There’s a lot of controversy in the United States about the role of pharmaceutical representatives in medical practice. Pharmaceutical representatives hand out freebies ranging from luxury vacations to branded pens, with the expectation that doctors will return the favour and prescribe their brand-name medications. Some hospitals, practices, and medical schools have started cracking down on these practices, worrying that doctors may not be making the best choices with (good doctors make choices with, not for patients) their patients as a result of the intensive lobbying on the part of the pharmaceutical industry.
There are a lot of ethical problems with this which have been raised before, ranging from concerns that doctors will pick a medication on the basis of freebies received, rather than patient welfare, to worries about the obvious expense of brand name medications for patients paying out of pocket or dealing with restrictive insurance plans. There are also concerns that patients given a freebie sample of a medication might be drawn to request it by name in the future, which is of course the goal of the pharmaceutical representative, but may not be best for the patient.
But there’s one thing that doesn’t get brought up very often: the benefits of freebies for patients.
Many patients with chronic conditions have received free samples of medication. Back in the days when I had health insurance and we were trying to work out an appropriate regimen to manage my asthma, I benefited from scores of freebies, some of which were very expensive medications. My doctor recognized that my insurance would fight on every prescription she wrote, so it made more sense to give me a free sample to see if the medication even worked than it did to write a prescription for one round, fight viciously with the insurance company to get it honored and filled, and then find out that the medication wouldn’t be suitable.
Now that I don’t have insurance, I benefit from freebies in a major way. Asthma medications are rather expensive. The Advair Diskus, pictured above, is not available generically, and a 250/50 inhaler costs between $100-$200 in the United States. The inhaler pictured above lasts for two weeks. Medications for other conditions I have are also extremely expensive, with out of pocket costs which can climb into the thousands every month.
I can’t afford these medications at this time. That means that even though I should be using them on a regular basis, I can’t if I have to pay for every drug I use. So, my doctor gives me freebies. Lots and lots of freebies. Those help bridge the gaps between when I can afford the medication, and when I can’t. I’m sure this isn’t how the drug rep meant for those freebies to be used, but a lot of medical practices which deal with low income patients and patients in weird financial situations like mine use their freebies in this way; not as promotional tools to get patients interested in medication, but as life-saving assistance for patients who need medications and can’t afford them.
Some pharmaceutical companies have plans which offer medication at little or no cost to people of low income. But these plans don’t cover all medications, and it takes time to apply and prove eligibility. This is time which many patients may not have. And some patients don’t qualify; my income is such that most would be unlikely to think I was a worthy beneficiary of such a program. Thus, renegade doctors and medical practices stretch their freebie privileges to get medications into the hands of patients who need them.
Do we need to have a larger discussion about the ethics of pharmaceutical representatives and the impact they have on medical practice? Yes, we do. It’s a problem. It’s not going to go away. But let’s not forget, at the same time, that there are some distinctive benefits happening under the existing system, like making sure that at least some patients who need them can get medications they can’t afford.