Hitting a Nerve

Keeping the sample closet out of medication decisions


When I first began practice the COX-2 inhibitors had first come to market. My sample closet was awash with Celebrex and Vioxx.

Generic nonsteroidal anti-inflammatory drugs naproxen and ibuprofen Denise Fulton/MDedge News

I was young and naive. These drugs were allegedly safer than NSAIDs, so shouldn’t I be using them? They were new, and therefore had to be better, than plain old naproxen and ibuprofen. And hey, the samples were free.

As a result, I handed them out for pretty much all musculoskeletal stuff. “Here, try this ... ”

Of course, that came to a crashing halt when I encountered the realities of payers and drug coverage. No history of GI issues, no previous tries/fails ... Why on earth are you prescribing this? Obviously, the answer “because the samples were free” wasn’t going to pass muster.

Granted, history wasn’t particularly kind to the COX-2 drugs. Out of the three that made it to market, two were withdrawn and Celebrex’s star faded with them. But the lesson is still there.

Today, 20 years later, I use more generics. Maybe it’s because I’m familiar with them (many came to market during my career). Maybe it’s because years of calls from patients, pharmacies, and insurance companies have taught me to try them first. Probably a mixture of both.

This isn’t to say I don’t use branded drugs. I prescribe my share. There are plenty of times a generic isn’t appropriate, or a new approach is needed after a treatment failure.

Dr. Allan M. Block, a neurologist is Scottsdale, Ariz.

Dr. Allan M. Block

But I’ve also learned that the sample closet is never a good basis for medical decisions.

We learn a lot about the many different medications available in medical school and residency. But learning facts about dosing, side effects, and mechanisms of action (while quite important) is quite different from the practical aspect of learning what is more likely to be covered and affordable. Only the experience of everyday practice will teach that.

It sure taught me.

Dr. Block has a solo neurology practice in Scottsdale, Ariz.

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