The People's Perspective on Medicine

Show 973: The Pros and Cons of Generic Drugs

How well do generic drugs mimic their brand name counterparts, and what do the differences mean?
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The Pros and Cons of Generic Drugs

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The FDA has insisted for years that generic drugs are identical to their brand-name counterparts. Physician and medical historian Jeremy Greene writes:

“Generic drugs never were–and still are not–exactly the same as their brand-name counterparts, but they are similar in ways we deem to be important.”

We discuss the value of generic drugs and the questions surrounding quality control with Dr. Greene. Your questions and stories are welcome at 888-472-3366 or email between 7 and 8 am EDT.

This Week’s Guest:

Jeremy A. Greene, M.D., Ph.D., is associate professor of medicine and the history of medicine and the Elizabeth Treide and A. McGehee Harvey Chair in the History of Medicine at the Johns Hopkins University School of Medicine. He is the author of Prescribing by Numbers: Drugs and the Definition of Disease and coeditor of Prescribed: Writing, Filling, Using, and Abusing the Prescription in Modern America, both published by Johns Hopkins. Dr. Greene’s most recent book is Generic: The Unbranding of Modern Medicine.

To hear Dr. Greene discuss his new book, Generic: The Unbranding of Modern Medicine, click here.

Listen to the Podcast

The podcast of this program will be available the Monday after the broadcast date (Dec. 13, 2014). The show can be streamed online from this site and podcasts can be downloaded for free for four weeks after the date of broadcast. After that time has passed, digital downloads are available for $2.99. CDs may be purchased at any time after broadcast for $9.99.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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Greetings Joe and Terry!

From my experience, many of the generic medications that I take are not as effective as the name brand drugs that I had previously taken before the name brand drugs patent expired and my insurance company insisted that I choose the generic or pay a very high co-pay (~$65 to ~$125 for one month’s supply) if I elected to have the pharmacy fill the brand name medication.

Just to mention two drugs: the generic form of Ambien, zolpidem, is not nearly as effective as the name brand Ambien. Friends, family members and colleagues’ of mine can attest to the weakness of generic zolpidem. I’ve also taken Fioricet with codeine for many years (I always received the Sandoz brand name) and in the last ten years I have received the generic version which is less effective and does not provide the same level of pain reduction. Several years ago, I had my physician prescribe me 20 capsules of the name brand Fioricet with codeine and then I had her prescribe me 20 capsules of the generic Butalbital/APAP/Caffeine/Codeine and it became very clear to me that the name brand acted quicker, was much more effective and was the superior drug of the two that my physician had prescribed for me to compare.

I’m sure there are many other patients out there that have parallel stories about their experiences with generic versus name brand medications that they too can comment about. Keep up the excellent work and continue inviting great scientists on your program. I’ve learned so much listening to your radio program for ~15 years or longer. Take care.


James D. S.

I don’t take anything but OTC Prevacid, was just on the OTC Nexium but causing issues. I should be on a statin and Flomax but the generics caused a reaction of anxiety. Those Indian made generics can’t be good and I will avoid them.. I may have to pay for the Name Brand

In hospital they gave me the Generic Oruvail. I could feel it was not working like the Orudis does. Within 4 hours I had a huge asthma attack.

My Aunt also Rheumatoid was on the generic – when I got her to take the brand name drug she was immediately 50% better in pain/inflammation.

For $3 more I always get the Brand name. I’ve read generic companies do their own testing and many get by the FDA…TGA Australia with only 30% of main ingredient in my experience I agree with that. FDA does not do any testing and only take the manufacturer’s word for it. Lots generic’s made in India.

Bit like getting the fox to guard the hen house.

The last time I wanted to go back to name brand from generic I was told by the pharmacy they had to have the docs permission. If they are supposed to be the same then why not just fill it. I’ve never thought they were the same. I just buy the generic because of the price diff.

Sometimes I think all this hype about generics is being promoted by the drug companies to encourage us to ask for the brand name. Thousands are on generics without a problem. The few problems wind up on boards like this. I take very few prescriptions and many times what I do take is generic and I’ve never had an issue. I have an asthma type condition and I really wish the asthma drugs would have generic equivalents which would, hopefully, make them less expensive. The pharmaceutical companies make huge profits and we fill their pockets with money….

There is no question that certain meds — ones that need to break down slowly over 24 hrs — lose effectiveness when generic inactive ingredients cause the med to deliver a big hit of the active ingredient fast, with little blood level med left for the body the rest of the day. A huge problem for those generics — and the patient. It can take a number of years for the FDA to reclassify and take the “extended release” label off the generic. “Identical” does not always mean that. Delivery and effectiveness are what really matter. More and more drs and pharmacists are beginning to admit that. In these cases, forget the generic, save your money entirely and just opt to go without med — unless you can get the original brand name drug that was working before switching. Also side effects can vary with differences in the formula for the inactive ingredients. One never knows how the body will react with any med or formula change until trying.

Good Morning Dr. Greene, Terry and Joe.

Just want to include that I was first prescribed Toprol for elevated blood pressure that developed 6 years ago following my experiencing a neurological event that altered my movement causing me to gain some weight.

Quickly we found the brand name drug Toprol to be expensive and the pharmacy providing the medication seemed to automatically fill the Rx with the generic metoprolol (perhaps by physician permission but without my knowledge). I only found that the new medication I was receiving was not effective.

Then by my own search, I found the company that makes Toprol also makes a generic- metoprolol.
BTW, the pill(s) look exactly like the brand name version.

SO, Then the physician specifically prescribed the generic version-only the, one made by that company (and I found a pharmacy that provides that metoprolol specifically made by that brand name manufacturer). This generic metoprolol is effective for me.

Thanks for this wonderful show,

Most prescription plans insist on generic drugs, unless the prescribing doctor prescribes brand drugs only. I have had a plan for many years, and I receive generic only.

If time permits, a review of the price fixing scam by Mylan Labs in the 90’s would inform consumers. In brief, the 2 cent generic drug was later costing over a dollar per pill and the last time I looked was 30 cents – the first of many price fixing scams to monopolize drugs and raise the price to consumers. The captured FDA was and is a central part of these price fixing schemes.

“Generic” drugs may not always be 100% identical to the originator’s product,but they are considered “therapeutically equivalent” to the comparable brand name products,and if fact are 100% bio-identical the original product in the vast majority of the cases,and should not be discounted for use as a lower cost alternative to the expensive brand name prescription products. Much depends on the quality control and testing of the generic manufacturer and in the origin of the generically produced drug. The “buyer” by all means,needs to become engaged in this process and,needs to be pro-active in your approach to taking both,brand name and generic drugs. Your,endpoint delivery (i.e. your Pharmacist) is a very valuable resource to use in this regard. Choose wisely!

I can’t find the link to your podcast. I used to be able to so I’m not sure what’s happened.

Try it now, Kathy. This show was broadcast on Saturday December 13th, and our podcast was not available until after the radio broadcast. It is now available to download from iTunes or to listen to as streaming audio from this page. Thanks for your interest!

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