I guess the thread title pretty much sums it up. When I get a prescription from my doctor, there will be a checkbox or something for the doctor to indicate if he’d rather the patient only fill the prescription with brand name drugs.
Why is this? That is, why would a doctor limit his patient to a more expensive medication when the generic consists of the exact same chemicals?
Because in some cases doctors feel that the generic is not equivalent; the generic does not consist of the exact same chemicals; it consists of an identical active ingredient and approximately identical inert ingredients. Those “inert” ingredients (excipients) are responsible for the disintegration rate of tablets, the release rate of timed-release drugs, the stability of the formulation, etc.
The generic drug industry, with proper FDA oversight, does a pretty damn good job. But there are proprietary secrets to the making of a drug product, and the copy is never exactly the same as the original – though most of the time, no one can tell the difference.
Besides, sometimes the patient insists that nothing but the “real thing” will do.
It would be nice if it were always true that generics are always exactly the same as the originals, but it ain’t so.
Making a drug so that it has the proper composition, purity, lastingness, and other traits is a highly developed art. Some factories can do this better than others.
And all meds contain inactive ingredients that can have a great effect on performance. The time it takes these to dissolve, the percentage of the effective dose that is released at the precisely correct time, the potential side effects of otherwise innocuous fillers like the extremely commonly used lactose, and the proverbial others may be highly significant.
Some of these effects may be of more concern for some specific patients than for others. Even though I believe it is now law that generics must be offered unless specifically stated otherwise, brand names meds are better for some patients at some times and I’m glad that doctors have the ability to choose.
(Can this choice be abused? Yes, anything can and therefore has been. But it’s still a good thing.)
A lot of times doctors feel that generics don’t control the condition as well, either because of differing inactive ingredients, different quality control guidelines, or whatever. This is very often true about seizure-control drugs like Dilantin, where fairly minor changes in the drugs one takes can make fairly major changes in how well one’s disease is controlled.
In some cases, generics are inferior, but in most they are absolutely idendtical. I used to work for Merck, and we got questions all day long about “Genetic” medicine, no I did not misspell that. People are programmed to think that generics are inferior because of similar practices with such things as store brand foods. Merck once had a product that they released as brand name, and later released as generic also, the price difference for brands is suppusedly to offset R&D costs to the creator. Anyway, we had tons of calls from people than had been switched to the generic (per their benefit plan) and said it didn’t work at all. These pills came out of the exact same machine, had the exact same content, and recieved only different stamps. I had to ask people “Are you allergic to the letters L and O ? , Because that’s the only difference in your meds”. My point is that people have a predisposition to generic drugs, sometimes simply because of the negative connotations of the word “generic”.
As for the Prescriber’s point of view…have you ever seen a novelty office item (pen, clipboard, memo pad, magnet, mouse pad) that had a generic name on it? Of course not! Why do you think 3 out of 4 Dentists prefer Oral-B? They give out the most freebies. Your doctor has been bought, now they’re trying to sell you with pharmecuetical ads.
I’ll listen to a chemist, or a pharmacist that hasn’t been paid off, but no commercial or fear of generics will control me.
If everybody gets brand names, prescription insurance goes up, across the board.
The explanation by dnooman is certainly the truth here in Australia. I confronted a doctor about stamping my prescription “No Substitutes” and he sounded like a drug company shill in his efforts to justify it and this only weeks after it was revealed that one drug company was giving doctors PC’s. No pharmacist I have ever spoken too has indicated any difference when substituting generics. I would be interested in seeing any research that indicates differences brought about by inert contents of medications because it sounds like urban legend to me.
I work in a pharmacy and very often customers (often elderly) will utterly refuse to believe that a generic product is the same as the brand name they are used to. If they have been recommended a product by the doctor then they are, understandably, determined to buy that exact product. Similarly, If they have been a loyal customer of a certain product for a number of years they are often made uneasy by a different name/box design, or they feel that they are being fobbed off with a cheap alternative. If it gives the patient more peace of mind then they will recieve brand name drugs.
I am a pharmacist who works for a major retail chain in the United States. I can tell you with no certain doubt that the generic medications you get vs. branded medications are the exact same thing. The only difference is the manufacturer. Once a manufacturer has lost their patent then other companies may make the same drug, without investing in R&D, marketing, etc., and that is why generics cost less. The FDA has strict guidelines regarding generic medications which take the place of brand name drugs. If a generic medication is deemed to be equivalent to a brand name medication (‘AB’ or ‘AA’ rated) by the FDA, then trust me, it will do the same thing in your body - and drug stores would not be able to substitute that medication for a generic without the FDA’s approval. In short, if a brand name medication has a generic for it, the generic is equivalent to the brand name no matter what your doctor, SO, or HMO tells you. It doesn’t make a difference to me what you choose to spend your money on, but at least I’ll try to give you the Straight Dope.
P.S. Some drugs are very controversial r.e. substituting generic vs. brand. Synthroid (a thyroid supplement), Digoxin (used for congestive heart failure among other things), Tegretol (carbamazepine, used for epilepsy, migraines, BPD, and other conditions), as well as Coumadin (a blood platelet reducer, “blood thinner”) had all been on the State of Florida’s “negative formulary” which meant that pharmacists could not substitute generics for these medications. That law has been repealed recently, and there is also research that shows that the generic equivalents actually have better bio-equivalency and absorption profiles than the brand name medications.
I’m not a doctor or a pharmacist, but a friend of mine with a lot of allergies has to be VERY careful which exact brands of meds she takes. She’s a celiac (wheat and gluten intolerant) so she can’t take any med that has an unidentified “food starch” filler, because it is probably wheat. She also reacts badly to some food coloring, so it has to be a pill that is not bright red. If the exact nature of the fillers and coatings and colorings can’t be determined, she can’t take the chance. This applies to both prescription and non-prescription, BTW.
I imagine the same might be true for someone with a severe lactose intolerance, although I am led to believe that the tiny amount of lactose in a pill probably won’t affect most people.