Reciprocity Power: A Study That May Shock You


pharmaceutical reciprocity

Doctors in the U.S. are generally well-compensated. One survey showed that family practitioners earn $227,000 per year, while some specialties can hit $400,000 – $600,000.

One would hardly expect a cheap free lunch to influence which drugs they prescribe for their patients.

The conclusion of a new study may surprise even students of behavior science.

A team of researchers examined the prescribing behavior of 279,669 physicians found that even very inexpensive meals (less than $20) were correlated with more brand-name prescriptions. (Branded drugs are usually much more expensive than their generic counterparts.)

Prescriptions and meal charts

Even a single cheap meal could, apparently, change behavior.

The study concluded that receiving sponsored meals was associated with an “increased rate of prescribing the promoted brand-name medication to Medicare patients.”

Even a few cheap meals changed prescription-writing by doctors. Share on X

This is certainly a non-conscious effect. No doctor would admit to being influenced by a slice or two of pizza, nor would such a link even be rational.

While ethical guidelines suggest doctors not accept any gifts “for which reciprocity is expected or implied,” both parties to the cheap meal transaction almost certainly believe that no such reciprocity is present.

Reciprocity Isn’t Always Explicit

Just about every marketer knows about reciprocity (or as it’s also called, reciprocation).

Research by Robert Cialdini and others has shown that if you do something for someone first, they are more likely to reciprocate. And, the “favors” don’t have to be equivalent – a small favor can beget a bigger return favor.

And, this kind of reciprocity isn’t overt – either party or both may be unaware that their behaviors are linked.

The doctor study is an example of this – despite the lack of conscious awareness of reciprocity being triggered, the effect is significant.

The Small Big?

the small big cialdiniThis rather remarkable finding evokes the name of Cialdini’s recent book, The Small Big (co-authored with Steve Martin and Noah Goldstein). The central thesis of that book is that even tiny interventions can have an outsized influence on behavior.

I spoke to Cialdini about that book when it was released. He pointed out that it “applies a return on investment model to persuasion science,” and highlights “tactics and procedures and practices that make a big difference, but which require very little effort or time or resources on our part to produce that effect.”

Reciprocity: a small favor can trigger a much bigger return favor. Share on X

Treating a doctor to a cheap meal that could drive tens of thousands of dollars in additional prescription revenue seems like a high-ROI example of a small intervention! And, the minimal value of the meal mutes potential ethical questions.

cialdini-6-principles-cardCialdini himself invokes reciprocation at his speaking engagements, as I describe in How the World’s Leading Persuasion Expert Gets Your Business Card.

Why Reciprocity?

Why use reciprocity as a marketer when you could simply establish a quid-pro-quo transaction? The latter would seem to result in a more certain outcome.

The reason is simple. In a defined transaction, perceived fairness and rough equivalence of outcomes is important. All commerce where goods are exchanged for money is based on both parties seeing the transaction as fair.

But, trading a slice of pizza and a Diet Coke for months of favorable prescription writing would be laughable as a transaction. (Not to mention unethical.)

The power of psychological reciprocity is that the benefits to each side can be profoundly unequal.

How You Can Use Reciprocity

The underlying concept in using reciprocity to influence others is that it is never a quid-pro-quo exchange. It doesn’t work if one favor is contingent on the other.

For example, the common technique of rewarding those who subscribe to a newsletter with, say, a free ebook, can be effective. It can win A/B tests compared to no bonus material. But, it’s not reciprocity. It’s a transaction.

That type of transaction could invoke reciprocity if the publisher let a visitor download a free ebook first, and then suggested they subscribe. (I described this approach in Collecting Visitor Info: Reward vs. Reciprocity.)

Arguably, though, most blogs and news sites establish reciprocity by providing freely accessible content for their visitors. The free e-book they may offer is merely an additional incentive in that scenario, not the primary driver of behavior.

Let’s bring this closer to home…

At the end of this post there’s an offer to subscribe to my newsletter. One could argue that the reader who gets that far has reciprocity activated and is more likely to subscribe than, say, had the appeal been at the beginning of the article.

One could likely increase the reciprocity effect for a content site by pointing out the value given to the visitor. For example, I could add messaging to this blog like, “You are free to browse our entire archive of more than 1,100 articles!”

Another way to boost subscriptions might be a double-reward approach. This method would let visitors download something without subscribing. When they get their free item (and reciprocity is invoked), they would see a call to action to subscribe with another related free item.

The second free item wouldn’t be reciprocation, but it would make the offer to subscribe more attractive.

Product Launches and Reciprocity

Launch by Jeff WalkerMany of the product launches I see today are modeled on Product Launch Formula developed by Jeff Walker.

While individual approaches may vary, a key characteristic of these launches is to use a series of free videos. The first video is always valuable content that will help the viewer in some way. There’s no sales pitch in the first video. Additional free content like a checklist or workbook may be offered, too.

Subsequent videos add more value, but transition from pure content to a pitch for the paid product.

That first video establishes the reciprocity effect – not only is the seller demonstrating knowledge of the space, he or she is giving the viewer something of value with nothing requested in return. As Walker writes in Launch,

Reciprocity is a very powerful trigger…

That’s what the whole prelaunch is about . . . giving out great, free content… In the end, when you ask for something back, your prospect will have a greater tendency to want to reciprocate. And at the end of the launch, that reciprocation often equates to a sale.

The fact that variations on this approach are used by many, if not most, successful internet marketers testifies to its effectiveness.

Reciprocity is a key factor in Walker Formula launches. Share on X

Give Before You Get

There’s a massive amount of both scientific and commercial data that show reciprocity increases your influence and persuasiveness.

So, even if it seems wrong to you, give your potential customers something with no conditions or catches before you try to close the sale. You may be surprised at the results!

Are you already using reciprocity, or have you tested it? Share your story in a comment!

Reciprocity: Give first with no return favor expected or implied. Share on X

And, if you’ve enjoyed this article and aren’t yet a subscriber… now’s the time to act! 😉

  1. Mark Wayland says

    Roger. RE the pharma study… your next post needs to deal with the distinction between correlation and causation…. The last sentence in the article says, “The findings represent an association, not a cause-and-effect relationship.” Nonetheless you jump to the conclusion that “Even a single cheap meal could, apparently, change behavior.”

    Rather I’d suggest that you do some research about what happens in these meetings (or in general, what impacts doctors’ prescribing patterns) and look at the impact of Cialdini’s Authority (that comes from the guest speaker) and maybe even whether there’s some of Mark Granovetter’s Threshold Model of Collective Behaviour happening.

    And in a none too subtle way you’ve also slighted every primary care physician with your suggestion that they can be bought with a slice of pizza… or is that just a correlation?

    1. Kasia Hein-Peters says

      I agree with you, Mark. It is very easy to jump to conclusions, especially that pharma is normally getting a bad press – so correlation can be easily misconstrued for causality. There are potentially other explanations of these findings, such as doctors who already prescribe certain drugs are more willing to meet with reps who promote them, for example.

  2. Roger Dooley says

    I agree, Mark, there are various ways to explain the correlation. Perhaps the cheap meals give pharma reps more time to be persuasive. Perhaps docs who, for whatever reason, don’t like to prescribe money-saving generics are more apt to accept a free meal. I’m sure no docs are consciously selling out for a slice of pizza.

    I think all of us can be influenced by small things that we are not consciously aware of and would strenuously deny had any impact. One good example is that “what the neighbors are doing” was dead last when people were asked what message would cause them to conserve energy. When the messaging was tested in an actual mailing, it was the MOST effective.

  3. Remco says

    As usual a very high value article with very practical tips. I’m going to put this into practice, just not sure yet how.

    I’m in software development and coincidentally we also develop software for pharmacies. I would like to get an opportunity to show pharmacists our software.

    Maybe I should setup a free networking event with several (different) free presentations. Then place a plate with free pizza slices in front of the presentation I want them to to attend.

    Thanks for the great article.

    1. Roger Dooley says

      Not a bad idea, Remco. And, be sure to have a slice or two of pizza yourself, based on this research.

  4. Dennis Wiggins says

    Taking this article a step further, Maimonides’ Eight Levels of Charity (Rambam’s Ladder) a 12th century Jewish Scholar and Edgar Cahn “Time Banks” a modern day earth changer, both write that reciprocal charity is the best way to give. If you give to someone and they then offer you something and you don’t except then you are telling them they have no value to you. You dis-empower them and injure their self-worth. This highlights our societies broken since of Charity and ineffective Social Programs. By excepting what they give, you are validating them and making them look and feel good. This strengthens your relationship, reciprocating consistently creates trust and and leads to loyalty. We don’t forget loyalty.

  5. Lynn says

    Walking along Venice Beach in California this weekend, I was offered a CD by a pleasant fellow with beautiful accent. “Take it, it’s free, my own music. I want to share it with you.”
    “No. No thank you.”
    “I understand. You’re on holiday and have things to do. Where did you travel from?”
    “I am from out of state”
    “Oh! You have traveled a long way. My name is xxx I came here all the way from Jamaica. What is your name?”
    “My name is yyy”
    “Put on my ear phones and listen while I sign this for you yyy. You can take it home from me. A memory of your trip and of meeting me.” [leans in to autograph CD, ear phones on my head–music is original and good, obviously his voice–my friend snaps photo capturing the moment]
    “The CD is yours to keep, a gift from me to you. A donation would help me progress in music, if you feel inclined to assist.”
    Yea, he provided a memorable experience, a keepsake and a photo. I happily reciprocated with a cash, a smile and words of encouragement.

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