"If you're a patient who receives a sample, you may
perceive that doctor is giving you better care because they gave you
a gift," Dr. Alfred Lane told Reuters Health. "But that doctor may
have increased your medical costs by giving you that sample."
Lane is the study's senior author, from the Stanford University
School of Medicine in Stanford, California.
Addressing fellow dermatologists, he added, "You have to realize
that these samples are making you write more expensive
In an editorial accompanying the new study in JAMA Dermatology, Dr.
Kenneth Katz and colleagues from Kaiser Permanente Northern
California note that the drug industry in 2011 distributed $6.3
billion of samples.
In principle, samples are intended to be beneficial — for example,
they allow patients to try a drug before filling a prescription and
they give poor patients access to costly medications.
Some studies have pointed to troubles with the practice of giving
samples, however, including their not always reaching the neediest
individuals and their potentially influencing how doctors prescribe.
Doctors also may not fully explain the drugs' use and risks to a
patient as well as a pharmacist would.
"I think attitudes are evolving and I think there is increasing
awareness that samples are actually bad medicine," Katz told Reuters
Katz said Kaiser Permanente Northern California has a strict policy
against samples and any other conflicts of interest.
At Stanford as well, Lane said doctors have been prohibited from
giving patients drug samples since about 2004.
For the new study, he and his colleagues compared 2010 prescription
data from first-time acne and rosacea patients in Stanford's
electronic medical records to a national database of dermatologists
from across the U.S.
They found that dermatologists in the database gave about 25 percent
of patients samples with their prescriptions.
They also found that 21 percent of prescriptions given by doctors in
the database were for less-expensive generic drugs. That compared to
83 percent of prescriptions at Stanford.
The top drugs prescribed differed markedly between the academic
medical center and the practices in the national database.
Nine out of 10 drugs prescribed by practices in the database were
for the more expensive branded and branded-generic drugs. And
samples were given with between one-third and two-thirds of those
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Because the bulk of the drugs prescribed by dermatologists in the
database were more expensive, the total cost of treatment per visit
was also higher.
Dermatologists in the national database prescribed an average of
$465 worth of treatments per visit, compared to an average of $200
per visit at Stanford.
"I was shocked," Lane said. "I never thought it would be twice as
The researchers note that they can't say for certain that the
samples cause doctors to prescribe more expensive drugs. For
example, those doctors may be the target of other drug marketing as
Katz and his colleagues write in their editorial that dermatologists
should take a united stand and get rid of drug samples.
"It's time that we physicians take samples out of our closets and
put them where they belong — in the dustbins," Katz said.
Lane said it wasn't their intention to call for doctors to throw out
all of their samples. Instead, it was to make people aware of the
connection between samples and prescribing practices.
"I think in the future additional data may show samples need to be
given up, but that's not what we were looking at initially," he
But personally, he added, "I'm glad we don't use samples now. And I
fought it tooth and nail when we had to give it up."
Dermatology, online April 16, 2014
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