And some physicians liked the gifts, the meals and the company of affable and often attractive salesmen and women, especially after a day spent dealing with difficult patients and cost-wary insurers.
"Doctors in practice say, 'I'm overworked. I'm underpaid. I'm besieged on all sides by insurance companies. The only solace I get all day is a sales rep taking me to dinner and not complaining about anything,' " said Dr. Jerry Avorn, professor of medicine at Harvard Medical School and author of "Powerful Medicines: The Benefits, Risks and Costs of Prescription Drugs."
But in recent years, Avorn said, drug recalls and rising prices have undermined consumer confidence in pharmaceutical companies. Doctors began to fear getting caught up in the backlash.
Even small gifts and modest meals open doors and promote friendly relations between sales reps and physicians, according to a roundup of research published in the American Journal of Bioethics in 2003. The studies suggested that the more doctors interacted with drug marketers, the more likely they were to prescribe expensive new drugs when less costly generics would do.
"It was indisputable that small gifts had tremendous power in influencing favorable attitudes toward products," said Arthur Caplan, director of the University of Pennsylvania's Center for Bioethics and an author of the research paper.
In fact, he said, frequent small gifts, especially when combined with regular treats like doughnuts or pizza, carried as much sway as the occasional extravagant trip or hefty consultant fee.
"With a big gift, you're on guard right away," he said. "The very act of giving a small gift creates a cultural sense of obligation. Yet it's subtle. Your guard isn't up."
Most of the medical centers that have announced new rules began the process before the AMA magazine's article appeared, but some consider it to have been a tipping point.
"It gave us the green light," KirkHart said. "If you want to make changes happen in your institution, go for it."
At UCLA's medical school, Dr. Andrew Leuchter, professor of psychiatry and chairman of the faculty executive committee, has already emptied his desk drawers of drug-logo pens and instructed his researchers and students to do the same.
"It's quite remarkable the things you find," he said, listing refrigerator magnets, penlights, computer memory sticks and, because he's a psychiatrist, models of the brain. "Anything they can put a brand on, they'll give to you."
