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Free Drugs

Recently I visited a medical specialist for a recurring condition. After the examination, he handed me a bag of drug samples on the way out and said, "Try these. Let me know if they help."

There were probably 20 samples in the bag. I took them home, tried them over the next month, and sure enough, they helped.

Now, I happen to know this particular specialist doesn't see many uninsured or low income patients. There are physicians in safety net clinics who provide drug samples to people who otherwise couldn't afford them, and that's a good thing - although it's hardly a substitute for health insurance and a rational national health policy.

Instead, I assume a drug company salesman regularly visits this specialist, drops off samples of the latest new thing, and encourages him to try them out with his upscale patients, who will then ask for more, thus "making a market." It's the same time-honored principle used by Starbucks and other retailers that put free samples of product out on the counter: try it, you'll like it, you'll buy it.

No big deal, you say? It certainly is to drug companies, which spent $15.7 billion dollars in 2000 on promotional spending, up a whopping 71 percent from 1996. More than 80 percent of that total is for handing out samples and "detailing" -- expenses for sales activity directed at office-and hospital-based physicians. Docs can go to a nice early evening dinner on the way home from work at the drug company's expense. All they have to do is listen to a "short presentation" on exciting new pharmaceutical discoveries.

The big jump in pharmaceutical promotional spending has been in direct-to-consumer advertising, which more than tripled in the 1996-2000 period. Even with that, direct-to-consumer advertising accounts for only 16 percent of total promotional costs. The big bucks remain targeted at physicians who, after all, write the scripts.

Obviously it's paying off. The pharmaceutical industry was the most profitable industry in the U.S. for every year from 1995 through 2001. Factors driving this were the increased use of prescription drugs, the development of more expensive drugs and price inflation, the latter driven by high demand and increasing research and promotional costs.

But paying off for whom? For all of us, drug companies say. They point to studies indicating that the use of new pharmaceuticals actually lowers overall health care costs by keeping people out of expensive acute care facilities: Better to take a statin and lower your cholesterol than to undergo open heart surgery.

Perhaps, but if we really want to lower overall health care costs, the best thing to do is to stop eating fatty foods and exercise more. Unfortunately, that would eventually result in the need for less prescription drugs and acute care, neither of which serves the immediate interests of pharmaceutical companies and hospitals.

Prevention pays, but not for them, not now, when they need to make payroll and satisfy shareholders.

Nor does prevention serve the immediate interests of consumers, who have developed an insatiable appetite for wonder drugs and procedures that somebody else both selects and, for the most part, purchases for them. We're addicted to the quick fix. If we really want to find the party most responsible for rising drug and health care costs, we should all just look in the mirror.

Meanwhile, there's considerable momentum for tacking on a prescription drug benefit in Medicare, which lays insult upon the injury of a system that is financially unsustainable even without the added cost, and a growing suspicion of allegedly rapacious pharmaceutical execs who "don't give a damn about the little guy."

Those same execs, in turn, point out that too much regulation, litigation and price controls will kill the goose that laid the golden egg, and the medical advances we count on today won't be there in the future if we squelch the incentive to invest in new ideas and products.

I would venture to guess, however, that their sales reps will be handing out free samples of drugs tomorrow, and well into the future, as more of us look for remedies and quick fixes to stem the maladies of advancing age.

My only hope is that with more consumer education and direct involvement in our own personal health care, we will accept those samples with the understanding that there is nothing free about them at all.