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."
By April 1, none of the medical center's 530 practice sites will accept samples from drug reps. Instead, doctors can turn to the eSample Center, a "virtual sample closet" launched last month, says Barbara Barnes, a medical center vice president. Pitt doctors can order samples online from participating makers, who ship them for free. "We feel that the direction that we are moving in will give physicians a greater choice of samples," Barnes says.
The Charlotte-based Carolinas HealthCare System went a step further Jan. 1, when it banned its more than 700 doctors from accepting or dispensing samples. At first, says internist Peter Justis, who helped develop the ban, "I can tell you, doctors were not very happy with this decision, nor patients."
Two main factors led to the ban, Justis says: concern about free samples' effect on treatment decisions and most doctors' failure to fill out the "cumbersome" paperwork required when they dispensed drugs.
For those who can't pay to try a drug, Carolinas doctors have vouchers for some pills that cover a prescription at a store. With 24-hour pharmacies nearby, Justis says, that shouldn't inconvenience anyone.