Sometimes they’re in strip malls. A lot of times they’re on the internet, and they have nothing to do with a hospital or actual medicine.

We hear a lot about PBMs and the cost. What I’m seeing here in Chicago is that the CVSes and the Walgreens are circling the drain because pharma’s going direct to the patients. So direct-to-patient, I don’t know if the motive is to bypass the FDA, but it certainly has the effect of bypassing the FDA, because we know the FDA will not really allow incorrect ads or marketing.

So direct-to-patient would be just grabbing their space and, you know, there’s an instant, we know on the internet people like instant results. It’s like, “See a doctor now about your insomnia, and get your drug tomorrow.” Well, the FDA, as I’ve worked with them, doesn’t want that. That’s snake oil, you know?

Kevin Pho: So are we talking about bypassing physicians and offering tests? What are some examples of this direct-to-patient marketing that you’re talking about?

Martha Rosenberg: Well, that would be disease mongering to sell drugs. In other words, I see this sometimes on the internet. “Are you on the spectrum? Talk to a doctor now. We can get your medication tomorrow.” The bypassing, Dr. Pho, would be things like just giving you a questionnaire rather than an office visit, and certainly the prescriber is paid by the drug company. There’s no mystery about that.

When you see these little offices, they’re pop-ups. They’re pop-up drug sales offices. All the material and the pamphlets are from GSK or from Eli Lilly or Merck. So there’s not really an attempt to pretend to be with a hospital or a practice.

Kevin Pho: Now, is there a case that some of this less overt pharma marketing can be helpful in keeping physicians up to date on some of the latest drugs and treatments and diagnostic paths? Because, as you know, doctors are busy, and sometimes they aren’t able to keep up to date on the latest journals. And sometimes this information, being less overtly pharma-branded, is there a legitimate educational component? Can that case be made at all?

Martha Rosenberg: Well, you make a good point. I think the lack of time that prescribers have is a real factor in both selling and knowledge. I would say, I hate to say this, Dr. Pho, but a lot of news outlets have now grabbed onto journal news, and the journal says this drug prevents dementia, and it’s the clinical trial, and it’s just a surrogate endpoint anyway. But the clinical trial was sponsored by a drug maker, and that news byte will be presented by outlets as news.

So my worry is that prescribers hear that and they think, “Oh my goodness.” Well, that’s marketing. That’s just marketing. So in answer to your question, I would tell anyone who is a prescriber, including nurses and nurse practitioners, to go to their peers and peer groups, because that would be more free from the marketing influences.

Kevin Pho: We’re talking to Martha Rosenberg. She’s an investigative reporter. Today’s KevinMD article is “Three new pharma marketing tactics every physician should know.” Martha, as always, let’s end with some of your take-home messages that you want to leave with the KevinMD audience.

Martha Rosenberg: Oh, thank you, Dr. Pho. I would just ask prescribers and patients to be cynical and skeptical of all the messages they get, especially when they’re frenzied and overnight and dramatic and breaking news. Be cynical, because really good medicine, as you know, takes a while. It’s not overnight news. So I’d say be skeptical, be cynical. The selling that’s going on now is very stealthy.

Kevin Pho: Martha, thank you so much for sharing your perspective and insight, and thanks again for coming back on the show.

Martha Rosenberg: Thank you. Thank you.