A call for medicine to ban drug samples

A prominent critic of drug industry influence on healthcare is calling for the medical profession to eliminate free drug samples, asserting that they can harm patients and raise costs while serving only as a marketing tool.

Dr. Jerome P. Kassirer, a professor at Tufts University School of Medicine and a former editor of the New England Journal of Medicine, builds a case for banning drug samples in an essay he wrote with Susan Chimonas of the Center on Medicine as a Profession at Columbia University.

"The tradition of physicians dispensing samples has many serious disadvantages and is as anachronistic as bloodletting and high colonic irrigations," the authors write in this week's PLoS Medicine. "As the profession begins to slowly extract itself from the influential grip of industry, it must also deal with the undue influence of free samples."

Among other research, they cite a study by Dr. Sarah Cutrona of Cambridge Health Alliance showing that less than one-third of the people who receive drug samples are poor and less than one-fifth were uninsured, in contrast to the pharmaceutical industry's contention that the samples help them.

Patients who get the samples don't save money and do disrupt their care if they can't afford to continue to buy the medication when the samples run out, Kassirer and Chimonas say. Newer, more expensive drugs are more likely to be given as samples in a marketing campaign. That means they also lack a safety track record, making them potentially dangerous, they write. Because there is no pharmacist involved in dispensing samples, they say, there is less opportunity to give patients information about interactions with other drugs, how they should be taken, or what to do in case of a recall, as with Vioxx.

The authors also refer to Cutrona's later study showing that some of the most common free samples given to children later received new or revised "black box" warnings within two years of approval.

In addition to concerns about safety and doubts about helping poor people afford their medications, Kassirer and Chimonas also point to evidence that samples steer doctors toward more expensive, heavily advertised brands, raising the cost of healthcare for all.

Kassirer and Chimonas's work was funded by the Institute of Medicine as a Profession, the Pew Charitable Trusts, and the Prescription Project.