Everyone loves a bargain. Imagine buying a new Mercedes-Benz worth $60,000 for the price of a Hyundai, say around $20,000. As long as the vehicle had Mercedes parts and performed like a Mercedes, you would be thrilled.
In reality, no one gets a 66 percent discount on a new luxury car. Even with the automobile market in desperate shape, no one gives away Mercedes at bargain basement prices.
Most people believe that you get what you pay for. That’s why they are justifiably suspicious when someone offers a Rolex-brand watch over the Internet at a Timex price. The likelihood is pretty high that there is some counterfeiting going on.
When it comes to prescription drugs, however, this law of economics has been suspended. According to the FDA, “A generic drug is identical, or bioequivalent to a brand name drug in dosage form, safety, strength, route of administration, quality, performance characteristics and intended use.”
Despite being identical to its brand-name counterpart, the generic drug costs much less. Now that many discount chains are selling a month’s supply of many popular prescriptions for $4, the savings are truly spectacular.
Take the antidepressant Prozac, for example. A month’s supply would cost around $150. The generic fluoxetine might run about one-tenth as much or roughly $15. But if you shopped at a big-box discount drugstore you could get a 90-day supply for $10. Over three months, the savings would add up to $440. Who wouldn’t want to save 98 percent on prescription drugs?
Some patients and physicians have voiced concern about the quality of generic drugs. The extraordinary savings are only a bargain if the generic is truly identical in safety and effectiveness.
A recent review of generic drug research carried out since 1984 concluded that “generic and brand-name cardiovascular drugs are similar in nearly all clinical outcomes” (Journal of the American Medical Association, Dec 3, 2008).
Although this research is reassuring, it has some limitations. More than half of the studies included in the review were published before 2000 and only about a third were conducted in the U.S.
Before 2000 we had little worry about the quality of generic drugs. We encouraged readers to buy low cost medicines whenever possible. We would still do so if we thought that someone was monitoring the quality of the products on pharmacy shelves.
After 2000 an increasing proportion of generic drugs originated overseas. The weak link in our national drug supply system is that the FDA operates mostly on the honor system. The agency expects manufacturers to be honest. There are few resources devoted to verifying that generic drugs (or even branded products) contain what they claim.
Ever since patients died from a contaminated blood thinner (heparin), Americans have lost faith in government oversight. New reports that minuscule amounts of melamine have been found in baby formula in the U.S. and Canada suggest that Chinese suppliers should not always be trusted.
We’ve been promised a change in Washington come the new year. One change we would like to see is FDA monitoring the quality of imported pharmaceuticals so that Americans can have confidence in the drug supply once again.