Drug company logos may influence medical students, pro or con

Those ubiquitous pens and coffee mugs bearing drug-company brand names may make a difference after all, according to a new study of attitudes among medical students. But the kind of reaction they prompt might depend on the school's policies toward pharmaceutical marketing.

A movement to eliminate pharmaceutical company marketing influences from the decisions doctors make when they write prescriptions has led to a ban in Massachusetts on gifts to physicians and limited industry contacts in some hospitals and medical schools. But many doctors have argued that trivial gifts like pens or notepads couldn't overcome their medical judgment.

To test the power of small promotional items, researchers conducted an experiment among third- and fourth -year medical students at the University of Miami, a school without restrictions on pharmaceutical marketing, and at the University of Pennsylvania, a school with rules prohibiting most gifts, meals, and samples from drug companies.

The 352 students, who had volunteered for a survey on clinical decisions, were randomly assigned to receive a clipboard emblazoned with the logo for Lipitor as they signed in and a paper with their registration number that also had the name of the cholesterol-lowering drug on it. A control group used plain clipboards and registration papers.

The students were asked explicitly whether they preferred Lipitor to Zocor, another statin with a lower brand-name profile. In a test of implicit attitudes, they were asked to match the drug names to words like "pleasant" or "unpleasant" while their responses were timed. All the students were later e-mailed a survey asking them about their attitudes toward drug company marketing.

When asked explicit questions about Lipitor vs. Zocor, the students at both medical schools had a slight preference for Lipitor, whether they saw the brand name or not. But on the test designed to reveal unconscious attitudes, there were differences between the two schools.

The fourth-year students at Miami exposed to Lipitor branding showed stronger implicit preferences for Lipitor than their classmates who had not seen Lipitor-branded items. But at Penn, fourth-year students exposed to Lipitor branding did the opposite, showing less of an implicit preference for Lipitor than the students who saw no branded items.

The follow-up surveys showed higher skepticism of pharmaceutical marketing among the Penn students compared to the Miami students.

Writing in the Archives of Internal Medicine, the study's leader Dr. David Grande of Penn and his colleagues suggest that seemingly trivial items can prime the attitudes of medical students toward particular drugs as they advance in their training.

"Our results provide evidence that subtle branding exposures are important and influential," they write. "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."