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Originally published May 27 2009

Drug Company Freebies Turn Medical Students into Drug Pushers

by S. L. Baker, features writer

(NaturalNews) Pharmaceutical companies routinely shower medical students with all sorts of freebies -- from notepads and ballpoint pins to clipboards and calendars that are emblazoned with the names of prescription drugs and devices. That may sound pretty harmless but research just published in the current issue of Archives of Internal Medicine concludes these seemingly trivial items can influence these doctors-in-training's attitudes about the products drug companies are pushing. The freebies can also sway behaviors, making med students more likely to prescribe the promoted medication or device to patients in the future.

David Grande, M.D., M.P.A., of the University of Pennsylvania and his research team conducted a randomized controlled experiment using 352 third and fourth year medical students as subjects. There were 154 med students in the study who attended University of Pennsylvania School of Medicine (Penn), a school which has a policy that forbids most free gifts, samples and free meals offered by drug companies. The other 198 med students attended the University Of Miami Miller School Of Medicine (Miami), which does not prohibit the common Big Pharma marketing practice of handing out promotional freebies.

Some of the med students (181 in all) were randomly assigned to one group. They didn't know that the small promotional items they were given, including a clipboard and notepad promoting the cholesterol-lowering drug Lipitor, had anything to do with the purpose of the study. The other 171 students were not "primed" by exposure to freebie gifts advertising any drug.

All of the research subjects in both groups were given a test that measured their attitudes toward the statin drug Lipitor (one of the most heavily promoted brand-name drugs in the US) and Zocor (another statin available as a generic). They completed an image-and-word association test by matching drug brand names to what the med students perceived to be attributes of the drugs. By documenting the differences in reaction times, the researchers were able to measure the students' unconscious attitudes towards the drugs. The med students also completed a questionnaire that asked them to specifically list which drug, Zocor or Lipitor, was the best in terms of safety, superiority, efficacy and convenience.

The results showed significant differences between the exposed and control groups among fourth year medical students who attended both Penn and Miami. The students at Miami, where freebies from drug companies are allowed, demonstrated a much stronger preference for Lipitor after exposure to promotional items. But fourth year students at Penn, a school that normally prohibits the drug companies' promotional items, had an opposite response. Those in the group exposed to the promotional give-aways had weaker preferences toward Lipitor than the control group.

No differences between the control and exposure groups among third year students were found, however, and the study authors concluded that's probably because fourth year medical students have more clinical experience. They've already formed attitudes toward treatment options that apparently can be heightened when they are exposed to the branded promotional freebies.

"Our results provide evidence that subtle branding exposures are important and influential, as the psychology and marketing literature would suggest," the researchers concluded in the journal article. "Our findings are particularly notable because they are attributable to simple exposure to promotional items independent of other effects attributable to the social relationships associated with gifts. Our study also suggests that institutional policies, by way of their influence on student attitudes toward marketing, could lead to different responses to branded promotional items."

In an accompanying editorial, Philip Greenland, M.D., of the Feinberg School of Medicine at Northwestern University in Chicago, expressed a strong warning about the influence of Big Pharma's freebies on med students. "The powerful influence by drug companies on physicians and medicine has drawn increasing public attention," he wrote. "As others have outlined, it is time to act and adopt restrictive policies. It is imperative that the profession police itself, or it is inevitable that government will step in and create a policing structure that will be punitive and require expensive oversight. Why are most of us still waiting? The evidence is clear, and the path is defined. It is time to act."

Reference: Arch Intern Med. 2009;169[9]:887-893.

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