To the Editor

      I agree with the recommendation for public disclosure of transactions between physicians and pharmaceutical companies as a tool to avoid conflicts of interest.
      • Alpert J.S.
      Doctors and the drug industry how can we handle potential conflicts of interest? (editorial).
      I do take issue with the comment to exclude the provision of medication samples from the Internet-based registry. No matter if well intended, offering samples could well be a marketing strategy to increase sales of more expensive medications, and, as such, represents a potential conflict of interest. Assume a physician offers the purple pill esomeprazole (Nexium; AstraZeneca, Wilmington, Del) as a sample for empiric treatment of gastroesophageal reflux disease. When the sample is exhausted, the patient learns that Nexium costs $4.67 per pill, but the generic over-the-counter omeprazole (Prilosec; AstraZeneca) costs $0.64. Skepticism ensues when experts state that esomeprazole is somewhat more effective than omeprazole for healing erosions of the esophagus,
      Prilosec, Nexium and stereoisomers.
      but no mention is made of any difference between the two in treating gastroesophageal reflux disease, a much more prevalent disorder. Skepticism increases when the name similarity between omeprazole and esomeprazole becomes apparent and when a coupon for a free trial offer of esomeprazole is located on the Internet ( Finally, one must wonder whether esomeprazole, the stereoisomer of omeprazole, was manufactured because the patent had expired on omeprazole. With the above in mind, I recommend including the provision of medication samples as a public transaction between a physician and a pharmaceutical company. The act of providing the samples is what is important, not the dollar amount.


        • Alpert J.S.
        Doctors and the drug industry.
        Am J Med. 2005; 118: 99-100
      1. Prilosec, Nexium and stereoisomers.
        Med Lett Drugs Ther. 2003; 45 ([No authors listed.] (w1159c):): 51-52

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      • The Reply
        The American Journal of MedicineVol. 118Issue 10
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          I do not disagree with Dr. Nardone. I worried that including drug samples in the Web database might make it almost impossible to navigate because so many of these samples are distributed. Perhaps one might merely list the phrase “drug samples” and the cost.
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