The Hidden Costs of “Free” Drug Samples

They seem so benign — those free samples of prescription drugs in bubble packs that your doctor hands out at the end of an office visit. But there are plenty of hidden costs in free samples, and two prominent doctors have written an essay asking that the pharmaceutical industry stop the $15 billion a year practice of what is called “sampling.” In an article by Susan Chimonas and Jerome Kassirer (former top editor at the New England Journal of Medicine), they write:

The samples that drug representatives offer are almost never time-worn and well-tested drugs, nearly never generics, and usually comprise the newest agents on the market. As such, they expose patients to risks not yet identified in clinical trials. The experience with Vioxx is a case in point. By 2002, only three years after Vioxx was introduced, it became the most widely distributed sample [3], and two years later the drug was withdrawn from the market because of an excess risk of myocardial infarctions and strokes [9]. Needless to say, Vioxx was not the only drug given extensively as samples and later found to enhance risk. Samples given to pediatric patients have similarly been associated with notable safety concerns. In 2004, four of the 15 medications most frequently given as samples to children in the US received new or revised “black box” warnings from the US Food and Drug Administration within two years of approval [10]. Finally, patients may not be the only ones at risk from distribution of free samples. Physicians who offer samples to patients and fail to supply appropriate cautions and warnings about the use of these drugs may be subject to liability, along with the company that promoted the drug [11].

There are plenty of other problems with “sampling.” It encourages casual use and misuse of potent drugs. It doesn’t really help indigent people get affordable medications. It bypasses the pharmacist, who provides user-friendly educational pamphlets that can alert patients to potential problems with the drug.

The authors conclude:

The tradition of physicians dispensing samples has many serious disadvantages and is as anachronistic as bloodletting and high colonic irrigations. As the profession begins to slowly extract itself from the influential grip of industry, it must also deal with the undue influence of free samples.

The article is also reprinted in Public Citizen’s “Worst Pills, Best Pills” newsletter.

In Chapter 7 of my new book on health care, The Life You Save: Nine Steps to Finding the Best Medical Care — and Avoiding the Worst, I discuss the idea that safe and wise use of prescription drugs includes not taking a drug during its first five to seven years on the market. That’s because the real hazards of a new drug are not well known until it has been widely used. For the same reason, it’s a good idea to avoid free samples, which usually are newer drugs that don’t have the safety track record of established drugs. The only exception is for “breakthrough” drugs that truly offer treatment where no drug was available before.