a few years ago, I was at a major drug company and talking to people runnning phase 4 studies
all of them were in a tizzy of delight:
they got to do business, rather than this difficult nasty drug stuff
1) all clinical trials were outsourced
2) most effort was on designing indications and their appropriate advertising campaign, so when you did a clinical phase 4 study, you needed to plan the advertising, and vice versa
3) they were delighted that the marketing companies had done marketing studies.
they could "prove" that the more they advertised, the more sales they got
so now they had a product that could be worked with like any other product
and they didnt even have to clinical studies any more
farm them out