There is a long article in this month’s Self magazine with a scary title: “Bad Bargain: All of us want cheaper medicine- but not if it costs us our health.” The title suggests that generics are evil, and the article opens with case reports of suicidality returning in patients on the generic version of the extended-release antidepressantbupropion (Wellbutrin™) and recurrence of seizures in a patient switched to a generic antiseizure medicine.
The article, by Katherine Eban, a credible reporter with good credentials, sites many anecdotes about lack of therapeutic equivalency. She goes on to report in depth about what appear to be fabricated reports from the Indian generic pharmaceutical giant Ranbaxy. The Ranbaxy CEO recently resigned over this issue, and the FDA has blocked importation of some (but not all) medicines from Ranbaxy. The Self article quotes many physicians who believe that generics are not a good idea for their patients. Most of these physicians have pharmaceutical company ties.
Eban makes it clear that the FDA does not have adequate resources to inspect international manufacturing sites, and Aaron Kesselheim previously reported in the Annals of Internal Medicine that “the most effective way to decrease drug costs overall is the appropriate use of domestic generic drugs, which are available for almost every major therapeutic class."
The Today Show on NBC picked up the story – and Matt Lauer interviewed a pro-brand-name pediatrician and the Self magazine editor (not the reporter). Lauer gasped when he heard that pharmacists are allowed, and even required, to substitute generic medications for brand name medications.
Generics are one of the few true successes in health care affordability. The Congressional Budget Office concluded that generics saved $8-10 billion a year in 1994 dollars – and this was long before blockbuster medicines like Prozac (fluoxetine) and Prilosec (omeprazole) and Zocor (simvastatin) went off patent. Pharmacy inflation has abated substantially in the last few years – and generics are the reason.
Saving money on prescriptions isn’t just about saving a few (or many) bucks. Patients facing huge bills for their medications are much less likely to follow their physician’s prescriptions – so generics will likely help us get better health outcomes. And it’s not just the evil insurance companies trying to plump up their profit margins by substituting inferior pills. If we backpedal and make generic substitution more difficult, our health insurance premiums will go up and more Americans will find themselves priced out of the market. Just today, Health Affairs posted a new article suggesting that almost 7 million more Americans will lose their insurance through 2010.
There are a few drugs where the toxic-therapeutic ratio is so narrow that physicians and pharmacists should choose to keep patients on medications from the same manufacturer (whether brand or generic). Neither the Self article nor the Today Show noted that there have been problems with bioequivalence of brand name drugs, including Synthroid (thyroid medicine) and Dilantin (antiseizure medicine). In both of these instances generics were at many points more reliable than brand name preparations.
Generic extended release bupropion is a troubling case –there are so many case reports of drug failure that I wouldn’t prescribe it. But for the most part, generic drugs help us make health care affordable overall, and help individual patients gain the full benefits of what their physicians prescribe. I’m staying on my generic simvastatin (Ranbaxy).
