Taking the Pain
The 1997 legalization of physician-assisted suicide in Oregon raised questions regarding the use of federally controlled substances for this purpose. In 1998, when Janet Reno ruled that the Controlled Substances Act established no uniform national policy against the use of federally regulated drugs for assisted suicide, the Pain Relief Promotion Act was born. Currently before the U.S. Senate's Committee on Health, Education, Labor, and Pensions, the bill's intent is to prohibit the use of drugs covered under the Controlled Substances Act for assisted suicide or euthanasia. Should the bill become law these drugs could not be used to assist suicides in any state that, like Oregon, allows the practice. It passed the House in 1999.

Proponents applaud the bill for closing loopholes that allow federally regulated drugs to be used for assisted suicide. Cardinal William Keeler of Baltimore, in a National Conference of Catholic Bishops press release, stated "This gross abuse of federal authority must end, so that once again no federal program will be used to support the killing of vulnerable patients." Other groups, including Concerned Women for America, praise the measure as "an important bill in the fight to protect life from conception to natural death."

Opposed is Jim Guest, executive director of the American Pain Foundation. In a Chicago Tribune editorial he wrote, "It would be the utmost of cynicism to turn patients with pain into political pawns by wrapping their medical care into the debate on physician-assisted suicide." The American Cancer Society calls the bill flawed. In a position statement published on their website they charge that the bill has "serious potential to exacerbate the current problem of under treatment of pain."

Support for the measure is roughly split along party lines: Republicans supporting, Democrats opposing. With the 107th Senate evenly divided, end-of-life advocates have reason to hope the ill-conceived bill will die a painless death—in committee.

First Time's Free
With the cost of drugs spiraling ever upward, a small but growing number of health care organizations are limiting or eliminating the practice of accepting product samples from pharmaceutical companies, reports the New York Times. Administrators in these organizations worry about the high cost of free samples.

The drugs that companies hand out have the highest profit margins. Lower cost generic drugs are rarely given away. If the sample works for the patient, physicians will prescribe that product even though a generic drug might be just as good. While there have been no definitive studies of this phenomenon, there is mounting anecdotal evidence. A clinic in Washington state saw its drug costs decline after banning samples, while drug costs rose at other facilities in the same area.

There are safety issues as well. One risk of uncontrolled distribution of samples is the danger that a patient might be given medication that is later recalled; there would be no way of notifying the recipient. In the last two years the Joint Commission on Accreditation of Healthcare Organizations has increased its focus on medication safety, making sure hospitals properly control drug samples.

Some physicians at these organizations are unhappy with the policies. They say the samples are often used to help patients with inadequate insurance gain access to expensive new drugs. Administrators, they believe, are too focused on the bottom line. Chicago doctor Finley W. Brown Jr. said, "It is as if a doctor cannot be trusted to make a judgment." Some specialties use the samples to determine a drug's efficacy prior to writing prescriptions.

Dr. Bert A. Spilker of the Pharmaceutical Research and Manufacturers of America, the industry's trade organization, defends the practice: "[The samples] allow doctors to learn about the benefits of new drugs recently introduced to the market." But Dr. Al Fisk of the Everett Clinic, a medical center that banned both samples and visits from drug reps, has his doubts: "I have been troubled by the fact that the major source of information that physicians use to educate themselves is from drug representatives." He went on to characterize that information as "one sided," as it tends to include a drug's benefits while omitting its drawbacks.

Drug company reps will tell you that they perform a vital service in contemporary health care by educating doctors about new therapies. But the question lingers: are they purveyors of useful information or serpents in the garden?