But, he says, samples spur doctors "to prescribe these more expensive brand-name drugs." Without samples, Miller says, "their decision on what drug to prescribe is what's best for the patient." Besides, he says, many stores sell 30 days' worth of generics for $4, and community and drug industry resources aid patients who can't pay that.
Other research suggests that most samples go to insured patients. In a study in Pediatrics in October, Sarah Cutrona of the Cambridge Health Alliance in Massachusetts found that few needy children got samples, because they couldn't afford the doctors who dispense them.
And in the February issue of the American Journal of Public Health, Cutrona and her co-authors reported that 13% of insured Americans received at least one free sample in 2003, compared to 10% of those uninsured for part or all of the year.
Responding to the Pediatrics study, Ken Johnson, a top official of the Pharmaceutical Research and Manufacturers of America, a trade group, said: "While it is true that poor and uninsured patients are not the only recipients of drug samples, a patient's financial situation is a factor physicians often consider when distributing such samples."
But Georgetown University Medical Center physician Adriane Fugh-Berman says the idea that a ban would hurt the needy is "a delusion, a rationalization." Getting doctors to stop taking samples is tough, though, says Fugh-Berman, director of PharmedOut, a publicly funded project to inform doctors about drugmakers' influence. They might nix lunches and pens from drug reps, but "they really, really clutch on the samples. It's an unacknowledged gift for physicians and their staff and their families to use."
The University of Pittsburgh Medical Center and Schools of the Health Sciences have created a unique compromise, part of a new conflicts-of-interest policy. While acknowledging that free samples boost drug sales, the new policy notes that "this practice provides invaluable assistance to some patients to quickly begin a course of treatment or to determine which therapeutic option is most beneficial."
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