We’ve all been there: stuck in the Rite Aid medicine aisle, desperately trying to quell a headache. Do you spring for the beloved brand name with its own commercial jingle, or save a few cents on its no frills, “just like it!” competitor?
Jeremy Greene, an assistant professor of medicine at Johns Hopkins, has some valuable advice: take a chill pill.
“Substantively, there’s no real difference between Advil and the CVS brand. Any choice that makes you feel ‘better’ is entirely anecdotal and experiential, and likely a placebo effect.”
Greene, author of “Generic: The Unbranding of Modern Medicine,” attributes the popularity of brand name drugs like Advil to trivial flare — flavor, color, and shape. So the next time you find yourself in an indecision-induced cold sweat mid-drugstore, you may just need to keep an open mind.
“The generic competitor needs to prove to the FDA that all of the standards of similarity are met. The color is different, the taste might be different, the price, hopefully, is different. But it must be the same in all ways that matter.”
He said that the more serious the illness, the slower we should be to spurn the tried-and-true.
“With an antihistamine, I will always choose the generic version, because I don’t perceive any actual experiential difference. If my patient has pneumonia, [the prescription] will almost certainly be generic.”
The recent consideration of the 21st Century Cures Act, which proposes longer protection for the original patent holder, has only furthered Greene’s conviction that population-level consumers should support healthy competition:
“No one’s really looking out to make sure lots and lots of companies are still competitively producing a drug and driving prices down,” he says.
In his eyes, this might require a grassroots education approach, in addition to pushback against pharmaceutical companies.
Greene practices internal medicine at a community health center in East Baltimore, where access to primary care and cheap medicine is notoriously hard to come by. He believes this is dramatically worsened by big money politics — including active campaigns to turn minorities off to any generic option.
“[The National Pharmaceutical Council] spreads the sensibility that generics that might work with white and middle class patients will work less well with black, Latino, and Asian American patients. So they’ve become particularly suspicious.”
The effect? A flip-flop of what’s expected: "Those zip codes most likely to see high generic utilization were those with higher income and levels of education,” Greene maintains.
The National Pharmaceutical Council, however, disputes Greene's assessment, noting that a "one-size-fits-all approach to health care will not provide patients with the optimal care they need and deserve. For this reason, patients need access to a broad range of treatments within a drug category — regardless of whether those treatments are brand or generic."
Greene dismisses the popular idea that lack of financial incentive will prevent medical innovation — a fear he calls “the Boogeyman that always comes out.”
“I’m more concerned with people who cannot access therapies that are already available. ... I will always come down and say, ‘I wish these drugs were cheaper, and I wish my patients could get them.’”