The Reply

      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. I do this to make sure the patient can tolerate ACE inhibition before putting them on the product that will cost them the least. I also follow this practice when starting patients on beta blockade for heart failure. Second, some of my patients are on quite limited incomes. I often give these patients the full course of the expensive medicine from my sample cabinet thereby hoping to ensure compliance, something that probably will not happen if the patients had to pay for the medicines themselves. I teach this practice to my residents and students. Thanks again for responding to my editorial.

      Linked Article

      • Doctors and the drug industry: Reader feedback
        The American Journal of MedicineVol. 118Issue 10
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          We read with interest the editorial1 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.
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