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Comment by chimeracoder | Hacker News Reader

> hey're required BY LAW to have the same "active" ingredients; you just might be paying for a slightly different pill shape, packaging, or taste.

Yes, but the margin of error of the amount of the active ingredient can be significant (up to 20% in either direction!).

The inactive ingredients can be relevant. Some people have allergies[0], and sometimes the inactive compound can affect the absorption of the drug (which can vary from person to person).

Generics are fine, but it's important to remember that they're not exactly the same as the brand-name drugs, and that can matter.

[0] For example, a lot of drugs contain lactose-based compounds as inactive ingredients, which is one of the reasons that a lot of drugs can cause diarrhea as a side-effect.

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What's the mechanism of action for lactose causing stomach irritation? Lactase isn't found in the stomach so it can't be lactose intolerance (as in the common meaning of the phrase, ie. lactase non-persistence).

Microflora in your gut. That's what lactose intolerance basically means--it doesn't directly harm you, but when it's not taken up by the intestines because you lack the lactase enzyme it's consumed by microflora, which create gas and other issues. Kinda like beans which haven't been properly prepared and contain too much non-digestible starch.

It's also why some people who are genetically completely lactose intolerant can actually consume quite alot of lactose, and conversely why people who are genetically lactose tolerant can suffer from gastrointestinal issues pretty easily from dairy products, especially if they haven't consumed them in awhile. The tolerance or intolerance boils down to how the microflora react, not specifically to whether the person produces lactase.

That happens after the stomach.

Did the previous poster edit his comment? I realized after the fact that you appeared to be responding to something different from what the post currently states.

Not as far as I know. My response was to "tolerance or intolerance boils down to how the microflora react", which does happen after the stomach, so it seems unlikely that it could influence stomach irritation.

The word "stomach" doesn't appear anywhere in chimeracoder's post. It only mentions "absorption" and "diarrhea", both of which imply the intestinal tract.

Chimeracoder appears to have edited it. It originally said "stomach irritation".

Totally fair; thanks for the extra info!!

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