Just a reminder, or is it?

24 05 2009

ResearchBlogging.orgThe decision on what medicines you are prescribed can be a matter of life or death. These decisions need to be based purely on what is best for you, the patient, not on who has the flashiest marketing campaign.

Medicines Australia, the national self-regulatory body for the pharmaceutical industry, is in the process of revising its Code of Conduct for 2010. The code is based mostly on ensuring that any marketing its members engage in is based primarily on accurately educating health-care professionals, and that their activities will withstand professional scrutiny and not bring the industry into disrepute.

The new code is expected to heavily crack down on the use of once ubiquitous Brand Name Reminder – all those free give-aways brand logos emblazoned on them. All brand name reminders will be expected to cost less than $20 and be directly relevant to the clinical setting – an umbrella or coffe mug is definite no, but this might also cover generic office equipment – like USB sticks, mousepads, sticky notes and pens.

Is this ban based on evidence? Sadly, yes. And even items under $20 may still cause some influence. And Research published in the Archives of Internal Medicine suggest the mere presence of logos can influence how a doctor thinks about what he prescribes. But that influence may be a good thing. It depends on how he was educated.It really shouldn’t be too much of a surprise that brand name reminders exert some influence. Why else would industry invest in them (Pharmaceuticals certainly aren’t the only one)? Their purpose is also explicitly stated in their name. For some reason it has often been assumed that all that medical training creates some kind of immunity to brand influence. Particularly doctors themselves – a previous survey found only 8% of doctors thought that a simple pen would not influence them (compared to 31% of patients who thought a pen might influence their doctor).

The pharmaceutical industry is not stupid, nor resource poor. Not only is a lot of money invested in creating branded items – but even more is poured into creating the brands in the firstplace. A well crafted brand is made to be as recognisable and memorable as possible. The hope is to insert the name into position as “top-of-mind” (or I’d say “tip-of-tongue”), so when your doctor is thinking “painkiller”, they are actually thinking “PainKillor™” and that’s what ends up on your script.

This study were 3rd and 4th year med students, the test group was “primed” with Lipitor logos found on a sign-up sheet clipboard and notepaper supplied during the session. Very minimal placement. That’s not even a gift (though all students were paid $25). The students then filled out some questions on Lipitor and a similar drug Zocor. What was measured was not only the students’ explicit attitudes towards the two drugs – i.e. did they prefer one drug over the other?- but also their implicit attitudes – how quickly would they make a positive/negative links between the drugs?

The results show that the logos had little affect on 3rd years at all, and also none on any student’s explicit attitude – most still prefered Lipitor (though I think the test itself appears rather Lipitor-friendly). The fourth-year primed students differed from controls when it came to implicit attitudes – but one school was affected positively, while the other negatively.

What’s that? Brand name reminders actually made students more critically evaluate their attitude to the drug they were exposed to? At least that’s what I read the IAT to measure. While they still reached the conclusion Lipitor was better, it’s just that they took longer to reach that decision.

The researchers note that the negatively affected school “held more skeptical views toward pharmaceutical marketing” than the other school (which was representative of US schools previously surveyed). Could this “skeptical view” to Pharma encourage subconscious evaluation of equally subtle brand placement?

This is definitely worth more investigationing. Is the Penn U curriculum providing that immunity to medical marketing that the majority of doctors asssume they already have? Critically evaluating marketing messages is a wanted skill and should be heavily encouraged, and if it an be incorporated into a medical school curriculum’s all the better. Pharma probably won’t be too enthused, but perhaps they can take comfort that the students ultimately still selected the drug despite possibly registering on some level that they had been marketed to.

It’s probably worth considering, on some level, that the test subjects are students. Even if the curriculum is instilling immunity to medical marketing, will it last beyond graduation? Maybe it can be incorporated into CME?

Final question: Whose responsibility is it to combat the brand name reminder effect? Pharma, by not using BNRs in the first place -or- Medical Schools, who should provide doctors with skills to deal with medical marketing?


David Grande, Dominick L. Frosch, Andrew W. Perkins, & Barbara E. Kahn (2009). Effect of Exposure to Small Pharmaceutical Promotional Items on Treatment Preferences Archives of Internal Medicine, 169 (9), 887-893 PMID: 19433701

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2 responses

24 05 2009
Internet socks on drugs « It’s Alive!!

[medical marketing and online sockpuppets]

16 06 2009
Rx-ky business « It’s Alive!!

[…] more commentary on industry sponsorship […]

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