Drug samples not going to the poor. So what?

January 4, 2008

There’s a big to-do over a new study to be published in the American Journal of Public Health. According to the Boston Globe (Drug sample distribution system faulted):

Free drug samples are more likely to go to wealthy and insured people than to poor or uninsured Americans, according to a study by Boston-area doctors that conflicts with the view that giving away prescription medications forms a safety net for low-income patients.

Fewer than one-third of all people who received samples in a 32,000-person, nationally representative survey had low incomes, and fewer than one-fifth who got the free drugs were uninsured at any point in 2003, the year analyzed by researchers at Cambridge Health Alliance and Harvard Medical School. Low income was defined as less than 200 percent of the federal poverty line.

“Doctors are trying to target samples to needy patients, but their individual efforts failed to counteract societywide factors that determine access to care,” lead author Dr. Sarah L. Cutrona said in an interview. The study appears in the February issue of the American Journal of Public Health.

I don’t see why this is surprising and I don’t think it’s bad.

Drug samples are given away by drug reps as a way to gain access to physicians. Reps hope to influence doctors to write prescriptions for insured patients whom they hope will become long-term users of the product. Pharma companies aren’t targeting the uninsured or the poor and why should they do so with samples? Patient assistance programs –not sampling campaigns– are the mechanism to get drugs into the hands of those who can’t afford them.
Giving an uninsured or poor person a sample is a decidedly mixed blessing. A close internist friend of mine who cares for mainly low income patients tells me he doesn’t accept samples or give them out to patients. Rather than start a patient on a high-priced drug they won’t be able to afford in the long run, he prescribes a suitable generic. If they need an expensive drug he helps them apply to the patient assistance program.

Doctors shouldn’t waste their time trying to play Robin Hood with samples.

11 thoughts on “Drug samples not going to the poor. So what?”

  1. The findings in the American Journal of Public Health likely reflect the fact that many poor patients are cared for in academic based/sponsored clinic where the providers are more informed about the pitfalls of using samples.

    For an informative review of this issue, refer to the NO FREE LUNCH organization’s website (www.nofreelunch.org). Here is a brief summary of the medical literature they cite to support their anti-sampling stance:

    Adair, et al, in a randomized trial, found that residents who were randomized to use samples were less likely to prescribe over the counter medications and more likely to prescribe advertised drugs than residents randomized to agree not to use samples.

    Chew, et al, found that in the treatment of hypertension, over 90% of physicians would dispense a sample that differed from their preferred drug choice.

    Boltri, et al, found that following prohibition of sample use in their practice, use of first line anti-hypertensive therapy increased from 38% to 61%.

  2. You will have to forgive the rant, but this is a perfect example of:

    1.) Lying by omission. The journalist (and the editor) knows that samples are intended as a marketing tool, not as a donation.

    2.) Attempting to use journalistic power to influence public opinion. I don’t believe for a second that the timing of this article to the Iowa and New Hampshire caucuses is a coincidence. And the message of the article is clearly negative towards Pharma.

    3.) Assuming the public is gullible enough to buy it.

    It sickens me.

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