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Generic medications pose more questions than answers
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In recent years, in most countries almost all medical specialties have been faced by the emergence of new players: generic medications. They have entered the field of interest and the lives of many individuals, caregivers, payers and eventually the patients themselves, who are the final “targets” of drugs; generics have slowly become a societal matter of concern. Even though ophthalmology is a small slice of the big pharmaceutical expenses pie (no more than 1.5% on average, depending on the country), we are faced now with the fact that something new is not always something better.
As a citizen paying more taxes, I would consider the generics era as a great improvement. I would have been sensitized by articles written in several newspapers, by journalists paid by our governments, trying to make me feel guilty if I stick to brands. Because I would have been informed that the price of the drugs could be cut by 80%, after all, I would be oriented to think that pharmaceutical companies do not need to make so much profit. The problem is that we have had generics available for several years in my country, but the overall tax rate is, instead, on the rise.
As a caregiver working in a hospital, I am aware that the medical expenses related to drugs are below 5% to 10% of the budget of our hospitals and that more than 75% of the budget is taken by salaries. So I feel that the information given to the public is completely flawed.
As a patient, I would like to stay confident in care providers. When I am recommended to take drug A and drug B, I would expect to have drug A and drug B provided with the prescription.
In my clinical practice I have to say that I was rather anxious before the invasion of generics. For instance, some papers described the poor effect of thyroid substitution drugs given as generics, and due to the subtle and still largely unknown pharmacokinetics of eye pharmacology, it was easy to fear some weaknesses in generics for eye diseases because agencies rely on only the similarity of the active principle, not the excipients, which in ophthalmology play a key role. In reality, some patients have a poor tolerance when they are switched to generics, and other patients lose control of their IOP. But I have to say it is a minority. Most of them are still well controlled and do not mention any new troubles.
The main problem to me is that, as a prescriber, I feel less in touch with what I am prescribing. The patients are unable to tell what kind of generics they have had for the last 6 months. Moreover, the generics are changing from one pharmacist to another, and even with the same pharmacist, generics may not be the same in the long term. It is not surprising because pharmacists are “encouraged” — meaning they receive money to give generics or fines if they give brands — to promote generics and to “educate” their consumers to “the good way of thinking.”
This feeling extends to other areas of my practice. I am seeing more people making decisions for me. A complex bureaucracy, in which no one is actively involved in care, has the power to make decisions on finances, organizing patients’ care, and choosing our equipment and supplies, often forgetting that the first aim of hospitals is to treat patients and, in university hospitals, to educate caregivers. This multilayer model of health administration looks like a mille-feuille, and each layer ignores who is really choosing the direction. I see a great dilution of decisions, in which the main actors — physicians, nurses, technicians, medical secretaries — are more or less completely eliminated.
We should not categorize that generics are all good or all bad. They probably are somewhere in the middle, like most things. One thing is sure: They are unavoidable nowadays.
It would be interesting to know whether generics have finally led to saving money when everything is taken into account and whether advertising — generic drug companies can advertise on TV, radio and newspapers, while branded drugs companies cannot — affects patients. Finally, it will be interesting to see the impact of generics on further drug development. The development of new drugs has been so far almost completely supported by pharmaceutical companies that have invested enormous amounts of money that none of our governments could afford. If generic drug companies are not able to develop new drugs, what future do we prepare for our children?
After all, the great winners of the generics experience could not be the finances of our nations nor the satisfaction of those who are thinking politically correct. The great winners could be the diseases per se, thriving in the no man’s land of ignorance and zero innovation.
- For more information:
- Alain Bron, MD, is an OSN Europe Edition Board Member and a professor at the University Hospital of Dijon, France. He can be reached at Hopital Général, 3 Rue de Faubourg Raines, BP 519 21033 Dijon, France; +33-3-80293756/80293277; fax: +33-3-80293589; email: bronalain@orange.fr.
Disclosure: Bron is a consultant for Allergan, Bausch + Lomb and Théa.