- BIOETHICS FORUM ESSAY
When my brothers and I were growing up in South Carolina in the 70s, the only reason to go to the drugstore was for ice cream. If we needed medicine, my father, a family doctor, would go to a cabinet in our utility room. That cabinet served as our personal branch office of the drug closet in my father’s office, which was supplied with samples given to him by drug reps. I was 25 years old before I ever had a prescription filled at a pharmacy.
Every year, about half of the drug industry’s promotional budget is spent on drug samples. In 2004, the retail value of free drug samples given out in the United States was $16.4 billion. Samples, according to Medical Marketing and Media, are “the most powerful one-on-one tool for selling physicians.” For many drug reps, samples are the ticket that gets them through the waiting room door. Even doctors who have no fondness for take-out lunches, gifts, or branded knick-knacks will often see reps solely in order to keep their drug closet stocked. On the surface, the rationale doctors give for taking drug samples sounds compelling. They say they need the samples for patients who are poor and uninsured, and who could not afford to pay for drugs at the pharmacy.
But do drug samples really go to the poor? Not exactly, according to a study in the February issue of the American Journal of Public Health. Sarah Cutrona and her colleagues at Harvard looked at data on over 32,000 U.S. residents from the 2003 Medical Expenditure Panel Survey. They found that, contrary to the claims of doctors and the drug industry, poor and uninsured Americans were actually less likely than wealthy or insured Americans to get free drug samples. Less than a third of sample recipients were low income patients, and less than a fifth were uninsured. Patients were also less likely to get samples if they were black, Hispanic, or born outside the U.S. In other words, the higher your income, the better your insurance coverage, and the whiter your face, the more likely are to get free drug samples from a doctor.
Critics of pharmaceutical companies have always been suspicious of the claim that samples benefit the poor. Reps generally distribute samples of their newest drugs, which are often more expensive than the alternatives, such as generics. The companies also package samples so that it is difficult to accumulate a full course of treatment without sending a patient to the pharmacy. And of course, many free samples wind up with the families of doctors themselves. But this is the first large, representative study to suggest that samples are more likely to go to wealthy patients. As Cutrona and her colleagues put it, “Our findings suggest that free drug samples serve as a marketing tool, not as a safety net.”