There is an ongoing campaign to convince health care providers, decision-makers and the public that generic medications cannot be trusted and that if you want the real goods you need to pay the brand-name price.
Yet another patient told me this week that she was switched from an affordable generic medication to a more expensive brand name, warned that generics are lousy copies and should not be trusted. I have heard the argument myself when unable to tiptoe past the "drug rep" dropping off free samples, or when stomach rumblings have landed me at the lunch talk by a specialist getting side income from a drug company speakers bureau.
"Generic medications can be up to 20 per cent less effective or 25 per cent too strong and still get approved by Health Canada or the US Food and Drug Administration," the line goes.
The line is actually a twist, a re-packaging of some complicated statistics into an easy-to-understand sound bite, but one with the unfortunate weakness of not being true. Still, when you hear a statement repeated enough times it can take on the look of a truth.
In fact, research shows that there may be small differences in how strong the drugs are or how fast they work but that those differences are basically undetectable to the patient. They are generally less important, experts say, than the difference in absorption between one patient and another, or the effect of that recent cheeseburger and fries.
There are surely times when you might react differently to one company's product or another. The dyes, fillers and other co-ingredients can be different and you might be allergic or intolerant to one. It is certainly possible to feel different (though rarely for sure) when switching from one to another. But there is no reason to avoid starting with a generic first and saving you the patient or you the taxpayer money.
Brand name drug companies have a lot to gain from dispensing distrust for generic medications and a lot to lose from patients, governments and insurance companies insisting on reasonable discounts once the drugs are off patent.
Disparaging generics is part of a broader strategy for reducing competition once patent protection expires that includes legal manoeuvres and brand reinforcement. The relentless branding of drugs like "Advil" and "Tylenol," for instance, keeps us from buying cheaper versions labelled with the less-memorable names "ibuprofen" and "acetaminophen." Companies also work to keep health care providers thinking brand name the way we think Kleenex instead of tissue and Rollerblades instead of in-line skates.
Brand name salespeople have a favourite phrase they would like to see on all branded prescriptions: no substitutions. Do not give my patient one of those inferior copies that could be 20% less effective or 25% too strong, it says. A bottle of your finest. Only when the insurance company or the formulary refuses to pay for the more expensive version should the physician back down.
The mathematical acrobatics used to ensure that generics are basically the same are complicated to judge, and there are critics. But I can tell you what reassures me: brand-name companies are held to the same standard.
If the marketed brand name formulation is a little different from the one in the clinical trials, the same test applies. If a change is made to a brand name product once it is on the market, the same test applies. The same standard is used to ensure that one batch of brand name drug is similar enough to another.
In fact, though a brand name company might tell you that generics are inferior on Tuesday, on Wednesday another will sell you their own generic version of a drug (called a pseudo-generic). As many as one quarter of generic copies on the market in Canada are actually made by brand name companies themselves.
Our system provides brand name companies with many years of patent protection for their products so they can recoup the costs of drug development and clinic trials. Their innovation does provide a valuable service to society. But when that patent protection expires and brand name companies have gotten their due (and more some would argue), other companies have a right to compete for market share, bringing the price down and saving us money.
Generic drugs are just market competition in action. They are a reliable alternative to the original brand name medication. If your doctor tells you otherwise they have been misinformed.