For the past couple of decades, the healthcare market has gradually made it more difficult for drug companies to market their products.

Initial constraints — mostly in teaching hospitals — were imposed as a way to reduce pharmaceutical influence on prescribing practice, especially among vulnerable medical students and residents. These constraints became increasingly more prevalent as institutions and managed care organizations tried to protect the integrity of their drug formularies from the undue pressures from drug companies.

Then, the pharmaceutical industry was hit with seemingly endless public disclosures of unethical and sometimes illegal marketing and sales activities, resulting billions of dollars of fines and settlements.

The heightened concerns about the questionable motives of drug company sales representatives and the Internet-facilitated access to information led more hospitals and physicians to justify limiting and outright denying access to sales representatives. Restricting access also became a business necessity as physician time priorities shifted to seeing more patients in a day so as to maintain practice financial feasibility.

As a result, drug company marketing has tried to reach prescribers, formulary decision-makers and even patients with a variety of nonsales rep tactics, including Internet advertising, social media and television ads.

So why is all this important? Don't doctors know how to prescribe drugs? Aren't there prescribing guidelines and best practices? Can't doctors just go to the Internet or their smartphones to find a treatment for a patient if they don’t know what or how to prescribe a drug? More importantly, shouldn't doctors know how to treat patients without pharmaceutical company influence?

For established products and common therapeutic areas that may be true, and you wouldn't expect there would be much of a role for drug company marketing and sales.

But what about a new product or a new indication? What about a change in dosing or a side effect that is now seen to be more prevalent and serious than anticipated from the limited preapproval clinical trials? How do physicians learn about these?

If drug companies have no access to prescribers or if drug company information is considered too biased to be of value, how is a prescriber to learn about these new products or changes to prescribing information? If you happen to practice in a teaching institution medical center, you have a much better chance of learning about these changes from a nonindustry source.

But even in these situations, where would the original information come from and how would the drug company get the information to those who need it? Scientific and medical journals perhaps? Internet discussions? News releases from the company? Snail mail or email notification? Who should be responsible for the communication if drug companies are to be excluded from the drug information dissemination process?

Perhaps the least biased way would be by some formal communication from the FDA directly to all healthcare professionals notifying them of new products and any changes in prescribing information for existing products.

In the United States alone, there are more than 800,000 practicing physicians, more than 250,000 nurse practitioners and physician assistants, and almost 300,000 pharmacists who must stay current with drug information. To exclude drug companies from the drug information dissemination process seems unconscionable.

This is a huge responsibility for institutional medicine to assert that it is capable of fulfilling this role without the help of pharmaceutical companies. I'm also torn by the fact that drug companies are held responsible and accountable (legally and financially) for fully informing prescribers and patients about the products they market.

When institutions or prescribers refuse access and/or decide to ignore critical drug information provided by drug companies, it seems that these constraints become a convenient defense of ignorance when their patients are denied access to a new treatment or when patients experience a serious adverse reaction.

So, how could important drug information be disseminated to healthcare professionals while still limiting drug company influence?

Well, healthcare institutions and insurers could establish a communications channel that allows for drug companies to introduce critical drug information for expert review prior to dissemination. This information would be packaged by the drug companies in a technical document (not marketing or advertising) with suggestions for how the information might be presented to prescribing physicians within the scope of the institution or insurer.

The drug company may propose using its sales resources to get the agreed-upon information to physicians in a nonpromotional, informational presentation. This collaborative effort to inform physicians could work.

It becomes a little more challenging when the institution or insurer wants to completely eliminate drug company involvement, especially when they decide the information is not worth the effort to disseminate or is not in the best interest of the patient or their members.

Or, even more troubling is when they decide disseminating the information is just not in their financial best interest. Unfortunately, given the drug company's legal responsibilities to inform and the unlikelihood that institutions or insurers would indemnify the drug companies of this responsibility, this is not a realistic option in these situations.

The important point here is that drug companies frequently have important information that needs dissemination in order for patients to benefit from new treatments and to avoid harmful and potentially life-threatening adverse reactions. As much as some might feel it is in the best interest of patients to completely eliminating drug companies from this process, the reality is it doesn't seem feasible, nor is it actually in the best interest of patients.

How and what drug information is disseminated is really the issue. Because the traditional drug company methods are no longer tolerated or effective means new acceptable communication channels for disseminating drug information are needed. This will require creativity, innovation and a collaborative effort on the part of drug companies, healthcare institutions, insurers and prescribers.