Dilemmas in the Pharmaceutical Industry
 The pharmaceutical industry is one of the biggest and richest industries across the world. The industry offers a lot to be learned on the efforts of international experience particularly in the control of the spending in the industry as well as in the improvement of access and efficiency in pharmaceutical markets. The industry motivates the policymakers to reinvent multiple policies aimed at controlling the behavior of doctors, patients and promote the effectiveness of the industry. Therefore, it is evident that the pharmaceutical industry faces multiple ethical, legal and political dilemmas. The paper, therefore, seeks to analyze the unethical marketing practices in pharmaceutical industries.

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 The global pharmaceutical industry has seen more drug liabilities being costly, publicized and frequent. Such liabilities in the industry have massive impacts on the perception of the patients, the practice of the physicians, medical communication and clinical research. Although most people have advocated for enforcement of the ethical guidelines and codes of conduct for marketing features, lack of enforcement and monitoring limits the impacts of such guidelines (Resnik & Elliott, 2016). Ethical concerns in the pharmaceutical industry have been perceived quite negatively for quite a long time and employed in highlighting the scrutiny evident in pharmaceutical companies. Some of the most common issues discussed in understanding the legal dilemmas include data disclosure, safety, and pricing of drugs, clinical study design, animal testing, marketing restrictions and growth of counterfeiting drugs (Ahen, 2017). Therefore, corporate social responsibility is an important aspect of the pharmaceutical industry. The definitive ethical objective in the industry is aimed at developing and discovering efficacious and safe drugs that provide long life for the patients, more productive and healthier lives while ensuring the industry makes a profit and rewarding the shareholders and more investment in research studies for the next generation medicines in the industry.  
 It is as well important to note the pricing of drugs which raises multiple concerns on sound management particularly in reference to meaningful R&D costs as well as the public perception of wasteful advertising. Although there are multiple calls for enforcement of mandatory drug registry of clinical trials, clinical data must be heavily understood to relate the business and science aspects of the pharmaceutical industry (Resnik & Elliott, 2016). More specifically, clinical data is essential in the approval of new drugs’ sales. In instances where the company has to comply with the various ethical standards and concepts such as commitment to the objectivity in science and protection of all people involved in clinical studies, the clinical researches must be approved and be for good cause (Fusch et al., 2017). Nonetheless, the pharmaceutical industry must understand the importance of maintaining transparency in carrying out inherent research as well as on the research inferences to alleviate the fears on potential misuse of genetic data and information. Developed drugs, therefore, should have their needs and marketing prescribed in the industry.
 Notably, marketing and sales practices in the pharmaceutical industry form potential ethical transgressions such as the provision of incentives and gifts to the physicians, the promotion of the benefits of the drugs and application of only approved drugs. More specifically, it is vital to understand the pricing issues and interactions of pharmaceutical companies with the government to create coverage and reimbursement levels for the industry (Pozgar, 2019).  The primary interface between patients and pharmaceutical companies make the physicians in the industry to be the marketing and sale efforts targets in most cases. The sales and marketing practices appear quite costly and can add up to more than the company’s spending on R&D.
 Moreover, heavy regulation in the industry remains to be one of the concerns and facilitators in safeguarding the pharmaceutical industry, especially against corruption. Heavy regulation is important in safeguarding the communities against the common unfair pricing of drugs and the production of sub-standard drugs as well as in strengthening the economic competitiveness through the industrial policies (Resnik & Elliott, 2016). Such a measure is quite likely to improve efficiency and innovation in the industry.
Evergreening Practices
 Evergreening refers to the application of strategies whereby pharmaceutical companies employ the use of minor drug modifications and application of patent laws to extend their drug monopoly privileges. Such strategies are developed far before the patent expiry dates of the drug especially if it is a case of high revenue drugs. The most commonly adopted evergreening strategies include redundant creation and extension of next-generation drugs which lead to superfluous variation to a new product in the industry before it is patented as a new application (Pozgar, 2019). In other instances, there have been exclusive partnerships with players of nonspecific drugs in the market before the expiry of the drug patent, and significantly enhance the value of the brand and interim earning of the product royalties.
Impacts of evergreening
 Evergreening practices lead to the deferred entry of generic drugs into the marketplace with more leeway of the patent of the unique drug and rivalry between the generic drugs and the patent-protected minimally altered drug variety. Such a measure is quite likely to improve the reimbursement costs of drugs by keeping the generic versions of the drug considered cheaper and partly out of the pharmaceutical market (Lipowski & McKercher, 2016). The evergreening practices have been heavily defended by the pharmaceutical companies on the claims that revised formulas are important in benefiting the drug industry as well as the patients.
According to Ahen (2017), the dilemmas faced in the pharmaceutical industry can be extensively solved through improved transparency in the industry. Pharmaceutical industries like any other industry is likely to experience conflicts between the expected profits and the ethical standards expected by the consumers. The only difference is that pharmaceutical industry can have their activities suspected, detected and labelled unethi9cal by their consumers. Patients may find it quite difficult to tolerate unethical behavior in the industry, and will go to an extent of involving the stakeholders and the media which may exaggerate the situation. Therefore, pharmaceutical industries need quite effective and string corporate governance especially because these companies have massive effect on human health. The consumers in the industry believe that the pharmaceutical companies have the duty and responsibility of providing steady supply of medicine for saving the people, and no mistake should be tolerated in such vital companies. Pharmaceutical companies are expected to emphasize the significance of transparency at every stage of the operations especially on its political contributions, corporate governance, financial disclosure, executive compensation and lobbying. High transparency in the company is important in addressing the shareholders’ need for information and ensuring maximum return of their investments. Moreover, pharmaceutical industry is known for its long-standing and well structure that has enabled it to have a stronger impact on the society (Ahen, 2017). The tight scrutiny and pressures on the industry from the media, NGOs, the public and legislators emphasizes the need for transparency to avoid most of the dilemmas the industry has been known for in a long time.
 Although there have been constant complaints from the patients on the affordability of drugs, the insurers continue to protest specialty costs of drugs that have forced them to jack up premiums. The pharmaceutical industry believes that spiking pharmacy costs are responsible for the painful coverage trade-offs. In the United States, for instance, politicians have advised on the negotiation by Medicare with the manufacturers of drugs in the industry. Ensuring the affordability of drugs for the society and the individual patients is such a sensitive and complex issue that cannot be solved through political approaches only (Fusch et al., 2017). Alternatively, the willingness of society to target profiteering on older branded pharmaceutical drugs and generic drugs can be used to solve the pricing challenges in society.
Conclusions
 Ethical, political and legal dilemmas in the pharmaceutical industry remain to be quite complex issues and can occur at any stage such as during dispensing, distribution and manufacturing. The industry is likely to consider ethics as a major in every decision made in the industry. It is, therefore, important that ethics are integrated into every aspect of organizational and individual functioning in the industry. The pharmaceutical industry and healthcare professionals need to work together and ensure quality healthcare services and products based on the codes of ethics. The bad reputation in the industry makes most people believe that there are bad intentions of the products and services and quite likely to cause life and death on an individual. The right to health should remain an ethical imperative to all individuals rather than an economic equation as perceived in the pharmaceutical industry. It is morally wrong for the industry does not need to pursue profits at the expense of all individuals who need access to vital life-saving drugs. All healthcare professionals need to understand the need to avoid engaging in practices that are likely to represent unethical practices and unnecessary costs. The paper has extensively discussed the dilemmas in the industry and the need for ethical leadership in the industry.
References

Ahen, F. (2017). Responsibilization and MNC–stakeholder engagement: who engages whom in the pharmaceutical industry? In Stakeholder engagement: Clinical research cases (pp. 87-112). Springer, Cham.
Fusch, P. I., Ness, L. R., Booker, J. M., & Fusch, G. E. (2017). The ethical implications of plagiarism and ghostwriting in an open society. Journal of Social Change, 9(1), 4.
Lipowski, E., & McKercher, P. (2016). Structure and Dynamics of the Pharmaceutical Industry. In Pharmaceutical Public Policy (pp. 211-224). CRC Press.
Pozgar, G. D. (2019). Legal and ethical issues for health professionals. Jones & Bartlett Learning.
Resnik, D. B., & Elliott, K. C. (2016). The ethical challenges of socially responsible science. Accountability in research, 23(1), 31-46.