from the this-cancer-diagnosis-brought-to-you-by-Johnson-&-Johnson dept.
Researchers from Johns Hopkins University published a new Journal of Marketing article that examines how receiving negative medical results might affect how people choose between generic and brand name drugs:
At the height of the COVID-19 pandemic, Manuel Hermosilla received a call from a family friend in Chile who had been recently diagnosed with cancer. The friend needed help tracking down Hydroxychloroquine to treat her rheumatoid arthritis—a drug in short supply given its supposed therapeutic powers to combat COVID-19.
Hermosilla found two alternatives for Hydroxychloroquine: a generic version for about $15 a month and the branded version for a hefty $330. The family friend didn't want the generic version, Hermosilla says. "Given her cancer diagnosis, she felt the generic wasn't 'safe' enough—which got me to thinking: could medical-related insecurities impact patients' brand/generic choices?"
Getting bad medical news can be alarming. It might influence us to embark on a healthier lifestyle, perhaps by exercising more or eating healthier food. Given that brand name drugs are perceived to be more effective and perhaps even safer than generics (despite many experts viewing generics as molecular replicas of brand name drugs), bad news might also affect how we choose between drugs.
This new research points to estimates suggesting substantial savings for the U.S. healthcare system— about 10% of drug expenditures, or $36 billion a year—if patients always chose a generic option when available. The researchers suggest that a broader use of generics could significantly lower expenditures without sacrificing the quality of patient care.
Journal Reference:
Hermosilla, M., & Ching, A. T. (2023). EXPRESS: Does Bad Medical News Reduce Preferences for Generic Drugs? Journal of Marketing, 2023. https://doi.org/10.1177/00222429231158360
(Score: 4, Insightful) by datapharmer on Wednesday April 26, @12:10PM (13 children)
It's a given using generics would save money, but likewise so would not allowing drug companies to charge 100x or more what they do in other countries for the same medication. "U.S. prices were 256 percent of those in the 32 comparison countries combined. In comparisons with individual countries, U.S. prices ranged from 170 percent of prices in Mexico to 779 percent of prices in Turkey." https://aspe.hhs.gov/reports/international-prescription-drug-price-comparisons. [hhs.gov]
It isn't just consumers being fooled, it is intentional price gouging.
(Score: 4, Informative) by bzipitidoo on Wednesday April 26, @12:45PM (9 children)
Big Pharma has a lot of tricks. Don't know how but they can also swing some price gouging on the generics. Don't take that one for granted. Doctor prescribed a drug from the -dipine family, this felodipine, which is generic yet still cost $1 per pill. I hunted through the entire family until I found amlodipine, for less than half the price of the other even though I had to order from Canada.
(Score: 5, Insightful) by mcgrew on Wednesday April 26, @01:52PM (3 children)
Big Pharma is no more evil than any other multi-billion dollar corporation, it's just that "our" representatives don't represent US, they represent only those who can cut big re-election campaign checks. "I'll lay it out straight, Senator: Vote against my bill and we'll see to it that you lose in a landslide. We can afford it!"
It's not that the politicians are corrupt. They're not taking bribes, it's EXTORTION.
Carbon, The only element in the known universe to ever gain sentience
(Score: 4, Touché) by tangomargarine on Wednesday April 26, @08:01PM (1 child)
I dunno, most other megacorps don't have products that can make you sick or dead if they screw it up. Or even make you sick or dead if you can't afford it.
"Is that really true?" "I just spent the last hour telling you to think for yourself! Didn't you hear anything I said?"
(Score: 2) by mcgrew on Saturday April 29, @06:18PM
Tobacco? Automobiles? Fast Food? GROCERIES? Grandpa McGrew fell four stories down an elevator shaft because Purina, where he worked, was too cheap and heartless to put doors on the elevators. Before the EPA, driving past Monsanto required closed windows to avoid burned lungs. Rivers and streams caught fire.
They're all heartless bastards who don't give a damn about anything or anybody except for their God damned money. Show some proof otherwise if you want me to change my mind, I've been alive too long to believe any billionaire has any morals at all.
Carbon, The only element in the known universe to ever gain sentience
(Score: 1) by Coligny on Friday April 28, @09:56AM
Bullsh1t warglarbh generalization. Even Lockheed Martin don’t pull that kind of crap… and they are in the literal “death” business…
(Score: 3, Insightful) by Thexalon on Wednesday April 26, @05:28PM
Even without any illegal chicanery going on, if you're a generic manufacturer, the only check on your pricing is the other generics manufacturers making that particular thing, and there aren't that many of them because production lines are expensive. So game theory takes over as each generic is tasked with deciding between price gouging to increase profits or undercutting a competitor to increase volume. Most choose to price gouge in that situation, because if all competitors price gouge all of them win.
In the US dystopia, pharmaceuticals are one of those industries that's legally allowed to say what amounts to "give us all your money or you die".
The only thing that stops a bad guy with a compiler is a good guy with a compiler.
(Score: 4, Insightful) by choose another one on Wednesday April 26, @07:22PM (3 children)
> I hunted through the entire family until I found amlodipine, for less than half the price
Don't do this. Seriously. Generic versions of same drug is one thing, different drugs (even in same family) is a whole different ball game, might as well just forget the doctors and just ggolge ranodm prescription drugs to take (without prescription).
There may well be medical reasons why you were presecribed one drug and not the other, side effect profiles will differ, interactions with other medications will differ, and pharmacokinetics will almost certainly be different.
Amlodipine is first choice / first line for that drug class where I am, if it is where yhou are then there will be a reason the docotr chose not to use first line. I actually take lacidipine, another drug in same family. The reason I take lacidipine is that I found out the hard way that I cannot take amlodipine. Same family, very much not the same drugs.
(Score: 2) by bzipitidoo on Thursday April 27, @01:18AM (1 child)
Oh, no, we ran it past the doctor, and he was okay with switching from felodipine to amlodipine. He only chose felodipine because it was generic and readily available. He had no reason to think the patient would have any trouble with any of them.
Amlodipine has about the longest history, and is known to be among the safest of the whole family. It is the one drug of that family that is on the WHO Model Lists of Essential Medicines. Main reason not to use amlodipine is if you're one of the few individuals who has an adverse reaction to it. Perhaps an allergic reaction. That's when your doctor should go hunting for a different drug in the same family.
(Score: 2) by choose another one on Thursday April 27, @03:40PM
> Amlodipine has about the longest history, and is known to be among the safest of the whole family.
Which would be why I thought it would be prescribed first unless a specific indication for something else, but doctors don't always behave the way we think they logically should...
> Main reason not to use amlodipine is if you're one of the few individuals who has an adverse reaction to it. Perhaps an allergic reaction.
In my case not allergic, long(ish) term and isidious, took some tracking down. Rare but not unknown once you know what you are looking for, consequences nasty if left.
(Score: 2) by driverless on Thursday April 27, @07:44AM
I don't know about the specific drugs mentioned here but there are entire families of drug-variants that exist solely so the pharma companies can extend the patent lifetime of the base drug after the patent on the base drug expires. So the mechanism of action is the same but it's tweaked just enough to make it patentable again.
(Score: 2) by HiThere on Wednesday April 26, @02:02PM (2 children)
Perhaps, but generics are also allowed to vary more from the stated dosage. Sometimes this doesn't matter, but sometimes it does.
Javascript is what you use to allow unknown third parties to run software you have no idea about on your computer.
(Score: 5, Informative) by datapharmer on Wednesday April 26, @02:41PM
That’s more or less a myth. It has to die with the 80/125 rule but the reality is generics have an average variance of 3.5% absorption vs branded medication they are based on (could be more, could be less). Given they general error bars are around 5% for production this should be considered insignificant - it could be the branded drug is under-dosed and the generic is spot on.
https://www.uspharmacist.com/article/discussing-brand-versus-generic-medications [uspharmacist.com]
https://www.pharmacytimes.com/view/debunking-a-common-pharmacy-myth-the-80-125-bioequivalence-rule [pharmacytimes.com]
(Score: 2) by JoeMerchant on Wednesday April 26, @09:36PM
There are a lot of shortcuts that generics can take, sometimes those may have significant negative impacts on efficacy or side effects. Rarely, they may actually be better than the original formulation for your particular condition, especially when the original formulator is attempting to squeeze every last cent of profit from every dose, which they should have absolutely no need of, but as so often demonstrated: greed knows no limits.
Україна досі не є частиною Росії Слава Україні🌻 https://news.stanford.edu/2023/02/17/will-russia-ukraine-war-end
(Score: 4, Interesting) by looorg on Wednesday April 26, @12:32PM (12 children)
Isn't it the same with over the counter things? Who wants to buy the standard when you can get the Super-Uber-Extra-Strength (whatever the legal limit they are allowed to sell for human consumption) dosage that is sure to murder whatever ails you instantly by just opening the box. Why go for standard or the noname generic brand when you can get the "real" thing. Then there is also that one thing I found baffling about the US when I was there that you had medical commercials on TV --- "... talk to your doctor if X is for you" type deal. Weird. You are getting medical advice as commercials now, if you have any of the following hundreds of vague symptoms this could be for you ....
It's probably applicable for other consumer products to -- do you buy the big brand softdrinks or just something generic for a fraction of the cost, ordinary ketchup or that overpriced artisan grown super tomato handled only by italian nuns or whatever. People thing they deserve "nice" (ie brand) things instead of generic.
With that in mind tho I know my parents find it super annoying when they pick up their prescriptions of whatever they take and they keep changing the package, the "brand" or manufacturer etc every damn month. Still "the same" pill inside the boxes, or the same active ingredients or whatnot since they can't be exactly the same since "copyright" etc.
(Score: 3, Funny) by janrinok on Wednesday April 26, @12:58PM
You owe me a new keyboard! This one has a cup of tea all over it.
(Score: 4, Informative) by mcgrew on Wednesday April 26, @02:04PM (2 children)
More so. I was looking for Naproxin at Walgreens last year, the lady working there pulled out Alieve. "That's naproxin but three times the price," I said. "You don't have a generic?"
"What's a generic?" she asked, never having heard that word before. Fortunately she understood the term "store brand."
Carbon, The only element in the known universe to ever gain sentience
(Score: 2) by krishnoid on Wednesday April 26, @06:09PM
I mean, you can take the store brand box and the brand name box and compare the active ingredients, and if they match numerically, they should be the same. I used to think that if the label misrepresented the contents, that could be a huge black eye for a drug manufacturer if they covered it in the news -- "box labels from drug manufacturer Ovoid Propulsion inaccurate."
Nowadays I think some people will pick up both boxes and go "Ovoid Propulsion generics vs brand-name Tylenol, Ovoid vs Tylenol ... I'm going with hydroxychloriquine with a drop of bleach."
(Score: 1) by anubi on Thursday April 27, @11:30AM
I just bought a huge bottle of generic naproxen pills from Amazon. 300 tablets. 220mg. ea. $12.18 .
Amazon brand, no less...
"Prove all things; hold fast that which is good." [KJV: I Thessalonians 5:21]
(Score: 2) by krishnoid on Wednesday April 26, @05:49PM
If you read down to the 4th paragraph [nih.gov], circa 1997 the United States Food and Drug Administration helpfully, ahem, clarified what it allowed with regards to pharmaceutical advertisements. Older US-types will remember when all of a sudden prescription medication started being advertised in television ads, and a decade later, will also remember how we were thinking "Hey ... how come they started advertising pharmaceuticals all of a sudden on television a while back?"
(Score: 2) by tangomargarine on Wednesday April 26, @07:56PM
And remember not to take Gloombeza if you're allergic to Gloombeza!
...how the heck would I know that before taking it?
"Is that really true?" "I just spent the last hour telling you to think for yourself! Didn't you hear anything I said?"
(Score: 2) by sjames on Wednesday April 26, @09:30PM
Half the time, the damned drug commercials don't even say what the drug is for! Might be metastatic cancer or athlete's foot, ask your doctor.
I actually figured out the whole thing was going to hell as a child in the early '70s when an ACTOR started hawking a coated aspirin tablet and actually said in the commercial "I'm not a doctor...but I play one on TV!" before going in to the spiel. It was at that moment when I was mabe 8 years old that I realized that playing a doctor on TV meant nothing and that he was also being paid to say those things about the pills AND that it was sad that grown-ups might actually buy it because of what he said and they saw him "saving patients" on "Emergency!".
NOTE: The Vicks commercial in the '80s was actually a re-use of the all too successful ploy.
(Score: 2) by driverless on Thursday April 27, @08:01AM (4 children)
The canonical example of over-fancy preparation was for handmade marzipan made by girls who lived in a convent on an island in the middle of a lake, so in theory the product could have been sold as "handmade by 15-year-old virgins[*] who live in a convent on an island in the middle of the lake".
[*] No males allowed on the island, not even male cats, so fairly likely at the time.
(Score: 0) by Anonymous Coward on Thursday April 27, @01:31PM (3 children)
also just cause there are no men on the island doesn't mean they are all virgins ...
(Score: 2) by driverless on Thursday April 27, @01:44PM (2 children)
I'm pretty sure that Lesbian Spank Inferno was not an entirely accurate depiction of convent-girl life.
Or independent filmmaking, for that matter.
(Score: 3, Insightful) by looorg on Thursday April 27, @02:47PM (1 child)
Are you trying to tell us that Jeff and Steve are not experts in the field of this sort of things? I'm sure they watched the video many MAAANY times. They know how these things work. Apparently there was even some kind of multi-speed trophy involved. They sure had be convinced. (btw that was a brilliant episode of Coupling, probably one of the best if not the best).
(Score: 2) by driverless on Thursday April 27, @03:14PM
I think The Girl with Two Shadayim is one of the best, in particular when Richard Coyle ad-libs an entire language on the spot. It takes some serious talent to fake speaking a coherent language rather than just making random gibberish noises, particularly while he's also faking a Welsh accent, which was so good that the producers apparently didn't realise until the second season that he wasn't actually Welsh.
(Score: 0) by Anonymous Coward on Wednesday April 26, @01:06PM (14 children)
The generics might have the same active ingredients but the preservatives, stabilizers etc might not be the same. So X months or even weeks later the drug is no longer the proper dose.
Also some of us might have been paying attention:
https://www.telegraphindia.com/business/the-inside-story-of-ranbaxy-s-dirty-drugs-scandal/cid/1696405 [telegraphindia.com]
https://www.business-standard.com/article/pti-stories/ranbaxy-recalls-over-64-000-bottles-of-generic-lipitor-in-us-114030800646_1.html [business-standard.com]
https://www.bbc.com/news/world-asia-india-63226055 [bbc.com]
https://www.japantimes.co.jp/opinion/2023/04/05/commentary/world-commentary/indian-drug-safety/ [japantimes.co.jp]
(Score: 1, Insightful) by Anonymous Coward on Wednesday April 26, @01:28PM
On a related note don't forget that stuff like Roundup contains more than the active ingredient glyphosate.
The allegedly "inert" stuff isn't that inert: https://www.scientificamerican.com/article/weed-whacking-herbicide-p/ [scientificamerican.com]
So a "generic" glyphosate weedkiller could be very different from Roundup in its effects. It might be less toxic or it might contain other stuff that makes it more toxic.
(Score: 2, Insightful) by RamiK on Wednesday April 26, @02:15PM (8 children)
Drugs with that long half-lives are extremely rare.
As for everything else, there's anecdotes everywhere. The stats tell a different story:
( Comparing generic and innovator drugs: a review of 12 years of bioequivalence data from the United States Food and Drug Administration https://pubmed.ncbi.nlm.nih.gov/19776300/ [nih.gov] )
Besides, why assume the fillers and stabilizers in generics are worse than the ones used in the brand pharmaceuticals? Not only do brands change their formulations without notice so you can't even QC following the brand label, the cheapest formulations are almost always the oldest and best tested otherwise someone would have requested a patent on delivery so the generics end up giving the most stable results over time.
Whether it's food, cosmetics or drugs, the old stuff is always better unless the new stuff has clear performance advantages. And since generics are almost always using the old stuff, they're probably safer even if they're slightly less (but not in a meaningful measure as the study above showed) effective.
compiling...
(Score: 3, Touché) by GloomMower on Wednesday April 26, @03:34PM (5 children)
> Drugs with that long half-lives are extremely rare.
do you mean, that short of shelf-lives?
(Score: 1, Troll) by RamiK on Wednesday April 26, @05:24PM (4 children)
A drug's half-life is the time it takes the active components to be reduced in half in the blood. That is, if what you're taking is supposed to clear out in the hours, 4% is just a few more/less minutes so it hardly matters. However, if what you're taking is bonded with a long lasting ester that supposed to last for weeks...
Anyhow, fillers are sourced the same in both generics and non-generics and the active components are strictly tested the same (sampled per batch is fixed the same for each) so that only leaves the 4% difference to the absorption compounds as being meaningfully different between generics and non-generics.
compiling...
(Score: 2) by GloomMower on Wednesday April 26, @05:39PM (1 child)
Ahh got it, when preservatives were mentioned I thought people were talking about shelf-life. Thanks.
(Score: 0) by Anonymous Coward on Thursday April 27, @09:02AM
In the real world most drugs don't immediately get consumed upon leaving the factory.
They end up being stored for some time before usage.
(Score: 2) by sjames on Wednesday April 26, @09:36PM (1 child)
In many cases, what you had for lunch and how long ago that was will have more effect on blood levels, including duration.
(Score: 2) by RamiK on Thursday April 27, @08:08AM
Unless people taking generics have (statistically meaningful) different diets than people who don't take generics...
On that topic, non-generics are not within reach of poorer people in most places so much of the stats might be reflecting poorer diets and life style.
compiling...
(Score: 2) by krishnoid on Wednesday April 26, @06:01PM (1 child)
in that case, it would be great to be able to randomly assay a medication as a consumer service. If you're paranoid and rich, why not buy the generic and the brand-name and compare them?
(Score: 3, Interesting) by RamiK on Thursday April 27, @08:35AM
Those that understand the issue know there too many variables to test out the differences themselves while those that don't understand the issue just default on buying the most expensive drugs/smartphones/cars/houses/clothes... e.g. Look up the history of black vs. white bread consumption.
compiling...
(Score: 2) by datapharmer on Wednesday April 26, @02:45PM (1 child)
Bad manufacturing practices aren’t just for generics. Plenty of name brands have similar issues:
https://www.fiercepharma.com/manufacturing/j-j-s-mcneil-shuts-down-plant-another-tylenol-recall [fiercepharma.com]
(Score: 0) by Anonymous Coward on Thursday April 27, @09:11AM
(Score: 1, Interesting) by Anonymous Coward on Wednesday April 26, @05:03PM (1 child)
This is why I get the 30 day generic supply. They offered me a 90 day supply but I was able to insist on 30, and told them it was because it's hard to keep my house cool all the time in the Summer. Generic 30 day supply is probably just as good as any 90 day name brand supply. The minute you leave the pharmacy, you're leaving an environment that's very well controlled and subjecting it to your home environment. This can vary widely of course. If you've got a setup where the thermostat keeps everything in range all the time, great. If you're like me and you don't heat or cool until things get fairly far out of comfort range, you're probably degrading your drugs just a bit every day.
(Score: 2) by datapharmer on Thursday April 27, @01:56AM
Your 3 refills on the 30 day supply probably come from the same bottle as the 90 day supply. I suppose you could argue the storage conditions are moderately better at a pharmacy, but realistically the required storage conditions for many drugs is outside the comfort level of most houses and your prescription probably doesn’t expire on day 31 or 91 for a 30 or 90 day fill respectively. Most pharmacies use up their supply with a long amount of time left before the legal expiration and the viable shelf life may be even longer - they just stop testing after a certain point. There are exceptions of course - vitamins and antibiotics come to mind as relatively unstable.
(Score: 2) by mcgrew on Wednesday April 26, @01:46PM
Well, DUH!
Carbon, The only element in the known universe to ever gain sentience
(Score: 2) by GloomMower on Wednesday April 26, @02:45PM (6 children)
What companies and brands do is create psychological value. You can't say that has no worth. If you are scared, you can bet people want that psychological value.
(Score: 1, Insightful) by Anonymous Coward on Wednesday April 26, @03:26PM (3 children)
Follow on question, are there any good studies that look at outcomes with name brand vs generics (where the generics are known to be chemically "identical")? If there is a useful improvement in outcomes, it would seem like it must be from the psychological value that you mention(?)
In a logical world (ha!!), it would seem like results of an experiment like this could be used to, for example, improve outcomes for all in some way or another (to be determined). And/or it could also be used to decide if we (society) want to allow advertising for pharmaceuticals.
(Score: 3, Interesting) by GloomMower on Wednesday April 26, @05:54PM (2 children)
> Follow on question, are there any good studies that look at outcomes with name brand vs generics (where the generics are known to be chemically "identical")? If there is a useful improvement in outcomes, it would seem like it must be from the psychological value that you mention(?)
Sorry I wasn't clear. As far as I know in pricing and marketing, the psychological value has nothing to do with improvement in outcomes, or anything of actual physical or real in nature. It is only in the thoughts the consumer has about the product over another. The idea of like "I'm doing the best thing I can do.", "I can afford the best!", "I know this brand and that gives me confidence", "No one got fired for buying IBM", "peace of mind", "this brand is awesome and is an extension of myself", and is separate from any actual physical benefit like improvement in outcomes.
One way maybe to increase the psychological value of generics might be to market how if you get generics you are doing the right thing for yourself and the country, that they are quality. It will be hard because you are trying to put this value on a blanket of all "generics" and not one specific brand. So it is hard to link that value to something that will trigger in your head.
Any bad quality that happens to generics lowers the some psychological value of all generics. Any bad quality that happens to a name-brand products likely only lowers the psychological value of that brand and not all name-brands.
Even if it is true that name-brand have quality issues, they have a marketing machine to make you forget that and increase the psychological value of their brand.
(Score: 2) by sjames on Wednesday April 26, @09:40PM
Except in the U.S. healthcare jumped the shark and a growing number of people actually cannot afford the name brands. The stress of possibly losing their home over medical bills probably has some real negative effects on their health.
(Score: 1, Funny) by Anonymous Coward on Thursday April 27, @09:08AM
When there are studies showing that expensive placebos work better, how sure are you that cheaper generics would work the same... 😉
https://www.science.org/content/blog-post/expensive-placebos-work-better [science.org]
https://www.sciencedaily.com/releases/2008/03/080304173339.htm [sciencedaily.com]
(Score: 2) by corey on Wednesday April 26, @10:09PM (1 child)
Yeah this is exactly the same for software. Corporates believe that software you pay lots for is more reliable and valuable than FOSS. I even had a chat with my project manager at about about this, he was arguing that modeling with Matlab ($$$) is more trustworthy than doing the same with Python (free). I couldn’t easily change his mind but I’ve known for years that the more they pay for things, the more they autotrust them.
(Score: 2) by Mykl on Thursday April 27, @05:34AM
Depends how you're using the tools. If you're using Matlab's built-in functions then I'd agree - I'm going to trust those more than your Python script given the sheer volume of real-world testing they've undergone. If, on the other hand, you're using Matlab to write your own custom script then I would argue they're functionally similar - equally likely to contain your bugs and logic errors.