Need a raise? Give away a few mints....

November 26, 2012 5:39 AM

The Rule of Reciprocation: an interesting read for anyone who works for tips, or wonders why your physician is prescribing that particular medication. From NPR "Give And Take: How The Rule Of Reciprocation Binds Us"
posted by HuronBob (13 comments total)

I've favorited all of you, for the holidays.
posted by notyou at 6:32 AM on November 26, 2012 [4 favorites]

"Why would someone send a three-page letter to a complete and total stranger?"

Presumably because blogging hadn't been invented yet.
posted by lore at 6:38 AM on November 26, 2012 [2 favorites]

I really wish this point had been backed up with some numbers, because it's probably the biggest point raised by the article:

"You find doctors more willing to prescribe medication based on what gifts, favors and tips they have been given by one pharmaceutical company or another," he says.
posted by jbickers at 6:40 AM on November 26, 2012

Someone at NPR read Robert Cialdini! Now they just need programs to cover the other 5 methods of influencing: Commitment & Consistency, Social Proof, Authority, Liking, & Scarcity.
posted by leotrotsky at 6:54 AM on November 26, 2012

Not really shocking. While there are doctors that do a lot of independent review of the available literature on various drugs a lot tend to go with the drugs that they are comfortable with and what their drug reps are pushing via pamphlets and drug samples.

So if your drug rep comes in and brings $100 bucks worth of free samples and takes you to lunch and tells you about this new patented drug that does the exact same thing that the generic does you tend to still have the thought of prescribing that new drug when someone comes into your office.

It's even easier when someone comes into the office having basically self-diagnosed and is asking for overpriced drug A.

Honestly I don't know the solution, you could have insurance companies force doctors to prescribe from a fixed list of cheaper drugs but that's going to raise all sorts of issues plus there are actually times when you need to go with the new overpriced wonder drug. I don't know that you could regulate the drug rep practice that much.
posted by vuron at 6:56 AM on November 26, 2012

Hm, people are just discovering that now? When I was an anthropologist we talked about gift exchange, but it was sort of an old area of studies, relegated to ethnologists and a few Marxian/economic focused researchers.

you could have insurance companies force doctors to prescribe from a fixed list of cheaper drugs

It's called a preferred drug list and it already exists for most insurances. Getting drugs off the list covered is often a huge time sink and sometimes a health risk.
posted by cobaltnine at 7:03 AM on November 26, 2012

It's not new research, just a new bringing together of several studies and ideas through that program. Cialdini's own work with it dates back to the 90s, at least.
posted by bizzyb at 7:35 AM on November 26, 2012

I really wish this point had been backed up with some numbers, because it's probably the biggest point raised by the article:

"You find doctors more willing to prescribe medication based on what gifts, favors and tips they have been given by one pharmaceutical company or another," he says.

This 2000 meta-analysis is a good roundup and is available in free fulltext. The bottom line is that "Interactions with pharmaceutical representatives were also found to impact the prescribing practice of residents and physicians in terms of prescribing cost, nonrational prescribing, awareness, preference and rapid prescribing of new drugs, and decreased prescribing of generic drugs." Table 4 has the relevant numbers.
posted by jedicus at 7:53 AM on November 26, 2012 [2 favorites]

"Why would someone send a three-page letter to a complete and total stranger?"

I imagine the thought process was as follows: "Oh, crap. I don't remember who these people are, but we must know them/my spouse must have met one of them for work and forgot to mention it to me. I'll just send them my generic Christmas card/letter/whatever and put them on the list for next year, so I don't forget." I doubt it was "I bet this person is a complete stranger, but it's important that I write back even to strangers."
posted by jeather at 9:29 AM on November 26, 2012 [2 favorites]

"I bet this person is a complete stranger, but it's important that I write back even to strangers."

Well now that they've sent you a Christmas card they aren't strangers anymore!
posted by Meatbomb at 10:12 AM on November 26, 2012

Well now that they've sent you a Christmas card they aren't strangers anymore!

They're just strange.
posted by jeather at 10:19 AM on November 26, 2012 [2 favorites]

I imagine the thought process was as follows: "Oh, crap. I don't remember who these people are, but we must know them/my spouse must have met one of them for work and forgot to mention it to me. I'll just send them my generic Christmas card/letter/whatever and put them on the list for next year, so I don't forget."

When The Fella and I got engaged, one of our very first gifts was a souvenir plate featuring our home state, mailed to us from a small town in our state. Neither of us recognized the name on the return address and there was no card enclosed. The Fella and I racked our brains and I made some calls to family members: does anyone know [FirstName M. LastName] in [SmallTown, State]? Is he a family friend? A distant uncle? A one-time classmate? An old boss?

Who the heck was this guy whom neither of us remembers but who is close enough to send us [what was presumably] an engagement gift? It was such a weird little occurrence that I mentioned it in an email to an old friend.

After a few days of thought --- and a few days is an eternity in etiquette terms --- I gave up on figuring out who he was and just wrote a carefully worded thank-you note of a few paragraphs focusing on how thoughtful the gift was, how grateful The Fella and I were, and how kind it was of FirstName LastName to think of of us and share our joy.

Minutes after I dropped that note in the post, my old friend responded by email: WAIT, she had solved our mystery! Her mother, whom I've known since I was a child, had bought a souvenir plate off eBay from a buyer more-or-less local to us and had it shipped directly to us. (Our package arrived just 36 hours after she paid, so she hadn't yet told us to expect it --- FirstName LastName was FAST. A++++++ would buy again.)

And that is how I sent a lovely, carefully written, effusively thankful note of shared joy and remembrance to an eBay seller.
posted by Elsa at 10:50 AM on November 26, 2012 [13 favorites]

From the article:

And so if someone passes you in the hall and says hello, you feel compelled to return their greeting. When you don't, you notice it, it makes you uncomfortable, out of balance. That's the rule of reciprocation.

"There's not a single human culture that fails to train its members in this rule," Cialdini says.

I've told the story of The Socially Enforced Reciprocal Hellos before. That guy still waves to me.
posted by Elsa at 10:56 AM on November 26, 2012