Insured and wealthy Americans were more likely than the poor to get billions of dollars in free drug samples distributed by pharmaceutical companies to win patient and doctor loyalty, a study released on Wednesday showed.

The pharmaceutical industry contends that the samples help the uninsured and people with low incomes, but the study of prescription use by nearly 33,000 U.S. residents during 2003 found that the neediest were least likely to get samples.

"Our findings suggest the free samples serve as a marketing tool, not a safety net," said Dr. Sarah Cutrona, co-author of the report to be published in the February issue of the American Journal of Public Health.

The Pharmaceutical Research and Manufacturers of America, a trade group representing most major drugmakers, called the study out of date and said a major facet of the problem is that many uninsured do not get healthcare from doctors' offices.

Samples are popular among doctors who want to try new drugs.

"As important as free pharmaceutical samples are in improving healthcare, they represent one - not the only - option for patients in need," Ken Johnson, a spokesman for the group, said in a statement.

Lack of access to regular medical care by the uninsured and underinsured is a major factor contributing to who gets free drug samples, the report said. The uninsured are more likely to get care from emergency rooms and clinics.

Nearly 47 million people living in the United States do not have health insurance.


About $16.4 billion in drug samples were given out in the United States in 2004, up from $4.9 billion in 1996, the study said. Distributed by sales representatives, samples are nearly always the newest, most expensive drugs, the report said.

Critics have said that in addition to steering doctors and patients to pricey drugs, samples can lead to medications being used for conditions they were not intended to treat.

Drugmakers are forbidden from recommending drugs for uses for which they have not been approved by the U.S. Food and Drug Administration, but doctors can prescribe drugs for any use.

The now-recalled painkiller Vioxx, made by Merck & Co, was the most frequently distributed free drug sample in 2002, the study found.

Vioxx was often prescribed beyond its approved uses before it was withdrawn from the marketplace because of a link to an increased rate of heart attacks and death.

The study analyzed U.S. government data in a 2003 nationally representative survey, and found that about 12 percent of Americans had received at least one free sample.

About 13 percent of those with insurance were given a sample, while about 10 percent of those who were uninsured for all or part of the year got one.

Seventy-two percent of those who received a sample had income in excess of 200 percent above poverty level, while 28 percent had income below poverty level.

William Shrank, a physician at Boston's Brigham and Women's Hospital who studies pharmaceutical use in large populations, said the study "helps debunk the assertion" that drug samples help the needy.

Brigham and Women's Hospital bans sales representatives, but Shrank described how early in his career he worked at academic centers where representatives freely roamed the halls. For doctors short of time and unable to keep up with medical literature, "You are getting biased data. It's not objective," Shrank said.

(Editing by Braden Reddall, Leslie Gevirtz, Toni Reinhold)