MONDAY, March 24 (HealthDay News) -- Patients who receive free drug samples from their doctors end up having significantly higher out-of-pocket costs for their prescription drugs than people who don't receive free samples, a new study finds.

In fact, patients who received free samples spent about $166 in out-of-pocket costs on prescription drugs in the six months before receiving the samples, $244 for the six months in which they received samples, and $212 for the six months following receipt of the free drugs, the study found.

But patients who didn't get free samples spent about $178 on prescription drugs over six months.

"This is a curious finding because one would think, intuitively, that if you receive a free sample, one's out-of-pocket prescription cost would be lower, not higher," said lead researcher Dr. G. Caleb Alexander, an assistant professor of medicine at the University of Chicago Medical Center.

There are several possible explanations for the finding, Alexander said. One is that patients who receive free samples may be sicker than patients who don't get samples.

"The second possibility is that patients who receive free samples may go on to receive and fill prescriptions for the very same medicine that were initially begun as free samples," Alexander said. "We know that drugs that are available as free samples are those that are being widely marketed and promoted and these drugs are more expensive than their older, less promoted counterparts."

The study findings are published in the March 24 issue of the journal Medical Care.

For the study, Alexander's team collected data on 5,709 patients who had participated in the Medical Expenditure Panel Survey. The survey was done by the U.S. Agency for Healthcare Research and Quality and the patients were followed for up to two years.

Seventy-six percent of the patients had private health insurance. During the study period, 14 percent of them were given at least one drug sample. A total of 2,343 samples were distributed during the period, the researchers found.

Patients who received free samples were more likely to be younger and have private insurance, while patients with Medicaid were less likely to receive samples, the researchers noted.

The findings follow earlier research, reported in the February issue of the American Journal of Public Health, in which Harvard University researchers showed that more than 80 percent of free drug samples were given to wealthy and insured patients, not to uninsured and poorer patients.

Alexander said there are many ways doctors and patients can work together to reduce drug costs, but giving away free samples may not be the best one.

"Doctors and patients both should be encouraged to consider alternative ways to reduce patients' out-of-pocket costs," he said. "There are many other strategies doctors can use, such as prescribing a three-month rather than a one-month supply, such as using greater numbers of generic medicines, and discontinuing non-essential medicines."

Dr. David Katz, director of the Yale University School of Medicine's Prevention Research Center, said free samples aren't designed to help lower drug costs, but rather to sell newer and more expensive drugs.

"Almost every clinician's office is stocked with drug samples," he said. "For patients and providers alike, these free drugs can take on the aura of Halloween goodies. Passing them out feels like giving a gift."

But, Katz added, "free samples are by no means a long-term solution to high prescription drug costs. Rather, they are at least, in part, a marketing device, a chance to sample the wares."

The pharmaceutical industry had this to say: "Free pharmaceutical samples are beneficial to patients of all income levels. Patients are able to try out a new therapy - gaining valuable first-hand experience of its benefits and side effects - without making a co-payment," said Pharmaceutical Research and Manufacturers of America (PhRMA) senior vice president Ken Johnson.

"What's more, contrary to statements made by critics, America's physicians prescribe medicines based on a wide range of factors, not simply receipt of free prescription drug samples," Johnson added in a prepared statement.

More information

For more on prescription drug trends, visit the Kaiser Family Foundation  .

SUNDAY, March 23 (HealthDay News) -- While many people view spring as a time of renewal and hope, the greatest number of suicides in the United States occur each year in April and May, notes the American College of Emergency Physicians.

It's not clear why suicide rates spike in the spring, said ACEP President Dr. Linda L. Lawrence. But "we do know that suicide is the 11th leading cause of death for all ages in the United States, with one suicide occurring every 16 minutes or about 11 suicides per 100,000 people," she said in a prepared statement.

"Moreover, suicide is the second leading cause of death among 25- to 34-year-olds and the third leading cause of death among 15- to 24-year-olds. Men take their own lives nearly four times more often than women, with men ages 75 and older having the highest rate of suicide, although over a lifetime, women attempt suicide two to three times as often as men," Lawrence said.

For every successful suicide attempt, there are 25 failed attempts that often leave people seriously injured and in need of medical care. More than 90 percent of all suicides are linked with a mood disorder or other psychiatric illnesses, which can be treated through behavioral therapy and medication, Lawrence said.

"So we want to build greater public awareness and understanding of suicide in order to prevent these needless deaths and injuries from occurring," she said.

As part of that effort, the ACEP wants to educate people about the warning signs of suicidal behavior, which include:

• Feeling depressed, down or excessively sad.
• Feelings of hopelessness, worthlessness or having no purpose in life, along with a loss of interest or pleasure in doing things.
• Preoccupation with death, dying or violence, or talking about wanting to die.
• Seeking access to medications, weapons or other means of committing suicide.
• Wide mood swings -- feeling extremely up one day and terribly down the next.
• Feelings of great agitation, rage or uncontrolled anger, or wanting to get revenge.
• Changes in eating and sleeping habits, appearance, behavior, or personality.
• Risky or self-destructive behavior, such as driving recklessly or taking illegal drugs.
• Sudden calmness (a sign that a person has made the decision to attempt suicide).
• Life crises, trauma or setbacks, including school, work or relationship problems, job loss, divorce, death of a loved one, financial difficulties, diagnosis of a terminal illness.
• Putting one's affairs in order, including giving away belongings, visiting family members and friends, drawing up a will or writing a suicide note.

If a person is threatening to commit suicide, take it seriously, remain calm and take the following steps, ACEP advises:

• Don't leave the person alone. Prevent access to firearms, knives, medications or any other item the person may use to commit suicide.
• Don't try to handle the situation alone. Call 911 or the local emergency response number. Phone the person's doctor, the police, a local crisis intervention team, or others who are trained to help.
• While waiting for help, listen closely to the person. Let the person know you're listening by maintaining eye contact, moving closer, or holding his or her hand, if appropriate.
• Ask questions to determine what method of suicide the person is considering and whether he or she has an organized plan.
• Remind the person that help is available.
• If the person does attempt suicide, immediately call for emergency medical assistance and administer first aid, if necessary.

More information

For more on preventing suicide, visit the U.S. Centers for Disease Control and Prevention.

FRIDAY, March 21 (HealthDay News) -- Because sleep deprivation may give rise to sleepwalking, it can also help specialists diagnose the condition, say Canadian researchers.

They studied 40 patients referred to a sleep disorder clinic for treatment of suspected sleepwalking.

The patients were examined and spent one night of baseline sleep in the lab. They did their normal activities the next day and returned to the sleep lab in the evening. On the second night, the patients were prevented from falling asleep. They were allowed to have a recovery sleep the next morning, after being awake for 25 hours.

The patients were videotaped during their sleep sessions so that the researchers could evaluate behavioral movements -- such as playing with bed sheets or getting up from the bed -- linked with sleepwalking episodes.

During the baseline sleep session, 32 behavioral episodes were noted in 20 sleepwalkers (50 percent), compared with 92 episodes in 36 patients (90 percent) during recovery sleep.

The researchers found that sleep deprivation also significantly increased the percentage of patients who experienced at least one complex episode.

"By yielding a greater number of episodes with a wide range of complexity, sleep deprivation can facilitate the video-polysomnographically-based diagnosis of somnambulism (sleepwalking) and its differentiation from other disorders," wrote Antonio Zadra, of the University of Montreal, and colleagues.

The study appears in the journal Annals of Neurology.

Observing behavioral events in the sleep lab following sleep deprivation isn't always sufficient to confirm a diagnosis of sleepwalking, the researchers noted. However, when it's used "as a diagnostic tool, sleep deprivation shows a high sensitivity for somnambulism and may be clinically useful with a wider range of somnambulistic patients than previously reported."

Sleepwalking, which affects up to four percent of adults, usually involves misperception and unresponsiveness to surroundings, and mental confusion and amnesia about sleepwalking episodes. There is no proven method of diagnosing sleepwalking, so the disorder is diagnosed on the basis of a patient's clinical history.

The study authors said their findings support recommendations that sleepwalkers should maintain a regular sleep schedule and avoid sleep deprivation.

More information

The (U.S.) National Sleep Foundation has more about sleepwalking  .

THURSDAY, March 20 (HealthDay News) -- One year after suffering major trauma, many patients have moderately severe pain, a U.S. study finds.

Researchers at the University of Washington in Seattle, who noted that post-injury pain can lead to disability, depression and post-traumatic stress disorder, analyzed data from 3,047 patients (ages 18 to 84) who were hospitalized for treatment of acute trauma and survived at least one year.

"At 12 months after injury, 62.7 percent of patients reported injury-related pain. Most patients had pain in more than one body region, and the mean (average) severity of pain in the last month was 5.5 on a 10-point scale," the study authors wrote.

"The most common painful areas were joints and extremities (44.3 percent), back (26.2 percent), head (11.5 percent), neck (6.9 percent), abdomen (4.4 percent), chest (3.8 percent) and face (2.8 percent)," the researchers wrote.

They also found that 59.3 percent of patients with injury-related pain had three or more painful areas one year after injury, while 37.3 percent had a single painful area.

Patients 35 to 44 years of age were most likely to experience pain one year after their injury, while patients 75 to 84 were least likely to have pain.

"The reported presence of pain varied with age and was more common in women and those who had untreated depression before injury. Pain at three months was predictive of both the presence and higher severity of pain at 12 months. Lower pain severity was reported by patients with a college education and those with no previous functional limitations," the researchers wrote.

The study was published in the March issue of the journal Archives of Surgery.

"The findings of this study suggest that interventions to decrease chronic pain in trauma patients are needed. The high prevalence of pain, its severity and its effect on functioning warrant such interventions. This may consist of interventions during the acute phase of hospitalization to aggressively treat early pain and better manage neuropathic pain," the study authors concluded.

More information

The U.S. National Institute of General Medical Sciences has more about trauma and other kinds of injuries.