Hostname: page-component-586b7cd67f-vdxz6 Total loading time: 0 Render date: 2024-11-24T20:13:31.834Z Has data issue: false hasContentIssue false
  • English
  • Français

Physicians under the Influence: Social Psychology and Industry Marketing Strategies

Published online by Cambridge University Press:  01 January 2021

Sunita Sah  and
Adriane Fugh-Berman
Get access Rights & Permissions [Opens in a new window]

Extract

It is easier to resist at the beginning than at the end.

– Leonardo da Vinci

Physicians often believe that a conscious commitment to ethical behavior and professionalism will protect them from industry influence. Despite increasing concern over the extent of physician-industry relationships, physicians usually fail to recognize the nature and impact of subconscious and unintentional biases on therapeutic decision-making. Pharmaceutical and medical device companies, however, routinely demonstrate their knowledge of social psychology processes on behavior and apply these principles to their marketing. To illustrate how pharmaceutical marketing strategies use psychological techniques to promote targeted therapies, we draw on the relevant social psychology literature on conflicts of interest and on the six principles of influence articulated by the eminent social psychologist Robert Cialdini. Hospitals, professional organizations, medical educators, and other stakeholders must also draw on social psychology to respond effectively to commercial activities that compromise good medical practice.

Type
Symposium
Information
Journal of Law, Medicine & Ethics , Volume 41 , Issue 3 , Fall 2013 , pp. 665 - 672
Copyright
Copyright © American Society of Law, Medicine and Ethics 2013

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

McCurdy, E., The Mind of Leonardo da Vinci (New York: Dover Publications, 2005): at 23.Google Scholar
Sah, S., “Conflicts of Interest and Your Physician: Psychological Processes That Cause Unexpected Changes in Behavior,” Journal of Law, Medicine & Ethics 40, no. 3 (2012): 482–487.Google Scholar
Cialdini, R. B., The Psychology of Persuasion (New York: Quill William Morrow, 1984).Google Scholar
Wazana, A., “Physicians and the Pharmaceutical Industry: Is a Gift Ever Just a Gift?” JAMA 283, no. 3 (2000): 373–380; Orlowski, J. P. Wateska, L., “The Effects of Pharmaceutical Firm Enticements on Physician Prescribing Patterns. There's No Such Thing as a Free Lunch,” Chest 102, no. 1 (1992): 270–273; Chren, M. M. Landefeld, C. S., “Physicians' Behavior and Their Interactions with Drug Companies,” JAMA 271, no. 9 (1994): 684–689; Elliott, C., White Coat, Black Hat: Adventures on the Dark Side of Medicine (Boston: Beacon Press, 2010).Google Scholar
Shaughnessy, A. F. Slawson, D. C. Bennett, J. H., “Separating the Wheat from the Chaff,” Journal of General Internal Medicine 9, no. 10 (1994): 563–568; Molloy, W. Strang, D. Guyatt, G. Lexchin, J. Bédard, M. Dubois, S. Russo, R., “Assessing the Quality of Drug Detailing,” Journal of Clinical Epidemiology 55, no. 8 (2002): 825–832.Google Scholar
Avorn, J. Chen, M. Hartley, R. et al., “Scientific Versus Commercial Sources of Influence on the Prescribing Behavior of Physicians,” American Journal of Medicine 73, no. 1 (1982): 4–8.CrossRefGoogle Scholar
Sah, S. Moore, D. A. MacCoun, R., “Cheap Talk and Credibility: The Consequences of Confidence and Accuracy on Advisor Credibility and Persuasiveness,” Organizational Behavior and Human Decision Processes 121, no. 2 (2013): 246–255.CrossRefGoogle Scholar
Tversky, A. Kahneman, D., “Judgment Under Uncertainty: Heuristics and Biases,” Science 185, no. 4157 (1974): 1124–1131; Strack, F. Mussweiler, T., “Explaining the Enigmatic Anchoring Effect: Mechanisms of Selective Accessibility,” Journal of Personality and Social Psychology 73, no. 3 (1997): 437–446; Skurnik, I. Yoon, C. Park, D.C. Schwarz, N., “How Warnings about False Claims Become Recommendations,” Journal of Consumer Research 31, no. 4 (2005): 713–724.CrossRefGoogle Scholar
Makhinson, M., “Biases in Medication Prescribing: The Case of Second-Generation Antipsychotics,” Journal of Psychiatric Practice 16, no. 1 (2010): 15–21.CrossRefGoogle Scholar
See Sah, , supra note 2; Sah, S. Loewenstein, G., “Effect of Reminders of Personal Sacrifice and Suggested Rationalizations on Residents' Self-reported Willingness to Accept Gifts: A Randomized Trial,” JAMA 304, no. 11 (2010): 1204–1211.CrossRefGoogle Scholar
Lurie, N. Rich, E. C. Simpson, D. E. Meyer, J. Schiedermayer, D. L. Goodman, J. L. McKinney, W. P., “Pharmaceutical Representatives in Academic Medical Centers,” Journal of General Internal Medicine 5, no. 3 (1990): 240–243; Wazana, A., “Physicians and the Pharmaceutical Industry: Is a Gift Ever Just a Gift?” JAMA 283, no. 3 (2000): 373–380; Chren, M. M. Landefeld, C. S., “Physicians' Behavior and Their Interactions with Drug Companies: A Controlled Study of Physicians Who Requested Additions to a Hospital Drug Formulary,” JAMA 271, no. 9 (1994): 684–689.Google Scholar
McKinney, W. P. Schiedermayer, D. L. Lurie, N. Simpson, D. E. Goodman, J. L. Rich, E. C., “Attitudes of Internal Medicine Faculty and Residents toward Professional Interaction with Pharmaceutical Sales Representatives,” JAMA 264, no. 13 (1990): 1693–1697; Steinman, M. A. Shlipak, M. G. McPhee, S. J., “Of Principles and Pens: Attitudes and Practices of Medicine Housestaff toward Pharmaceutical Industry Promotions,” American Journal of Medicine 110, no. 7 (2001): 551–557; Sigworth, S. K. Nettleman, M. D. Cohen, G. M., “Pharmaceutical Branding of Resident Physicians,” JAMA 286, no. 9 (2001): 1024–1025.Google Scholar
Dana, J. Loewenstein, G., “A Social Science Perspective on Gifts to Physicians from Industry,” JAMA 290, no. 2 (2003): 252–255.CrossRefGoogle Scholar
Pronin, E. Lin, D. Y. Ross, L., “The Bias Blind Spot: Perceptions of Bias in Self Versus Others,” Personality and Social Psychology Bulletin 28, no. 3 (2002): 369–391; Pronin, E. Gilovich, T. Ross, L., “Objectivity in the Eye of the Beholder: Divergent Perceptions of Bias in Self Versus Others,” Psychological Review 111, no. 3 (2004): 781–799.Google Scholar
Pronin, E. Gilovich, T. Ross, L., “Objectivity in the Eye of the Beholder: Divergent Perceptions of Bias in Self Versus Others,” Psychological Review 111, no. 3 (2004): 781–799; Babcock, L. Loewenstein, G. Issacharoff, S., “Creating Convergence: Debiasing Biased Litigants,” Law & Social Inquiry 22, no. 4 (1997): 913–925.CrossRefGoogle Scholar
Babcock, L. Loewenstein, G., “Explaining Bargaining Impasse: The Role of Self-Serving Biases,” Journal of Economic Perspectives 11, no. 1 (1997): 109–126; Babcock, L. Loewenstein, G. Issacharoff, S. Camerer, C., “Biased Judgments of Fairness in Bargaining,” American Economic Review 85, no. 5 (1995): 1337–1343; Loewenstein, G. Issacharoff, S. Camerer, C. Babcock, L., “Self-Serving Assessments of Fairness and Pretrial Bargaining,” Journal of Legal Studies 22, no. 1 (1993): 135–159.Google Scholar
Id. (Babcock, Loewenstein, , “Explaining Bargaining Impasse: The Role of Self-Serving Biases,” Journal of Economic Perspectives 11, no. 1 (1997): 109–126.CrossRefGoogle Scholar
Festinger, L., A Theory of Cognitive Dissonance (Stanford University Press, 1957): at 1–31.Google Scholar
Chimonas, S. C. Brennan, T. A. Rothman, D. J., “Physicians and Drug Representatives: Exploring the Dynamics of the Relationship,” Journal of General Internal Medicine 22, no. 2 (2007): 184–190.CrossRefGoogle Scholar
See supra note 2.Google Scholar
Sah, S. Larrick, R., “I Am Immune: A Sense of Invulnerability Predicts Increased Acceptance of, and Influence from, Conflicts of Interest,” Research in Progress (2013); Pronin, E. Lin, D. Y. Ross, L., “The Bias Blind Spot: Perceptions of Bias in Self Versus Others,” Personality and Social Psychology Bulletin 28, no. 3 (2002): 369–391.Google Scholar
L'Oréal Paris, available at <http://www.loreal-paris.co.uk/_en/_gb/lorealinsider/news-and-reviews/news-article.aspx?cat=Skincare&id=201203_News029> (last visited July 2, 2013). (last visited July 2, 2013).' href=https://scholar.google.com/scholar?q=L'Oréal+Paris,+available+at++(last+visited+July+2,+2013).>Google Scholar
See Sah, S. Loewenstein, G., “Effect of Reminders of Personal Sacrifice and Suggested Rationalizations on Residents' Self-reported Willingness to Accept Gifts: A Randomized Trial,” JAMA 304, no. 11 (2010): 1204–1211.CrossRefGoogle Scholar
Cialdini, R. B., Influence: The Psychology of Persuasion (New York: HarperBusiness, 2006); Goldstein, N. J. Martin, S. J. Cialdini, R. B., Yes!: 50 Scientifically Proven Ways to Be Persuasive (New York: Free Press, 2008).Google Scholar
See Cialdini, , supra note 24, at 17–56.Google Scholar
Mauss, M., The Gift: The Form and Reason for Exchange in Archaic Societies (London: Routledge, 2006).Google Scholar
Mather, C., “The Pipeline and the Porcupine: Alternate Metaphors of the Physician–Industry Relationship,” Social Science Medicine 60, no. 6 (2005): 1323–1334.CrossRefGoogle Scholar
Oldani, M. M., “Thick Prescriptions: Toward an Interpretation of Pharmaceutical Sales Practices,” Medical Anthropology Quarterly 18, no. 3 (2004): 325–356.CrossRefGoogle Scholar
See Elliott, , supra note 4, at 63.Google Scholar
Id., at 55–56.Google Scholar
See supra note 27.Google Scholar
See, Rodwin, M., “Five Un-Easy Pieces to Pharmaceutical Policy Reform,” Journal of Law, Medicine & Ethics 41, no. 3 (2013): 581–589.CrossRefGoogle Scholar
PhRMA Code on Interactions with Healthcare Professionals, available at <http://phrma.org/sites/default/files/pdf/phrma_marketing_code_2008–1.pdf> (last visited April 8, 2013).+(last+visited+April+8,+2013).>Google Scholar
Fugh-Berman, A. Ahari, S., “Following the Script: How Drug Reps Make Friends and Influence Doctors,” PLoS Medicine 4, no. 4 (2007): 621–625.CrossRefGoogle Scholar
See Cialdini, , supra note 24, at 17–56; Cialdini, R. B. Vincent, J. E. Lewis, S. K. Catalan, J. Wheeler, D. Darby, B. L., “Reciprocal Concessions Procedure for Inducing Compliance: The Door-in-the-Face Technique,” Journal of Personality and Social Psychology 31, no. 2 (1975): 206–215; Malmendier, U. Schmidt, K. M., “You Owe Me,” Working Paper (2011); Friedman, H. Rahman, A., “Gifts-Upon-Entry and Appreciatory Comments: Reciprocity Effects in Retailing,” International Journal of Marketing Studies 3, no. 3 (2011): 161–164.CrossRefGoogle Scholar
Id. (Malmendier, Schmidt, ).Google Scholar
Regan, D. T., “Effects of a Favor and Liking on Compliance,” Journal of Experimental Social Psychology 7, no. 6 (1971): 627–639.CrossRefGoogle Scholar
See Friedman, Rahman, , supra note 35.Google Scholar
See supra note 33.Google Scholar
Fugh-Berman, A., “Prescription Tracking and Public Health,” Journal of General Internal Medicine 23, no. 8 (2008): 1277–1280.CrossRefGoogle Scholar
See Cialdini, , supra note 24, at 57–113.Google Scholar
Knox, R. E. Inkster, J. A., “Postdecision Dissonance at Post Time,” Journal of Personality and Social Psychology 8, no. 4 (1968): 319–323.CrossRefGoogle Scholar
See supra note 40.Google Scholar
Howard, D. J., “The Influence of Verbal Responses to Common Greetings on Compliance Behavior: The Foot-In-The-Mouth Effect,” Journal of Applied Social Psychology 20, no. 14 (1990): 1185–1196.CrossRefGoogle Scholar
Cialdini, R. B., Influence: Science and Practice (Illinois: Scott, Foresman Glenview, 1985): at 116; Asch, S. E., “Studies of Independence and Conformity: I. A Minority of One Against a Unanimous Majority,” Psychological Monographs: General and Applied 70, no. 9 (1956): 1–70; Deutsch, M. Gerard, H. B., “A Study of Normative and Informational Social Influences upon Individual Judgment,” Journal of Abnormal and Social Psychology 51, no. 3 (1955): 629–636.Google Scholar
King, M. Essick, C. Bearman, P. Ross, J. S., “Medical School Gift Restriction Policies and Physician Prescribing of Newly Marketed Psychotropic Medications: Difference-in-Differences Analysis,” BMJ 346 (2013): 1–9.CrossRefGoogle Scholar
Grande, D. Frosch, D. L. Perkins, A. W. Kahn, B. E., “Effect of Exposure to Small Pharmaceutical Promotional Items on Treatment Preferences,” Archives of Internal Medicine 169, no. 9 (2009): 887–893.CrossRefGoogle Scholar
Austad, K. E. Avorn, J. Kesselheim, A. S., “Medical Students' Exposure to and Attitudes about the Pharmaceutical Industry: A Systematic Review,” PLoS Medicine 8, no. 5 (2011): 1–12.CrossRefGoogle Scholar
Id.Google Scholar
McCormick, B. B. Tomlinson, G. Brill-Edwards, P. Detsky, A. S., “Effect of Restricting Contact between Pharmaceutical Company Representatives and Internal Medicine Residents on Posttraining Attitudes and Behavior,” JAMA 286, no. 16 (2001): 1994–1999; Ferguson, R. P. Rhim, E. Belizaire, W. Egede, L. Carter, K. Lansdale, T., “Encounters with Pharmaceutical Sales Representatives among Practicing Internists,” American Journal of Medicine 107, no. 2 (1999): 149–152.CrossRefGoogle Scholar
See Steinman, et al., supra note 12; Sierles, F. S. Brodkey, A. C. Cleary, L. M. McCurdy, F. A. Mintz, M. Frank, J. Lynn, D. J. et al., “Medical Students' Exposure to and Attitudes about Drug Company Interactions: A National Survey,” JAMA 294, no. 9 (2005): 1034–1042.Google Scholar
See supra note 33.Google Scholar
See Elliott, , supra note 4, at 64.Google Scholar
Id., at 56.Google Scholar
See supra note 33.Google Scholar
See, Sismondo, S., “Key Opinion Leaders and the Corruption of Medical Knowledge: What the Sunshine Act Will and Won't Cast Light On,” Journal of Law, Medicine & Ethics 41, no. 3 (2013): 635–643.CrossRefGoogle Scholar
See Elliott, , supra note 4; Steinman, M. A. Harper, G. M. Chren, M.-M. Landefeld, C. S. Bero, L. A., “Characteristics and Impact of Drug Detailing for Gabapentin,” PLoS Medicine 4, no. 4 (2007): 743–751.Google Scholar
See Elliott, , supra note 4, at 77.Google Scholar
See supra note 33.Google Scholar
Goldfinger, S. E., “A Matter of Influence.” New England Journal of Medicine 316, no. 22 (1987): 1408–1409.CrossRefGoogle Scholar
Festinger, L., A Theory of Cognitive Dissonance (Stanford, CA: Stanford University Press, 1957); Festinger, L. Carlsmith, J. M., “Cognitive Consequences of Forced Compliance,” Journal of Abnormal and Social Psychology 58, no. 2 (1959): 203–210.Google Scholar
Id. (Festinger, Carlsmith, ).Google Scholar
Kelman, H. C., “Attitude Change as a Function of Response Restriction,” Human Relations 6, no. 3 (1953): 185–214.CrossRefGoogle Scholar
See Goldfinger, , supra note 60; Chren, Landefeld, , supra note 11.Google Scholar
Id. (Chren, Landefeld, ).Google Scholar
See Sierles, et al., supra note 51.Google Scholar
Sagarin, B. J. Cialdini, R. B. Rice, W. E. Serna, S. B., “Dispelling the Illusion of Invulnerability: The Motivations and Mechanisms of Resistance to Persuasion,” Journal of Personality and Social Psychology 83, no. 3 (2002): 526–541.CrossRefGoogle Scholar
Fugh-Berman, A. Scialli, A. Bell, A. M., “Why Lunch Matters: Assessing Physician's Perceptions about Industry Relationships,” Journal of Continuing Education in the Health Professions 30, no. 3 (2010): 197–204.CrossRefGoogle Scholar