Thursday, January 03, 2008

Psst, Wanna Sample Some Free Pills

A study of prescription use of nearly 33,000 U.S. residents during 2003 found that the neediest are least likely to get free samples:

"Our findings suggest the free samples serve as a marketing tool, not a safety net," said Dr. Sarah Cutrona, co-author of the report to be published in the February issue of the American Journal of Public Health.

I have to tell you that the findings of this study are far removed from my experience. From the first days of internship, when I learned from senior residents to hoard Lupron samples ($400/shot) in my locker to give to uninsured patients, to clinic days when we used to stuff all the available drawers with free OCP samples*, I'm hard pressed to come up with a single example when the free samples were used as a marketing tool.

Our patients could barely afford the trip to the clinic; spending money on the latest or trendiest OCP just wasn't an option for them.

*[Even when we were no longer allowed to keep free samples in the clinic (possibly, one of the most counterproductive regulation ever), we still managed to supply our patients with OCPs from, you guessed it, the free supply of samples.]

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At 3:33 AM, Anonymous Anonymous said...

Did you notice that the percentages of people receiving samples were 13 vs. 10? That's really not a huge difference. The study say it's statistically significant, but it doesn't seem like a huge substantive difference to me.

At 5:26 AM, Blogger ema said...

I haven't read the actual study, but I see what you're saying.

At 3:49 AM, Anonymous Anonymous said...

Even if nearly all doctors try to give free samples to the neediest, the poor could still end up getting fewer prescriptions. Different economic classes receive statistically very different health care (frequency, size of practice, etc.). All of those factors could potentially skew the distribution of samples.

To illustrate, imagine a doctor in a rich community versus a doctor in a poor community, and suppose they both get about the same number of samples, and that the doctor in the poor neighborhood gets far more patients. As a result, the doctor who has the larger number of poorer patients ends up giving free drugs to a smaller percentage of his or her patients.

This sort of effect, known as "Simpson's Paradox", shows up all the time trying to aggregate results from different groups. In this case, it mostly just illustrates that marketing samples are a poor substitute for a plan actually designed to deliver drug subsidies to those who need them the most.

At 4:42 AM, Blogger ema said...

matthew l.,

Good point (and I especially agree with your conclusion), but what surprised me wasn't that poorer pts end up getting fewer samples. Rather, it was the suggestion that ...the free samples serve as a marketing tool, not a safety net.... Of course, as you mentioned, the type of patient population one serves makes all the difference.

At 2:00 PM, Blogger lyrl said...

I'm sure the drug companies distribute free samples in the way that serves them best for marketing purposes. It serves their purposes to distribute some samples to doctors serving needy patients: this is PR for the drug companies. But overall, the intention of the samples is as a marketing tool.

I believe the doctors will do their best to use the samples to help people. But the doctors are not the ones in charge of distributing the samples.


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