Healthy Skepticism Library item: 1944

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

Adair R, Holmgren L.
Do Free Drug Samples Influence Residents' Prescribing Decisions?
Newswise 2005 Jul 25
http://www.newswise.com/articles/view/513332/

Keywords:
PRESCRIBING HABITS, INTERNSHIP & RESIDENCY, DRUG SAMPLES, PHARMACEUTICAL INDUSTRY

Notes:

Ralph Faggotter’s Comments : This study confirms something we have long suspected— that doctors giving out to patients drug samples which they have received from drug reps increases the followup prescribing of more expensive and less appropriate drugs than would otherwise be the case. There is a clear case for banning this practice.

Full text:

http://www.newswise.com/articles/view/513332/

Description

Investigators from the University of Minnesota and Abbott Northwestern
Hospital found that resident physicians with access to drug samples in
clinic were more likely to write new prescriptions for heavily
advertised drugs and less likely to recommend OTC drugs than their
peers.

Newswise – When a pharmaceutical company puts drug samples into the
hands of residents as a form of marketing, how does it influence their
prescribing behavior? To what extent are treatment decisions based on
which samples are available and further, what are the implications for
patient care as well as resident education? While this is a frequently
debated issue, there has been little objective data describing how drug
samples affect resident physicians.

In a study published in the August issue of The American Journal of
Medicine, researchers from the University of Minnesota and Abbott
Northwestern Hospital conducted a randomized study of 29 internal
medicine residents over a 6-month period in an inner-city primary care
clinic. Highly advertised drugs were matched with drugs commonly used
for the same indication that were less expensive, available over-the-
counter, or available in generic formulation. By random selection, half
of the residents agreed not to use available free drug samples. The
authors observed 390 decisions to initiate drug therapy in five drug
class pairs.

After selecting drug classes where samples of heavily advertised drugs
were provided to the clinic, and where lower priced alternative
formulations existed, the authors looked for prescribing differences
between physicians who had access to free samples and those who agreed
before the study to not use the samples.
There was no contact between pharmaceutical company representatives and
residents – all samples were stocked in a cabinet in the clinic – and
there was periodic monitoring of the cabinet to ensure that the study
drug classes were available.

Richard F. Adair, MD, writes, “We found that resident physicians with
access to drug samples in clinic were more likely to write new
prescriptions for heavily advertised drugs and less likely to recommend
OTC drugs than their peers. There was also a trend toward less use of
inexpensive drugs.”

Although the study was small and limited to 5 drug classes, the results
suggest some potential concerns. Dr. Adair continues, “Access to drug
samples influenced prescribing decisions of resident physicians,
something that would seem to violate published national guidelines on
physician interactions with the pharmaceutical industry. This finding
contradicts two widespread beliefs: Drug samples are inherently
different from other forms of marketing, and samples help patients
manage drug costs in the long term. They raise questions about whether
drug samples belong in clinics where residents are learning or low-
income patients are receiving care. Other studies have shown that many
Americans do not take prescribed medications because they cannot afford
them. Whether to provide ‘free’ samples of expensive drugs to these
patients is an ethical dilemma for many doctors.”

The study is reported in, “Do drug samples influence resident
prescribing behavior? A randomized trial” by Richard F. Adair, MD, and
Leah R. Holmgren, MD. It appears in The American Journal of Medicine,
Volume 118, Number 8 (August 2005), published by Elsevier.

_______________________________________________