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Doctors and the drug industry: Reader feedback

      To the Editor:
      We read with interest the editorial
      • Alpert J.S.
      Doctors and the drug industry how can we handle potential conflicts of interest?.
      by Dr. Alpert in The American Journal of Medicine February 2005 issue. The editorial raises many of the complex issues related to the interactions between the pharmaceutical industry and physicians and presents some intriguing ideas.
      We disagree, however, with Dr. Alpert’s statement regarding excluding pharmaceutical samples from his national Internet-based registry “since these benefit patients.” The available research on the topic of drug samples does call into question the practice. Studies have shown that the availability of drug samples leads physicians to dispense and subsequently prescribe drugs that differ from their initial preferred medication choice.
      • Chew L.D.
      • O’Young T.S.
      • Hazlet T.K.
      • et al.
      A physician survey of the effect of drug sample availability on physicians’ behavior.
      Often more expensive medications are chosen when less expensive, equally effective alternatives are available for therapy, thereby leading to increased costs and suboptimal prescribing patterns over the long run.
      The American Medical Association endorses Dr. Alpert’s view of supporting the voluntary “time-honored practice” of physicians providing drug samples to selected patients at no charge.

      Policy Statement, American Medical Association H-120.991 Sample Medications. Available at http://www.ama-assn.org/apps/pf_new/pf_online.

      However, the American College of Physicians-American Society of Internal Medicine at least acknowledges the practice as a potential area of conflict and concern.
      • Coyle S.L.
      Physician-industry relations. Part 1: individual physicians.
      Furthermore, the use of drug samples by physicians, their families, and medical office staff illustrates how the system fosters access to physicians’ offices and encourages a gift relationship.
      • Westfall J.M.
      • McCabe J.
      • Nicholas R.A.
      Personal use of drug samples by physicians and office staff.
      We applaud Dr. Alpert’s stance and appreciate his tackling the controversial issue in the editorial. However, we believe physicians need to reflect on the use of medication samples for their patients.

      References

        • Alpert J.S.
        Doctors and the drug industry.
        Am J Med. 2005; 118: 99-100
        • Chew L.D.
        • O’Young T.S.
        • Hazlet T.K.
        • et al.
        A physician survey of the effect of drug sample availability on physicians’ behavior.
        J Gen Intern Med. 2000; 15: 478-483
      1. Policy Statement, American Medical Association H-120.991 Sample Medications. Available at http://www.ama-assn.org/apps/pf_new/pf_online.

        • Coyle S.L.
        Physician-industry relations. Part 1: individual physicians.
        Ann Intern Med. 2002; 136: 396-402
        • Westfall J.M.
        • McCabe J.
        • Nicholas R.A.
        Personal use of drug samples by physicians and office staff.
        JAMA. 1997; 278: 141-143

      Linked Article

      • The Reply
        The American Journal of MedicineVol. 118Issue 10
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          I thank Drs. Warrier and Houghton for their response to my editorial. I am aware of the literature that suggests that drug samples given out to physicians influence their prescribing practices. However, my personal experience has been somewhat different. I often start my patients with samples so that if they experience an untoward reaction, they have not had to spend money unnecessarily for a medication that they must then throw out. However, when I give a patient samples for an expensive angiotensin-converting enzyme (ACE) inhibitor, I usually accompany these samples with a prescription for the least expensive ACE inhibitor on their formulary, for example, lisinopril.
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