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Comment by mmohebbi | Hacker News Reader

While the FDA does a fantastic job of reminding the population of the process it uses to ensure generics deliver the same experience, there is still a ton of waste in the system due to brand-name drugs being chosen over generics. Part of the problem is the massive marketing efforts by pharma trying to convince patients and doctors that their brand-name drug is better. For details see:

http://www.iodine.com/blog/do-people-prefer-under-patent-dru...

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Part of the problem is that the name brand drug is sometimes better than the generic, and one generic brand is sometimes better than another. I have experienced this as a patient.

as a study of one, how do you know it isn't the placebo effect?

There have been a few examples where the FDA received complaints, looked at the data and asked the generic manufacturer to rest test/reformulate their drug since it wasn't therapeutically equivalent.

The best example is generic Wellbutrin[1]. Many patients complained of side-effects from generics that they didn't experience with the brand-name drug. The FDA did testing and realized that the generic Wellbutrin extended-release resulted in much high blood concentrations than the branded version. The generics in questions were withdrawn from the market.

The interesting thing is that to get approval for an "AB-rated" (therapeutically equivalent) generic drug, you don't have to be identical. The FDA only requires that the generic drug deliver 80-125% of the drug the branded drug does[2]. Normally that range is fine, but for some drugs (antiepileptics are a good example) the differences can produced a less than equivalent therapeutic outcome.

[1]http://www.fda.gov/Drugs/DrugSafety/PostmarketDrugSafetyInfo...

[2]http://www.nature.com/clpt/journal/v94/n4/full/clpt2013104a....

Problematic generics seem to come up often about extended release formulations when hanging around ADHD communities. Judging from this latest one I remember, it takes a big push for the FDA to start looking into it and ask questions:

http://www.fda.gov/Drugs/DrugSafety/ucm422568.htm

As consumers, we don't really have much of a way to test for placebo effects or when generics are actually subpar other than complaining until someone listens... so... it's a bit of a chicken/egg problem.

I think that's my question, as an individual, you can't say that one is more effective than the other because, as an individual, you can't account for the placebo effect. Personally, if it works, it works, placebo or otherwise.

If you search online, you can find isolated regulatory incidents, patient anecdotes, and even statements by doctors that they prefer patients not switching brands when something works for them. Beyond that, I'm not sure what is really known, or how you would go about studying this phenomenon in a scientific fashion.

Even if it is a placebo, if two medications that are supposedly the same cause different effects on me, e.g. one has much more manageable side effects than the other, then why shouldn't I take the one that makes my life better?

I'm a strong believer in the placebo. If it works, then stay with it...

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