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This is a question False Economies

Sometimes the cheapest option isn't the right one. I fondly remember my neighbours going to a well-known catalogue-based store and buying the cheapest lawnmower they stocked. How we laughed as they realised it had non-rotating wheels and died when presented with grass. Tell us about times you or others have been let down by being a cheapskate.

(, Tue 24 Jun 2014, 12:42)
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Generic drugs
I'm a pharmacist in real life, and I'm going to answer this question wrong.

Whatever you think of the morality and ethics of large drug companies (clue: they don't have any), they invest massive amounts of money in developing new drugs. Most drugs never make it to the market, and quite a few of those that do are withdrawn somewhere down the line when unfortunate side-effects come to light.

To protect that substantial investment in research & development, there is an extended patent on each successful drug, so the company that developed it is the only one allowed to market it. They make the most of that by charging as much as they like for it, so they can recoup those costs and make a tidy profit before the patent expires (after 7-10 years, usually). Then any drug company can manufacture it.

An example of a drug that recently came off patent is sildenafil. Until it came off patent, any pharmacy that dispensed a NHS prescription for sildenafil was reimbursed for the branded product, Viagra. When the patent expired, generics manufacturers started making it. Because they hadn't spent decades investing in research and development and clinical trials, they could charge a hell of a lot less for it than Pfizer does, and the price the NHS pays for sildenafil was substantially reduced as a result.

So, the generic version of a drug is a lot cheaper than the branded version. The NHS likes generic versions to be prescribed, so that it costs a lot less to pay for drugs prescribed to patients. The generics are identical, and subject to the same tests and quality assurance. They're just cheaper.

Sometimes, patients insist that they have to be given the brand.

Very occasionally, there might be a clinical reason why someone needs one particular brand of their medication. Perhaps they have an adverse reaction to one of the other ingredients, or the formulation (e.g. they can't swallow one brand which comes in round tablets, but they can cope with another brand which comes in oval tablets). This, however, is true in a vanishingly small number of cases.

Usually, it's some cunt with a massively inflated sense of entitlement - who is almost invariably very well-off - who insists that they have to get a particular brand of medication because they've twigged that the other one is cheaper, and therefore doesn't work.

They're wrong.
(, Wed 25 Jun 2014, 18:37, closed)
nobody cares what you think, shopkeeper
just press the buttons on the till and stop pretending the lab coat makes you a scientist
(, Wed 25 Jun 2014, 18:56, closed)
Wait a minute, I make more profit selling the stupidly expensive brands.
Ignore everything I just said.
(, Wed 25 Jun 2014, 19:02, closed)
You should totally post this up on /links, they LOVE this stuff over there.

(, Wed 25 Jun 2014, 19:14, closed)
You're right, you have answered the question wrong.
What you say if true, however, although I've never known anyone insist that their doctor prescribed a branded medication over a generic. Surely the correct answer would be to tell them to fuck off (as politely as possible)?
(, Wed 25 Jun 2014, 19:48, closed)
A lot of patients do.
Ultimately it depends on the doctor, most refuse but some will just prescribe whatever certain patients want for an easy life. (And of course, sometimes there is a clinical reason.)

Most cases I come across are generic prescriptions, but the patient has told the pharmacy in no uncertain terms what brand they want. Strictly speaking it's unethical, because it probably qualifies as giving an incentive to a patient to bring an NHS prescription to their pharmacy - but it's the pharmacy that loses money doing it.

It's always pharmacists who work in chains, though - independents (who have to balance their own books) seem strangely unwilling to haemorrhage money.
(, Wed 25 Jun 2014, 20:00, closed)
Woah woah woah...
Yes, the branded and generic products may be chemically identical (in terms of the active ingredient) but there may well be a genuinely measurable difference owing to the placebo effect being magnified by the patients belief in that brand.
(, Wed 25 Jun 2014, 19:55, closed)
This is a good point, and it is probably true in many cases.
In those cases, though, the patients should go private. I would imagine that having to fork out the difference themselves would go a long way towards negating the placebo effect.

edit: to bring up sildenafil again, it's only allowed to be prescribed on the NHS under certain circumstances. A lot of patients saw their GP and had it prescribed privately. Since it came off patent, I haven't seen a private prescription for Viagra. Everyone's getting the generic and paying a lot less for it.
(, Wed 25 Jun 2014, 20:04, closed)
Fair enough,
I think it is completely appropriate for the NHS to prescribe the generics (except in such circumstances as you already outlined), freeing up cash for people with conditions for which a placebo isn't gonna do anything. There is nothing stopping a patient from forking out for the brand if they so desire.
(, Wed 25 Jun 2014, 20:38, closed)
Yeah, that's the thing really.
I'm completely in favour of the NHS principle of being free at the point of use, but the (possibly inevitable) downside of that is that a lot of people simply don't appreciate what they're getting, and think it is their right to demand more than other people get. But that's nothing to do with the NHS, it's just human nature.

In summary, we're all cunts.
(, Wed 25 Jun 2014, 20:49, closed)
To be fair, the cunts need edumacation
As a pharmacist you're used to describing drugs by their generic name, but a lot of punters don't realise that Nurofen / ibuprofen, Ventolin / salbutamol and sildenafil / Viagra are identical and think they're being fobbed off with an inferior product.

The patent holders are too good at marketing and he medical profession not god enough at explaining.
(, Thu 26 Jun 2014, 8:19, closed)
Absolutely.
The pharmacy profession has made great strides in recent years to be more patient-centric, with (I think) some success.

I would slightly disagree about punters' understanding - as I just mentioned up there, in my experience most people who get regular prescription medication understand and are fine with it. The generic name is what's on the prescription, their repeat prescription request form and the pharmacy label.

But yes, medical professions (all of them) still have a long way to go to explain things adequately to patients. And thank fuck it's still illegal (in this country, anyway) for drug companies to advertise prescription-only drugs directly to the public. Although they've been pushing at the edges of that bit of legislation whenever they can ("does your willy not work? Speak to your GP. THIS IMPARTIAL HEALTH INFORMATION MESSAGE BROUGHT TO YOU BY LILLY, WHO MAKE CIALIS").
(, Thu 26 Jun 2014, 19:45, closed)
Brands are for suckers
I buy my ibuprofen in Poundland or similar. It's ibuprofen. It's exactly the same as Nurofen / Advil except it costs 1/5th the price.

In the US they take it one step further. If you go into a CVS or Walgreens they'll plonk the CVS/Walgreens own brand medicine right next to the advertised product. The packaging will use similar colours and it will contain the same number of pills but they'll hang a sign saying compare the active ingredients. It's usually half the price and it's the same thing. Sadly CVS and Walgreens do this for utter shit like homeopathic medicine where there is no "active" ingredient but they still want the money anyway.
(, Thu 26 Jun 2014, 3:21, closed)
Poundland?
How much is it in Poundland then?

heh
(, Thu 26 Jun 2014, 7:20, closed)
50p in the sale.

(, Thu 26 Jun 2014, 8:00, closed)
1lb.

(, Thu 26 Jun 2014, 9:45, closed)
ibuprofen costs 89p at tesco
you'd be an idiot to buy that from poundland
(, Thu 26 Jun 2014, 8:28, closed)
It's probably half that in Aldi.
Paracetamol is 16p, and you can normally multiply that by 3 to get the price of ibuprofen.
Probably all made by Galpharm, anyway - they seem to supply all the own brand pharmaceuticals.
(, Thu 26 Jun 2014, 8:57, closed)
ibuprofen doesn't work on me, i never feel a blind bit of difference
plain bog ordinary paracetamol or gtfo
(, Thu 26 Jun 2014, 10:42, closed)
thanks
I'll keep that in mind when faking your suicide.
(, Thu 26 Jun 2014, 12:53, closed)
i don't think you're a real doctor

(, Thu 26 Jun 2014, 14:23, closed)
Eeeuuurgh.
Paracetamol is one of the worst suicide methods.

The poor fuckers who choose it are apparently not aware that high doses will mainly just kill your liver and kidneys leaving everything else in tact. This generally results in a slow painful and death over the course of about a week as everything else shuts down due to build up of untreated bodily waste products, and subsequent multiple organ failure.
(, Thu 26 Jun 2014, 17:49, closed)
I'd like to go 'death by organ donation'

(, Thu 26 Jun 2014, 18:00, closed)
Yeah, and they wake up the morning after their overdose
and think "oh look, I'm still alive. It didn't work. Just as well, I've now changed my mind and decided to embrace life." Then die in agony 3 days later.
(, Thu 26 Jun 2014, 19:47, closed)
I don't trust generic placebos.

(, Thu 26 Jun 2014, 9:45, closed)
Alright Alasdair?
How's things?
(, Thu 26 Jun 2014, 10:16, closed)
Not bad thanks, much the same in many ways
which is probably a good thing at this age. How are you?
(, Thu 26 Jun 2014, 20:01, closed)
So on that premise
And being a spaz-leptic are you saying: considering absorption rates, Epilepsy meds on delayed dispersal aside from active compound are no different between: for example Tegretol SR and Generics?

I have always been warned that its kinda dodge to switch between generics and prescribed named brand.
Reason I ask is that I am pissing off again to NZ and will have to pay full price for meds as opposed to sticking with NHS script here in the UK.

Tegretol is expensive in sheep land.

Interested in your answer,

Thx much.
(, Thu 26 Jun 2014, 23:47, closed)
I as sock choker I've also been told this about the lamotrigine I take. My pharamcist gives me different brands of the stuff & it's yet to make a difference to me.

(, Fri 27 Jun 2014, 7:10, closed)
Well, modified-release preparations are sometimes different.
Some drugs (e.g. diltiazem for high blood pressure/angina) are available in a lot of different branded modified-release preparations, and the bioavailability varies between them. In cases like that, the prescriber is always supposed to specify the brand to be given. They frequently don't, but that's a different story.

As far as neurological drugs go, it's certainly prudent to approach any change with some caution. However, I've never heard of any problems with patients switching between Tegretol and generic carbamazepine, even the modified-release ones. Similarly with sodium valproate - when Epilim's patent expired, Sanofi made some bleating noises about generics not being equivalent, but they were talking out of their arse.

Some people are still prescribed Tegretol, but most are prescribed carbamazepine, and whether they actually get Tegretol or one of the generics depends on which pharmacy they use. Like I say, I've never heard of or been told of any problems with switching between them.
(, Fri 27 Jun 2014, 7:14, closed)
My body did NOT like carbamazepine at all. Night sweats, hallucinations etc. Lamotrigine FTW.

(, Fri 27 Jun 2014, 7:27, closed)

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