Can something as small as the logo on a pen sway a doctor to write a prescription for one drug over another? You bet. Medical students, at least, fall prey to the influence of drug company trinkets, says a study published today in Archives of Internal Medicine.

Big-ticket items, such as a fancy dinner or NBA tickets, might seem like more powerful persuaders than a free ceramic mug. But the researchers conclude that, in fact, "subtle branding exposures are important and influential."

After mounting criticism, many drugmakers halted the flood of pens, notepads and clipboards that kept doctors scribbling within sight of brand-name medicines under a voluntary code adopted by the Pharmaceutical Research and Manufacturers of America (PhRMA) in January. Companies can still take doctors out (as long as there's an 'educational' component to the event) and funnel gifts to those in school.

The study of tsotchkes, led by David Grande, an assistant professor of medicine at the University of Pennsylvania, shows that even the smallest item with a logo can influence the preference for one kind of drug, especially in students who receive promotional materials at school already.

To test the effectiveness of the small freebies, Grande and his team had half of the 352 med school test subjects register sign in for the testing session on a clipboard and notepad bearing the logo for Lipitor, Pfizer’s heavily promoted cholesterol-lowering drug. The other half of the subjects used plain clipboards and notepads.

The student came from the University of Miami Miller School of Medicine, which allows drug companies to distribute gifts, and the University of Pennsylvania School of Medicine, where drug company goodies are verboten.

After analyzing the students' attitudes toward Lipitor and the competing generic simvastatin (sold by Merck as Zocor), the researchers found that although most students preferred Lipitor, fourth-year students from Miami (where gifts are allowed) had the highest preference for the drug. 

Pardoxically, the Lipitor exposure before the test made fourth-years from Penn, unaccustomed to freebies, favor the brand less. "Institutional policies can reverse the effects of drug marketing tactics," Philip Greenland, chairman of preventive medicine and professor at the Northwestern University's Feinberg School of Medicine, writes in an accompanying editorial. "Data suggest that adopting these more restrictive policies will reverse longstanding adverse trends of physicians' prescribing habits," he concludes.

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