to support promotional efforts outside the US was done either by the few local agencies within specific markets or by in-house staff at the US pharmaceutical companies themselves. The Early Global Marketplace The global pharmaceutical marketing landscape looked a lot different prior to and immediately following the Second World War than it does today. The marketplace was made up of both small local and regional US companies and a few larger organizations that had already begun to reap the benefits of global expansion. In the latter case, the expansion started with small sales offices or distributorship outposts and continued through investment and acquisition. The so-called "wonder drugs" of the 1950s, and the advent of blockbuster brands with annual sales in excess of $1 billion, helped usher in a pronounced expansion of US pharmaceutical companies into the global marketplace. As these companies expanded their corporate reach outside of the US, their international promotional needs expanded as well. The International Market Evolves By the mid-to-late 1950s, as the once-fledging US healthcare agencies were becoming significant marketing and communications forces, recognized for their expertise, some US-based multinational pharmaceutical companies began requesting help in developing programs that would extend beyond the United States. In those early days, the US agencies would work with their clients' international marketing departments, helping to develop materials for use in key overseas markets. Pharmaceutical advertising, as a defined communications discipline, was not well established in many parts of the world. Specialized expertise wasn't always available on the ground, so many
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