Healthy Skepticism Library item: 17934

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Favole JA
Drug Makers Provide View Of Sampling Practices
The Wall Street Journal 2010 Jun 5
http://online.wsj.com/article/SB10001424052748704764404575286423798063474.html

Full text:

Pfizer Inc. gave out 101 million drug samples worth $2.7 billion in 2007, according to documents that provide the first glimpse of how widely pharmaceutical companies use the marketing practice.

Patients and doctors often welcome the free packets of top-selling medicines. But the custom has its critics, who cite safety issues and say samples induce prescriptions for more costly brand-name medicines when cheaper generics might be available.

The health overhaul passed in March requires companies to tell Congress how many samples they distribute, part of an effort both in Washington, D.C., and state capitals to change the culture of companies wooing doctors with free goods including dinners, calendars and trips.

While some industry-wide estimates for drug sampling have been available previously, congressional documents viewed by The Wall Street Journal outline drug-sampling by Pfizer, the largest distributor among those submitting data, and other well-known drug makers in 2007.

According to documents submitted to Congress by the companies, Merck & Co. dispensed 39 million samples worth about $356 million; Eli Lilly & Co. 33 million worth $67 million; Wyeth, which was acquired by Pfizer last year, 52 million worth $64 million; Abbott Laboratories 16 million worth $32 million, and Baxter International Inc. 33,000 worth $7 million.

Information wasn’t available on individual drugs, but Pfizer, which the documents suggest has by far the biggest sampling program, markets several blockbuster products, including cholesterol drug Lipitor and arthritis treatment Celebrex, for which samples are often provided.

The companies reported the value of the drugs to Congress based on either market price or wholesale cost for the drugs. The companies noted that the medicines were not to be resold. Some companies counted samples by dose while others counted by unit. Multiple samples may be contained in one unit.

A spokesman for Pfizer said samples “enable patients and physicians to try a medicine and evaluate tolerance, assess effectiveness, and adjust dosage before committing to a full prescription regimen.” Other companies offered similar explanations for their sampling programs and noted that samples help some patients get on a drug quickly without having to wait for a prescription to be filled.

Anand Mehendale, a neurologist based in Kerrville, Texas, said he has “toyed with the idea of not receiving samples.” But he accepts them for two reasons: to save patients money and to test drugs before issuing a full prescription.

Dr. Mehendale in 2007 received 7,500 samples from Wyeth, according to the documents submitted to Congress. He said he still commonly receives samples for Eli Lilly’s depression medicine Cymbalta and Pfizer’s Pristiq, among other drug maker’s medicines.

Shahram Ahari, a former Eli Lilly drug-sales representative who left the firm in 2000 and is now a medical student, said samples helped him gain access and cement relationships with doctors. He said patients should ask: “Am I being prescribed this medication because the drug rep just came by and dropped all these drug samples, or is it really the best medicine for me?”

Some doctors and hospital systems, including the Mayo Clinic and University of Wisconsin Health System, limit use of samples because of potential conflicts and safety concerns.

Lee Vermeulen, director of the University of Wisconsin’s Center for Drug Policy, said the institution began restricting sample distribution about 10 years ago. He said doctors often don’t keep a good tally of when samples expire and could inadvertently hand out old medicines.

He also said that bypassing pharmacists is risky because a pharmacist may view a database on a patient’s other prescriptions and notice potentially dangerous interactions.

However, few specific examples of patient harm resulting from such adverse interactions have been reported.

A 2008 study in the Southern Medical Journal found that doctors in a clinic were more than three times more likely to prescribe generic medications to uninsured patients after drug samples were removed from that clinic. “Free drug samples may lead to higher costs for uninsured patients by encouraging physicians to write prescriptions for brand-name drugs only,” the study said.

Last year the Institute of Medicine, part of the National Academy of Sciences, recommended that companies shouldn’t give out samples except in cases when patients can’t otherwise afford the medicines.

It is unclear how much the pharmaceutical industry spends on samples. Companies say their data is proprietary. An estimate by the New England Journal of Medicine calculates the pharmaceutical industry spent $18 billion on samples in 2005.

Some lawmakers fear disclosure of drug-sample distribution might dissuade doctors from providing free samples to people who can’t afford their medicines, Senate aides said. Vermont has passed a law, despite drug-industry opposition, requiring pharmaceutical firms to disclose to the state attorney general sample distributions.

Samples are separate from the often robust programs pharmaceutical firms have set up to help lower-income patients get access to free or discounted medicines. Pfizer, for example, said in the last five years it has helped six million patients receive more than 48 million Pfizer prescriptions, the equivalent of $5.7 billion worth of free medicines and savings, it said.