INTRODUCTION

Jean-Paul Gaudillire and Ulrike Thoms

Who will pay for this? was the headline of a short article published in May
1974 in the critical German journal Arznei-Telegramm (Drug Telegram), an
independent, advertising-free bulletin that had been published since 1969. The
article was supplemented with a table containing data from market surveys conducted by the renowned Institute for Medical Statistics.1 The table showed that
the twenty-five leading German pharmaceutical companies spent nearly DM
250 million each year to cover the cost of advertising in journals, mass mailing and pharmaceutical representatives visits to physicians offices.2 One firm in
particular came under special criticism: Nattermann, a pharmaceutical company
which accounted for nearly 20 per cent of this expenditure.
This did not come as a surprise to the authors given that Nattermanns drug
portfolio depended mainly on the much-discussed Lipostabil, an essential
phospholipid used to lower blood cholesterol levels. As the authors of the article stated in their short notice, however, Lipostabil was obviously ineffective.3
They also suggested that only ineffective drugs needed to be advertised at all.
This was therefore a case of double waste since a lot of money was spent on
advertising rather than on more useful actions and, on top on that, the drug
would not even cure patients.
Unsurprisingly, Nattermann did not take kindly to this criticism and filed
a lawsuit against the Arznei-Telegramm. The firm complained of unbalanced
reporting and demanded that the journal stop publishing negative results without including positive outcomes too. Instead, the Arznei-Telegramm justified its
article with citations from the recent American and German medical literature.
Above all, it pointed to the fact that the drug had not been licensed in the USA,
where the Food and Drug Administration (FDA) allegedly only allowed the
marketing of efficient drugs. Ultimately, the court ruled that the journal was free
to choose which articles it would publish. This would not be the end of the story
for the Arznei-Telegramm. It continued to request that Nattermann explain

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why its advertising material insistently claimed that the drug was effective even
though positive effects were at best unproven, if not purely imaginary. The
Arznei-Telegramm ironically mocked the firms use of imprecise terms and formulations, for instance in adverts stating that Lipostabil support[ed] expansion
of the collateral and took over its protection.4 This statement in the advertisement seems to be intended as an expert claim but is obviously meaningless. The
editorial board finally explained complacently that Nattermanns owners had
refused to answer their questions on efficacy, while a specialist in internal medicine filed another lawsuit in which he accused the firm of misleading advertising.
These events are not as spectacular as the drug scandals that in the past twenty
years have attracted the attention of many observers from the media, the political
world or academic circles, including the social sciences. The Arznei-Telegramm
was, and still is, a journal with a relatively small audience, read by physicians only.
Lipostabil-type altercations are however routine in the contemporary world of
industrial pharmacy. This was one example out of dozens every year of recurrent
and everyday struggles between pharmaceutical firms and their critics, physicians
as well as muck-raking journalists, who often play the card of evidence-based
medicine while the industry claims that its investments in research and development (R&D) provide the basis of the quality of its products.
Claims and counterclaims are nonetheless not made on a level playing field.
Although they are both competing for doctors and patients attention, the
pharmaceutical industry and its critics are not playing the same game. Their
respective resources and scale of operations are barely comparable. This becomes
obvious when considering the ability to launch investigations and produce data,
but it is also true of communication. At the time of the Lipostabil discussion,
practising German doctors were confronted with a massive amount of information on new drugs, their effects and their uses. As EMNID (Erforschung der
ffentlichen Meinung, Marktforschung und Meinungsforschung, Nachrichten,
Informationen, Dienstleistungen), an institute for opinion and market research,
had already stated in a 1958 survey, doctors were getting increasingly irritated
with the massive amount of leaflets, brochures, adverts and mailings they were
receiving.5 Given the asymmetric power between pharmaceutical firms and
single physicians, doctors had indeed many reasons to feel overwhelmed by marketing campaigns and incapable of deciding whether the claims on safety and
efficacy they spread were reliable or not.
This is the visible face of the scientific marketing of drugs as it has existed since
the 1960s: a problematic by-product of the transformation of pharmacy into a
fully fledged capitalistic industry; an industry that finances its massive research
activities with high income from drugs that are protected by patents and are marketed aggressively. Beyond this visible face, scientific marketing is more than just a
problem of conflict of interests and boundaries between science and marketing. It

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is rather a work of articulation and association through which science facilitates

the construction of drug markets while the latter inform the making of relevant
knowledge. Scientific marketing is based on complex arrangements for making
market-relevant knowledge and to establish it between many different actors
beyond drug representatives and their physician targets, including professional
associations, administrative bodies, government scientists, lawyers and academic
researchers. These arrangements touch upon questions of professional expertise,
administrative regulations, public health policies and market-based mass consumption of therapeutic agents.
These linkages as well as the conflicts between science of drugs and their
marketing do not come out of the blue. There is a vast amount of literature on
the practices of pharmaceutical marketing provided by investigative journalists,
former executives of marketing departments or health economists.6 Business
historians have examined the development of the pharmaceutical industry and
pharmaceutical companies as a typical example of modern corporations investing
in R&D.7
Historians of science and historians of medicine for their part have reminded
us that drug marketing must be understood against the background of the larger
process of industrialization, standardization and the increasing reliance of pharmacy on laboratory sciences. What the work of S. Chauveau, V. Quirke, D.
Tobbell, D. Carpenter, W. Wimmer and many others in the past fifteen years
teaches us is that post-war reorganization of the Western world of drug making
can be characterized by five main features: (1) the changing scale of a market
increasingly supported by the extension of benefits provided by health insurance ; (2) the mergers and disappearance of vast numbers of small family-run
firms that had originated in pharmacies established by graduate professionals; (3) the introduction of whole new classes of drugs, opening the door to
chemotherapy in areas that had either not at all been working with therapeutic
substances (cancer) or not doing very successfully with them (tuberculosis); (4)
the rising importance of administrative rather than professional or industrial
regulation; which led to (5) the generalization of chemical-biological-clinical
screening as the dominant path to drug invention, which in the eyes of most
firms gave them the possibility of finding radically new active substances rather
than copying, modifying and combining those included in the pharmacopoeia,
therefore legitimizing massive investments in internal research infrastructures.8
The advent of scientific marketing must be placed against this background.
Until the late nineteenth century, drugs in their majority were prepared in
pharmacies and apothecaries, where a learned craftsman whose expertise was
guaranteed by the possession of an academic diploma was obliged to provide
the population with the drugs described in the national pharmacopoeia and in
turn received some legal protection of his rights by the state. Nevertheless, from

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the mid-nineteenth century onward, drug production was increasingly taken

over by industrial companies, some of which had developed out of traditional
pharmacies, such as Dausse, Roussel, Merck, Schering or Boehringer, while others like Bayer or Rhne-Poulenc were chemical companies entering the drug
business.9 Industrialization did not only mean changing the scale of production,
it also implied the making of new products and practices. This is well illustrated
with the changing status of the pharmacopoeia.10 These regulatory tools participated in the standardization of drugs but their aim was to establish references
for the preparative work of pharmacists; they contributed less to the regulation
of industrial activities than to the regulation of professions, i.e., of the duties
and rights of the pharmacists and of the division of labour between them and
physicians.11 When the industrial production of pharmaceutical substances took
off in the late nineteenth and early twentieth centuries, it went together with
the development of different kind of specialities, i.e., mass-produced, standardized and possibly purified. Parallel to this process the long-discussed balance of
power between doctors and pharmacists was replaced by new arrangements, new
ways of regulating, which furnished the industry with ever greater impact on
the structure of the drug business.12
The escalating role of the industry has therefore not gone unnoticed in the
history of American and European medicine and pharmacy. Investigations have
however often focused on the production of knowledge and on the role of industrial research.13 What is often forgotten is that the industrialization of pharmacy
was part of more general developments in business and corporate capitalism.
As a consequence, and although an interest in the general history of marketing
has emerged in the past years, especially in the US context, the history of pharmaceutical marketing has been neglected.14 Only recently Jeremy Greene and
Elizabeth Watkins in their path-grounding work on the history and changing
patterns of medical prescription in post-war United States have carved out the
dense web of relations linking practitioners and industry in a world increasingly
associated with clinical trials, quantitative risk of diseases, and new modes of
scientific promotion.15
One may wonder about the reasons for a neglect that is especially striking
when it comes to the European history of pharmacy. One explanation may be
that the drug business is often seen by the actors involved but also by historians and social scientists as something special because what is at stake are not
only drugs but peoples lives. This special dimension is used to argue about the
inevitable conflicts between public health and the logic of the market. Ironically,
it is also mobilized to advance the opposite argument, i.e., that pharmaceutical
companies are atypical corporations because their unique goal is not just profit
making given that they are dealing with health, they have as a consequence
adopted ethical practices by investing in proper drug evaluation and refrain-

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ing from aggressive marketing and false claims. These two positions are utterly
incompatible unless the role of the market is seriously considered, which is to
create both use value and financial value. In this respect, there is nothing atypical
about the drug sector.
As clearly revealed by the history of drug patents and their problematic normalization during the twentieth century, the specificity of the drug sector is less
a question of ethics than a problem of balance of powers and of the relationship
between the industry (which replaced producer pharmacists) and practising
physicians.16 The professional medical organization and the existence of state
regulations that mandated prescription for the most powerful (eventually dangerous) drugs prevented firms from advertising or marketing many of their drugs
directly to patients and final consumers, who were seen as lacking the necessary
knowledge to evaluate the usefulness of a treatment and its alternatives.
Just as pharmacists had opposed patents, in the early twentieth century most
doctors refused advertising for drugs and pointed to the secret-remedy trade
as a reprehensible business making false promises and exaggerating the effects
of drugs.17 The growing role of the industry changed this perception. In order
to distance themselves from these dishonourable practices, the so-called ethical firms developed a business model that focused on the central role of the
physician as prescriber, addressed them rather than the end buyers, and underscored the scientificity of both their production and clinical claims. This first
mode of scientific promotion was not based on in-house research but rather on
informal, quite personal collaborations with selected university scientists and
hospital physicians.18 This was by no means a one-way relationship as physicians
and clinicians benefited from a connection that allowed them to access new substances or technical knowledge while opening new opportunities for them to
carry out trials, publish articles and establish themselves as renowned scientists.
Firms would then feel free to use this research for promotion.19 They produced
abstracts or offprints, which were then sent out to doctors or brought to them
by representatives, who would then use the content as an entry point for conducting a conservation between scientists, thus paying tribute to the physicians
claim to being a man of knowledge and expertise.
Initially, this model was rather successful. After all, it acknowledged the
prestige of physicians and scientists by giving them access to technologies and
production sites while making the knowledge of the latter available to the companies. What made it obsolete during the second half of the twentieth century
was the changing scale and nature of the operations performed by pharmaceutical firms. With the transition from advertising to marketing , the focus
moved from mere selling to building markets by mobilizing science. This move
embraced three different developments, which will be analysed in the contributions to this volume.

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First, advertising was professionalized: new publicity agencies specializing in

pharmaceuticals sprang up. In the same line, special textbooks on marketing were
written, often based on the practice of existing firms, which had developed their
own curricula for their apprentices, trainees and young employees. Second, and
at the same time, marketing developed as a research activity going far beyond
the observation of sales figures and their analysis and focusing on techniques for
planning and building an organization centred on therapeutic classes and product divisions.20 Third, this was linked to massive changes in the nature of the
research conducted by drug companies. These changes included the growth of inhouse R&D capabilities, the generalization of large-scale screening procedures,
an increasing emphasis placed on chemistry, purity and molecular structures, and
the organization, by the companies themselves, of controlled clinical trials.
All three developments began before the beginning of World War II, partly
as responses to the economic crisis of the 1920s and early 1930s, but they
achieved their full potential after 1945 in the context of the therapeutic revolution. Marketing then became scientific in two different ways: (1) it evolved into
a research activity, which was observed, analysed and steered according to the
newest findings of social and communication sciences; and (2) it increasingly
mobilized biomedical research to build drug markets.
Instead of presenting innovations to be advertised and accepted or rejected,
the firms now tried to understand competition and the structure of the market, how physicians prescribed, the needs of patients and the epidemiological
landscape. Research not only provided knowledge about market niches and
putative new drug use, but helped to integrate promotional activities into uniformly and purposefully designed marketing campaigns. This process was not so
much connected to the use of new advertising channels given that the arsenal
of advertising means already covered the whole range of communication channels in the 1920s (print advertising in the professional and lay press, flyers, shop
window advertising, posters, films and drug representatives) as it was related
to the integration and scaling-up of all these tools.
Second, during the same years, marketing developed into a series of practices that not only used scientific facts as advertising arguments, but merged
pharmacological and clinical research with promotional activities. Firms did
not only spread scientific knowledge; they began to shape research and scientific
discourse on the basis of perceived market potentialities. The internalization of
clinical research was in this respect a decisive development. It not only meant
that toxicity and efficacy trials were increasingly financed and coordinated by
company managers and salaried physicians, it also produced a new integrative
space. In the 1960s and 1970s, marketing and medical research departments
of large drug companies increasingly worked together and finally joined to form
departments that organized all activities related to single drugs from research to

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advertising. This implied that new substances were tested with an eye not only
on the regulatory exigencies but also on the future marketing campaigns, while
new screening targets and procedures were intentionally defined according to
market surveys and feedback from the promotional apparatus. With their own
clinical research departments, firms would from the 1960s and 1970s onwards
actively participate in the definition of medical practices, categories and needs.
This in turn implied a new hierarchy of marketing tools such as: (a) the growing
role of printed material resembling academic journals and reference manuals; (b)
encounters such as conferences where company scientists and physicians could
meet and key opinion leaders be identified, addressed and used as multiplicators; and (c) sponsorship of medical societies and cultural events.
The analysis of the rise of scientific marketing presented in this volume
evolved from a French-German research project entitled From Advertisement
to Marketing: Pharmaceutical Enterprises, Patients, Physicians and the Construction of Medical Markets. The aim of the project was not only to explore the
validity of the two regimes hypothesis outlined above but also to gather information on the specific trajectory of drug marketing in Europe to foster comparison
with the less badly known developments in the United States. Such comparison
was badly needed given the stronger role played by the professional organization
of pharmacy in Europe, the longer history of many firms with a background in
apothecaries, the early socialization of drug costs or the (relatively) late generalization of marketing permits, administrative regulation and clinical trials. The
project was jointly financed by the Deutsche Forschungsgemeinschaft and the
Agence Nationale de Recherche from 2009 to 2012.
It ended with a conference called The Birth of Scientific Marketing organized
in Berlin in June 2012 at which drafts of most of the chapters in this volume were
first presented and discussed. In contrast to a previous series of papers published
in History and Technology and focusing on the two regimes of drug promotion,
this collection addresses the post-war changes and the dynamics of scientific
marketing in Europe. This allows for a more specific understanding of the two
meanings science has taken in the set of practices, which became standards of
drug market construction during the therapeutic revolution, i.e., the mobilization of biomedical, first of all clinical, research and increasing reliance on market
research while planning firms operations. Moreover, the focus of these papers on
development in France and Germany helps understand how, within the context
of an increasingly global market, the practices of US companies as well as the
regulatory requirements of the FDA became pervading references in spite of the
longer history of scientific marketing in large European firms, especially German
ones. In other words, the new glocal nature of drug markets proved critical in
generalizing the system of professionalized and knowledge-based marketing. The
volume is accordingly organized into three parts.

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The first three papers are centred on marketing research and the problem of
innovation, which is considered to be one of the pharmaceutical industrys major
driving forces. Pharmaceutical companies marketing strategies strongly insist
on the revolutionary, ground-breaking or simply innovative character of newly
introduced products. Even critics who question the innovative character of many
pharmaceutical products by asking whether they are true innovations share the
idea that the main goal of pharmaceutical companies should be innovation.
As Nils Kessels paper agues, innovation as an essential condition for both
medical and entrepreneurial progress has so far dominated the history of drugs.
A closer look reveals, however, that new substances, or the improved efficacy
or the increased safety of a product, do not necessarily reflect the structure of
consumption, which may be seen as the result of the consumers expectations
with regard to drugs. In fact, the story of post-war drug consumption and marketing is less about innovation and more about tradition than the blockbuster
stories nourished by media attention and launch narratives would like us to
believe. Nils Kessel thus points to the market relevance of therapeutic groups
such as cough and cold medicines, laxatives and anorectic drugs, which are often
neglected and regarded as non-scientific, empirical and traditional, if not oldfashioned, and should not have been able to compete with the iconic products
of the therapeutic revolution seen in the glossy advertisements of today. Using
sales figures, the paper is a counter-narrative to the story of a seemingly almighty
pharmaceutical industry, which uses marketing successfully to place drugs on
saturated markets in order to sell the new, where in fact both physicians and
consumers prefer old, well-proven products. The paper underscores the fallacies of following the narrative of permanent innovation that drug companies
have used time and again in their marketing campaigns and is still used today
by associations of pharmaceutical producers in their public relations campaigns.
Ulrike Thoms in her paper questions innovation from another angle, referring
to the pivotal role it plays in the self-promotion of pharmaceutical companies as
scientific and ethical. The novelty of certain products has been used as a major,
if not the central sales argument in almost every branch of industry from the
very beginning of advertising , but nowhere has it played a greater role than in
the pharmaceutical sector. Here it has not only been a sales argument, it has also
proved a crucial element in competition and thus a precondition of economic
success, as only new drugs are granted the patents that will protect the producers
and help them achieve high profits. These mechanisms are rather old, but in the
postWorld War II era they became central to the success of new drugs for two
reasons. First, while the number of really new and innovative drugs decreased,
research expenses increased enormously. The planning of research and costly
promotion thus played an ever-growing role. Second, only new and improved
drugs were allowed to enter the market and were protected against imitation.

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The paper then explores how the life-cycle concept, which until today is an
indispensable part of the theoretical toolbox of business studies, came into being
as a tool to estimate the most probable success of a drug. It shows that the concept
was influenced by the then-emerging field of cybernetics, the organization of science and business studies, which aimed to analyse and grasp the different factors
influencing the trajectory of an industrial product in order to help to estimate
its life span and economic potential. The promise here was to be able to steer
these factors for the sake of increasing sales and profits. A growing awareness of
the new systemic thinking led company marketing departments to be granted
a much more prominent place during the 1960s and 1970s, especially as a new
generation of managers entered the firms, who were familiar with the use of these
theoretical models to forecast future developments. As the paper shows, however,
the pharmaceutical industry did not only use this model for its marketing, which
many believe to have been implemented later than in other industrial branches.
The opposite is true. As with the theoretical model of the opinion leader, which
originates in the context of industry-sponsored social research in medical innovation, the pharmaceutical industry was at the very forefront of investigating
and implementing research planning and its economic exploitation. In parallel,
the life-cycle model as well as the theory of innovation became cornerstones of
entrepreneurial thinking in the drug business and the very foundation of modern
marketing theory. This development was strongly related to the emergence of systems research, which was used to analyse the relations between different actors
in the market and formed part of the development of social science and communication science, which were to become indispensable parts of basic marketing
knowledge and of standard marketing routines. These then helped to minimize
the risks associated with the launch of new innovative drugs.
The final paper of this part, by Quentin Ravelli, broadens the perspective
to the global scale and to the problems and possibly massive consequences of
scientific marketing. Marketing Epidemics discusses the role of scientific data,
which has always been essential in drug marketing: it is a way of convincing doctors to prescribe a firms drugs and to obtain market authorization from public
administrations. This same type of information, often generated by clinical trials, is also used by regulatory agencies to restrain pharmaceutical markets. Here
again, science plays an ambivalent role: as a tool for and as an obstacle to market
forces. Are regulatory agencies really limiting markets by controlling scientific
data? Would it not be more accurate to describe their activity as adapting medical needs to market realities?
The case study of antibiotics highlights this ambiguous role of scientific regulation between states and corporations, medical needs and corporate profit.
Over the last decade, multi-resistant bacteria, known since the 1940s, has
emerged as a global health issue: doctors are now facing clinical dead end situ-

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ations that are not confined to emergency care units only but are threatening
larger outpatient communities. For public health promoters, the solution is to
find new drugs and to limit the prescriptions of older ones, those responsible for
the growth of resistances. Pharmaceutical corporations, however, consider antibiotics as one of the less profitable classes in terms of research investment and try
instead to increase the market shares of their old antibiotics. Trying to fill this
gap, but dependent upon pharmaceutical corporations, regulators do not only
try to restrain marketing activities but also seek to include them in their agenda.
Ravellis paper concentrates on the case of pristinamycin, which was launched
in 1973 for skin infections, but soon shifted its indication to bronchopulmonary infections in 1988. Through genetic and chemical engineering the active
principle was improved and used to create a new product called Synercid, which
obtained FDA approval in 1998. At that time resistant strains had been identified as a major health concern in the United States: a healthcare deal was then
cut between the firm and the agency to authorize a drug both for compassionate
use and for more traditional markets.21 This case shows how scientific regulation
can oscillate between market and public health concerns and how hard it is for
government agencies to counter the enormous financial potential of firms and
their marketing activities.
The second part discusses the changing tools and practices of marketing with
a special interest in the ways in which the professionalization of promotion was
linked to visualization as an essential dimension of scientific marketing. The first
contribution in this part by Stephan Felder, Jean-Paul Gaudillire and Ulrike
Thoms displays the major findings of an extensive analysis of advertisements in
two major medical journals, one in France and one in Germany, during the period
from the 1920s to the late 1970s. The chapter discusses the methodology, then
the choice of an approach that combines quantitative and qualitative analyses.
Based on the evaluation of several thousand drug advertisements, the paper demonstrates that the period under discussion was not only marked by a vast growth
in the number of advertisements, but also by a change in their appearance, structure and informational content. The increasing use of elements such as brand
signs, logos, colours or pictures not only illustrates the professionalization of marketing and the changing fashions in design, but also borrows from the practice of
scientific publishing and brings in more technical information, which is typical of
scientific marketing. Moreover, as the paper shows, there are major national differences that cannot merely be explained by different regulatory frameworks and
practices; these are also related to the two countries different therapeutic cultures
as well as to different consumption patterns in France and in Germany.
Christian Bonahs paper presents medical films as a marketing tool by using
the case of Sandoz. The paper is not centred on what could be understood as
advertising films, which had for instance been used since the 1930s in the form

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11

of animated cartoons to underscore the beneficial effects of certain drugs in

countries with a low literacy rate. Instead it discusses the ambitious artistic and
educational films made by renowned film directors and artists with the support
of pharmaceutical companies who wanted to acquire social and cultural benefits
from their sponsorship. The marketing value of these films was twofold. First,
as they often dealt with general biological and medical topics, they were used
as a vehicle to visualize the effects of specific drugs for the sake of doctors. Second, these films addressed physicians as part of an intellectual elite habitus in a
prestigious way that created a common ground between physicians and pharmaceutical companies in that it referred to education and culture as a social and
cultural capital that they shared. These films were very often artistically innovative and crafted with sophistication by well-known film artists. What was then
at stake was less the shaping of prescription patterns than the establishment of a
shared social and cultural world in which it was suggested that both physicians
and companies were striving for the same goals.
Anne-Sophie Mazass analysis of print advertisements highlights that in
France, post-war advertisements referred to science in a very different mode than
ads from the pre-war period. Advertisements increasingly cited research results
and used graphics or charts, but this was only the tip of the iceberg. Blending
information and promotion involved less direct, more complex visualization
strategies. The systems of signification which integrated research, information and promotion thus connected meanings and products to selected sets of
images, icons, slogans and specific symbols, building new medical narratives. In
France, the development of scientific advertising was immensely influenced by
American practices that were brought to France by French marketers returning
from trips to America and by the translation of American books, and speeded up
by the growth of a massive European market. An additional specificity of developments in France was the regulation of publicity. From the 1950s onwards, a
visa system was set up, intended to reinforce the informative value of advertising
to physicians by stating that if a producer wanted to be allowed to advertise his
product without getting a special advertising permit from the health administration, it had to include a certain number of elements regarding composition,
dose, price, etc. In this framework, visualization was a particular matter of concern. The paper then presents a typology of visualization techniques, such as
tropes, emblems and colour codes by analysing advertisements identified from a
corpus of advertisements combining the GEPHAMA database and the archives
of companies such as Geigy, which sold psychotropic drugs in France.
In contrast to this general approach to visualization strategies, Lisa Malich in
her paper on the French and Western German marketing of oral contraceptives
uses a set of ads from the period between 1961 and 2006 to analyse how ideas
of standardization were represented. Two different uses of standardization can

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be found. On the one hand, the pill was presented as a standard drug that promised safety building on the notion of the woman as a patient in need of medical
advice. On the other hand, in a second phase, during the 1980s and 1990s, the
women taking the pill were, in the promotion material, increasingly diversified.
The advertisements identified bodily differences as well as diverse female gender
roles and consumer types with distinct wishes. In both cases, however, representations of standardization reduced random variability and produced controlled
variation in drugs and women. This way, they emphasized both the safeness and
the uniqueness of the advertised product. Malich identifies strong national differences. In Germany, preparations of synthetic oestrogens and progesterone were
quickly marketed as contraceptive, whereas in France the pill was advertised as a
multi-purpose drug. In a second step her paper analyses how pill advertisements
referred to standardization and how standards were employed.
The other paper of this part, authored by Tricia Close-Koenig and Ulrike
Thoms, demonstrates how insulin was used as an inroad to create an entire
market of products for diabetics. Insulin holds a special place in the history of
biological medical products. The role played by patients in the successful treatment of diabetes was recognized very early on as these had to control their diet,
monitor injections and later survey their blood sugar concentration. Diabetics would therefore not only need insulin, they would also need devices such
as syringes, measuring devices and diagnostic tests. Patient organizations such
as the Deutscher Diabetiker Bund and the Association Franaise des Diabtiques, founded in 1931 and 1938, respectively, helped to convey the necessary
knowledge on treatment and devices to the patients and pleaded for greater
autonomy. As such, they became marketing targets. The paper analyses the ads
in the journals of the mentioned diabetics associations and documents strong
relations between these organizations and the producers of specialized goods
for diabetics. It suggests that diabetics were regarded somewhat differently from
other patients. The state did not prosecute the firms that advertised prescription
drugs such as insulin to laypeople in these journals, although this was prohibited
by law in both countries. The ads are deciphered in regard to the definition or
conception of the diabetic as a consumer of special, remarkably profit-making
goods, showing, for instance, how the ads for insulin and later on for oral antidiabetics were by far outnumbered by ads for special diet products and medical
devices, often produced by the very same firms that sold the prescription drugs.
In this respect, the paper sheds some light on todays pharmaceutical companies
much discussed strategies to use self-help and patient groups, the position of
patients as well as diabetes specialists, and their relations to the industry, to serve
their own economic interests.
The third part of the book pursues the question of the relationship between
science and marketing by focusing more precisely on the first meaning of the

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13

term, namely the mobilization of biomedical research to build markets and

the looping effects of the markets on the development of in-house industrial
research. The paper by Jean-Paul Gaudillire approaches the advent of scientific
marketing by using the case of Ludiomil, an antidepressant developed and marketed by the Swiss firm Ciba-Geigy. It argues that this shift took place towards
the end of the 1960s in the context of the merger between Geigy and Ciba. On
the organizational side it was linked to major changes inside Geigy both in terms
of how clinical research was conducted and how marketing was organized. Until
1970 this work had been structured into two departments: publicity and sales,
and medicine. The new organization occasioned a major growth in in-house
and collaborative research with the development of pharmacological screening
and clinical trials, while the institution of a marketing department led to new
modes of research on prescription and sales. Based on the Ciba-Geigy archives,
the paper analyses how the advent of scientific marketing , i.e., the massive use of
clinical research in promotion and the rise of marketing research for the purpose
of strategic planning, contributed to shifting the boundaries of depression.
In the early 1970s, Ciba-Geigy organized a whole series of initiatives
(workshops, publications and training of its sales representatives, as well as the
enrolment of physicians, general practitioners or specialists in clinical trials).
They concerned the changing status of the disease, what seemed to be its generalization worldwide, how this generalization was related to the changing roles of
psychiatry, the use of antidepressants outside the hospital, and the proper ways
of handling an emerging mass of depressive patients. Special attention is paid to
the ways in which the relationship between the company, a core set of psychiatrists engaged in long-term collaboration with Geigy and general practitioners,
made the problem of depression visible in general practice and stabilized a new
category, masked depression, the diagnosis and treatment of which were widely
advocated through the multi-layered organization of scientific marketing.
Lucie Gerber investigates similar marketing loops by analysing the links
between Geigys marketing and the development of psychopharmacological
screening. As she argues, a whole range of new psychotropic drugs gradually
entered clinical practice in the late 1950s and early 1960s. When in 1952 chlorpromazine became the first chemotherapeutic treatment of psychoses it opened
up a market for such drugs that promised a high sales potential. Nevertheless,
knowledge on aetiological and pathophysiological mechanisms underlying psychiatric afflictions was still very limited, and this posed a severe problem for
developing new drugs quickly and at low cost. The paper examines how animal
models were developed for this purpose and as tools for psychopharmacological screening. Based on printed sources as well as on sources from the Geigy
archives, it analyses in detail how the local understanding of the market structure
and of its prospects nurtured the establishment of a screening system aiming

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The Development of Scientific Marketing in the Twentieth Century

to discover big antidepressants that could compete with tranquilizers. Putting aside the psychological and mental dimensions of depression, industrial
pharmacologists focused on a limited and selected set of secondary manifestations, such as loss of vitality and psychomotor retardation. Once this model was
developed it was exploited for matching clinical targets and commercial goals by
grouping different psychiatric disorders alongside their symptoms. As the paper
demonstrates, with the development of psychopharmacological screening , a
complex feedback system between the market, the clinic and the laboratory was
established, and this led to shifting the focus from diagnosis-based therapy to
drug-induced behaviour change.
Altogether these chapters show that it is possible to develop a history of science and medicine that acknowledges the centrality of pharmaceutical markets
and their complex construction. Drugs are and are not goods like any other.
They are like any other because they are industrial products, massively promoted
and massively used. They are not like any other because the fact that they are
appropriated and commercialized by large capitalistic firms remains a matter of
open controversy as it is perceived as detrimental to health. A history of drug
marketing thus goes far beyond the history of consumption, which emphasizes
discourse and culture and ignores the uneven balance of powers, the hierarchies
and their relations to the making of knowledge and expertise.22 Power is distributed unequally and according to hierarchies; moreover it is linked to knowledge
and expertise, and access to these resources differs enormously depending on the
different groups of people, organizations and professions. As shown in the papers
in this volume, these imbalances have been built not only into the marketing
practices but also and even more radically into the structures of drug companies,
including their research apparatus. Viewed from this perspective, the question of
capture, of the influence of marketing on drug prescription, consumption and
regulation, appears in need of reformulation that will give firms a central but
not isolated and all-powerful role. Marketing can be understood as a technique
aimed at influencing the multiple actors in the pharmaceutical system in order to
increase sales. This works mainly through the collection and production of a vast
body of information as the precondition for taking any action. In this system
agency remains unequal not only because of unequal access to financial or technical resources, but also because of the strong power gradient associated with
unequal roles in the production, control and circulation of biological, clinical,
social and economic knowledge. Taking stock of these differences and hierarchies is a precondition for any reflection on change.

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