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12 | James Hubbard's My Family Doctor | The Magazine That Makes Housecalls T he economy has made bargain shoppers out of all of us. And for many people, one of the most expensive things to do is go to the doctor. Generic medications' cheaper price tags help. But there are some questions that need answering before we accept them as ideal budget savers. Are they the same as name brands? Are they safe? Effective? A good option in every case? Sometimes, the answer isn't as simple as you might have been told. MISLEADInG CLAIMS The Food and Drug Administration assures us that generic medicines are "chemically identical" to their name-brand counterparts. They base this claim on the idea that they require generics to have the same safety and effectiveness as the original drugs. This is a bit mislead- ing. Because name-brand- drug companies have a right to protect their trade secrets, generic manufac- turers often produce their products through reverse engineering. This basi- cally means they make an educated guess about how the brand drug is made before producing a medicine with the "same" characteristics. In fact, generic medi- cations are only required to be 80- to125-percent as effective as the origi- nal. Because of this dis- crepancy, many doctors are a bit squeamish about prescribing generics, especially when it's critical that the patient get a specific dose. This is particularly true for hor- mones like the thyroid medicine levothyroxine (Synthroid) and for blood thinners like warfarin (Coumadin), just to name a couple. STILL GOOD ... uSuALLy All this might lead some to conclude that generics are a bad thing. Usually, however, they're a great option. In most cases, a small variation in active ingredients doesn't pose a problem. "Generics are generally a win-win for everybody," says Carl Labbe, R.Ph., a Walgreens pharmacist at Banner Desert Medical Center in Mesa, Ariz. "Remember, too, that a patient's health may be severely affected by high- cost drugs that are never purchased, or taken in subthera- peutic doses to make them last longer." The important thing to remember is, although a treat- ment's monetary viability is one critical element of the de- Drugs to Question The Food and Drug Administration allows generics to be 80- to 125-percent as effective as the brands. that's usually ok, but for drugs with a narrow therapeutic window—meaning exact dosage is important—it can be disastrous. for example, if your doctor prescribes 125 micrograms of synthroid, you may get as little as 100 or as much as 156 micrograms from the generic. one hundred and 150 micro- grams are themselves actual doses of synthroid! this much variation makes it nearly impossible to ensure you're getting an appropriate amount. for this reason, many physicians do not allow hormone substitution at the pharmacy. Here's a partial list of drugs with a narrow therapeutic window. • anti-seizure medications such as carbamazepine (Tegretol) and phenytoin (Dilantin) • heart medicines like digoxin (Lanoxin) and procainamide (Procanbid, Pronestyl) • levothyroxine (Levoxyl, Synthroid), a thyroid hormone • theophylline (Theo-Dur), for lung diseases • warfarin (Coumadin), a blood thinner What They Don't Tell You About Generics And when it really matters by Matthew n. parker, M.d.