There are a lot of myths put out by Big Pharma hoping to convince the credulous that generic substitution is a horrible idea that imperils the public health.
Since even active medications benefit from a kind of placebo halo that turbocharges its efficacy above and beyond the primary physiological effect, this kind of poor-mouthing by Big Pharma most likely does have some effect at making generics work less effectively than their brand name equivalents.
However, brand name equivalents, as well, show a steady decline in efficacy from their initial release, when doctors and patients alike are excited about the latest and greatest new thing.
As a psychiatrist, did you once have more excitement, for instance, about Prozac than you do today, and did you manage to communicate this excitement to your patients? The bloom is off the Prozac rose not because generic fluoxetine is really any different from its brand name predecessor, but because it's no longer benefiting from patent protection, and drug makers have moved on to the latest "new and improved" variations to hype and extort profit from.
As far as the 80 to 125 percent bioavailability, three responses:
1) this is most likely important only in a very slim number of drugs, like anti-seizure medications, were the therapeutic window can be quite thin--a slightly low dose might not work, and a slightly high dose might cause side effects. Most drugs don't have this problem. If you have a headache, you can take either 1, 2, or 3 aspirins, and it's not going to have a huge deleterious effect.
2) many generics end up being too strong in dosing because the FDA doesn't require that manufacturers use the same inert filler materials. There have been cases where the generic maker is told to, in effect, make their drug weaker so that it is closer to the original brand name drug.
3) most big pharmaceutical companies make generics themselves--it's not only the Mylans of the world (and other dedicated generic manufacturers) that specialize in this. The Brand Name companies very often make their own generic forms of brand name drugs, hoping to capture at least some of the generic market while at the same time continuing to mean-mouth generics in the hopes patients will demand the Brand Name originals at many multiples of the cost.
Bottom line: Big Pharma is part of the Solution. It is, alas, a bigger part of the Problem.
I am not saying "Big Pharma" is great(they don't even give me free pens anymore.) I am saying the government could make generics better by tightening up the definition of equivalent.Once a med has gone generic for several years the quality of the generics is generally pretty good,but I had many patients with depression who were doing great on Wellbutrin XL who had a recurrence of symptoms when it went generic.
There are a lot of myths put out by Big Pharma hoping to convince the credulous that generic substitution is a horrible idea that imperils the public health.
Since even active medications benefit from a kind of placebo halo that turbocharges its efficacy above and beyond the primary physiological effect, this kind of poor-mouthing by Big Pharma most likely does have some effect at making generics work less effectively than their brand name equivalents.
However, brand name equivalents, as well, show a steady decline in efficacy from their initial release, when doctors and patients alike are excited about the latest and greatest new thing.
As a psychiatrist, did you once have more excitement, for instance, about Prozac than you do today, and did you manage to communicate this excitement to your patients? The bloom is off the Prozac rose not because generic fluoxetine is really any different from its brand name predecessor, but because it's no longer benefiting from patent protection, and drug makers have moved on to the latest "new and improved" variations to hype and extort profit from.
As far as the 80 to 125 percent bioavailability, three responses:
1) this is most likely important only in a very slim number of drugs, like anti-seizure medications, were the therapeutic window can be quite thin--a slightly low dose might not work, and a slightly high dose might cause side effects. Most drugs don't have this problem. If you have a headache, you can take either 1, 2, or 3 aspirins, and it's not going to have a huge deleterious effect.
2) many generics end up being too strong in dosing because the FDA doesn't require that manufacturers use the same inert filler materials. There have been cases where the generic maker is told to, in effect, make their drug weaker so that it is closer to the original brand name drug.
3) most big pharmaceutical companies make generics themselves--it's not only the Mylans of the world (and other dedicated generic manufacturers) that specialize in this. The Brand Name companies very often make their own generic forms of brand name drugs, hoping to capture at least some of the generic market while at the same time continuing to mean-mouth generics in the hopes patients will demand the Brand Name originals at many multiples of the cost.
Bottom line: Big Pharma is part of the Solution. It is, alas, a bigger part of the Problem.
I am not saying "Big Pharma" is great(they don't even give me free pens anymore.) I am saying the government could make generics better by tightening up the definition of equivalent.Once a med has gone generic for several years the quality of the generics is generally pretty good,but I had many patients with depression who were doing great on Wellbutrin XL who had a recurrence of symptoms when it went generic.
