Forty-one percent of registered nurses find generics are less effective than name brand drugs say American Society of Registered Nurses

May 5 2008

In a national online survey conducted by the American Society of Registered Nurses, 41% of the 781 Registered Nurses surveyed on April 28 reported that generic drugs are less effective than their equivalent brand-name counterparts.

For most people, most of the time, a generic drug makes economic and medical sense. But doctors say that differences between brand-name and generics can occasionally affect how the drug works, especially in cases where the exact dosage of the drug is critical.

Certain conditions require people to maintain a constant and precise level of medication in the blood over long periods of time. For those with epilepsy, asthma, diabetes, heart ailments, mental disorders, and thyroid problems, switching drugs may upset a delicate balancing act.

In cases in which the difference between a therapeutic dose and a toxic dose is small (what researchers call a "narrow therapeutic index drug"), some doctors say brand-name drugs are often the best choice.

Are generics as good as brand name drugs? In theory, yes they are as good as brand-name drugs. The FDA requires generic drugs to have the same quality, strength, purity and stability as brand name drugs. One area they may differ in, however, is inactive ingredients.

In the United States, the Food and Drug Administration (FDA) requires that all drugs, whether a brand-name drug or a generic drug, meet standards of safety, strength, purity and effectiveness. A drug may be chemically exact but not bioequivalent. In other words, two different products of the same drug may not get into the body in exactly the same way. Bioequivalence depends on how the drug is formulated and how it is absorbed and eliminated by the body. Other ingredients can affect the absorption of the drug. These include starch fillers, gum-like substances and other products which allow a drug to be formulated into a pill or capsule. Factors such as a person's age, body mass, kidney, liver and intestinal function can also affect the absorption of the drug by the body.

In any case, they point out that the average difference in blood absorption between brand names and bioequivalent generics is much smaller than what's allowed, often just 3.5 percent, a rate comparable to differences between brand-name drugs. The main issue is that when initially switching from brand names to generics, in certain cases, some extra monitoring may be required by the physician.

Today, generic drugs account for 63% of all U.S. prescriptions for drugs. Since generic drugs sell at substantially lower prices than their brand-name counterparts, they save consumers and purchasers of prescription drugs tens of billions of dollars per year. Moreover, their expanded role has been linked to an attenuation of overall price increases for prescription drugs. Between 2007 and 2010, roughly 110 drugs will lose their patent protection. Estimates suggest that these 110 drugs are currently responsible for $50 billion a year in sales.

Senior citizens are especially at risk for rising drug costs. Drug costs for seniors are rising faster than for any other age group. Among patients 70 years and older, drug costs rose 14% in 1999, while the average drug costs for all other age groups rose 9.6%. A number of factors account for these rising costs. Advances in technology (gene therapy and biotechnology, for example) have contributed to the increases. People are living longer and using more drugs to do so. It is fair to add that some of the new expensive drugs are actually less costly overall than conventional therapies, such as surgery.