Evidence of why mustachiasm works

[Rich M]

This on NPR...Planet Money

http://www.npr.org/blogs/money/2013/07/04/198504001/why-doesnt-everybody-buy-cheap-generic-headache-medicine

People pay a price for ignorance.  Just a little bit of knowledge is worth a lot.  And with something like this, it's not even inconvenient.

[arebelspy]

On the other hand, if you are reading the Mustachian Book Club book for July, Predictably Irrational, you'll read a chapter on how a 50-cent aspirin can do what a penny one can't.

But since so much of it placebo anyways, if you know and accept that, you can outwit your irrational self.

Very interesting stat that 90% of pharmacists bought generic versus 70% of the regular population.

Thanks for sharing.

[Rich M]

Nice point.  I definitely know a half hour bike ride can cure all the pains from my last ride! ;)

[LowER]

MD here. Always generic for me and recommend same.

[KimPossible]

MD here. Always generic for me and recommend same.

+1

[Frankies Girl]

My dad used to get sooooo pissed off at the idea that generic wasn't as good as the name brand stuff (he was super frugal, some would say cheap too). I couldn't believe once I started noticing what other people bought - I really thought they were kind of brainwashed, but even when you told them the facts - most of my friends still would fight me on the idea that the name brand was somehow better.

I used to get the bottles to compare the active ingredients between the two, and even with the exact same ingredients and dosage, some people still won't believe that the generic is the same damn thing, just scads cheaper.

[mpbaker22]

People buy name brand?

The only time I do that is when the allergies are so bad I can't do anything else.  And even then it's because I'm hit big time by the drowsiness side effect of the generic to the point of nearly falling asleep driving.

[Dr.Vibrissae]

I always by generic OTC meds, and usaully by generic presecritions, but it's fair to point out that there are situations with certain prescription meds where the generic may not be equivalent.  In certain cases, although the active ingredient is the same, the rates of delivery and absorption are different in the generic formulation, which can lead to problems.

Granted that is not the reason most people by name brand.

[renbutler]

Just bought generic Benadryl for my kids last night.

I'll try generic EVERYTHING at least once. If it doesn't work or (in the case of food) taste as good, then I'll consider paying more for a brand name next time. There is only a small handful of items that I won't buy generic again. (I'm suffering with bad generic socks right now until they wear out!)

[ivyhedge]

Just bought generic Benadryl for my kids last night.

I'll try generic EVERYTHING at least once. If it doesn't work or (in the case of food) taste as good, then I'll consider paying more for a brand name next time. There is only a small handful of items that I won't buy generic again. (I'm suffering with bad generic socks right now until they wear out!)

@Ren - I hear you. One of the only (recent) failures I've had with generic OTCs at Costco was with their Claritin fighter. Even in a double blind I could *easily* tell which one I'd taken: one worked; the other didn't. The great thing is that Costco periodically offers substantial coupons ($15) on their 40+40+10+10 packages. Ahh...


One other thing I will not buy generic: Cheerios (regular)!

[SMMcP]

I always by generic OTC meds, and usaully by generic presecritions, but it's fair to point out that there are situations with certain prescription meds where the generic may not be equivalent.  In certain cases, although the active ingredient is the same, the rates of delivery and absorption are different in the generic formulation, which can lead to problems.

Granted that is not the reason most people by name brand.

True.  I read that some generic levothyroxine (med for hypothyroidism) doesn't deliver as consistent a dosage as the brand name Synthroid does.  Since I switched to taking only Synthroid I've had better luck keeping my TSH levels where they should be.  However, this does keep me from buying generic for everything else.

[dragoncar]

There are some reasons to buy the brand.  They might have higher quality control, quicker recalls when something goes wrong, more money to pay you if their screw up causes you harm, etc.

That said I still buy generic. 

[Chowder]

I always by generic OTC meds, and usaully by generic presecritions, but it's fair to point out that there are situations with certain prescription meds where the generic may not be equivalent.  In certain cases, although the active ingredient is the same, the rates of delivery and absorption are different in the generic formulation, which can lead to problems.

Granted that is not the reason most people by name brand.

Generic manufacturers have to show their drug has the same ADME (absorption, distribution, metabolism, and excretion) to be permitted to manufacture the generic drug. There are only a handful of drugs that are the exception to this, like thyroid medication, but that's a different can of worms.

[ch12]

I read this same article. It's really funny because education doesn't mean behavior change for the vast majority of people - people know that they "should" do something, but don't do it (like me and biking :( - I'm very guilty of being a bad Mustachian but I do live in the center of a lot of highways).

And the difference here is that doctors/nurses/pharmacists (what we call "clinicians" in my day job) somehow have converted their education into behavior change from before they completely understood that generics are the exact same. I'd really really really love to see why that is. There are overweight/unhealthy doctors, so is it when the behavior is very easy (grabbing a different bottle next to the brand name) that it can be changed? Could we push through behavior change by framing it differently?

[dragoncar]

I read this same article. It's really funny because education doesn't mean behavior change for the vast majority of people - people know that they "should" do something, but don't do it (like me and biking :( - I'm very guilty of being a bad Mustachian but I do live in the center of a lot of highways).

And the difference here is that doctors/nurses/pharmacists (what we call "clinicians" in my day job) somehow have converted their education into behavior change from before they completely understood that generics are the exact same. I'd really really really love to see why that is. There are overweight/unhealthy doctors, so is it when the behavior is very easy (grabbing a different bottle next to the brand name) that it can be changed? Could we push through behavior change by framing it differently?

Well buying generic is a win because its less expensive and you lose nothing (prestige?).  But eating healthy is win-lose because you have to do something you don't like.

[Christof]

There's one more reason that pharmacist are more likely to buy generics: They do have access to information that the general population does not have (or not easily, depending on your country). They can therefore more confidently verify whether a generic is really the same thing (most are).

[ch12]

I read this same article. It's really funny because education doesn't mean behavior change for the vast majority of people - people know that they "should" do something, but don't do it (like me and biking :( - I'm very guilty of being a bad Mustachian but I do live in the center of a lot of highways).

And the difference here is that doctors/nurses/pharmacists (what we call "clinicians" in my day job) somehow have converted their education into behavior change from before they completely understood that generics are the exact same. I'd really really really love to see why that is. There are overweight/unhealthy doctors, so is it when the behavior is very easy (grabbing a different bottle next to the brand name) that it can be changed? Could we push through behavior change by framing it differently?

Well buying generic is a win because its less expensive and you lose nothing (prestige?).  But eating healthy is win-lose because you have to do something you don't like.

Eating healthy does not always have to be a win-lose situation, at least when that situation is desperately framed by people writing books about it. :) You do give up pleasurable foods when you decide to eat healthy, though. There's a really great article about how junk food is designed to be addictive - and it's good to think about stuff like that when you stuff your face with Cheetos. http://www.nytimes.com/2013/02/24/magazine/the-extraordinary-science-of-junk-food.html?pagewanted=all&_r=0

[slowth]

There's one more reason that pharmacist are more likely to buy generics: They do have access to information that the general population does not have (or not easily, depending on your country). They can therefore more confidently verify whether a generic is really the same thing (most are).

Here's everything you ever wanted to know about drug therapeutic equivalence. But don't get too crazy and start storming your pharmacy demanding cheap drugs.

Preface: http://www.fda.gov/Drugs/DevelopmentApprovalProcess/ucm079068.htm

The goods: http://www.accessdata.fda.gov/scripts/cder/ob/default.cfm

[Jamesqf]

You do give up pleasurable foods when you decide to eat healthy, though. There's a really great article about how junk food is designed to be addictive - and it's good to think about stuff like that when you stuff your face with Cheetos.

Now that depends on one's taste, doesn't it?  I honestly don't like most junk foods, and think there's nothing better than a fresh, ripe peach straight from the tree.  Well, unless it's cherries ditto, or fresh peas from the garden...

[amicableskeptic]

I too buy generic drugs and have thought that they are the only way to go for some time now.  The Supreme Court has just passed down a ruling that does provide some small reason to use name brand drugs instead of generic.  In Mutual Pharmaceutical Co. v. Bartlett the court has just ruled that you can't sue a generic drug manufacturer if they don't include a warning about a side effect on their labeling. 

In the case itself a woman was prescribed a drug for simple shoulder pain and ended up getting toxic epidermal necrolysis as a side effect. She is now severely disfigured, has physical disabilities, and is nearly blind.  Toxic epidermal necrolysis was not listed as a potential side effect on the label of the drug she took and so she sued and won damages, but the Supreme Court has just reversed the ruling and said that Generic drug makers only have to duplicate the warnings put on by regular drug makers and don't have any more responsibility than that.

I feel like people in general don't even read the side effects list of drugs and just take what their doctor prescribes (I'm doing that right now with an antibiotic) so part of me feels like while this is a tragedy it is not going to really change much.  That being said, it shifts the economic incentives towards generics even more.  I wonder if after a ruling like this original developers of drugs will put even less effort into researching side effects and instead just try and sell their own drugs as generics somehow to make money without testing/labeling.  I guess my take away is that I'm going to be a little more careful taking generic versions of drugs that are relatively new so if I do get hit with a terrible life destroying side effect I can at least sue the crap out of somebody.  And most importantly it will make me support increase FDA funding/standards and universal healthcare even more as those are the two real protections against this I can see (FDA making sure drugs are safe, universal healthcare keeping you alive and not bankrupt without the need for tort suits if they aren't).

SCOTUS Blog summary
http://www.scotusblog.com/?p=166652

Full case
http://www2.bloomberglaw.com/public/desktop/document/Mutual_Pharmaceutical_Co_Inc_v_Bartlett_No_12142_2013_BL_165503_U/1

[Dr.Vibrissae]

In the case itself a woman was prescribed a drug for simple shoulder pain and ended up getting toxic epidermal necrolysis as a side effect. She is now severely disfigured, has physical disabilities, and is nearly blind.  Toxic epidermal necrolysis was not listed as a potential side effect on the label of the drug she took and so she sued and won damages, but the Supreme Court has just reversed the ruling and said that Generic drug makers only have to duplicate the warnings put on by regular drug makers and don't have any more responsibility than that.

I'm not sure using name brands would have helped in this case. It's tragic, but generics only have the same warnings as name brands.  Maybe the name brand would have settled, but maybe not.  Toxic epidermal necrolysis is a terrible, but idiopathic occurrence, meaning it's unpredictable.  In my field, at least, we are instructed that almost any drug can be associated with it.  I'm just not convinced that using only name brands will protect you either physically or financially, especially when you consider the extreme rarity of the side effect.

[Micheal]

We go generic all the way with one exception.  My wife has a thyroid med that has to be the Name Brand because she is allergic to the "filler" in the generic brand, still a cheap med on the $4 dollar list though.

[grantmeaname]

I guess my take away is that I'm going to be a little more careful taking generic versions of drugs that are relatively new so if I do get hit with a terrible life destroying side effect I can at least sue the crap out of somebody.

That seems like such a remote possibility to spend your life worrying over. I'll stick to my optimism gun.

[MrsPete]

I can only think of one situation in which I needed to buy the name-brand:  When I was expecting, the OB/GYN told me to stick to the name brand prenatal vitamins, explaining that the name brand has a better coating that melts /absorbs more slowly and upsets the stomach less.  Since I was already throwing up on a constant basis, I took his word for it and bought the name brand. 

Other than that one example, I've never been disappointed with generics.  However, occasionally I find a coupon that makes the name brand cheaper than the generic -- and I can't tell a difference. 

[Nyarlathotep]

Generic for the win. It seems to work to be just as good the name brand most of the time.