They don't just hand out pens and pads. They pay for vacations thinly disguised as business trips, they pay for equipment, whatever it takes. One company selling generics paid doctors 5% of the cost of each prescription, they just send them a check. The latter was just ruled legal by the highest regular German court, basically saying that it's corruption, but there's no law in the books that forbids this particular kind of corruption.
I can't imagine these things are hugely different in the land of the free.
similar. my mom is a physical therapist and her building also has some doctors. a few years ago her employer/state laws banned accepting gifts (like lunch, pens, and pads of paper, &c.) from drug reps, but I still have a massive box of clicky pens with weird drug names on them from before the ban a few years ago.
My mom has a strict no-gifts-from-reps policy-- she won't even take a card, as far as I know. There's been one exception to this: At one point, a rep found out it was her birthday, and delivered a huge cake. To the unit.
Of course, she wanted to refuse it-- but after they walked it all the way down the wing, how could she tell her staff that they weren't actually getting any cake?
I can't imagine these things are hugely different in the land of the free.