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6 Drug Samples: The Most Important Gifts Central to the techniques used in marketing pharmaceuticals to healthcare professionals is the practice of providing samples of prescription drugs. ousands of company sales representatives make frequent visits to physician offices and routinely leave samples of medications. Having them available in their offices, physicians can and do distribute these medications to patients. e practice is extensive. e retail value of the sample drugs distributed is estimated to have been $11 billion in 2001 alone, more than the amount spent on direct-to-consumer advertising and a major portion of the industry’s enormous marketing budget.2 One study found that these samples were given to patients in 20 percent of doctor-patient encounters.3 Drug samples have been accurately called “the most important gifts” that sales representatives bring to physicians.4 e practice of providing physicians with sample medications has recently begun to be subjected to critical ethical analysis and assessment, but it does not yet receive the same scrutiny as many other practices involved in marketing drugs to physicians. In a national survey of physicians published in 2002, significantly more Sampling effectively lowers the threshold for prescribing and taking a costly new drug. At the critical moment—the “point-of-decision,” to quote the marketers’ jargon—the drug is there, and it’s free. Once the patient is on it, he or she is more likely to stay on it. And the doctor , now familiar with the drug, may be likely to prescribe it to others.1 83 Drug Samples physicians acknowledged having accepted free drug samples from a drug company representative (92%) than acknowledged having accepted meals, tickets to entertainment, or free travel (61%).5 Physicians generally find taking drug samples acceptable. e AMA ethical guidelines on what kinds of gifts physicians can accept from industry do not even address samples except in regard to the question of whether physicians may use these samples for personal or family use.6 e “PhRMA Code on Interactions with Healthcare Professionals” identifies no concerns about this practice beyond the need to comply with federal regulations (section 7.a). e major reason that the use of drug samples as a marketing technique has not raised many of the same concerns as other gifts that are given by company representatives is that it has often been viewed as a win/win/win situation. Many physicians like the availability of samples; many patients like to be given something free; the companies like having their products in doctors’ offices. “e drug company increases awareness of its new drug. e doctor endears himself to patients by offering something of real value . . . And the patient can test out a new drug—which, after all, may not work or work well—without incurring any expense or even going to the pharmacy.”7 Further, the rationale often used to distinguish between acceptable and unacceptable gifts (discussed in the previous chapter) has clearly put samples in the category of acceptable. Because the distinction between gifts for patient benefit and gifts for the personal use of the physician is accepted as having key ethical significance, samples are not getting the careful scrutiny they need; they clearly can have a patient benefit use. Providing drug samples is not, however, such an unquestionably beneficial practice. Not all stakeholders benefit. ere has been growing recognition that, while the industry “wins,” the practice does not promote high quality and affordable healthcare. A key concern is that the samples provided, because they are typically new drugs, are often more expensive than older drugs and, though approved by the FDA, may not yet have an established safety record at the recommended dosage. Companies have a financial interest in marketing their newer and most profitable products, which are usually those with patent protection against generic equivalents. e quick and widespread use of a new medi- 84 Marketing to Healthcare Professionals cation may be applauded at times, but new medications often raise questions about both safety and cost. In the 2002 position paper on “Physician-Industry Relations,” the American College of Physicians and the American Society of Internal Medicine acknowledged some of the problems associated with the practice of accepting drug samples from company representatives: e practice does allow the patient to try out a new medication before being committed to an expense. However, the sample serves to encourage physicians to prescribe the new product. Research shows that once a patient exhausts the free supply of medication, the physician typically writes a...

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