Eli5: what is the difference between a generic drug to the original drug, and why do some doctors will swear by the original drug?
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There are also some drugs, animal products, really like hormones and insulin, where switching to generic or another brand is simply an unknown because the science is as yet not understood exactly how the drugs work once ingested. Drugs like Premarin and Armour Synthroid are not recommended to be replaced by pharmacists with a similar product by another manufacturer because it may not be as efficacious.
A drug is made up of active ingredients and inactive ones. A pill might have a tiny amount of the actual drug and the rest is various other ingredients – some of them are designed to ensure that the actual drug is released in the right part of the body to get where it needs to go to be effective – the pH of the stomach is different than the intestines for example. The rest of the pill may include various fillers or dyes.
A company doesn’t have to do their own clinical studies in humans and animals to get a generic drug approved, you only have to show that the active ingredient is the same and that the generic drug is bioequivalent to the original drug (meaning that the active ingredient is the same and will release the same way in the body). The inactive ingredients can be different and the manufacturing methods can be different.
Companies aren’t allowed to make a generic drug unless the patents on the original drug have expired. Once the patents expire, any company that wants can apply to make a generic, and if it’s a big drug you can easily have 5-10 companies all making generics. (There are a lot of complex FDA rules on this but that’s beyond the scope of ELI5.)
Normally, the generic version is much cheaper than the original drug, so almost everyone will want the generic once it becomes available. If a doctor just writes a prescription and doesn’t say specifically that it has to be the original drug, a pharmacy will usually (and in many states is required to) give you the generic even if you don’t ask for it.
There are rare cases where doctors will insist on the patient getting the original drug – (1) a patient has a lot of allergies, the patient can take the original drug without a problem, and the doctor is worried about the patient being allergic to the inactive ingredients in the generic, (2) an elderly patient who knows what pills to take when by color and shape, and the doctor doesn’t want to confuse them by changing their routine, or (3) for whatever reason the doctor doesn’t trust a particular generic manufacturer or generic version of a drug to be genuinely safe and identical – “that company has had a lot of problems; I wouldn’t use anything they make.”
So I’ve worked for a company that makes the name brand and multiple generics. The biggest difference was often the supply chain of the non active ingredients. In this drugs case everyone uses the same active ingredient and supplier.
This is actually a bit more difficult now with the rise of biologic drugs. Since the synthesis of the “active ingredient” is so much more complicated the generics are now just identified as bio similar as the end result has been studied to give the same effect. Either way the process to make a name brand and bio similar drug are often very different unlike a traditional chemical drug where the process is generally the same (chemistry is better understood) The first bio similar products are just now entering the market as patent protection is ending for the first wave of biological drugs. So it’ll be interesting to see the public reaction.
Fun fact in biologic drugs the chemical that cures you is no longer called “active ingredient”
No one is mentioning the elephant in the room: doctors are humans and we are biased towards name brands over generic. People will swear by brands even if the generic is made by the same producer. Same thing in medicine.
In general they should be the same in that they both should use the same active ingredient in the same quantities but generics can use a different excipient (the inert part that is used just to “carry” the actual medicine) so it can be a different flavour or unpleasant in other ways, worst case scenario the generic has something your body reacts badly to or that makes it a bit less effective but tbh it is extremely rare so unless otherwise specified by your doctor you can use generics without issue
For the second question:
Other posters have commented on what the doctor would tell you.
The real reason though is because it makes them more money.
Here’s an article on it:
https://www.fiercepharma.com/marketing/more-money-more-prescriptions#:~:text=More%20than%20%242%20billion%20a,the%20Annals%20of%20Internal%20Medicine.
https://www.healthline.com/health-news/is-your-doctor-getting-paid-to-prescribe-painkillers-for-you#How-to-know-if-doctor-is-being-paid-to-prescribe-you-certain-drugs
Depends on the drug, but generally it comes down to profit motive and taking advantage of the fact that the general public does not have the knowledge to find alternatives.
Doctors get paid to recommend some branded products over others. Since you can’t identify alternatives, you do what they recommend. The companies who make the branded drug often charge 2-3x the price as the generic equivalent, so they can afford to pay the doctor. The patient uses insurance, and that insurance company is fine with it because they can charge higher insurance premiums to the patient, and to government.
So essentially, insurance companies, drug companies, and doctors all make more money, at the expense of patients and government (aka the general public).
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This is a very “no public healthcare” problem – in most countries ALL drugs are generic. As in I pick up my prescription every couple of months in the UK and it’s nearly ALWAYS a different brand of exactly the same drug because anyone is allowed to make it.
In America, big drug companies try to make it hard for someone else to make their product so they can justify charging you an arm and a leg for it.
There is **ZERO DIFFERENCE** between the “original” (which is not actually an original in any way) and the generic (non-branded) form. The reason some doctors might try and convince you otherwise is that the big pharmaceutical companies want you to doubt generic medicine because it threatens their profit margins – so they’ll try and influence doctors to discourage the use of generics. Don’t fall for it.
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