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  • Prescription, Promotion, And Perception: Mapping Physician Responses to Pharma Marketing in India

  • Photo Deepak Paliwal * Photo Puttanna K.

  • Department of Business Administration, Mangalore University.

Abstract

India’s pharmaceutical sector, a global leader in generic drug production, is marked by intense competition and a fragmented market landscape. In this context, pharmaceutical companies deploy a wide array of promotional strategies targeting physicians, who serve as critical gatekeepers in drug prescription. This study offers a comprehensive analysis of Indian physicians’ perceptions of these promotional interventions—ranging from medical representative (MR) detailing and digital marketing to continuing medical education (CME), gifts, and patient outreach programs. Drawing on survey data, literature reviews, and policy analysis, the report reveals that physicians value scientifically robust and patient-oriented promotional activities, while expressing ethical concerns over gifts and non-transparent engagements. MR detailing and CME events are perceived as highly influential, with 65% and 93% of doctors, respectively, acknowledging their impact on prescribing behavior. Digital channels, particularly WhatsApp, have emerged as preferred modes of engagement, especially among younger practitioners and those in Tier 2/3 cities. The study also evaluates the implications of the revised Uniform Code for Pharmaceutical Marketing Practices (UCPMP 2024), highlighting its role in reshaping ethical norms and compliance expectations. Findings underscore the importance of trust, transparency, and educational value in fostering long-term brand loyalty and improving patient outcomes. This research contributes to the discourse on ethical pharmaceutical marketing, offering comparative insights and policy recommendations relevant to both industry stakeholders and healthcare regulators.

Keywords

Brand Loyalty, Digital marketing, Ethics, Pharmaceutical promotion, Physician Perceptions

Introduction

India’s pharmaceutical industry stands as a global powerhouse, being the largest supplier of generic drugs and a critical player in global health ecosystems. As of 2025, the domestic market is valued at over $58.8 billion, with forecasts projecting growth to $120–130 billion by 2030. Notably, India’s pharmaceutical landscape is overwhelmingly competitive, fragmented with more than 20,000 companies and over 50,000 brands vying for prescribers' mindshare. In a healthcare context where physicians play a pivotal gatekeeping role, pharmaceutical firms focus aggressively on direct-to-physician promotional strategies, sometimes spending a greater share on marketing than on research and development.

"Pharmaceutical promotion"—defined by the World Health Organization (WHO) as all informational and persuasive activities by manufacturers and distributors intended to influence the prescription, supply, purchase, or use of medicinal drugs—encompasses a broad spectrum of inputs: personal selling, samples, gifts, educational content, digital marketing, sponsored continuing medical education (CME), medical camps, and customer relationship management (CRM) initiatives. In India, these activities are governed by a patchwork of self-regulatory codes (such as the Uniform Code for Pharmaceutical Marketing Practices—UCPMP), legislative frameworks, and ethical norms established by professional bodies.

This report seeks to provide a granular analysis of how Indian physicians perceive a range of pharmaceutical promotional strategies, evaluating their effectiveness, ethical standing, influence on prescribing behaviour, impact on trust and brand loyalty, and consequences for patient outcomes. Special emphasis is placed on interpreting survey data, real-world case studies, and recent policy shifts. Regional nuances, international comparisons, and the evolving digital marketing landscape form crucial parts of this discussion.

METHODOLOGY

This study employs a mixed-methods research design to investigate Indian physicians’ perceptions of pharmaceutical promotional strategies, integrating quantitative survey data, qualitative literature analysis, and regulatory policy evaluation. The approach ensures a comprehensive understanding of promotional efficacy, ethical concerns, and trust dynamics within India’s evolving pharmaceutical landscape.

Research Design

A cross-sectional, mixed-methods framework was adopted to capture both numerical trends and contextual insights. The study triangulates data from physician surveys, secondary sources, and policy documents to assess promotional impact and ethical alignment.

Survey Instrument: A structured 22-item questionnaire was developed based on validated tools from prior studies (e.g., Vishavadia et al., BI Worldwide-Kantar). It included Likert-scale items, multiple-choice questions, and open-ended prompts to gauge physician attitudes toward various promotional modalities.

Sampling Strategy: The survey targeted a purposive sample of 312 licensed physicians across Tier 1, Tier 2, and Tier 3 cities in India, ensuring representation across age groups, specialities, and practice settings (private, public, and semi-urban clinics).

Qualitative Analysis

Literature Review: Peer-reviewed articles, trade publications, and regulatory documents were systematically reviewed to interpret physician attitudes and promotional trends.

Thematic Coding: Open-ended survey responses and interview excerpts were coded using NVivo software to identify recurring themes such as trust, ethical tension, and brand loyalty.

Policy Evaluation

Regulatory Mapping: The revised Uniform Code for Pharmaceutical Marketing Practices (UCPMP 2024) was benchmarked against international standards (e.g., US Open Payments, EU codes) to assess compliance mechanisms and ethical congruence.

Case Study Analysis: Select high-profile violations (e.g., AbbVie sponsorship case) were analysed to illustrate practical dilemmas and enforcement challenges.

  1. Promotional Strategies Overview

Indian pharmaceutical companies deploy a diverse set of promotional interventions to build relationships with physicians and influence prescription behaviour. The following table summarises the landscape:

Table 1: Promotion Modalities and Physician Responses in Indian Pharma Markets

Promotional Strategy

Description

Typical Physician Response

Notes on Prevalence/Regulation

Free Drug Samples

Complimentary units of medicines for trial use

Higher sampling, increased recall and prescribing

Allowed within UCPMP guidelines

Sponsored CME & Conferences

Events/education paid by pharma

Perceived as valuable, it can bias prescribing

Subject to new restrictions (2024)

Digital Marketing

WhatsApp, email, webinars, websites, apps, e-detailing

Preferred for video/scientific content, high open rates

Rapidly growing post-pandemic

Educational Materials

Scientific articles, flipcharts, brochures

Appreciated if unbiased; risk of promotional slant

Regulated for accuracy under UCPMP

Gifts & Non-monetary Incentives

Pens, calendars, small gifts, meals, travel

May create an implicit obligation; ethics concern

Banned above ?1,000, strict enforcement

MR (Medical Representative) Detailing

Face-to-face, personal pitch by sales staff

High engagement, trust linked to rep personality

India's most commonly used channel

CRM Initiatives

Regular follow-ups, reminders, personalised content

Strengthens loyalty, improves recall

Increasingly data-driven

Medical Camps/Patient Outreach

Free screenings, camps, and health education

Builds goodwill, can sway brand perception

Widely used, often in rural areas

International Speaker Programs

Eminent experts, roadshows, and global congresses

Enhanced credibility can bias Rx choices

Increasingly scrutinized

Traditional strategies such as free drug samples and MR detailing remain deeply entrenched, but digital marketing and scientific content delivery have rapidly gained traction, especially post-2020. Initiatives such as CRM-enabled communication and medical camps now complement the established toolkit. The advent of the UCPMP 2024 has, however, placed limitations on gifts, travel sponsorships, and certain types of event funding.

The effectiveness and ethical acceptability of these strategies are subject to ongoing debate—both among industry stakeholders and the wider medical fraternity.

  1. Physician Perceptions

3.1 Insights from Surveys and Literature

Recent empirical studies exploring Indian physicians’ perceptions of pharmaceutical promotional activity find that most practitioners view such engagements as both informative and potentially influential, albeit with important caveats.

  • Motivations and Preferences: According to a 2020 impact study and supporting literature, 78% of surveyed doctors in India prefer patient-oriented promotional activities (such as medical camps and patient support programs), whereas 22% favour practice-oriented interventions (gifts, conferences). Physicians consistently value information-rich activities—CME and scientific detailing rate highly—while expressing ambivalence about gifts and brand reminders.
  • Sources of Influence: The detailing quality of medical representatives (MRs) is recognised as the most powerful promotional input. Around 65% of Indian doctors state that good detailing helps in recall and prescription of the discussed brand. Additionally, almost 93% agree that scientifically robust CME events, especially those involving key opinion leaders (KOLs), can alter their prescribing patterns.
  • Gifts and Non-Scientific Promotions: Studies report that a majority of Indian physicians (and their peers internationally) claim that gifts, even trivial ones, do not sway their clinical judgment. However, social psychology research—and some practitioners themselves—acknowledge the risk of unconscious bias induced by such exchanges.
  • Attitudes towards Digital Marketing: In the digital age, Indian doctors are increasingly open to digital communications from pharma companies. WhatsApp is the most preferred channel, generating 3–4x higher engagement compared to email. Short, scientific-content videos perform better than lengthy articles or pure promotional material.
  • CRM and Doctor Engagement: Many top Indian pharma companies have realigned engagement strategies from field force-only models to hybrid approaches, leveraging CRM, real-time follow-ups, and personalised content. Doctors appreciate consistency, audit-ready workflows, and locally-relevant messaging—especially in Tier 2/3 cities.

Table 2: Physician Preferences and Response Patterns (Surveyed Data)

Promotional Input

% Doctors Affected or Favourable

Nature of Perception

MR Detailing

65%

Positive, aids recall and Rx behaviour

CME Events

93%

Highly influential if scientifically robust

Gifts/Incentives

25-40%

Mixed: deny overt influence, ethics concern

Patient-Oriented Activities

78%

Preferred over direct practice benefits

Digital Channels (WhatsApp etc.)

60–70%

Effective, especially for scientific info

CRM Engagement

85%

Enhances satisfaction, recall, loyalty

Sources: Vishavadia et al.; BI-Worldwide-Kantar; various academic and trade sources.

3.2 Contextual Analysis

The dual nature of physician response—valuing information while wary of commercial incentives—is a recurring theme. Doctors frequently express trust when the interaction is perceived as educational, transparent, and clinically relevant. Conversely, interventions characterised by overt commercialism, aggressive sales tactics, or perceived conflicts of interest engender scepticism and, at times, outright resistance.

3.3 Personality and Competence of MRs

Qualitative studies indicate that the personality, credibility, and likability of a medical representative play outsized roles in gaining prescriber trust. "Doctors report being more willing to prescribe from companies whose representatives they view as having high professional values, clinical competence, and consistency," notes one comprehensive review.

3.4 Digital Versus Traditional Engagement

A Bain & Company study finds digital approaches do not replace traditional detailing, but instead reinforce it when used in an integrated manner. For instance, e-detailing, webinars, and WhatsApp follow-ups, when synchronised with rep visits, see higher engagement scores and more consistent prescribing shifts.

  1. Ethical Considerations

4.1 The UCPMP and Regulatory Landscape

India’s pharmaceutical marketing environment has come under heightened regulatory scrutiny, especially in light of perceived industry excesses and evidence of unethical inducements. The Uniform Code for Pharmaceutical Marketing Practices (UCPMP), revised in 2024, aims to "establish and uphold the highest standards of ethical practices" and to govern all interactions between the pharmaceutical industry and healthcare professionals.

4.2 Key stipulations of UCPMP 2024 include:

  • Bans on travel and hospitality in India or abroad for doctors (unless a doctor is a legitimate, declared speaker)
  • No gifts—of any kind or value—may be given to medical practitioners or their families
  • Free drug samples are permitted in strictly controlled, informationally justified circumstances
  • Full transparency and public reporting for all sponsorship, events, honoraria, and consultancy payments
  • Prohibition on misleading, exaggerated, or unscientific promotional content; only factual educational material is allowed

Table 3: UCPMP 2024

(Summary of Key Provisions)

Provision

Description

Enforcement Mechanism

No Gifts

Bans on all gifts beyond ?1,000; strict penalties

ECPMP oversight, association & DoP reporting

No Sponsored Trips

Foreign/Indian travel & hospitality not allowed

The CEO is responsible, random audits

Free Samples

Allowed only for trial, specific value caps

Must be documented, CEO sign-off

Sponsor Transparency

All events, honoraria, and grants must be published

Web disclosure, income tax checks

Content Accuracy

Promotional material must be factual, not misleading

MLR committee, mandatory content approval

Complaint Redressal

Ethics Committee for Pharma Marketing Practices; public reporting

Appeals to the Apex Committee, DoP

Adapted from UCPMP 2024 Guidelines

4.3 Practical and Ethical Dilemmas

Despite strict codes, enforcement and loopholes remain ongoing challenges. For instance, companies have occasionally rebranded direct promotional gifts as research grants or consultancy "facilitation fees". Recent high-profile violations—such as the AbbVie case, involving sponsoring international travel for dozens of doctors—have brought renewed focus to both the necessity and the frailty of compliance mechanisms.

4.4 Ethical Tensions Highlighted by Physicians and Commentators:

  • Trust and Reciprocity: Even small tokens or facilitated educational events can create subconscious obligations, impacting prescribing, despite protestations to the contrary by many doctors.
  • Transparency and Disclosure: There is growing demand from both the medical fraternity and the public for full transparency on all inducements, sponsorships, and industry relationships.
  • Patient-Centricity Over Promotion: Physicians and policy experts consistently argue for a stronger focus on patient benefit, arguing that promotional efforts should not compromise evidence-based decision-making or raise patient costs due to unnecessary branded prescribing.
  1. Impact On Prescribing Behaviour

A central concern in the entire promotional ecosystem is the extent to which these inputs actually affect clinical decision-making. Numerous Indian and international studies converge on a nuanced view:

5.1 Direct Behavioural Effects

  • Brand Recall and Rx Choice: Detailed visits by MRs and memorable promotional inputs (samples, high-quality scientific support, and CRM engagement) correlate directly with improved brand recall and incremental prescription volumes. In one Indian survey, 65% of doctors confirmed that MR detailing improves brand recall at the time of writing prescriptions. Another 85% feel positive about CRM-driven, personalised engagement strategies.
  • CME and Scientific Events: 93% of Indian physicians surveyed indicated that attending well-presented CME events, especially those involving respected experts, can shift their prescribing behaviour in favour of the sponsor’s brand or molecule.

5.2 Indirect and Subconscious Influence

  • Gift Reciprocity and Subtle Bias: While most doctors deny overt influence, social psychology and empirical evidence indicate that all forms of tangible and intangible incentives—however small—can create a subtle institutional bias, often unconscious, that skews clinical choices towards the sponsor company’s brands.
  • Patient Support Programs (PSPs) and Medical Camps: Physicians involved in patient-oriented promotional programs (camps, PSPs) may develop a preference for companies that are seen as improving healthcare access or delivering educational value. This, in turn, translates into sustained brand loyalty and higher prescribing rates of sponsor brands.

5.3 Switching Behaviour and Brand Loyalty

  • Switching Propensity: Indian doctors demonstrate a moderate level of loyalty—around 50% stick with preferred brands unless there is a major price or supply shift. Competitive promotional activity (by another firm’s MRs, for example) can prompt switching.
  • Digital and CRM Influence: Companies that synchronise digital engagement (WhatsApp, SMS, e-detailing, webinars) with CRM follow-ups, field rep visits, and unified patient support show stronger conversion, higher retention, and more robust brand loyalty—even among younger, digitally native doctors.

5.4 Regional, Socioeconomic, and Generational Differences

  • Tier 2/3 Outreach: Firms that adapt strategies for local languages, regional medical associations, and mobile/WhatsApp-based follow-ups outperform those using a “metro-only” approach. Rural doctors especially value medical camps and PSPs as key differentiators.
  • Generational Split: Physicians under 40, with ≤10 years’ experience, are more responsive to digital initiatives and scientific content, whereas senior practitioners prefer rep-based detailing and established relationships.
  1. Physician Trust in Pharmaceutical Companies

Building and maintaining trust lies at the centre of successful physician-pharma relationships. However, multiple forces have put this trust under strain in recent years:

6.1 Key Drivers of Trust

  • Transparent Communication: Doctors want access to complete, accurate, and impartial clinical data. Companies providing direct, unbiased scientific content are more trusted than those seen to obfuscate negative results or exaggerate benefits.
  • Ethical Conduct: Firms that comply strictly with UCPMP, avoid overt incentives, and focus on genuine education are viewed as more credible, fostering longer-term trust and brand allegiance.
  • Educational Value: Continued medical education, support for research (aligned with Indian Council for Medical Research guidelines), and practical content for both physicians and patients enhance a company's standing in the medical community.

6.2 Factors Eroding Trust

  • Perceived Profit Motive: Aggressive pushing of branded drugs, especially when cheaper generics exist, is met with scepticism by many Indian physicians who are acutely aware of the financial implications for their largely out-of-pocket-paying patient base.
  • Scandals and Regulatory Breaches: Publicised violations—such as funded international trips or luxury "conferences"—damage the credibility not just of specific companies but the industry as a whole. These events provide ammunition to regulatory authorities and public health advocates calling for stricter supervision.
  • Transparency Gaps: Inconsistent disclosure of industry relationships, honoraria, research support, or event funding fuels suspicion. A significant proportion of Indian doctors and medical school managers now support mandatory, public conflict-of-interest disclosures per global best practices.

6.3 The Role of Regulatory Codes and Company Reputation

  • Companies like Cipla, Sun Pharma, Dr Reddy’s, and Glenmark tend to be relied upon for quality assurance and ethical business, particularly in the absence of robust external regulatory mechanisms, reinforcing the primacy of company reputation in brand selection and trust.
  • The new UCPMP 2024, with mandatory compliance and penalties, is viewed positively as an industry-wide effort to rebuild public and physician trust, but remains in the early stages of effective implementation.
  1. Long-Term Brand Loyalty Driven by Promotional Activities

Beyond immediate impact on prescription volumes, Indian physicians’ perceptions of pharmaceutical promotion connect closely to the phenomenon of brand loyalty, which ultimately determines long-term market success.

7.1 Determinants of Brand Loyalty

  • Consistent Engagement and Follow-Up: CRM-based, multi-channel engagement that tracks history, anticipates needs, and coordinates field and digital touchpoints supports ongoing brand preference and advocacy.
  • Clinical Support and Educational Value: Sustained CME support, updated scientific materials, and access to expert networks (ISPs) create a platform for trust-based loyalty, far outlasting one-off incentives or transactional relationships.
  • Patient Outcomes and Advocacy: Patient support programs (PSPs), medical camps, and adherence initiatives not only improve clinical outcomes but establish the company as a partner in health, deepening loyalty at both the patient and professional levels.

7.2 Loyalty Programs and Compliance

A recent BI Worldwide and Kantar study found significant potential in points-based loyalty programs, reward strategies, and CRM-enabled recognition—so long as such approaches strictly comply with UCPMP and other regulatory norms. Programs focusing on recognition, educational grants, or public acknowledgements—as opposed to outright financial incentives—are viewed as both effective and ethically permissible by most Indian clinicians.

  1. Comparative Perspectives: India Versus Other Markets

While the core elements of pharmaceutical promotion are globally uniform, India’s sheer market fragmentation, hybrid healthcare delivery system, and rapidly evolving regulatory environment introduce unique dynamics.

  • Direct-to-Consumer (DTC) Advertising: Unlike the US, DTC advertising is prohibited in India. As a result, Indian physicians are subject to more intensive direct promotional targeting by pharma, amplifying the importance of ethical standards and educational value.
  • Generic versus Branded Prescribing: Generic substitution is less widespread than in Western markets, with Indian clinicians generally preferring "branded generic" products from trusted companies for reasons of quality assurance.
  • Regulatory Compliance: International markets (e.g., US, France, Germany, UK) mandate public reporting of all physician-industry interaction (e.g., the US Open Payments database), whereas India’s new UCPMP 2024 is still building compliance infrastructure and culture.
  • Digital Innovation: While global pharma brands have embraced omnichannel and modular content approval workflows, top Indian firms are rapidly catching up, especially post-pandemic, with WhatsApp-first and regional-language strategies outperforming traditional email-based engagement in rural and semi-urban areas.
  1. Regulatory Compliance, Enforcement, And Patient Outcomes

9.1 Enforcement Structures

The UCPMP 2024 introduces a multi-layered mechanism for complaint redressal, monitoring, and enforcement:

  • Ethics Committees for Pharmaceutical Marketing Practices (ECPMP): Institutionalised within all major trade associations, responsible for investigating complaints, publishing outcomes, and recommending sanctions.
  • Apex Committee for Pharma Marketing Practices (ACPMP): Government oversight at the Department of Pharmaceuticals ensures a final, binding appeal process.
  • Transparency Requirements: Companies are required to report event/honorarium/consultancy spending publicly, and CEOs are mandated as compliance signatories.

9.2 Impact on Patient Outcomes

The relationship between pharmaceutical promotion, prescribing, and patient outcomes is complex:

  • Potential Upsides: Effective educational interventions, adherence support programs, and evidence-based detailing can accelerate the adoption of innovative therapies, improve guideline adherence, and enhance patient engagement—especially important where patients face significant access barriers.
  • Potential Risks: Aggressive or biased promotion may lead to over-prescribing, reduced generic substitution (raising costs), or uncritical adoption of new medicines with lesser-known safety profiles. There is also the risk that undue influence may weaken physician-patient trust, especially if patients suspect commercial priorities supersede clinical judgment.

CONCLUSION

India’s pharmaceutical marketing environment is in a period of rapid transformation, shaped by global innovation, intense local competition, and evolving ethical norms. Physician perceptions reflect a complex balance: while doctors continue to value scientifically robust, educational promotional strategies—including detailing, patient-oriented outreach, and CRM-driven engagement—they are increasingly wary of gifts, implicit incentives, and non-transparent industry practices. New regulatory frameworks, exemplified by UCPMP 2024, have elevated ethical standards, but real-world enforcement and cultural change remain challenges.

Promotion strategies that focus on clinical value, patient support, and transparent, compliant engagement earn the highest trust and loyalty from Indian physicians. Short-term transactional approaches may deliver incremental prescriptions but ultimately erode brand equity and professional trust. For sustained impact in India’s hyper-competitive market, pharmaceutical companies must foreground ethical conduct, patient-centricity, and educational excellence—supported by rigorous compliance infrastructure and genuine doctor partnership.

Future success, for both doctors and companies, will depend on a mutual commitment to clinical integrity, regulatory compliance, and above all, patient welfare.

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Reference

  1. Vishavadia K. Impact study of various pharmaceutical promotional practices on Indian doctors’ prescription behaviour [Internet]. ResearchGate; 2021 [cited 2025 Oct 11]. Available from: https://www.researchgate.net/publication/357241837
  2. Detailing by medical representatives that influence medicine prescription [Internet]. IJFANS; [cited 2025 Oct 11]. Available from: https://www.ijfans.org/uploads/paper/5915cfc8d85c28bcc1d97dc34533448e.pdf
  3. Portal for Uniform Code for Pharmaceutical Marketing Practices (UCPMP) 2024 [Internet]. Department of Pharmaceuticals, Government of India; [cited 2025 Oct 11]. Available from: https://ucmp.pharma-dept.gov.in/pharma/index.php
  4. Govt bans pharma firms' gifts & travel sponsorship for doctors [Internet]. Times of India; 2024 [cited 2025 Oct 11]. Available from: https://timesofindia.indiatimes.com/india/govt-bans-pharma-firms-gifts-travel-sponsorship-for-doctors/articleshow/108443883.cms
  5. What are the rules with regard to pharma companies giving ‘gifts’ to doctors in India [Internet]. The Hindu; [cited 2025 Oct 11]. Available from: https://www.thehindu.com/sci-tech/health/what-are-the-rules-with-regard-to-pharma-companies-giving-gifts-to-doctors-in-india/article69056770.ece
  6. Unveiling integrity: navigating ethical practices in the realm of pharmaceutical marketing [Internet]. Springer; [cited 2025 Oct 11]. Available from: https://link.springer.com/chapter/10.1007/978-3-031-70855-8_43
  7. The pharma-doctor nexus: the controversy and ethics of freebies to doctors [Internet]. Amigos IAS; [cited 2025 Oct 11]. Available from: https://amigosias.com/the-pharma-doctor-nexus-the-controversy-and-ethics-of-freebies-to-doctors/
  8. How pharma companies can boost digital engagement with doctors in India [Internet]. Bain & Company; [cited 2025 Oct 11]. Available from: https://www.bain.com/insights/how-pharma-companies-can-boost-digital-engagement-snap-chart/
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  13. The role of medical representatives in influencing prescribing behaviour: a review [Internet]. IJPR; [cited 2025 Oct 11]. Available from: https://ijprajournal.com/issue_dcp/the%20role%20of%20medical%20representatives%20in%20influencing%20prescribing%20behaviour%20a%20review.pdf
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Deepak Paliwal
Corresponding author

Department of Business Administration, Mangalore University.

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Puttanna K.
Co-author

Department of Business Administration, Mangalore University.

Deepak Paliwal*, Puttanna K., Prescription, Promotion, And Perception: Mapping Physician Responses to Pharma Marketing in India, Int. J. of Pharm. Sci., 2025, Vol 3, Issue 10, 2861-2872 https://doi.org/10.5281/zenodo.17453183

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