Saturday, April 26, 2008


The practice of medicine, like everything, involves balancing many things, monitoring how one might be pulled into one extreme or the other. One area of particular concern to me has to do with pharmaceuticals. I try hard to resist the ubiquitous and at times overwhelming influence of the pharmaceutical industry's marketing machine on my practice of medicine. This affects so many areas of practice that if I had the time and discipline a daily blog just on this would be worthwhile, if not always interesting.

Prescribing generics has been something I've emphasized for a number of reasons, not the least of which is to offset the high cost of everything medical. Bioequivalence is a concept that indicates the degree to which a generic medication acts like the brand name in the body. Generics have the same active chemical at the same dose as brand names, but may very in how they are made, the inactive ingredients, the ingredients that "carry" or "bind" the active ingredient. A recent article in the Wall Street Journal describes the case of Wellbutrin, and points to yet another aspect in which the FDA may be suffering from the inability to live up to it's mandate.

It concerns me that patient reports of their experiences with medicines are minimized. This occurs frequently with reports of adverse effects with medicines whether brand name or generic.

I wouldn't want this article to feed the coffers of the pharmaceutical industry by making absolute that "brand is better". Brand may be different from generic A, and generic A may be different from generic B. Different does not mean better or worse. You might be doing great on generic A, and if you were switched to brand, it could be work less well. Bottom line: if you're on a brand and are switched to generic, or you're on a generic and you're switched to another generic, pay attention, and discuss it with me when you see me. Let your pharmacy know that you want the same brand or generic every time and that you want to know if it has changed. If you're pill looks different, it is.

And finally, what if we shifted some of the defense budget to the FDA? Hmmmmm.