Whatever Happened to Pharmaceutical Swag?

Goodbye, Viagra tchotchkes, hello digital screens.

Duluth Clinic neurology department manager Gwen Cressman gathers two handfuls of rubber reflex testers in 2008 in Duluth. (Julia Cheng/AP)

In 2008, a Duluth-based hospital operator went on a purge. After scouring four hospitals and 17 clinics across northeastern Minnesota, SMDC Health System found 20 shopping carts worth of "clipboards, clocks, mouse pads, and stuffed animals," as the AP reported at the time. It packed them up and shipped them to Cameroon.

Employees of SMDC had suggested the roundup as part of a strengthened conflicts-of-interest policy aimed at rooting out the influence of drug companies and device manufacturers.

It used to be that such branded trinkets were everywhere; a doctor might very well write a Lipitor prescription using a Lipitor pen on a Lipitor clipboard. It was swag—"stuff we all get"—and the "all" in this case mostly meant physicians.

Last week, I wrote that one way OxyContin wooed so many doctors in the late 1990s was by giving out heaps of swag, including this rockin' CD titled “Swing in the right direction with OxyContin":

That wasn't the end of it, though. There was also a pedometer:

"OxyContin ... A step in the right direction.”

And a beach hat:

Of course, Purdue Pharma, the maker of OxyContin, was far from the worst offender. A quick perusal of eBay unearths a mug promoting Klonopin, a highly addictive anxiety medication, a Viagra clock, a Nexium swiss army knife, and an Ambien plush doll. (For the kids!)

You don't see as much of this kind of loot anymore. So what happened?

A 2006 JAMA study showed that even cheap gifts can influence doctors' prescribing practices. Medical students who received branded freebies were found to be more partial to the drug after the fact. Some states, like Minnesota, and clinic operators, like SMDC, began banning medical swag voluntarily.

In 2008, the pharmaceutical industry agreed to a moratorium on branded trinkets—yes, even the t-shirts that spell out BOTOX in rhinestones. However, the new policy left a loophole for company-sponsored meals, drug samples, and other “educational” gifts valued less than $100.

More physicians began enacting "no-see" policies toward pharmaceutical sales reps, meaning they refused to meet with the drug promoters, or began requiring them to make appointments. Sales reps were reduced to dropping off drug samples without saying a word to the doctor, and their ranks began dwindling.

Other forms of pharmaceutical influence, like drug companies paying doctors to speak at conferences or buying them meals, are alive and well. ProPublica, which performed a four-year investigation of drug-company payments to doctors, found that more than three-quarters of doctors have at least one financial tie to a drug or medical-device company.

When they do make physician visits, pharmaceutical reps are still often caught saying that a drug is more effective than it has been proven to be, "or saying that it's also effective for populations of patients that it hasn't been proven to treat," said Erika Kelton, a lawyer who represents whistleblowers against the pharmaceutical industry.

Finally, where there's a marketing will, there's a way, and drug companies are getting more creative. These days, a drug maker might strategically paper doctors' exam rooms with brochures that feature information about the product alongside rebate coupons.

Drug companies also buy time on digital screens stationed throughout doctors' waiting rooms. A 2012 article in PM360, a pharmaceutical marketers' magazine, notes that today's difficult sales environment requires pharmaceutical reps to be "establishing new marketing channels and enabling multiple touch points," which can include "direct mail, email, e-detailing, banner ads, search-engine optimization, and digital screens placed in clinical areas."

The article includes a diagram from PatientPoint, a maker of these digital screens, showing how embedding pharmaceutical ads on these devices throughout the doctor's office can help "physicians stay up to date and deliver brand messaging."

When one drug company deployed this type of digital-screen campaign, the article notes, new prescriptions of the advertised medication went up by 14 percent.

You know what they say: Plus ça change, plus c'est la Medrol®.