This is much the most difficult and the most important for you as a patient:

Are generics as effective as the newer, medically innovative and more costly drugs that your doctor could prescribe for the same illness?

This is where the conflict between the best medicine and saving money is sharp. New, innovative medicines have transformed drug therapy during the last seventy years and saved the lives of millions from bacterial infections (like pneumonia, meningitis, and after surgery) and viral attack (like HIV/AIDS). They have also enormously helped patients (especially elderly patients) to live more comfortably with chronic conditions like heart disease, arthritis, ulcers and depression.

Such innovative drugs are not cheap and should not be expected to be cheap in the industrialised world. They are the result of costly research and development with high risks of product failure before a new drug can be proven safe and effective and introduced as a prescription product in hospitals and/or for outpatients. Pharmaceutical patents were first introduced in the 19th Century in order to encourage this type of research and development by rewarding inventors for a limited period of exclusivity, and with the express objective to stop the piracy of intellectual property.

Today’s and tomorrow’s problems can be stated very simply: Who is to pay for all this? The state? the insurer? the employer? the employee? or you – the patient – when you hand your prescription to the pharmacist?

The health care systems of various countries have tried to find different answers to the question ‘Who Pays?’, but there is general agreement that the health benefits that innovative drugs bring to medicine and patients need to be weighed against their cost and how that cost is to be shared.

That is where the conflict between prescribing cheap generics or costly innovative drugs comes to a head. The budget of health care payers will obviously benefit if old generics are prescribed and new medicines reserved only for exceptional cases. But will you, the patient, benefit? Will your health be maintained or improved as effectively with a generic that has been prescribed for the past 30 years as with the latest drug? That is not a conflict between brand and generic (as in Questions 1, 2 and 3, above) but between traditional and innovative remedies.

In the past, your problem as a patient was that you were not really in a position to judge whether your physician’s prescribing choice was the best for you. The majority of older patients were brought up to accept the doctor’s decision without question. They were not even told what drug was being prescribed, but handed a bottle labelled “The Medicine” – and that was that.

That was the past. Today, the situation has changed radically. There are self-help groups and patients’ advocacy groups for most diseases in the USA, in Europe, and increasingly in the emerging economies. There is the Internet. You can, if you wish, become fairly expert in the range of drugs that are available for the treatment of your illness. Above all, you can seek independent advice from advocacy groups whose pharmaceutical knowledge may be more up-to-date than that of physicians who have not taken refresher courses on Recent Advances in Pharmacology.

The idea is not that we should all become our own doctors or second-guess the professionals. It is simply that we have a right to understand whether we are being fobbed off with cheap, obsolete, second-class medicine or whether cheap happens also to be best – which in many cases it may well be.

Related article

Generics and You (Part 1): What is a generic drug?
Generics and You (Part 2): The doctor’s choice: brand or generic?
Generics and You (Part 3): In which countries are you most likely to receive a generic prescription?
Generics and You (Part 4): Are generics ‘first class’ medicine?
Generics and You (Part 5): Biosimilars
Generics and You (Part 7): You and generics