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Medicine in your junk mail

Medicine in your junk mail

By Jeffrey P. Kahn, Ph.D., M.P.H.
Director, Center for Bioethics
University of Minnesota

(CNN) -- For good or bad, a new form of prescription drug marketing seems to have arrived -- direct mail samples. In addition to the usual offers, ads and assorted fliers, some people are now also receiving unsolicited trial supplies of medication.

In response, a class-action lawsuit was just announced against Eli Lily -- the maker of Prozac -- along with three doctors and a drug store.

The charge? That they misused patients' medical records and invaded their privacy by mailing them a free one-month sample of a weekly version of Prozac, along with a "Dear Patient" letter.

The allegations will eventually be sorted out, but the case and the practice raise serious questions:

  • Who has access to patient records and on what grounds?
  • Should patients receive -- let alone take -- prescription drugs without consulting their doctor?
  • In addition, finally, should consumers decide which prescription drugs to take like they do laundry detergent or shampoo? Should they try a variety of samples that show up in their mailbox and then choose based on which offers the best coupon?
  • Doctors, patients, and medical privacy

    In the process of teaming up with drug companies, the doctor-patient relationship seems to have gone awry. A pillar of that relationship is that physicians will act in the best interests in their patients.

    Does sharing a patient's records with drug companies and their marketing departments serve the patient's interests? Even if medical care is well served by the practice, medical privacy demands that patients give their permission before their records are disclosed.

    That medical information is so readily available to others points out that it is not only physicians and patients in the examining room.

    Insurance companies have long been a part of health care decision making, and it seems the drug companies want a more prominent spot at the exam table, too.

    But when does information and marketing go too far? I think when psychoactive drugs are distributed like toothpaste samples, we have crossed the line.

    Does diagnosis always mean drugs?

    Even if physicians consulted with their patients before enrolling them in free sample drug programs, the fact that such programs exist at all is evidence of market forces encouraging the use of prescription drugs.

    And it is not necessarily the case that a diagnosis of depression always implies some sort of drug therapy to treat it.

    The woman leading the class-action suit claims she had tried Prozac a number of years ago and stopped taking it because "it didn't agree with her."

    Receiving a newly packaged version of the same drug did not appeal to her and seems to ignore her wishes in favor of what others wanted her to buy.

    The fact is that drug companies have a huge financial stake in making sure patients take the drugs they make, and offering samples is one way to get patients to buy theirs over a competitor's product.

    It is almost reminiscent of the cola wars, with Coke and Pepsi fighting over the soft drink taste preferences of millions around the world.

    But instead of our sweet-tooth, it's control of our psyches that's at stake, and that's what makes this a worrisome trend.

    Part of why we call it junk mail is that it is not much more than that.

    When free samples of expensive medications show up in our mailboxes, it is a different story. While we are well past the point of being able to stop junk mail, let's hope we're in time to stop junk medicine.

    Visit the
    "Ethics Matters" Archive
    where you'll find other columns from Jeffrey Kahn
    on a wide range of bioethics topics.

    "Ethics Matters" is a biweekly feature from the
    Center for Bioethics and CNN Interactive.




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