[EDITORIAL NOTE: The TGB Geriatrician is a bi-weekly column written by Dr. Bill Thomas (bio) for Time Goes By to give us the information we need to help us navigate the health issues of aging. Dr. Thomas also writes his own blog at Changing Aging.]
I know you are out there. I know that there are still some people who see generic medications as being somehow inferior to brand name drugs. This is a big issue, worth billions of dollars to major corporations, but I do have a funny story to tell you about generics.
A few years back, the anti-anxiety medicine Xanax™ lost its patent protection and became available as a generic called Alprazolam. A patient of mine who was, I'll admit, a very anxious person, called me at home on a Saturday after seeing me in the office on a Friday. "Hey Doc," he said, "this new medicine you put me on doesn't work!"
I asked a few questions and slowly came to understand that when he had refilled his prescription, the pharmacist had supplied him with the just-released, lower-cost generic version of the drug.
I explained this to him and he continued to insist that something was wrong. He'd taken the new pills as prescribed and they "didn't work at all. Nothing." I learned early on in my medical career that it is never a good idea to argue with patients, so I told him I would talk to the pharmacist and then call him back.
I was living in a small town then and was friends with the pharmacist (I'll call him John since that is his name.) John confirmed that he had supplied our patient with the generic version of Xanax. Then came the kicker. "You know Pfizer* makes the brand name (called Xanax) and the generic (called Alprazolam) on the same production line in the same factory." In fact, the only difference was the shape and color of the pill.
I called my patient back and explained all this - that it was the same medicine made in the same place by the same people with the same machines. It just looked different and cost less. He didn't care. He wanted the Xanax that he knew and nothing else. What could I say? I called John back and made the switch.
So what was going on here?
- Pill colors and shapes are designed by marketing teams, not doctors. Color and shape are related to sales. That's why Viagra is a blue football and not a pink softball. Drug companies spend billions trying to persuade Americans that color and shape matter. Remember the "purple pill?"
- The chemical compound inside brand name drugs and their generic equivalents are exactly the same. It's like the salt in salt shakers, you can pay big money for engraved silver salt shakers or you can save money and buy simple glass salt shakers. But, in the end, the salt inside the shaker is exactly the same - it is sodium chloride.
- Generics are manufactured according to the same rigorous standards that govern the manufacture of brand name drugs. They are Cadillac drugs for sale at Chevrolet prices.
- The big, brand name drug makers have started to make what are called "reverse payments" to generic drug makers. Because of the huge profits that they make on the brand name drugs, they are able to pay generic drug makers to NOT MAKE GENERICS. Keeping competition from an equally good product that can be sold for less is good for the drug makers' profit-and-loss statements and bad for the health and healthcare of Americans.
Drug companies have the right to force generic drug makers to make their pills a different color and shape. They rely upon the confusion sown by this difference to support sales of the brand name drug. As you can see in the case of my Xanax loving patient, it works.
Clear? Not as clear as you might think. Very soon after this post goes up someone is going to write a comment that reads something like: "Generics don't work on me. My doctor says that I have to have the brand name versions." Here is what I love about blogging at TGB, I get to tell you the story behind the story.
First, your doctor doesn't think that "generics don't work on you." She knows that your body reacts to generics the same way that it reacts to brand name drugs because, inside the body, brand name drugs and generics are the same thing.
Fillers and colorings are often blamed when patients say generics don't work, but generics use the same fillers as the brand names and the amount of food coloring in a pill is incredibly tiny. Problems with fillers and colorings are theoretically possible but the fact is, they are tremendously rare. Brand name drugs and generics are equivalent inside the body.
Second, your doctor has the same policy I do. She has explained that generics are just as good and that the only real difference is the price. You were not convinced and she is not going to waste time arguing with you. End of story.
Third, you should choose generics whenever you can. Why? I think that it is a matter of intergenerational fairness. Every dollar spent on brand name drugs that are no longer under patent and thus have a generic equivalent, is a dollar fewer for childhood immunizations, prenatal care, school health clinics and all the rest.
We all share an obligation to be thrifty with the health care resources we use. We are a rich nation, possibly the richest nation in history, but we are not so rich that we can afford to spend money foolishly on expensive pills simply because we are accustomed to a certain shape and color.
I look forward to reading this comment thread.
* The drug was developed by Upjohn before it merged with Pfizer.
[At The Elder Storytelling Place today, Herchel Newman attempts to exorcise the evil demons of modern life in Utter Frustration. ADDITIONAL NOTE: Today is the last day to vote in the Excellence in Storytelling Award. Polling closes at midnight eastern U.S. time. Links to nominated stories are here.]
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