Big debts in small packages — the dangers of pens and post-it notes

Abstract

You should be able to safely assume that your doctor’s recommendations are evidence-based and in your best interests rather than driven by advertising. And this is precisely why we should be concerned about the plethora of drug company paraphernalia scattered around doctors' waiting and consultation rooms, surgeries, kitchens and elsewhere. It’s obvious why we worry about overtly manipulative practices, such as companies paying for overseas trips for doctors and their families, and providing other forms of lavish entertainment. This kind of generosity is likely to make doctors feel indebted to these companies and more likely to prescribe their products. But while such practices attract critical media attention, they’re not the most common, and, indeed, might not be the most effective form of pharmaceutical marketing. Even small “gifts”, such as the ubiquitous post-it note or pen bearing a medicine’s name, or a free sample of a drug, have the potential to influence doctors. The effect is that you are prescribed medicines that are either not needed or are more expensive than alternatives. This might seem surprising. After all, doctors are highly-educated, highly-trained professionals who undoubtedly have their patients’ best interests at heart. But they are also human, and even small gifts have the potential to create an unconscious desire to reciprocate by prescribing a company’s product. Indeed, small gifts can be even more influential than large gifts, because – precisely as a result of their small value – they operate insidiously, with doctors usually remaining unaware of their ability to influence their behaviour.