Studies have demonstrated that gifts, however small, can influence behaviour, and simple exposure to brand names, especially when it is repeated, can have a subconscious effect. The pharmaceutical industry and marketing in general have exploited these techniques to influence sales.

Gifts  have a fundamental role in human relations. The recipient displays a minimum of courtesy, even gratitude, and feels a sense of obligation.

After accepting a gift once, it becomes easier to accept further gifts. Giving a gift creates closeness and trust. It is then easier to ask a first little favour in return, a few moments of a person's time, for example. Other, bigger favours can then be requested, and the recipient feels unable to refuse. This is the “foot-in-the-door” technique, beloved of pharmaceutical and other sales reps.

The giver and the recipient's interests become linked, directly affecting choices and resulting in a certain reciprocity, often unconscious, especially when the gift is modest.

To resist these sales ploys, it is necessary to understand the psychology behind them, which is often unconscious.

In managing experts' conflicts of interest, the French and European drug regulatory agencies deem that small gifts do not exert an influence and so they are not taken into account. Social science studies show however that this thinking is wrong. The regulations need to change to take into account the fact that small gifts also influence behaviour.

©Prescrire 1 December 2011

"The proven, often unconscious, influence of small gifts" Prescrire Int 2011; 20 (122): 303-305. (pdf, subscribers only)