Physicians drug sampling

Prescription drugs, except physician drug samples, allergenic extracts, intrauterine devices, medical gases, radiopharmaceuticals, low density form fill, and seal containers that are not packaged with an over wrap... 

Physicians codes, guidelines and policies on receiving gifts and drug samples... 

As outlined above, some professional organizations are more specific than others. However, the general theme appears to be that while minor gifts, entertainment, and drug samples should not be solicited they may be acceptable if they directly promote better patient care or indirectly promote education or research and, in either case, do not affect the integrity of the physician-patient relationship. 

Interactions with Closure Systems. Elastomeric and plastic container and closure systems release leachable compounds into the liquid dosage form, such as nitrosamines, monomers, plasticizers, accelerators, antioxidants, and vulcanizing agents [44], Each type of container and closure with different composition and/or design proposed for marketing the drug or physician s samples has to be tested and stability data should be developed. Containers should be stored upright, on their side, and inverted in order to determine if container-closure interactions affect product stability [6,45]. 

Sources of Suspected Drug 1 from physician 2 physician s sample 3 hospital 4 pharmacy 5 other retail source 6 mall order 7 door-to-door salesman 13. a. Has this case been reported to any other group or agency FDA Mfr. Poison Control Center Other (specify) b. Has or will this case appear in the literature ... 

Drug sample availability is intended to increase market share of products by directly influencing providers prescribing habits. Sampling also opens doors for pharmaceutical representatives to gain access to busy pre-scribers. Sampling gives representatives a reason to visit prescribers offices and provides prescribers an incentive to permit representatives to visit. The influence of pharmaceutical representatives on physician behavior is well established. 

Inventories of drug samples valued at tens of thousands of dollars fill closets and even entire rooms of many outpatient clinics, physician offices, and emergen-... 

Significant deficiencies in the security and control of samples have been well documented. " " In fact, it has been estimated that just over half of samples actually reach patients. Samples may be used by prescribers and staff, or they may be diverted. Personal use of drug samples by physicians and other healthcare providers raises ethical concerns and is not without risk." Limaye and Paauw described three medical residents who self-prescribed antimicrobials and were subsequently diagnosed with Clostridium difficile infection." Tong and Lien reported self-medication with samples and distribution of samples to nonphysicians by almost 60% of pharmaceutical representatives surveyed at a Canadian family practice office. A contributing factor to some of these issues is that institutional or facility sample policy and procedures are often absent, or compliance is poor. One institution found only 10% compliance when the inventory of samples was compared with the required written documentation. Even after an educational program in which the policy was explained to the house staff, a second audit found only 26% compliance. " Poor compliance with policy and procedure may jeopardize patient safety, as well as put the institution at risk for JCAHO recommendations or Board of Pharmacy penalties. 

Limaye, A.P. Paauw, D.S. Personal use of drug samples 27. by physicians and office staff [letter]. JAMA, J. Am. Med. 

Tong, K.L. Lien, C.Y. Do pharmaceutical representatives misuse their drug samples Can. Fam. Physician 1995, 4/, 1363-1366. 

Finding that "elixir" in the possession of the sick, or in the hands of survivors of those who had died, led to many adventures on the part of food and drug officials, and gave them a gloomy picture of the state of health care in the nation. At the start, getting records from the Massengill detail men posed some difficulties. Most were cooperative in indicating where sales had been made and physicians samples left (23). But some salesmen proved to be elusive, and a few reluctant to provide... 

In another study, Weissman et al. (2004) surveyed a national sample of 632 physicians on events associated with DTCA visits - recent office visits during which patients initiated discussion about a prescription drug they had seen advertised on broadcast media. Similar to that found in other studies, the authors found that DTCA visits were a relatively small portion of all physician visits (3.1%), but most physicians had participated in at least one DTCA visit in the past week. They summarized their findings as follows ... 

Beran, Mary Sue, Marianne Laouri, and Marika Suttorp. Brief Reports Medication Costs The Role Physicians Play with Their Senior Patients. Journal of the American Geriatrics Society 55, no. 1 (January 2007) 102— 107. How often do physicians discuss costs when choosing medications for senior patients A survey of 678 doctors found that they rarely discussed prices and, when they did, patients usually initiated the topic. The discussion typically results in recommending generic drugs and offering free samples. 

In California, mixer-loaders and spray applicators who work with toxicity category I and II organophosphates or N-methyl carbamates more than 30 hours per 30-day period are required to have medical supervision. Supervision consists of an interview and a medical examination to determine if a medical condition exists which would make the worker unusually susceptible to poisoning due to cholinesterase inhibition, and to caution the individual about the use of certain drugs such as the pheno-thiazine tranquilizers vdtich potentiate the effects of cholinesterase (ChE) inhibition. Two blood samples, taken several days apart, are analyzed to determine the individual s preexposure plasma and red blood cell (RBC) ChE activity (baseline value). The physician arranges a routine ChE testing program and provides for extra ChE tests should the worker be accidently exposed to OP s. If ChE activity is depressed to 50 percent of the baseline value, the physician may ask the employer to place the worker on... 

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