Grande David, Frosch Dominick L, Perkins Andrew W, Kahn Barbara E
Department of Medicine and Leonard Davis Institute of Health Economics, University of Pennsylvania, 3641 Locust Walk, Philadelphia, PA 19104-6218, USA.
Arch Intern Med. 2009 May 11;169(9):887-93. doi: 10.1001/archinternmed.2009.64.
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.
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.
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).
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.
有关药品促销的政策讨论通常认为，小型促销物品不太可能影响处方行为。我们的实验旨在衡量接触这些物品是否会导致对上市产品产生更积极的态度，以及限制药品营销的政策是否会减轻这种影响。
这是一项针对美国两所医学院352名三、四年级医学生的随机对照实验，两所医学院对药品营销的政策不同。被分配到实验组的参与者在不知情的情况下接触了立普妥（阿托伐他汀）的小型品牌促销物品，且不知道这种接触是研究的一部分。我们使用内隐联想测验（IAT）测量了实验组和对照组对立普妥和舒降之（辛伐他汀）的内隐（即无意识）态度差异。还测量了自我报告的态度，并进行了一项后续调查，测量对营销的态度。
与对照组相比，接触立普妥促销物品的迈阿密大学米勒医学院四年级学生对该品牌药物有更积极的内隐态度（IAT效应：0.66对0.47；P = 0.05），而在宾夕法尼亚大学医学院（IAT效应：0.22对0.52；P = 0.002），由于存在限制药品营销的政策，这种效应则相反（交互效应：P = 0.003）。在三年级学生中未观察到显著影响。在“怀疑态度”量表上，迈阿密大学的学生对药品营销的态度比宾夕法尼亚大学的学生更积极（0.55对0.42；P < .001），但其结果与之前发表的一项全国性研究的结果相似（0.42对0.43；P = 0.53）。
微妙地接触小型药品促销物品会影响医学生对上市产品的内隐态度。我们观察到，在限制性政策以及学校层面更消极的营销态度背景下，这种效应会发生逆转。
