Billions of dollars worth of free medication samples are distributed to physician clinics each year. Many offices have whole rooms filled with such samples. This study reporting on free samples received during the calendar year of 2003 had 4000 respondents, 82% had health insurance and 72% had incomes over 200% of the federal poverty line. Uninsured individuals were slightly more likely to receive samples than those with stable insurance. The drugs most frequently sampled were Vioxx, Lipitor, Celebrex, Allegra, and Advair. Most of these drugs have been the subject of aggressive direct to consumer advertising which suggests that samples are often just one more marketing tool.

Samples are often used by physician's staff and families. We often use them when another less expensive drug might be more appropriate but because of the convenience of having a sample pack it is prescribed. If the patient is doing well on it, a prescription is written for that specific brand. One recent medical school gave up sampling among residents because they found that the residents were writing fewer prescriptions for generic drugs because of the use of samples. Often the patients who receive the samples are those who least need them. It's up to each physician to decide the appropriateness of samples. (Am J Public Health 2008 Feb; 98:284)

Common medical wisdom gets transmitted through generations of medical students until someone looks to see how common it really is. This was a prospective cohort study of 47000+ male health professionals without a prior diagnosis of diverticular disease. It showed that eating nuts and popcorn didn't increase their risk for complications of diverticular disease. It's been thought that these items may cause colonic luminal trauma and initiate inflammation and bleeding within the diverticula. As is true with so many things in medicine we may have to adjust the advice we give patients regarding this condition and let them eat what they want. (JAMA 2008 Aug27; 300:907)

In July of 2008 the FDA announced the prescribing information for systemic fluroquinolones must include a box warning regarding the risk for tendonitis and tendon rupture. This risk is increased in patients over 60 or those taking steroids and those who have had organ transplants. Patients should be warned of this risk and told that if they have pain, swelling, or inflammation over their tendons, especially their Achilles tendon, to stop taking the drug, avoid exercise, and seek medical advice.

Dutch researchers recently randomize a 120 patients with acute gouty arthritis to receive either oral prednisolone (35mg daily) or naproxen (500mg twice daily) for five days. These patients were all diagnosed by joint aspiration finding monosodium urate crystals in the synovial fluid. The two drugs provided equal pain relief according to pain scores which were evaluated at 12 hour intervals, the adverse effects were minimal and all the patients had full symptom relief at three weeks follow-up. Indomethacin has been used for years but it sometimes causes gastro intestinal upset. This study shows that prednisolone is a reasonable alternative to NSAIDs if for some reason they are contraindicated. (Lancet 2008 May 31; 371:1854)

John J. Mohr, MD