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The decades-old debate over generic versus brand-name drugs, once mainly the stuff of medical journals, is now a hot topic on the blogosphere as well. A scan of the Internet turns up scores of postings that reflect the wide-ranging opinions and unanswered questions over whether generic drugs are as safe and effective as their more expensive branded equivalents. These online conversations also raise new questions about the impact of social media on health care knowledge, as both patients and health care practitioners increasingly turn to social networking sites for information and guidance.
Patient-written blogs on the subject are particularly interesting; they often provide real-world, real-time accounts of an individual’s experience with medications. Liz Spikol, a journalist who blogs about her life with bipolar disorder on her site, “The Trouble with Spikol” (http://blogs.philadelphiaweekly.com/trouble)wrote about an unsuccessful attempt to relieve her migraine headache pain:
“I know generic pills are supposed to be exactly like the non-generic, but I don’t believe it. This generic Imitrex is simply not working for me. I need one of those injectables, stat.”
Not surprisingly, patient blogs and online journals now exist for practically every disease and condition. Bloggers like Ms. Spikol are using their sites to reflect on their treatment progress and setbacks, and in the process, they provide support to a band of loyal followers and fellow sufferers.
Patient-centered chat rooms and discussion boards, as well as general Q&A sites like Yahoo! Answers and Askville.com, have also become increasingly popular with health care consumers and are often one of the first places people go to find answers about treatments and medications.
On one site, a reader asks: “Generic vs. Brand Well-butrin®—has anyone experienced a difference in their effect?” On another site, someone wants to know, “Has anyone out there switched to the generic Lamictal® [for seizures]?”
The responses to such questions, which are typically numerous and filled with a broad range of personal experiences, can be quite revealing and compelling. Regarding the question about antiseizure medication, one reader writes:
I took the generic against my doctor’s wishes, mainly because of cost. After being on it a couple of days, I became very dizzy and began falling a lot. Everything that could cause dizziness was ruled out. Since the generic Lamictal® was the only thing added to my daily routine, it was decided that was the culprit.
In general, physician bloggers approach the topic of generic versus branded drugs with much more moderation than patients, although they often do express an opinion. Many bloggers who do address this issue point out that although anecdotal evidence suggests that some types of generic and brand-name drugs might behave differently, the generic drugs, as required by the FDA, use the same active ingredients as brand-name drugs and are as safe and effective.1
However, when it comes to switching patients from one drug to another—whether from branded to generic or from generic to generic—some physician bloggers are more outspoken than others. Kevin Pho, a New Hampshire internist who blogs under the name KevinMD (www.KevinMD.com) writes:
Generic medications are a clear source of cost savings, which is why both the government and private insurers are making a hard push to convince both doctors and patients to switch. I continue to support the use of generic drugs, but there is growing sentiment that more rigorous study is needed to ensure that there will be minimal adverse effects when switching.
Other bloggers are less subtle with their message. Daniel Hartman, MD, known as “The Sidewalk Psychiatrist” (http://thesidewalkpsychiatrist.wordpress.com), suggests that the noticeable change in symptoms after certain patients are switched to a generic medication might not indicate a placebo response, as some would argue, but a substandard generic product instead:
I am equally sure that it comes down to an issue of quality as well. Brand-name medicines are made under very strict quality controls and standards of quality. Generics, on the other hand, enjoy some latitude as to the potency of the medicine that is produced.
And then there are the occasional eyebrow-raising headlines: “Bad Bargain: The Dangers of Generic Drugs” and “Generic Drugs: Caveat Emptor!”2 In the latter post, blogger Jeffrey Toney, PhD, a college dean, warns readers about the variations from generic to generic in terms of dosage, the clumping of active ingredients, and the pill coating, which may affect the rate of the tablet’s dissolution and release of ingredients. He then offers advice about selecting a medication:
If you are fortunate enough to have a good health insurance plan, choosing the brand-name prescription will ensure uniformity and reliability of the medicine. However, if you and your doctor choose a generic equivalent, be sure to communicate with your health care providers about any potential adverse side effects, as you should do for any brand-name medication.
Of course, not everyone who goes online is taking sides in the debate; some even question the validity of the debate itself. Following the publication of a New York Times article3 a few months ago, in which the author raises the concern that some generic drugs might not work as well as their brand-name counterparts, patient advocate Naomi Freundlich wrote on the “Health Beat” blog (www.healthbeatblog.com):
The ‘controversy’ over generic drugs is really less than meets the eye. There have been scattered concerns—some based on patient or doctor reports, others from proprietary drug makers—about generics not being biologically close enough (bioequivalent) to name brand meds. But the issue is mired in complexity and misinformation. For example, many doctors accept significant payment from drug companies to promote their name brand drugs—especially cardiologists and psychiatrists. It can be hard to remain unbiased when a pharmaceutical company is paying the tab on research.
How all of these blog-based commentaries, anecdotes, and personal observations play into the discussion about generic drugs is still unclear. Studies are needed to understand exactly how the online exchange of information about medication among patients, physicians, pharmacists, drug makers, and other health care stakeholders ultimately influences their behavior and decision making.
Meanwhile, the generic market is burgeoning and seems to enjoy the trust of the majority of consumers. According to a Harris Poll conducted in 2009, 81% of Americans say they prefer generic medications to brand-name medications, an increase of 13% since October 2006.4 So the debate goes on, and if the blogs are any indication, it is far from over.