Published On January 15, 2010
WHEN A PHYSICIAN REACHES INTO HER SAMPLE CLOSET, the act seems helpful: Her patient can try a few doses before paying for a prescription. But in a May 2009 paper in the journal PLoS Medicine, two experts call the tradition of doctors dispensing samples “as anachronistic as bloodletting,” citing evidence that samples create conflicts of interest and raise prescription costs. Amid such concerns, growing numbers of physicians and hospitals are restricting or banning the use of samples.
Drug companies typically use samples to promote their new (and thus expensive) drugs, many of which offer only minor improvement over older generic or over-the-counter medications. But when a physician starts a patient on a brand-name drug that works, both individuals often resist the switch to a generic; there’s a perception among some patients that generics are less effective.
And there’s the rub, the PLoS Medicine paper argues: Sticking with the brand-name drug leads to higher prescription costs. “Institutions are fooling themselves if they think allowing physicians to pass out free samples is in the institutions’ best financial interest,” says Jerome Kassirer, a professor at Tufts University School of Medicine and co-author (with Susan Chimonas of Columbia University) of thePLoS Medicine paper. In fact, the desire to control costs is one reason some hospitals have banned free samples.
Some physicians argue that certain patients, particularly those who require psychiatric drugs, need to test several medications for efficacy and side effects before settling on one, and that samples save them from filling entire, expensive prescriptions. Others argue that without free samples, their poorest patients wouldn’t get the medications they need. But research shows that fewer than one-third of samples go to the poor. Many are handed out to wealthier patients or to medical staff for personal use, or they’re unaccounted for. (This mismanagement is particularly troubling to pharmacists, who want samples properly prescribed and tracked.) Some indigent patients do rely on free samples, but this practice isn’t without cost: By handing out samples of a drug, physicians may get into the habit of turning to that drug even when a good alternative exists. One study found that without brand-name drug samples to hand out, physicians were three times as likely to prescribe generic medications for their uninsured patients.
“Even small gifts like samples can affect clinical judgment,” says Virginia Hood, an internist who chairs the Ethics, Professionalism and Human Rights Committee of the American College of Physicians; the ACP’s guidelines for its 130,000 members discourage accepting gifts from industry. Another strong set of recommendations was issued by the Association of American Medical Colleges, which represents accredited medical schools. As a result of its guidelines, several prominent teaching hospitals, such as Yale–New Haven Hospital and Stanford, have banned or tightly restricted accepting drug samples, among other industry gifts.
Compared with industry-sponsored junkets or “consulting fees” paid to talk up a drug’s benefits, free samples may still seem benign. But Hood thinks physicians are realizing that what seems like the right thing to do has its drawbacks. “More physicians are beginning to see the hidden costs and are changing their practices,” she says. “But change isn’t easy.”
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