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Did Free Pens Cause the Opioid Crisis?

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At a minimum, when doctors prescribe brand-name drugs rather than generics, insurance companies’ costs increase, as do your insurance premiums. Other recent research suggests more damaging consequences from gift-giving. One study found that placing limits on sales calls (including, in most cases, a ban on gifts) led to a decline in children being prescribed antidepressants and antipsychotics not approved by the FDA for pediatric use. (Such “off label” prescribing is common, but the direct promotion of drugs for off-label uses is prohibited by federal law—there is insufficient evidence that these uses are effective.) Whether because they simply felt less beholden to salespeople, or perhaps because they were hearing fewer pitches for off-label uses, doctors prescribed these drugs to children less often when detailers’ visits were restricted.

What about opioids? Well, there’s this: A short paper published in jama Internal Medicine in 2018 found that, while prescriptions have dropped across the country in response to their much-publicized abuse, among physicians who continued to receive gifts from opioid makers, prescriptions continued to see a modest rise.

The role of gifts in commerce dates back at least to ancient Rome. The poet Catullus described the gifts Caesar deployed to cajole and manipulate others as “wicked generosity.”

In recent decades, social psychologists have helped turn consumer-focused gift-giving into a science. One of the godfathers of this field is Robert Cialdini. Early in his career, in the 1970s, he became intrigued by the various tactics that salespeople used to get consumers to buy stuff. He set out to explore whether these tricks actually worked. He went undercover, taking sales and marketing jobs at a used-car lot, a fund-raising organization, a telemarketing company. He cataloged the tactics he witnessed and began to test them at Arizona State University, where he was a faculty member.

This work culminated in 1984 with Influence: The Psychology of Persuasion, which became a best seller and is still assigned and read in business schools today. The book lays out six principles that can make a pitch more persuasive. Among them is reciprocity, which Cialdini’s book helped package as an explicit—and easy-to-implement—tactic for marketers.

More recent research has highlighted just how good an investment gifts can be—no matter what you’re selling. In one experiment, the economist Armin Falk had a charity send about 10,000 letters to potential donors, asking them to give money. About a third of the would-be donors received only a letter. Another third received the letter accompanied by a postcard with a colorful drawing on it—a gift, the recipients were told, “from the children of Dhaka” that could be “kept or given to others.” The final third received the letter and four postcards.

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