DiagnosticsProviding Free Drug Samples To Patients Risks Harm To Public Health
The tradition of American physicians handing out free drug samples to
their patients "has many serious disadvantages and is as anachronistic as
bloodletting and high colonic irrigations," say two academics in an essay
in this week"s PLoS Medicine.
Susan Chimonas, a researcher at the Center on Medicine as a Profession at
Columbia University, New York City, USA, and Jerome Kassirer, former
editor
of the New England Journal of Medicine and a distinguished professor at
Tufts University School of Medicine, Boston, USA, argue that giving "free"
samples is "not effective in improving drug access for the indigent, does
not promote rational drug use, and raises the cost of care."
Although the pharmaceutical industry has claimed that providing free
samples helps financially struggling patients, Chimonas and Kassirer cite
research showing that low-income uninsured patients are in fact less
likely to receive free samples than patients with continuous insurance.
Many
samples, they say, "are appropriated by physicians for personal or family
use," and in one study nearly half of pharmaceutical sales
representatives surveyed reported using samples themselves or giving them
to their friends and relatives. These studies, say Chimonas and Kassirer,
indicate that samples often reach the wrong people and are frequently
misused.
Samples are also ineffective, they say, at lowering patient costs.
"Indeed, evidence shows that patients who received free samples had higher
out-of-pocket costs than their counterparts who were not given free
samples." Samples raise the cost of health care, as companies recoup
marketing
costs through higher prices and increased sales volume.
In addition, giving free samples risks poor quality of health care. For
example, when low-income patients are given a ""starter pack"" of
samples and a prescription to fill for the remaining period of treatment,
they might not be able to afford the cost of the extension, leading to
discontinuity of treatment. In doctors" offices, detailed patient
education regarding sample use rarely occurs, and when it does, it usually
lacks
information about drug interactions or instructions on how the drug should
be taken. And given the lack of oversight of samples by a skilled
pharmacist, there is a risk that expiration dates could be overlooked.
"It is difficult to escape the conclusion," say the authors, "that the
prime motivation behind the provision of free samples is marketing."
Samples have a major influence on physicians" prescribing habits, they
say, and are one of the most effective ways sales representatives get
their
foot in the door to pitch their companies" products. The authors call for
the medical profession to halt the practice of accepting samples from the
pharmaceutical industry and distributing them to patients.
Funding: This work was supported by the Institute on Medicine as a
Profession, the Pew Charitable Trusts, and the Prescription Project. The
funders
had no role in the decision to submit this manuscript or in its
preparation.
Citation:
"No More Free Drug Samples?"
Chimonas S, Kassirer JP (2009)
PLoS Med 6(5): e1000074. doi:10.1371/journal.pmed.1000074
PLoS Medicine