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G ift-giving has a variety of different domains, one of which is pharmaceutical. Pharmaceutical companies use both financial and nonfinancial inducements. Pharmaceutical gifts and giveaways come in many different forms. They can be anywhere from a pen with a company logo, to promotional items, drug samples, and even personal gifts or invitations to special events. According to an article, any sort of gift, of any size creates a social obligation for a person to respond accordingly. In terms of medicine, physicians would respond to these gifts by supporting the pharmaceutical company and its products. The aim of gifting in the pharmaceutical industry is to help promote pharmaceutical products or the company itself. The pharmaceutical industry in the U.S. is one of the most profitable industries, and about 84% of marketing from pharmaceutical companies is directed towards physicians. Drug prices have also been rising drastically in the recent years. Marketing for the pharma industry is mainly directed at physicians because they are the ‘gatekeepers’ to drug sales. Doctors’ behaviours and judgement are often, therefore, heavily influenced by these pharmaceutical companies.

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The Influence of Pharmaceutical Gifts on Physicians’ Practice

In some cases, physicians may also be hired by the pharmaceutical company to give talks or promote the pharmaceutical products. They are usually accompanied by drug reps and in return may receive invitations to special events or dinners, etc. This helps pharmaceutical companies become more well-known and encourages growth by encouraging doctors to write more prescriptions for their drugs. According to a Journal of the American Medical Association from 2000, when doctors are given free samples, they are more likely to prescribe that drug and have led to doctors requesting for these specific drugs to be placed on formularies. Even sponsored trips and events influenced doctors to write more prescriptions of the drugs accordingly. Specifically, these events have resulted in an increase of 80-190% in drug prescriptions by doctors. When invited to dinners sponsored by pharmaceutical companies, doctors were also two to three times more likely to request that the drugs be placed on formularies from the hospital. To affectively select which doctors to use for these enticements, drug reps assess the physicians preferences, practice and personality to see how they can influence their prescribing methods and select the right candidate for their gifting. To gain doctors’ trust, drug reps appear as cheerful, genuine friends and may provide unreliable information. The admirable attitude and persona created by drug reps helps influence doctors’ decisions and create a good first impression, as they spend the day around their distressed patients. Physicians are generally more influenced by the marketing techniques of the pharmaceutical industry than by the effectiveness of the drugs they promote themselves. They also tend to have a hard time determining the validity of statements made by drug reps. A study showed that physicians would claim that they rely on scientific evidence for the drugs they prescribe, but their beliefs when prescribing the medication leaned towards the side that was strongly promoted by the pharma industry in comparison to the drugs that were more scientifically valid.

Positive reassurance and marketing techniques by the pharmaceutical companies have influenced the decision making of physicians and have resulted in biases towards their products. These cognitive biases have resulted in the overuse of certain branded drugs. A study from 2019 focused on the marketing strategies of pharmaceutical companies and their influence on physicians’ behaviour and prescribing patterns. The study specifically focused on whether the influence of gifting in the pharma industry was limited to developed countries or whether it also extended to developing countries, such as Lebanon. In Lebanon, there have been inappropriate prescribing practices. Past studies have shown that over seven different hospitals in Lebanon, 40% of prescriptions were erroneous and 9% were unnecessarily prescribed. This is mainly due to physician-targeted promotions by pharmaceutical companies to increase use of their products. It was found that physicians generally changed prescribing patterns as a result of promotional tactics from pharmaceutical companies. The pharmaceutical industry tends to target those that can be easily influenced by the pharmaceutical market, and those who considered it ethically sound to accept gifts and samples from companies. It is clear that these cognitive biases influence physicians around the globe in both developed and developing countries.

Physicians and the Self-Serving Bias

Physicians assume that their prescribing patterns are not influenced by the marketing and promotion by the pharma industry, when in reality, pharmaceutical giveaways and promotions lead to increased prescriptions of the targeted drugs. There is a misunderstanding that physicians are not influenced by such marketing practices because of their believe in science, however, they are just as susceptible to biases as anyone else. This phenomenon is known as the bias blind spot, where an individual can determine cognitive and motivational biases in other individuals, but fail to see them when they are happening to themselves.

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Physicians’ Cognitive Dissonance Regarding the Pharma Industry

Physicians have a bias to accept gifts from the pharmaceutical industry, which results in cognitive dissonance, or the perception of contradictory information. According to the cognitive dissonance theory, there are three methods that help reduce dissonance: (1) changing your beliefs, opinions and behaviours (2), lowering the importance of discordant factors and (3) adding elements to reduce the dissonance. Doctors use different kinds of denial, such as avoiding the topic of interest and rejecting the influence of the industry on physician behaviour to reduce their cognitive dissonance in their relationship with drug reps. They also rationalized that meeting with drug reps was beneficial and educational for their patients .

Methods of Pharmaceutical Gifting Influence

Generally, there is always an obligation to help those who have helped you. In terms of gifting, it is socially unacceptable to accept a gift without reciprocation. Physicians are meant to ‘return the favor’ to the pharma industry by creating changes in their practice. A study on the prescribing behaviour of 150,323 physicians in the U.S. revealed that doctors who received gifts from drug and doctor manufacturers prescribed a higher percentage of branded drugs compared to doctors who did not receive gifts. According to former drug rep, Michael Oldani, essentially, the gifts from the pharma industry are really just bribes that aren’t considered bribes. When gifting, the drug reps know that physicians know of the obligation to reciprocate the gift. They are used to enhance feelings of guilt and social pressure. Gifts such as pens, prescription pads etc. from the pharma industry are used to keep their brand names in mind when writing prescriptions for their patients. Pharmaceutical reps also avoid giving lower-valued gifts such as mugs and calendars because these are usually not enough to influence the professional behaviour of a physician. However, a study shows that gifts that are low in value may also influence the physician’s behaviours in unobvious ways.

The study revealed that small gifts affected the recipient’s decisions in favour of the gift-giver. Unlikeable traits in the gift or gift-giver such as small gifts may have reduced the likelihood of the favour to be reciprocated, but it was not entirely eliminated. A study conducted in a restaurant where some customers were greeted with a small gift, while others weren’t showed that customers who received a gift spent considerably more money compared to customers who did not. Evidently, there is this tendency to reciprocate gift-giving behaviour after you have been gifted. Drug companies use the power of physician commitment and consistency in their favor to promote their products. Asking physicians for small commitments such as testing a drug on the next five patients with a heart disease may increase the likelihood of the physician taking the drug into account and using it for their patients. Drug reps are also consistent when asking physicians remind them of the drug if the physician has not used it in their practice. Creating a social proof that the drug is reliable and can work, and creating a friendly bond with the doctor also considerably influences doctors’ prescribing behaviours.

Abeer Mumtaz
Psychology Blogger,
The Shared Secrets Lab,
GiftAFeeling Inc.

Read The Official Research Paper On - Giveaways for the Pharmaceutical Industry

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