AJPH -- eLetters for Cutrona et al., 0 (2008) 200711424

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Research and Practice:
Sarah L. Cutrona, Steffie Woolhandler, Karen E. Lasser, David H. Bor, Danny McCormick, and David U. Himmelstein
Characteristics of Recipients of Free Prescription Drug Samples: A Nationally Representative Analysis
Am J Public Health 2008; 0: AJPH.2007.114249v1 [Abstract] [PDF]

eLetters: Submit a response to this article

Electronic letters published:

Fundamental flaw in study: Matthew A Schiffler (6 January 2008)

Exceptions: Dan Probonorep (6 January 2008)

Fundamental flaw in study 6 January 2008

Matthew A Schiffler,
student
Harvard University
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Re: Fundamental flaw in study

schiffl{at}fas.harvard.edu Matthew A Schiffler

Editor-in-Chief's Note: I elected to post this student eLetter as it is representative of a number of informal queries I received regarding the interpretation of these findings, even as I disagree with the title of this communication and some of the logic in the argument below. Nonetheless, as the AJPH believes in open and honest debate, and given that the authors of this paper are at the same institution as this student eLetter writer, perhaps they might continue this discussion together. Mary E. Northridge, PhD, MPH
It seems that this paper's conclusion that "free drug samples are a marketing tool, not a safety net" is subject to serious scrutiny depending on how the data are analyzed; in fact, the reported results could be used to draw just the opposite conclusion.
This study fails to take one common-sense factor into account: if you go to the doctor more, you are more likely to get free samples. Without any discussion of this, I would question any conclusions this paper comes to. According to Georgetown University's Center on an Aging Society, insured patients make an average of 6.75 office visits per year, and uninsured patients average only 4 visits per year. If you use these data combined with the numbers in the "Insurance status" line of Table 1, crude analysis reveals that the probability of an insured patient receiving a free sample in any given office visit is approximately 0.0203, and the same probability for an uninsured patient is approximately 0.0257. Therefore, when office visit frequency is factored in, an uninsured patient is approximately 27% MORE likely than an insured patient to receive a free sample.
I would have been interested to see the correlation between the demographic groups listed in this study and number of office visits, so that one would not have to use a disparate data set to do the above analysis. I would not be surprised if there were a similar trend along economic lines, as more wealthy patients are more likely to be insured and therefore likely to make more office visits.

Exceptions 6 January 2008

Dan Probonorep,
Pharmaceutical Sales Consultant
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Re: Exceptions

Diohdan{at}aol.com Dan Probonorep

Editor-in-Chief's Note: This eLetter was signed "Dan Probonorep, Pharmaceutical Sales Consultant." I edited it lightly for grammar and elected to approve it with the understanding that the content was authentic, even as a fictitious name may have been used to post it on our website. Mary E. Northridge, PhD, MPH
To Dr. Cutrona et al.:
Amazingly, there are exceptions to the conclusions in your article about drug samples provided to patients as it relates to their socioeconomic status. As a pharmaceutical representative who distributes drug samples often, I know that there do, in fact, exist representatives who with deliberate intent, albeit not necessarily often, seek out health care providers who primarily see and treat indigent patients. Their purpose is to provide them with samples used for promotion purposes which were provided to them by their employers, at times in large amounts, given authentically to such providers while expecting absolutely nothing in return. This, I surmise, opposes the objectives of their pharmaceutical organizations, yet I applaude their efforts to help those who are in greater need than others.