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David Grande, MD, MPA; Dominick L. Frosch, PhD; Andrew W. Perkins, PhD; Barbara E. Kahn, PhD

Arch Intern Med. 2009;169(9):887-893.

Background  Policy discussions concerning pharmaceutical promotion often assume that small promotional items are unlikely to influence prescribing behavior. Our experiment measures whether exposure to these items results in more favorable attitudes toward marketed products and whether policies that restrict pharmaceutical marketing mitigate this effect.

Methods  This is a randomized controlled experiment of 352 third- and fourth-year medical students at two US medical schools with differing policies toward pharmaceutical marketing. Participants assigned to treatment were exposed to small branded promotional items for Lipitor (atorvastatin) without knowledge that the exposure was part of the study. We measured differences in implicit (ie, unconscious) attitudes toward Lipitor and Zocor (simvastatin) in exposed and control groups with the Implicit Association Test (IAT). Self-reported attitudes were also measured, and a follow-up survey was administered measuring attitudes toward marketing.

Results  Fourth-year students at the University of Miami Miller School of Medicine exposed to Lipitor promotional items had more favorable implicit attitudes about that brand-name drug compared to the control group (IAT effect: 0.66 vs 0.47; P = .05), while the effect was reversed at the University of Pennsylvania School of Medicine (IAT effect: 0.22 vs 0.52; P = .002) where restrictive policies are in place limiting pharmaceutical marketing (interaction effect: P = .003). No significant effect was observed among third-year students. On a "skepticism" scale, University of Miami students held more favorable attitudes toward pharmaceutical marketing compared to University of Pennsylvania students (0.55 vs 0.42; P < .001) but the results were similar to those of a previously published national study (0.42 vs 0.43; P = .53).

Conclusions  Subtle exposure to small pharmaceutical promotional items influences implicit attitudes toward marketed products among medical students. We observed a reversal of this effect in the setting of restrictive policies and more negative school-level attitudes toward marketing.

Author Affiliations: Department of Medicine (Dr Grande) and Leonard Davis Institute of Health Economics (Drs Grande and Frosch), University of Pennsylvania, Philadelphia; Department of Medicine, University of California, Los Angeles (Dr Frosch); Jesse H. Jones Graduate School of Management, Rice University (Dr Perkins); School of Business Administration, University of Miami (Dr Kahn).

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