Friday, December 18, 2009

Do Generics Work as Well as Name Brands?


It's my first night of vacation! I saw my last patient today and then started pulling the pictures off the walls in anticipation of my move. I ran over to see the new place, and it still needs insulation (it's on the floor), paint, and carpet. And doorknobs might be nice.

So we're expecting quite the snowstorm here. I'll let you know how it goes tomorrow, but the current forecast is for up to 20 inches. It didn't take me long to float from the weather to the health section of the New York Times, and here's an article by Leslie Alderman about generics versus name brands.

Are generics as good as name brands? I don't have any studies, I'm purely running on anecdotes, but this is my thinking: Usually. When I was resident, I learned that 15% of the time (and this isn't science, I don't think, I believe it's someone else's anecdote) generic nortryptiline doesn't work when name brand Pamelor does. So I've always asked patients to start with Pamelor....I don't use it much anymore....because who wants to spend 6-8 weeks on a medication trial and have someone not respond only to realize they were in that small group of patients who are sensitive to the brand.

Other meds: I've had a handful of people complain about generic Prozac-- fluoxetine. It's not as effective for them, or they have more side effects. Alderman's article talks about Wellbutrin XL and I didn't even realize that the XL form now has a generic. Sometimes people want the name brand.

So what do I do when a patient specifically requests the name brand? I give it to them: if they are right, then they are right. And if they simply believe that they won't respond to the generic, because there are people who say "Generics don't work on me," well, then there's power to such beliefs, and I just want my patients to get better.

What do you think?