While eating lunch at my favorite restaurant the other day – the free sample displays at Costco – I got an idea for a column
on pharmaceutical samples. Pharmaceutical representatives have been bringing samples of their products to physicians' offices
for decades. But recently, the merits of this practice have become a topic of fierce debate.
Chicken or egg?
My thoughts on giving samples to patients have always been straightforward: Determine which medication is appropriate. Write
the prescription. Consider giving the patient samples if the patient questions the cost of the new medication, if I realize
that the patient is indigent and/or has no insurance, or if I happen to remember that a rep has recently dropped off samples.
However, a New York Times article from May of last year suggested that the process sometimes works in reverse, with the doctor making the treatment
choice based on whether or not samples are available: "Doctors should be choosing the most appropriate medication for a patient based on the best scientific evidence available
— not just grabbing something from the office stash that happens to fit the bill. 'The doctor will say, "Here, start on this,
and let's see how it works,"' said David J. Rothman, president of the Institute on Medicine as a Profession, a research group
at Columbia. 'The question to the doctor is: If you didn't have it in your drawer, would that have been your drug of choice?'
"The crackdown on free samples comes amid growing concern about the close ties between physicians and drug companies. Critics
like Dr. Rothman say physicians don't realize the extent to which their medical judgment is influenced by their acceptance
of the samples. They point to studies like a 2002 paper in the journal Annals of Family Medicine finding that the number of doctors who treated high blood pressure with the 'first line' drugs recommended by national guidelines
was low, but increased sharply when free samples were removed."
The sample argument above reminds me of the similar argument against pharmaceutical company dinners:
Critic: "You don't realize how much you're being influenced by that steak!"
Physician: "Oh, really? Well, last night, their competitor bought us steak at a different restaurant! Which steak was more
'influential'?"
My take on this is that if a "smattering" of doctors are apparently not accepting samples anymore, then the majority are still accepting them. Most physicians must apparently feel that the presence of samples will not cloud their judgment and
cause them to alter their treatment decision-making process. Besides, if a doctor accepts samples, he or she is likely to
accept samples of all the products in a given drug category, giving no one product any advantage over any other.
Delivery systems
Reps have traditionally brought samples into offices in person. But the practice has evolved – some companies are offering
samples through the mail and via online ordering.
I recently saw a rep whose company switched to sampling through the mail. She was happy about it, and said she doesn't have
to worry about mailing the samples, storing them, carrying them around and getting signatures. I thought the system might
put her at a disadvantage, but she told me that the new system hasn't decreased her "face time," and that she can use the
time once spent on sample issues for product messaging.
