"Who Benefits from Doctors' Free Drug Samples?"

MELISSA BLOCK, host:

Pharmaceutical manufacturers routinely shower doctors with free drug samples. And they've long claimed that they do so in part so doctors can pass the medicine along to poor patients. Well, a new study challenges that claim.

NPR's Joanne Silberner has details.

JOANNE SILBERNER: Physician Richard Baron(ph) practices medicine in Philadelphia. Some of his patients are poor, but he won't even take the time to talk to the drug company representatives who stop by to offer free samples.

Doctor RICHARD BARON (Physician): It's typically the wrong medications. It's not to say never, but the medications that they give us are the most expensive, the newest, the ones we know the least about, the ones that - as recent experience has shown - may have side effects that we don't know about yet.

SILBERNER: Up in Boston, Physician Sarah Cutrona shares his concerns. She says free medications can change the way physicians practice for the worse.

Doctor SARAH CUTRONA (Physician): You want to go to your doctor and get the medication that he or she feels is most appropriate for you, not the medication that's on the shelf.

SILBERNER: Well, Cutrona began thinking the free giveaways might have an upside. So several years ago, she started a study.

Dr. CUTRONA: We're looking to see if the use of free samples overall is such an overwhelming positive because without the free samples, we wouldn't be getting medications to our needy patients.

SILBERNER: Cutrona is a doctor with the Cambridge Health Alliance, a Boston area health system that's affiliated with Harvard Medical School. She and colleagues took a close look at a government health survey of 33,000 people. Participants were asked, among other things, whether they had received any free prescription drug samples in the previous year. The analysis is published in the current issue of the American Journal of Public Health. It shows 12 percent of Americans got free drug samples in 2003. But Cutrona wasn't happy.

Dr. CUTRONA: A few samples actually went to needy patients. In short, Americans and those of higher income were actually more likely to report receiving free drug samples.

SILBERNER: Not that doctors were faring those rich people with health insurance, she says. It was more a matter of poor people not seeing personal physicians as often, if at all. About 11 percent of low-income people received at least one free sample compared to 13 percent of people with high incomes.

Dr. CUTRONA: So these free samples really are not a safety net.

SILBERNER: An official at the drug company trade group PhRMA says there are medication subsidy programs to help poor people. Free samples are for something else.

Unidentified Man: Samples are made available to physicians when drugs are launched, so that physicians can get some experience with those drugs. Physicians may also use samples to get a patient started on a drug before they can go to the pharmacy and pick up a prescription.

SILBERNER: But that comes back to Cutrona and Baron's concerns, that free samples tend to be new drugs, which means they're usually more expensive and don't have a long safety record. That's especially a problem with chronic conditions such as high cholesterol or serious heartburn where patients may be on the drugs for many years.

Joanne Silberner, NPR News.