Most drug samples don't go to uninsured

Here's a study you'll find very interesting. The conventional wisdom (some would call pharmaceutical spin) is that free drug samples go to the poor and uninsured. Well, researchers at Harvard Medical School and the Cambridge Medical Alliance will publish a study in the February edition of the American Journal of Public Health which shows the contrary (Boston Globe).

Less than one-third of all people who received samples in a 32,000-person, nationally representative survey had low incomes, and less than one-fifth who got the free drugs were uninsured at any point in 2003.

Of course the pharmaceutical industry is calling this a flawed study - Duh! Now, don't get me wrong. The industry does some good things. There are some drug reps in my area who have gone out of their way to make sure some of my uninsured patients get the prescription meds that they require. I've also had many of my patients take part in pparx. I mean in 2004, approximately $16.4 Billion free samples were given out. However, the researchers also had these interesting findings...

Insured people with better access to medical care were more likely to see their doctors in offices, rather than hospital emergency rooms or hospital clinics. Patients who saw their doctors in offices were more likely to be given free drug samples.

"That finding suggests that the samples were a marketing tool and not a safety net because the poor and uninsured patients were not finding their way to where the samples were," [lead author, Dr. Sarah] Cutrona said.

To me, free drug samples are a two-edged sword. On the one hand, for my uninsured and economically disadvantaged patients, these samples are a kind of life line. And, in the economically troubled times of the community which I live, the young and healthy people are leaving to find work - which leave the older and sicker population. I know some offices around here who do not accept samples, and I understand their reasoning. But, that has to be tough on their patients.

On the other hand, when patients know we have samples of a particular medicine, their persistence on asking for samples can get frustrating at times - especially if I know they have insurance, a decent prescription plan, and know that they can afford to get the medication. It's not for me to judge, but it seems to me that samples for some people are a convenience rather than a necessity.

So, were/are samples a marketing tool? That's an interesting debate to have. I understand both sides of it, and I know people will leave comments probably on both sides of the issue. Our office continues to accept drug samples - along with its benefits and potential perils. What do you think? Are free drug samples a good thing or not?

USA: We're Number Two!

As Americans, we always pride ourselves in being Number One. Well, this time, it's probably better not to be the best. According to the Associated Press, a study was published today stating that the Brits are the biggest fans of fast food in the world - with the USA coming in second place.

"The results show there's a world of people who cannot deny themselves that hamburger or extra piece of pizza, but probably make themselves feel better by washing it down with a diet cola," [said Steve Garton of polling body Synovate, who produced the survey jointly with the BBC.]

In terms of fast food, 45 percent of Britons agreed with the statement "I like the taste of fast food too much to give it up" ahead of 44 percent for Americans and Canadians at 37 percent.

I am so disappointed in us as Americans. Did they poll high school and grade school students in this country? How about people who attend sporting events? I know that we can do better than 45 percent. Now, looking in the mirror, I admit I enjoy fast food every once in a while. And, I also admit that part of my New Year's "thing" is to try to cut back a little bit. So, I'm part of Fast Food Nation - but, I don't wanna be....

Cocaine vaccine

Ok, I'm no music pundit, but this is one of the best Clapton songs - EVER! After you finish watching the SIX and a half minute live version above (including what seems to be a five minute guitar solo), you may proceed with the rest of this post hehe....

So, a vaccine against cocaine. Hmmmm... It is currently in clinical trials right now and researchers have asked the Food and Drug Administration permission to perform a larger trial to continue its progress to possible clinical use. The theory is similar to other vaccines - researchers place an inactive cocaine molecule on a protein so that the body can form antibodies against cocaine. So, when cocaine is ingested, the antibodies gobble them up so they cannot reach the brain for their addictive effect. (AP)

[FDA] Approval would mark a breakthrough in the treatment of cocaine addiction, which now mostly involves psychiatric counseling and 12-step programs. It presumably would be the final clinical hurdle before the vaccine — more than a decade in the making — might be approved for treatment. But one expert warns against expecting too much.

"Addiction vaccines are a promising advance, but it's unlikely any treatment in this field will work for everyone," said Dr. David Gorelick, a senior investigator at the National Institute on Drug Abuse. "Still, if they prove successful, they will give those working in drug addiction an important option."

Who knows, this vaccine may not go anywhere. Certainly, it is years before there's even a possibility that it could be used as any kind of treatment in the real world. However, it is an intriguing possibility that one day, someone in a voluntary cocaine treatment program would be receiving a shot - and hopefully increase the change of sobriety. Fascinating....

Medpundit hangs it up

Early on when I was first considering starting my own blog, I began reading Medpundit. I could be mistaken, but I think this blog stopped and started again in the past couple of years or so. Well, the final post was last night.

Year's End, Blog's End: I've been making my annual year end inventory - deciding what to keep and what to toss. It's become obvious in the past several months that this blog is one of the things that it's time to toss. This will be the last post for Medpundit. Truly. Wishing you all the best in 2008 and the years beyond.

For what it's worth, thanks Medpundit for being a positive influence on me as a blogger and to the medical blogosphere in general. You will definitely be missed.....

Mental Health Court

With the new year, comes new opportunities to help kids. In the Cleveland, Ohio area, there is going to be a new program starting in the juvenile justice system. It is called Mental Health Court and the goal here is to focus on kids getting help instead of primarily focusing on their crime. (Cleveland Plain Dealer)

In this way, kids with mental illness can be kept from getting a criminal record - if they chose to get help. It has been well documented in the past that "dual diagnosis" or the diagnoses of substance abuse and mental illness is common. In a study done in preparation for this program, they found the following in juvenile crime offenders:

26 percent of males and 52 percent of females screened had a severe mood disorder, such as bipolar disorder or depression.

63 percent of the kids had had both a mental health and a substance abuse problem diagnosed.

The pilot program is voluntary and will be starting out with 12 kids. A care team is created to see what services the child will need. The intensive program starts with weekly meetings. And, if they are compliant with the program - like taking their medications and attending school - the frequency of the meetings will taper off.

I would imagine that a program like this is not unique. But, I'm all for trying to find other ways to keep kids out of the criminal justice system - particularly those with mental illness. I live in a part of the state where there is very little funding for mental illness health care. When this happens, as this article describes, the only other alternative people have is calling the police for immediate action when the mental illness worsens. Hopefully, programs like this will show positive results.

Grand Rounds

All the way from South Africa, Grand Rounds 4.15 is now up and running at the blog called Other Things Amanzi. This general surgeon has a fabulous blog. And this week, has probably the most pictoral GR in a while. I feel like I'm on safari. Thanks so much for including my post this week.

one of my favourite bloggers (and 'radio' hosts), doctor anonymous, discusses medical myths even doctors believe. but is it doctors that say they believe these myths or is it a myth that doctors believe them? take a look.

If you don't know what Grand Rounds is, it is a weekly compilation of the best posts from the medical blogosphere that moves to different sites each week. And, who doesn't like reading about medicine and science? Next week, Grand Rounds moves to the site called pathtalk.