The High Cost of Free Drugs: Beware of Pediatricians Bearing Gifts

No need to forgo the lollipops, but according to a group of physicians at Harvard Medical School, the free prescription drugs often available from your doctor do little to benefit the poorest children, contribute to rising drug costs and, because they include powerful medications prone to misuse, may pose serious health risks.

Of the $30 billion drug companies spend annually on promotion, more than 60 percent, roughly $18 billion, is devoted to the distribution of free samples to physicians. Supporters say the practice is a boon to poor and uninsured patients. The Harvard group found otherwise.

“Free samples have no place in the practice of healthcare,” says Dr. Steffie Woolhandler, a professor at Harvard Medical School and author of a 2008 study reported in the journal Pediatrics.  “It’s clear that free samples have nothing to do with charity or equality,” she says, “They really are just about marketing.”

These medications, she says, preferentially go to patients that need them least. Most children who receive free medications – nearly 85 percent, the group found – are fully insured and have the greatest access to healthcare. They visit their physician regularly and often are already taking other medications. Uninsured and nonwhite children on the other hand, are much less likely to receive free samples.

Many experts are convinced that such ready access leads doctors to prescribe the newest, most costly medications, driving up health care costs. “Samples are not charity by drug companies,” says Susan Chimonas of the Prescription Project, a foundation-funded advocacy group that tracks conflicts of interest between industry and physicians. “I’m concerned about this trend where companies are influencing prescribing through samples, and skewing prescribing towards the most expensive products.”

Then there are the health risks. Of the 15 medications most commonly distributed to children, four carry recent “black box” labels warning of serious complications, including suicidal thoughts, skin cancer and lymphoma. The attention-deficit hyperactivity disorder drug Adderall, given free to more than 60,000 children annually, is classed a schedule II controlled substance – meaning it has a high potential for addiction. Adderall has come under scrutiny in recent years for widespread abuse among teens and college students.

Information is a real concern, says Harvard professor Dr. Sarah Cutrona. “Samples have been shown to have inadequate labeling, a lack of pediatric information and poor monitoring,” she says. “I know of at least one case where patients had free access to sample closets.”

Still, many doctors are reluctant to voluntarily forgo free drug samples. In focus groups with physicians, researchers at the Prescription Project found that many patients have come to expect free samples. If none are available, doctors say, patients simply go shopping for another healthcare provider.

One solution is on trial at several university medical centers. At the request of doctors, pharmaceutical companies have begun distributing free samples directly to local pharmacies. Patients can access those medications only when given a voucher by their physician.

Harvard’s Dr. Woolhandler, though, is skeptical that any sort of voluntary compliance can work. The solution, she says, needs to be a regulatory one. “Putting more restrictions on the marketing of the pharmaceutical industry,” she says, “is a very, very good idea.”
 

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