Dr. Nav Persaud took the unusual step on Monday evening of emptying a cabinet full of drugs into two garbage bags.

The drugs in question were free samples that pharmaceutical reps had given to a family practice clinic at St. Michael’s Hospital for distribution to patients.

At a luncheon meeting earlier in the day, the 12 doctors who work there unanimously agreed to put an end to what has been a decades-long North American practice in the drug industry — at least at their little clinic, one of five family practices at the hospital.

“We decided as a group that it would be better for patients and better for trainees if we stopped distributing pharmaceutical samples,” explained Persaud, who led the charge.

The 12 doctors signed a letter to be given out to drug representatives who visit the Bond St. clinic at a rate of one or two a week, politely informing them of the decision and asking them to respect it.

Dr. Philip Berger, chief of the Department of Family and Community Medicine at St. Mike’s, stressed the decision taken by the doctors was their own and not the hospital’s.

“The hospital does not intrude into the professional practices of independent physicians, which they are, provided their practices are ethical and fall within the domain of reasonable, professional judgment, which this decision does,” he said.

But offering his own opinion, Berger said he supports the doctors, noting their decision is based on sound research.

“It’s a long time coming for individual doctors and I think it is a good thing that the younger generation is finally taking the lead on this. It may well extend to other areas of the profession, provincially and nationally,” he said.

Still, Berger said he appreciates there is a “legitimate diversity of opinion” on the issue, noting some doctors accept samples to help low-income patients. In such cases, doctors don’t even have to meet with reps, but instead send applications to pharmaceutical companies for specific drugs that can help patients who cannot afford to buy them, for example asthma inhalers.

What Persaud objects to is the standard practice of pharmaceutical companies sending reps to doctors’ offices to give out free samples of drugs, particularly newer and more expensive ones, in the hope physicians start prescribing them and patients start demanding them.

But Persaud, who has worked at the clinic for two years, said that for many reasons, he has always felt uncomfortable with the routine.

When free samples of certain types of drugs run out, it can cause problems for low-income patients who cannot afford to buy them, he said, explaining they can go into withdrawal after they suddenly stop taking the medication.

Persaud said he would never prescribe some of the drugs the clinic has been given. Among the drugs he emptied from the sample cabinet was the birth control pill Yaz, which some studies have associated with a higher risk of blood clots.

By accepting samples, doctors are setting a bad example for medical students and residents who do rotations at the clinic as part of their training, Persaud said.

“A lot of younger trainees get into the practice and see it as normal,” he explained, adding when doctors give out the drugs, it appears they are implicitly endorsing them.

Another reason Persaud objects to free sampling is that it distracts doctors and clinic staff from their real job of seeing patients. When reps come to the clinic, they would first meet with a nurse and then a doctor who would sign off on the samples.

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“It’s a waste of resources,” argued Persaud, adding nurses and administrative staff were involved in the decision to stop the practice.

“There is something unseemly and inappropriate about their presence in a clinical setting,” he said, describing how reps would make their sales pitches in areas of the clinic where patients are seen.

Persaud also pointed out that the drugs don’t always end up in the hands of patients. It’s an open secret, and a long-known one, that some physicians take the drugs for themselves and their families, he said.

These problems were highlighted in 2009 essay in the journal PLoS Medicine that Persaud taped up in the empty cabinet after safely disposing of the free samples.

Referring to free sampling as the “most potent (of) marketing techniques” employed by pharmaceutical companies, the essay argues that “it is not effective in improving drug access for the indigent, does not promote rational drug use and raises the cost of drug care.”

But the industry, represented by Canada’s Research-Based Pharmaceutical Companies, known as Rx&D, maintains sampling is beneficial to both patients and health-care professionals.

“We do not live in a world where all patients have the personal resources or health coverage that allow them to obtain the best course of therapy for their condition,” Rx&D president Russell Williams said in a written statement.

Giving out what the industry refers to as “clinical evaluation packages and samples” can enable doctors to immediately begin urgent treatment in some cases, he said.

As well, it can help doctors determine a patient’s response to a medicine before deciding whether to prescribe it, Williams said.

But Dr. Joel Lexchin, a health policy professor at York University, said sampling can be problematic because not as much is known about the safety profile of newer drugs.

As well, Lexchin argued about 90 per cent of new drugs do not offer any significant therapeutic advantage over drugs that are already on the market, but tend to be more expensive.