Hacker News Reader

Comment by kintamanimatt | Hacker News Reader

> It's depressing that they can still sell them

You may feel better about this if you take some Tylenol ;-)

I don't see how there's anything wrong with selling brand-name drugs next to generics. In fact people that believe brand name drugs are more effective will have a better response to the more expensive drug because of the placebo effect. If anything, they're getting a better response to the same dose of the same drug than the rest of us plebs that know better than to pay a multiple of the cost of the generic.

View on HN

In some very extreme/rare cases it does matter.

Something like ADHD medication can make a difference. One of the most difficult months I've had has been a month where I tried the generic and the side effects were way worse than the brand name at same dosage.

I once took a medication through a skin patch. The same issue: the generic did not deliver the medication consistently at all. The patch was supposed to be replaced every three days, so I'd get a huge rush of medication the first day and next to nothing the last day. What was worse was that there were two generics. One was as described, the other actually was fine.

The moral, for me, is to be very cautious with generics. I believe most of them are fine (I would never pay full price for Tylenol :), but the more critical the medication is to me, the more research I will do on the generic.

I'm no expert on this, but just guessing here: have pills been around longer than patches? Perhaps manufacturing pills is better understood/easier to get right, so you are probably safe with generics in pill form, but will want to double-check on generics in any other form.

That's very true. Creating an instant release generic is nowhere near as difficult as producing an extended release or transdermal formulation.

The FDA recently pulled a 300mg generic bupropion generic because the extended release formation produced nowhere near what the branded medication did.

Most generics are equivalent to the branded medication, but there are exceptions out there.

http://health.usnews.com/health-news/news/articles/2012/12/0...

lemme guess. fentanyl?

if so, you're a liar. the generic patches undergo thousands of tests before a doctor ever has one prescribed.

sorry to burst your anecdotal evidence bubble. but you are fabricating things.

FYI generic testing isn't as nearly as extensive as for new drugs. Also fentanyl isn't the only transdermal medication that exists. It's not even the most common. Nicotine, clonidine, birth control and hormone therapy can all be given in patch format.

There are less confrontational, more useful, ways to convey your point than to call people liars.

'Anecdotal evidence bubbles' are fascinating. Try posting links to research about the placebo effect instead of resorting to name calling.

In generics they can change the inactive ingredients and obviously they don't always use the same equipment or facilities to produce it. Some people have allergies to inactive ingredients which may explain the different side effects.

But in my mind the generics are just as good as name brand, albeit sometimes different. I guess I'd be just as likely to react poorly to the inactive ingredients in the name brand and might find a generic better in some cases.

Actually that's not true. Generics (at least in Canada but probably true elsewhere as well) only have to give between 85%-120% of the dose of the brand name drug, this is despite having the same official dosage as printed on the label. The difference comes from preparation, pill coatings, and inactive ingredients.

Also, my friend who works at a pharma factory says brand names have much tighter quality control - more batches are tested with far less tolerance.

In addition, some of the details of the chemicals (such as I guess the angles of the molecules) may be different, because the generic manufacturer imperfectly reverse engineers the process used to make the drug.

Clinical trials to validate the generic are less strict.

That's right. The impact that this has on the quality of the medication is dependent on the dose-response curve. I wouldn't expect this to be a big deal for painkillers, for instance, but it could easily cause noticeable differences elsewhere.

I'm curious, which ADHD medication and generic did you use? I'm on Ritalin myself.

Oh, it's not wrong, just embarrassing as a human being. ;)

> Oh, it's not wrong, just embarrassing as a human being. ;)

Care to explain why?

I buy Tylenol branded acetaminophen. Granted, I only buy one bottle every three years or so, but I'm perfectly fine spending a few dollars more. While acetaminophen is acetaminophen, when I buy Tylenol, I'm buying into their quality control and the experience that has come with that company, over many years. It's worth a few dollars to me to make sure that I'm getting what I'm buying and nothing more.

Do explain how brand loyalty is "embarrassing" to humanity.

It may feel like it's safer, but personally, I doubt it. You're paying mostly for a feeling, and that's somewhat irrational.

Medicine is a relatively good place for paranoia though, and for feeling safe. Most brand loyalty is even sillier. Don't get me started about designer clothing.

> Most brand loyalty is even sillier.

This makes no sense to me. If I have a good experience with a company, then any subsequent experience is far more likely to be good than a random selection?

The entire point behind brands is consistent experience.

If we're being pedantic, that's inductive reasoning. See the problem of induction [1]; you cannot justify any inference about future experiences of a product based on past experiences of it alone.

Brand loyalty is broader and can potentially be justified.

[1] https://en.wikipedia.org/wiki/Problem_of_induction

Induction works mostly fine in practice.

It mostly doesn't result in catastrophe. That doesn't mean it produces optimal results.

I can't think of anything I where I don't pay for a feeling. I could live in a closet and eat the bare minimum to survive, but I like to feel cozy and feel that my food is tasty.

Reply on news.ycombinator.com