Healthy growth in marketing of drugs

It used to be that patients could get free drug samples straightaway in a doctor's office. That still happens, but now patients also may get a voucher with an expiration date to pick up drugs at a pharmacy. Or they may receive a plastic card giving them $20 off, but only if they spend a specified amount.

The burst of creativity shows how effective samples have long been - along with television advertising - in encouraging patients to try new drugs. A sample "can play a key role in the doctor selecting a drug," said Michael Luby, chief executive officer of TargetRx Inc., a pharmaceutical-marketing firm in Horsham.

But samples also can steer patients to newer and more expensive drugs even when cheaper ones may work better, experts say. And the newfangled vouchers are not universally loved. "I have to read all this fine print to figure them out," said Charles Cutler, a physician at Norristown Internal Medicine Associates. "It just gets to be ridiculous."

Like it or not, drug samples are becoming more sophisticated and varied. Their use is booming, and so are other forms of pharmaceutical promotion, including the drug ads that patients see on television and read in magazines and newspapers.

Spending on television ads, first approved a decade ago by the Food and Drug Administration, has more than tripled, rising from $1.3 billion in 1997 to $4.8 billion in 2006, according to IMS Health Inc., a health-data firm in Plymouth Meeting.

The power of that advertising is often apparent to Thomas Lyon, a physician at the Mount Airy Family Practice. "Once a week, a patient will mention having seen an ad and say, 'Hey doc, how about that for me?' " Lyon said.

He doesn't dismiss it. "On my side, if someone requests something, it's medically appropriate, and it won't harm them, I'm more likely to prescribe it," he said.

Ads promoting drugs for erectile dysfunction now blare through living rooms nationwide, though some experts predict the deluge may not keep growing, especially if new drugs do not come through. Executives "are going on the belief that increasing the awareness will help them," Luby said. But "for a lot of them, it's hard to quantify."

David Kramer, CEO of Philadelphia-based Digitas Health, an interactive-marketing agency for health care, argues that the next marketing wave will arrive over the Internet, enabling surfers to delve into the disease areas they really care about.

He envisions rich Web environments in which viewers can tap video and podcasts while they exercise, get detailed information on their condition, or share experiences with others over social networks. "We find that peer recommendations in health care carry almost as much weight as doctor recommendations," Kramer said.

Samples represent the biggest chunk of drug promotion, rising to $18.4 billion in 2005 from $7.4 billion in 1997.

Part of the surge is due to higher drug prices, but the number of free samples is rising as well, said Julie M. Donohue, a researcher at the University of Pittsburgh Graduate School of Public Health, who documented those trends in a recent article in the New England Journal of Medicine.

"Physicians like to give their patients something when they leave. Consumers are happy not to fill a new prescription for a new drug they're starting that may or may not work for them," Donohue said.

"But you have to question whether they're really free. Are patients starting on an expensive drug rather than a generic because of these samples?"

For these and other reasons, many teaching hospitals across the country, including the Hospital of the University of Pennsylvania, have banned samples from the premises.

In January 2006, a group of leading researchers, writing in the Journal of the American Medical Association, proposed banning free samples altogether and replacing them with vouchers for low-income patients.

The group, led by then-Harvard University researcher Troyen A. Brennan, called samples "a powerful inducement for physicians and patients to rely on medications that are expensive but not more effective."

If anything, the industry is using samples even more heavily. A statement last week from the Pharmaceutical Research and Manufacturers of America praised samples for giving doctors "early hands-on experience to determine if certain treatments are going to benefit the patients." The statement also noted that "free samples are often given to uninsured patients who cannot afford their life-enhancing or life-saving medications."

At least one health clinic is reluctant to give samples to its uninsured clients. "We really don't want to start them on something we can't keep them on, and that they won't be able to afford," said Donna L. Brian, clinical director of PHMC Health Connection, a nurse-managed primary-care center in North Philadelphia.

"I'm not anti-samples," Brian said. "We use samples to try out new things. But unfortunately, we don't end up using them for our uninsured."

Many doctors also are conflicted by samples, which arrive courtesy of drug-firm representatives, who are paid to promote certain drugs.

The Mount Airy Family Practice accepts free samples, but only two of the four doctors there will meet with drug representatives to learn about new drugs.

Lyon is one of the two abstainers. He thinks he should get his information on new drugs from more objective sources. But he acknowledges that his partners sometimes pick up information sooner.

"The patients who are getting samples are very grateful," he said. "I think that there's some ethical benefit to getting samples."

But they tend to come only on certain top-selling drugs. "You can guarantee once it's generic we never see a sample again," he said.