Seth,

I couldn't agree more.  I've not stopped utilizing samples and will likely continue until there are simply no more to be had.  With a large indigent population who , as you aptly point out, can't afford to purchase multiple statin prescriptions or different formuations because of intolerances etc.,  samples are invaluable.

 As for those who are against sampling, I think they must deal with the elite insured and well informed patient...and for those who think samples will bias us toward a certain brand, they couldn't be more wrong.  I always ask my NP's, "do we have" any beta blockers, dihydroperidines, or statins for instance.  Whatever we have gets the start. 

 When you are desperate, the color of the box or the shape of the pill mean absolutely nothing.  I really appreciated this blog.

Melissa Walton-Shirley

hi seth, i was a fellow at lahey when u were cominng there. u may have the sampling laws in MA but in NY there is no such documentation requirement. i use sampleno meds at alls liberally so that early initiation of therapy is implemeneted. of course the indigent population is helped tremendously with the use of samples. but also in this day and age and economic recession the medicare population is tremendously helped by sometimes just a couple of weeks worth of samples. times are bad and even though we would like to believe our patients are compliant with therapy, most patients are on fixed incomes and between them and their spouses needs for medication, not to mention day to day living expenses, i suspect a majority of them are regularly non compliant as a mattter of need and not choice. i wish someone would do a study, head to head, full regimen of medication s/p des vs only asa, generic bb, simvastatin or even no meds at all. i suspect that one year out the overall mortality morbidity will be slightly higher in the no med group but no higher than what a private practice "loses" "lost to follow up" "phone disconnected" patient population. how do we know where these patients are ? specially in places like boston, wny where so many snow birds live. it is very few patients who will actually admit to non-compliance. while in the presence of a physician it is the odd paatient who will admit to severe financial troubles and inability to affords meds. your average cad s/p patient has a copay of almost 150 $ a month on meds not to mention more if they have comorbid conditions. in a addition all the non invasive testing we order, office visits and the fact that we want them on branded medication because it is so called evidence based. where does that leave the patient. that financial stress alone sends them right back to the convenience store for a pack of cigarettes and beer. that of course is another topic. As physicians is it our duty to promote evidence based medicine or afforable medicines. maybe you can initiate a study following 200 patients in each arm one with prescriptions for evidence based medicine and the other with just meds filled at wallmart for $ 10 copay for 90 day supply and watch for 6 month, 1 yr, 5 yr mortality morbidity and repeat procedures. if the same socio-economic population is taken we may be surprised seeing a higher incidence of end points in the evidence based prescription use simply because patients may not be able to afford them. thus back to samples my office policy is to help out as much as one can.  

I agree that there is a loss of convenience. However your argument that sampling has no effect on prescribing is not supported by the data. I doubt any physician 'thinks' that his or her prescribing is affected by pharma reps or sampling but the fact that the marketing budgets of the pharma companies exceeds their R&D costs is damning evidence to the contrary. Sampling is  bizarre and inefficient manner of drug distribution and ONLY makes business sense if it is an effective marketing strategy. I have to say that after all the pharma scandals (ghost writing, major conflicts of interest, inappropriate off-label marketing, pharma creation of 'new' diseases, supressed negative studies, etc) I find it hard to explain why physicians defend these egregious practices. 

Doubter,

I defend sampling because in indigent patients with ACS,  starting a statin lowers event rates, staying on a stastin improves outcomes. Without statin samples, many of our patients would NEVER start and many would not be able to continue.  We aren't choosing a brand, we are choosing a class.  Though certainly less than ideal,  we have to change the  statin depending upon which ones are available in our "drug cabinet".  Wiithout samples, for many there would be no statin at all.

 Melissa