The Patient Speaks!

Generic medicines, are they really, exactly, precisely the same as the branded stuff you’ve been taking?  Insurance companies say they are, as do the manufacturer’s of generic drugs.  Indeed, even the US government says “basically” so as per a blurb on the website http://www.barrlabs.com/pages/faqcon.htm

In a column in the December 1999 issue of the Journal of the American Medical Association (JAMA) then U.S. Food and Drug Commissioner Dr. Jane E. Henney   wrote: “Practitioners and the public may be assured that if the FDA declares a generic drug to be therapeutically equivalent to an innovator drug, the two products will provide the same intended clinical effect.“

Then why, oh why are there patients who claim a generic medicine does not affect them the same way the branded med does?  In my case, one generic of a specific medicine acts differently than another generic of the same drug.  Of the billions (OK, perhaps it’s only millions) of prescription pharmaceutical products I have consumed over the years, the bulk of generic drugs work just fine.  Sometimes I wouldn’t even know the difference as I began a specific med as a generic.  However, currently there are two I struggle with.  One med I insist be branded.  I tried the generic and it was disaster.  The mail order pharmacy insisted I try three months worth and would not send me the branded product unless I paid full price (mail order because that’s what my health insurance company requires to get the “lowest” price for medicines).  After three months of struggling, I was able to get back on the branded product and all is well.  The other medicine I insist it either be branded or provided by a specific generic manufacturer.  When the insurance company’s pharmacy switched generic providers – again for a three month supply – life was miserable.  So why, if the meds are exactly the same, do I experience different effects from branded vs generic of certain medications?

Doctors I have spoken with respond from “They are identical” to “Sometimes there are differences”.  My physician acknowledges there are occasional differences and will write the ‘script accordingly.  A quick Google™ search provides hundreds of web pages for defining a generic drug, but I have yet to find any information about concerns such as mine.  Perhaps it is a simple as my Registered Nurse wife points out: “Richard, if, in fact, there are any medical anomalies out there, I’m talking to it”.  Hmmm….

So, what is, exactly, the difference between branded and generic?  In all the admittedly unscientific research (e.g.  the internet) I have done, apparently it is the fillers added to form the end product.  One of the meds I am struggling with comes from one generic provider as a small, “compressed” oval pill.  The other less effective (for me) one comes from a different generic provider as a round “horse pill” I have to work at getting down.  Interesting.  Another med comes as a powder from both branded and generic providers.  However, the generic is clumpy and I have to work at it to make the correct measurement in a separate measuring cup.  The branded flows smoothly and has a convenient cap that also serves as a measuring device.  Interestingly enough, either powder costs exactly the same from the mail order pharmacy!  Another “hmmm….”.  While the generic meds have the same active ingredient, I wonder if the other stuff in it interferes with the end effect on a per patient basis?  I don’t know.  Perhaps it is all psychological, perhaps not.  Don’t think I’ll ask wife about that one.