Healthy Skepticism Library item: 19524

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: Journal Article

Katz D
Bioethics on NBC's ER: The Agony and the Ecstasy of Free Lunch
Bioethics.net 2002 Feb 10;
http://bioethics.net/articles.php?viewCat=7&articleId=163

Abstract:

A lap dancer swallows a customer’s wedding ring. A man is stabbed by a fallen icicle. Relationships are turbulent. Life threatening disease pervades. It is within this chaotic vortex that a seemingly innocent spread of bagels, cream cheese, and penlights threatens the wellbeing of our superheros.

As the episode opens, an exhausted and hungry Dr. Susan ____ reaches for a bagel only to be stopped by a questioning Dr. Carrie Weaver who informs her that the bagels were provided by a (shudder) drug company. Carrie questions the wisdom of accepting the gift in that it could compromise professional objectivity by creating a sense of loyalty to the company feeding them. To punctuate her point, she holds up a penlight emblazoned with the name of a company product. She asks Susan if she is truly able to distance herself from the influence of drug company gifts when it comes time to write a prescription for a patient and she has to choose between the products of competing companies. Susan dismisses the prospect of bagel bias as beyond belief, yet she nevertheless throws her bagel in the trash and goes off to buy her own.

Meanwhile, the rest of the ER staff blissfully enjoys the complimentary breakfast and is later plagued with stomach upset as a result. Even Carrie Weaver, our sagacious heroine, succumbs to her hunger and she too falls victim to the fetid, villainous, cream cheese.

Free bagels. A Trojan horse that can best be described as the ultimate “gag gift.” They turned the ER into a virtual vomitorium and, in the process, threw up some provocative issues that have long been deserving of attention.

It is common practice for health care professionals to receive small promotional gifts from drug companies (however they usually have less gastronomical impact). Often taking the form of snacks and office supplies, these trinkets seem to raise few eyebrows — not even those of patients, who potentially foot the bill for these marketing efforts through higher drug prices. These gifts even tend to fly below the radar screen of those most concerned about pharmaceutical promotion and conflicts of interest because of their small monetary value.

While it may seem logical to distinguish small gifts such as coffee, sticky pads, and stress dolls, from larger, seemingly more problematic gifts, social science research shows that this distinction is shaky, at best. Behavior can be influenced by unsolicited gifts of negligible value, particularly if the recipient fails to recognize his or her own susceptibility to this influence. Given that industry trinkets are essentially marketing wares designed to skew physician prescriptions in favor of a specific drug company’s products, it is important to understand their power.

Businesses use gifts to communicate, compensate, promote products, and persuade. Gifts are not given out of disinterested generosity. Drug company gifts are part of intricate marketing campaigns designed to purchase product and company loyalty from medical professionals.

Gift giving is an extremely effective marketing tool because it triggers in the recipient the basic human tendency to reciprocate whether the recipient is conscious of it or not. Dubbed “the reciprocity rule,” it is illustrated in a wide-range of social relationships. If someone gives us a birthday gift, we should give them one in return. If someone invites us to a party, we should invite them to ours. This situation is so common that, in several cultures, the phrase “much obliged” has become synonymous with “thank you”.

The custom of reciprocity is so highly valued that those who do not reciprocate are often regarded with disgust, and assigned negative labels such as “moocher”, “ingrate” and “free-loader”. Regardless of the size of a gesture, it is widely considered distasteful to take and make no effort to give in return. It tends not to matter whether we like the person giving the gift. Therefore, people who are ordinarily disliked — disagreeable acquaintances, beggars, sales people — can influence our behavior simply by imposing an unsolicited gift.

Interestingly, food tends to be a particularly powerful gift because recipients tend to project the good and favorable feelings they associate with the food onto the promotional messages accompanying it. , This tactic backfires in the case of food poisoning.

In advising Susan not to accept the gift, Carrie prevented Susan from becoming entangled in a web of obligation (and from becoming nauseated). In addition, by drawing attention to the fact that small gifts can be influential, she raised Susan’s awareness of her susceptibility to their influence.

Pharmaceutical marketing is very successful in getting physicians to alter their prescribing habits. In the year 2000 alone, the pharmaceutical industry spent $15.7 billion on product promotion. While it is important that physicians be made aware of new and important drugs that enter the marketplace, it is problematic for physicians to change prescribing practices in response to industry marketing tactics.

The giving of snacks and trinkets is one way companies influence physicians in subtle, yet measurable ways. It is important that all health care providers recognize their professional and ethical obligation to prescribe drugs rationally, and in a way that optimizes overall patient care. If accepting small gifts compromises the ability of prescribers to fulfill this obligation such that commercial interests skew prescribing decisions, then perhaps more physicians ought to follow the actions of Susan and “just say no” to the poison cream cheese.