The ASCO Meeting: The swag!

Dedicated advocate of evidence-based medicine that I am, I am sometimes labeled by those who do not understand skepticism as a "shill" for big pharma. Of course, such accusations are simply the logical fallacy known as poisoning the well, in which the credulous engage in preemptive ad hominem attacks designed to associate me with the hated big pharma, but it's a common enough tactic that sometimes I can't help but joke that I wish pharma did actually pay me for my little hobby here. After all, why do for free (or for a pittance from my Seed overlords) what, if you believe the alties, I could be paid big bucks to do, right?

This post may endanger my chance at that fantastical gravy train; that is, if the gravy train exists, which I sincerely doubt it does. I like the American Society of Clinical Oncology (ASCO). It does great work, particularly the ASCO Foundation, which is about as worthy a charity as there is out there, not to mention a very large private supporter of cancer research. ASCO itself provides a voice for cancer doctors, publishes several cancer journals, and disseminates the results of huge quantities of research every year at its annual meetings. Still, I have to admit that sometimes I find the massive big pharma presence at the annual ASCO meetings to be troubling, particularly after reading Dr. Len's article in which he discussed how ASCO debated in the 1970s about whether to let big pharma in.

However, what does exist, if you attend a meeting like the ASCO Meeting, is an amazing display of big pharma excess, as I alluded to last week. Of course, with big meetings and big displays like this an come big swag, and this meeting had some serious swag.

Because vendors pay a premium for placement close to the entrance, if you look at the entrance to the exhibit hall, you can get an idea of just who the biggest players were this year:




From these pictures, we can see that Genentech, Sanofi-Aventis, and AstraZeneca seemed to have the best placement. True, there was one other place I'd have wanted to be if I were a vendor, and that's where escalators from the lower level where the shuttle buses arrived dumped new arrivals right in the middle of the exhibit floor, but that's still not as good as being right up at the main entrance.

The first thing I noticed wandering about the exhibit hall was that the swag at ASCO was better than it was at the AACR Meeting, which I attended in April. A lot of the same vendors were at AACR; some of them even had displays as impressive as the ones at ASCO. However, they weren't giving out the same level of stuff. Just as an example, the simplest of all swag, the lowly pen, tended to be of the cheap plastic variety at AACR, while at ASCO there were very nice pens with metal barrels, and at at least one booth you could get the pen laser-etched with your name. You may ask why this difference in swag potential between the meetings exists, given that AACR is not all that much smaller a meeting than ASCO, clocking in at around 2/3 the number of attendees. The answer, I speculate, is simple. AACR is primarily a scientific meeting. A lot of physicians attend it, but so do a lot of basic science researchers, postdocs, and fellows. In contrast, the ASCO meeting is almost all clinical. It's attendees are nearly all physicians, many of them oncologists who prescribe the very chemotherapeutics that the drug companies are selling. At AACR, pens and the occasional laser pointer, along with the ubiquitous bags and occasional mug, were the main swag. At ASCO, I saw wireless mouses, engraved pens, laser pointers, thumb drives; in other words, higher class swag. Whereas at AACR, only a few booths were serving various treats such as cappuccino or fruit smoothies, at ASCO, my impression was that such perks were present at quite a few of the booths.

Believe it or not, I didn't actually gather that much swag to take home, although I knew at least a couple of people who were total swag-masters, hunting down only the finest items. They would not settle for mere pens, much as, say, Paris Hilton would not settle for shopping at Walmart. One example that stood out was Novartis, at whose booth were being given out leather compendiums. But not just any leather compendiums. Oh, no. Attendees could have these embossed with their names. Even better, the compendiums did not have the Novartis company name etched anywhere on them. Very classy, and appreciated by connoisseurs of swag. Had I needed a leather compendium for anything, I would have been seriously tempted.

However, Novartis' offerings paled in comparison to those of the company that had to win, hands down, the award for most outrageous swag. That company this year was, without a doubt, Genentech. Here's what greeted attendees who approached the Genentech booth:


At different ends of the booth, you'd see representatives like this waiting to greet people:


The black things in the wooden display next to the representatives were leather cases about the size of a CD caddy that could hold around 100 CDs. But they weren't CD holders. Rather, each case had four different compartments into which swag would fit. The attendees' job, if they decided to take it, was to go to four different stations inside the booth and fill up the compartments. Armed with one of these black leather cases and a multicolored cube, they sallied forth to do battle, and to the victors went the swag. Of course Genentech had it set up so that everyone could be a winner. All one had to do was to swipe one's ID badge (so that Genentech could deluge one with junk mail, presumably) and take four brief quizzes, one at each station, after each one of which, one would get one of the four items needed to fill the leather case.

"Contestants" started each quiz, by taking one of the multicolored cubes and placing it into a hole in a pedestal, like so:


This would begin the quiz, which basically consisted of mind-numbingly simple questions about Genentech products that almost anyone could answer, and, if anyone couldn't, the helpful Genentech reps would happily provide the answers. After attendees completed the quiz, they would put their cubes into large bowls:


(I have no idea whose hand that was. It just sort of snuck into the shot.)

So what was Genentech giving out? What were the four items that were needed to fill the leather case? I didn't actually go through and get them, but I observed, and this is what filled these cases: a wireless mouse; a 1 GB thumb drive; a combination laser-pointer/infrared remote control PowerPoint slide advancer; and, finally, a four outlet USB hub. Here's a wireless mouse with the Tarceva logo on it (a Genentech/OSI Pharmaceuticals product):


I'm pretty sure that, combined with the leather case, the total value of each one of these swag sets had to be around $100, and Genentech was handing out what to me looked like hundreds of them, if not thousands over the four day course of the meeting.

I found this a bit disturbing because I happen to like Genentech quite a bit as a company. I know a couple of people who work for the company (not well, I should point out, though). Moreover, back when I was in junior high school, I remember doing a report on genetic engineering, part of which included a mention of a (then) brand new biotechnology company dedicated to using genetic engineering to develop drugs and treatments for human disease. The time was the late 1970s, and the company was Genentech. In many ways, Genentech was a pioneer in the entire biotech industry, and as such it's research-driven in a way that goes beyond that of most pharmaceutical companies. Its research has led to products such as Herceptin, Tarceva, and Avastin, the latter of which was the first major antiangiogenic therapy to be approved for cancer. The company also consistently wins awards for being one of the best companies to work for and for being a "good corporate citizen." Indeed, in 2006 it ranked #1 in Fortune Magazine's "best companies to work for" list, although Google knocked it out of that spot in 2007. Somehow, Genentech, in transforming itself from the scrappy biotech company with a vision to use the (then) new techniques of genetic engineering to produce better pharmaceutical products into the behemoth that it is now, has taken on a lot of the excesses of big pharma in the process. I wonder if such a transformation was inevitable once Genentech became as profitable as it is.

All of this also made me wonder whether all this promotion and swag are really necessary. For example, in the case of Genentech, some of their products have, in essence, no competition. For example, there is at present no other drug that does what Herceptin does. Even so, the swag flowed freely from the Genentech booth at ASCO, as it did from many other companies' booths. I accept that in a free market capitalist system promotions and advertising are necessary, but how much of this swag is really necessary? Does handing out $100 batches of swag, after spending tens, if not hundreds, of thousands of dollars to set up and man a booth at ASCO, really produce that much of a return on the expenditure for promotions? It strikes me as overkill.

If I were a shareholder in any of these companies, I'd want to know.


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I'm sure the shareholders don't really care - they trust the management that it is worth the money, and a budget of a few million dollars for swag is probably not a big deal. The more worrying problems are 1) the ammunition it provides to alternative medicine cheerleaders in the media and 2) the not-to-be discounted possibility that a minority of clinicians have been subconsciously swayed by the swagfest and might change their behaviour in the swag provider's favour. It's certainly a long way from the endearingly straightforward ads that non-medical scientists are exposed to.

I remember being at the Liver meeting once, and a doc from the UK was disgusted at all the "hospitality" stuff, and remarked that a single course of treatment of hepatitis C with interferon was something like $30k, enough to cover all the food in a single one of the numerous bashes.

"Herceptin costs about $60,000 per patient per year."

It doesn't take many patient-years to cover a few hundred $k in swag.

I wouldn't care about the mouse, but the USB hub? Suweeeeeet....

(I don't go to trade shows in any industry; I went to one, once, that my husband was attending, and have been kicking myself for not sitting through a 20-minute presentation to get a Kermit the Frog doll. The tote bags that company was handing out were really sweet, much nicer for toting swag than the @#$% stiff paper bags of another company, and if you turned, you wouldn't smack someone in the chest with it, unlike with the bags handed out by that other company.)

Not to promote that swag giving to doctors,
I "do" think it distorts the market.
I suspect you overestimate the value of the swag

I have worked for a company providing swag ( including getting the logo printed on ) for companies - order the swag early enough and you can get the stuff for a fraction of the retail value ( if you go to Staples and systematically select for the cheapest item ) - actually it the art of the swagsellers to provide something looking like 100 USD for 25 plus printing plus delivery - a lot of saving potential is in the numbers - setting up the printing machine for 50 mice costs as much as the setting up for 1000. If you really want to save then finding a manufacturer in China and waiting 3 months for the shipment is the way to go that Chinese manufacturer might well throw in free printing to sell a couple of thousand - only most ad-campaign organizers don't have an attention span that long.

(No I cannot give quotes, I do not work for that swag-seller anymore, it was in Germany anyway and we did not part friendly. )

I love those thumb drives.

My husband attends many IT shows, and he's under orders to always bring those home when they have them!

The other good swag is little sets of screwdrivers for connecting cords to the back of your PC. But maybe Oncologists don't spend so much time crawling around under their desks hooking things up.

I kinda doubt that Genentech swag costs $100. They all existing electronics... The only 'new' component is the housing/packaging which wouldn't cost a whole lot to tool. I could be wrong though, I'm not as familier with pricing for stock pharma swag since I mostly worked on custom swag geared toward pt. education.

So, Orac, the obvious questions:

How much DO you think accepting a single crappy plastic pen and a logo-bespattered A5 notepad corrupts the soul of the medical student, intern or resident who accepts it?

(Note: In Australian public hospitals the drugs are generic, and the intern/resident who writes a script gives nothing to the big-name companies, although until recently we were permitted to write e.g. "Augmentin" as a shorthand for amoxycillin-clavulanate, or "Lasix" for frusemide).

Do you think this corruption (if it exists) rises with increasing seniority?

Now that I am in pathology and not writing scripts of any kind, I feel I'm immune from this. And while I'm still a path resident and not in a position to make decisions on expensive equipment, I feel I can take the swag from companies that make things like stainers and PCR machines and immunoperoxidase processors without soiling my soul.

By Justin Moretti (not verified) on 11 Jun 2007 #permalink

So what was Genentech giving out? What were the four items that were needed to fill the leather case? I didn't actually go through and get them, but I observed, and this is what filled these cases: a wireless mouse; a 1 GB thumb drive; a combination laser-pointer/infrared remote control PowerPoint slide advancer; and, finally, a four outlet USB hub. Here's a wireless mouse with the Tarceva logo on it (a Genentech/OSI Pharmaceuticals product):

I think what seems odd to me about this is how little any of this seems to have to do with Genentech's business.