By Mary Gabb ([email protected])

January 1, 2009 – typically a day of new beginnings – marked the beginning of the end of SWAG (stuff we all get, or freebies) for doctors from pharmaceutical companies in the United States . This change was the result of new voluntary industry guidelines published by the industry group, Pharmaceutical Research and Manufacturers of America (PhRMA). As of 15 January 2009, 41 companies have signed on to abide by the code.

Pharma swag has typically come in the form of free pens, notepads, soap dispensers, coffee mugs, and the like, all with the company and drug name prominently displayed. These “reminder items” serve a purely promotional purpose – to reinforce the brand. More recently, swag has also taken the form of more medically useful or educational items, such as anatomy displays or posters for doctor’s offices, or patient educational pamphlets or DVDs – all with the pharma company, drug name and logo in plain view.

The new guidelines ban the distribution of “items for healthcare professionals’ use that do not advance disease treatment or education – even if they are practice-related items.” Items that can be given away should be “designed primarily for the education of patients or healthcare professionals… are not of substantial value ($100 or less) and do not have value to healthcare professionals outside of his or her professional responsibilities.” Thus, other freebies such as DVD players or free sporting event tickets are now verboten.

While some doctors bemoan such blatant promotion, others insist it does not affect their prescribing habits, that they make prescribing decisions based on the individual patient. Given the billions of dollars spent by pharma on advertising each year, one imagines that the swag must have had some effect or the companies wouldn’t have bothered.

But what impact will the swag vacuum have on physicians’ practice balance sheets? For those in private practice, having to buy their own pens and notepads may not throw their budgets into the red, but free clinics and practices that serve predominantly Medicaid/Medicare or uninsured patients and operate on more strict budgets may be feeling the pinch.

Shannon Ortiz, the office manager for the Free Medical Clinic in Iowa City , Iowa , says her office will now rely on donations for such office supplies; such items are included on a “wish list” for donors. The pharma sales reps who visit her clinic don’t typically bring medical items (eg, branded tongue depressors, exam table paper) as swag but if they need such items, other doctors’ offices typically donate them.

By contrast, Carle Clinic in Urbana , Illinois , (which employs more than 330 physicians) has had some form of non-solicitation policy for the last few years and has actively discouraged both pharma reps from distributing swag and physicians from accepting them. This new pharma policy was not formally announced to the clinic and, according to Jennifer Hendricks-Kaufmann, Public Relations and Communications Manager for Carle Clinic, should have “minimal, if any, impact” on their budgets, because the office items and even patient education materials are already provided directly by the clinic.

The impact of this swag reduction remains to be seen – for both physician practices and pharma profits. It does show, however, that pharma is paying closer attention to appearances of undue influence on prescribing habits.