The sampling of medicines is a common practice in primary care settings throughout the United States. Most clinics will be well stocked with free medicines supplied by pharmaceutical companies. This allows the doctor to give free samples out to those patients who cannot pay for a prescription. Sounds good, right? Wrong.

Samples are supplied by the pharmaceutical companies because they want to promote a new product. This becomes problematic for many reasons. First, the antibiotics supplied are all new, second and third line agents. By resorting to these newer agents (e.g. cephalosporins and fluoroquinolones) before the recommended first line agents (e.g. amoxicillin, erythromycin, or doxycycline), the development of antibiotic resistance is encouraged. This is of particular concern because this antibiotic resistance, due to the sampling of medications, is to the most powerful and newest antibiotics. Everyone should be concerned about this- even those with insurance and/or enough money to pay for prescription antibiotics. When bacteria resistance to antibiotics develops in a community, all of us are at risk. The bacteria don't care about social class, race, or sex. Everyone pays the price.

How about giving out samples to patients with high blood pressure? Again, the samples supplied by the pharmaceutical companies are the newer and more expensive medicines. Starting a patient out on these medicines frequently is disasterous to poor patients, because they get on a regimen that can cost up to 10 times as much as a generic medicine that works just as well. When the samples are gone, the monthly bill can break a family's budget. Thus, the poor patient will often stop the life-saving medicine. This tragedy may have been avoided if the patient was initially started on the inexpensive, generic medicine.

Relevant to this discussion is an editorial by Dr. Merle A. Sande, Professor and Chairman of Internal Medicine at the University of Utah in Salt Lake City (Family Practice News, 15-June-1999, p.12). Here's how he puts it: "We have totally blown it- absolutely, completely screwed up. It's shattering to think how we've misused and abused what were once called wonder drugs." He goes on to describe how the misuse of antibiotics has resulted in serious antibiotic resistance. Furthermore, future generations will suffer as a result.

Is giving free samples to the poor a good idea? No. By doing so we are creating pockets of serious antibiotic resistance, that will eventually spread throughout the world. There must be a better way!