For generations Americans have been told, “you get what you pay for.” That’s why many people are willing to pay extra for Hershey’s Kisses, Dole pineapple or Hellmann’s mayonnaise. When you buy new tires for your car, you know you will have to pay more if you expect them to last 75,000 miles instead of just 25,000. But in the field of pharmaceuticals, Americans have been told that price doesn’t matter. Generic drugs are supposed to be identical to their brand name counterparts even if they only cost $4 a month from Wal-Mart. In fact, they are supposed to be just as good even if they’re free. Some insurance companies are so eager to get patients to switch to generic drugs that they are willing to give them away for a time without a co-pay. How is it that a fundamental law of economics—you get what you pay for—has been suspended? Does it make sense that a generic pill you get for nothing could compete in quality with a brand name product that costs more than $100? The FDA takes pains in approving generic drugs to make sure the generic contains the same active ingredient at the same dose as the brand name product it replaces. According to the government, this process guarantees that generic drugs are every bit as good as pricey brand name prescriptions. For nearly 30 years we believed this argument. We encouraged people to save money by insisting that their physicians prescribe generics whenever they were available. All that changed several years ago when some pharmacists started telling us they had doubts about the quality of certain generic products. We also began getting letters from readers who had trouble with their generic prescriptions: “My husband has been taking Dilantin as a seizure preventive for some time with great success. A generic came out that would save him a lot of money, so he tried it, and had a seizure. The neurologist made him promise not to do that again.” Other readers have shared their disappointment with generic pain relievers, antidepressants, blood pressure medicines and diabetes drugs. The generic drug manufacturers discount these reports. Kathleen Jaeger, president and ceo of the Generic Pharmaceutical Association, has written: “To set the record straight, there are no differences between FDA-approved brand and generic medicines. A generic must meet the same high standards as the brand-name drug, with the same safety and effectiveness, same active ingredients, same strength and dosage, same labeling and use and same high quality manufacturing standards.” While we agree with Ms. Jaeger that FDA approval is rigorous, we worry that once drugs are approved and marketed, monitoring is spotty at best. For the most part, the pharmaceutical industry runs on the honor system. The FDA is not capable of analyzing more than a handful of pill bottles from pharmacy shelves each year. As a result, unscrupulous manufacturers or counterfeiters may be slipping substandard generics into the marketplace. Anyone who would like to report a problem with a generic drug can go to our Web site, www.peoplespharmacy.com, and email us from there. We will forward messages to the FDA and the Generic Pharmaceutical Association.