http://www.eurekalert.org/

Public release date: 28-Jul-2005

Contact:Pamela Poppalardo
ajmmedia@elsevier.com
212-633-3944
American Journal of Medicine
Elsevier Health Sciences
Do free drug samples influence residents' prescribing decisions?

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."

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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.