"It's not just the pens -- it's the paper on the exam table, the tongue depressor, the stethoscope tags, medical calipers that might be used to interpret an EKG, penlights," Dr. Robert Goodman, an internal medicine physician at New York's Montefiore Medical Center, told The New York Times.

"Practically anything you can put a name on is branded in a doctor's office, short of branding, like a Nascar driver, on the doctor's white coat," said Goodman, founder of No Free Lunch, a non-profit group that encourages doctors to reject drug-company giveaways.

The voluntary moratorium, drawn up by Pharmaceutical Research and Manufacturers of America to start Jan. 1, still lets drug makers underwrite lunches for doctors and their staffs and sponsor restaurant dinners for doctors, as long as the meals are accompanied by educational presentations.

About 40 drug makers have signed on to the code, the industry group said.

Last year, besides giving doctors nearly $16 billion in free drug samples, drug companies spent more than $6 billion on sales activities such as doctor office visits, mealtime presentations and branded pens and other handouts, healthcare information company IMS Health Inc. said.