Narrative review: the promotion of gabapentin: an analysis of internal industry documents.
BACKGROUND
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.


OBJECTIVE
To describe how gabapentin was promoted, focusing on the use of medical education, research, and publication.


METHODS
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
Most available documents were submitted by the plaintiff and may not represent a complete picture of marketing practices.


CONCLUSIONS
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.
Steinman
Michael A
MA
San Francisco Veterans Affairs Medical Center and University of California, San Francisco, San Francisco, California 94143, USA. mike.steinman@ucsf.edu
Bero
Lisa A
LA
Chren
Mary-Margaret
MM
Landefeld
C Seth
CS
D026683:Advisory Committees; D000588:Amines; D000927:Anticonvulsants; D003509:Cyclohexanecarboxylic Acids; D004345:Drug Industry; D004502:Education, Medical, Continuing; D000077206:Gabapentin; D040541:Marketing / Q000379:methods; D011643:Publishing; D012106:Research; D005680:gamma-Aminobutyric Acid
D000588:Amines; D000927:Anticonvulsants; D003509:Cyclohexanecarboxylic Acids; D005680:gamma-Aminobutyric Acid; D000077206:Gabapentin