Drug companies have a reputation for handing out free samples. This can be a good thing; doctors need to know what drugs are on the market in order to help their patients. But is free really free? In a recent interview, Dr. John Spangler discusses the marketing practices of pharmaceutical representatives, the relationship between pharmaceutical representatives and doctors, and subtle messaging.

Drug commercials are on TV every single day. New drugs touting symptom relief are often depicted by happy couples riding bikes or gardening while a voice over explains the possible side effects. These commercials are familiar to doctors, because doctors often have their own version play out in their offices. Dr. Spangler is a primary care physician in Winston-Salem. He is also part of the faculty at Wake Forest School of Medicine, serving as a professor in the Department of Family & Community Medicine.

“Drug companies have a reputation for giving out free samples,” Dr. Spangler shared in a recent interview. “But nothing is free. The drug companies are able to do this for two reasons. One: Making the drug itself is not that expensive for them. And two: They're making so much money selling it to people full cost, that they can just give it away.”

Dr. Spangler notes that drug representatives market their product by delivering free gifts and office supplies labeled with the drug’s brand name.

“Generally, the drug representatives come at lunch time,” Dr. Spangler says. “They provide a nice meal and they usually give a slideshow or presentation about the benefits of their drug. Which educates the whole staff, nurses, the front desk, the doctors, about this drug. It gets the drug into the vocabulary of the staff.”

Familiarity among staff works its way into the rest of the population through casual conversations. The staff will remember the medication when patients mention seeing a commercial for it on TV. Once it's on everyone's mind, it makes it more common and easier to accept, prescribe, and refill.

“We used to get baseball caps or, you know, squeezy balls for your hand to relieve stress or little footballs or cups or whatever with the drugs’ names on it,” Dr. Spangler says.

The delivery of samples that come with the free swag can admittedly be helpful in rural areas where samples are depended on for care. Patients deserve to know what drugs are available. The problems arise when one drug becomes the only drug available. The price can rise, and the patient will have no choice but to pay it. Unless the next representative comes with a less expensive option, doctors are inclined to stick with what is working.

The trend these days is for doctors’ offices to decline free samples. It’s been shown that doctors who accept free samples can be subtly swayed into prescribing the newest medication, which is often the more expensive option.

“It has been shown that if the drug company gives you a notepad with the drug name on it, or a pen that has the drug name on it, there is a subliminal suggestion to you every time you write a prescription on that notepad,” he shares. “[You think] ‘Oh, that's a choice. That drug is a choice.’ Just by doing that, you are more likely to prescribe that drug. It's a sort of subtle suggestion.”

Dr. Spangler shared that his practice stopped accepting free drugs about 10 years ago.

“There's been a huge movement really looking into the cost of drugs, and one of the driving costs of medication is marketing of medication,” he continues. “Marketing includes not only being on primetime television, but drug representatives who go from office practice to office practice, talking to doctors about new medications. Doctors do need to know about new medications. The problem is the relationship the doctor may develop with a drug representative. Just having that relationship makes it a little bit more likely that that doctor will actually use the drug that the representative was talking about.”

Dr. Spangler notes that there are probably formal rules about the swag doctors can receive, but he stresses the focus on ethical best practices rather than a law.

“You can actually go to ProPublica and look up your doctor and see whether he or she has received money from drug companies,” Dr. Spangler shared.

Some doctors get a free lunch. Others? The doctor may have gotten $50,000 for lecturing on that drug.

“It can be eye-opening,” Dr. Spangler continued. “I would recommend patients to go and have a look and see what their doctors have received.”

Do you think there are any repercussions to the way drugs are marketed? Share your comment below or on our Facebook page.

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