Cover image for Generic : the unbranding of modern medicine
Generic : the unbranding of modern medicine
Greene, Jeremy A., 1974- , author.
Publication Information:
Baltimore : Johns Hopkins University Press, [2014]

Physical Description:
xii, 354 pages : illustrations ; 24 cm
Reviews the history of the generic drug industry, how they attempt to market a product that purports to be exactly the same as a better known one, what are the regulations protecting consumers, and whether or not generics actually are chemically and therapeutically identical. Small differences in binders or production methods can create two chemically similar drugs, with different effects. Greene also looks at how the explosive growth of the generic drug industry over the last few decades has impacted not only the pharmaceutical industry, but the future of the health care industry as a whole.
The same but not the same -- What's in a name? Ordering the world of cures ; The generic as critique of the brand -- No such thing as a generic drug? Drugs anonymous ; Origins of a self-effacing industry ; Generic specificity -- The sciences of similarity. Contests of equivalence ; The significance of differences -- Laws of substitution. Substitution as vice and virtue ; Universal exchange -- Paradoxes of generic consumption. Liberating the captive consumer ; Generic consumption in the clinic, pharmacy, and supermarket The generic alternative. Science and politics of the "me-too" drug ; Preferred drugs, public and private ; The global generic -- The crisis of similarity.
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RM301 .G74 2014 Adult Non-Fiction Non-Fiction Area
RM301 .G74 2014 Adult Non-Fiction Open Shelf

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Generic drugs are now familiar objects in clinics, drugstores, and households around the world. We like to think of these tablets, capsules, patches, and ointments as interchangeable with their brand-name counterparts: why pay more for the same? And yet they are not quite the same. They differ in price, in place of origin, in color, shape, and size, in the dyes, binders, fillers, and coatings used, and in a host of other ways. Claims of generic equivalence, as physician-historian Jeremy Greene reveals in this gripping narrative, are never based on being identical to the original drug in all respects, but in being the same in all ways that matter.

How do we know what parts of a pill really matter? Decisions about which differences are significant and which are trivial in the world of therapeutics are not resolved by simple chemical or biological assays alone. As Greene reveals in this fascinating account, questions of therapeutic similarity and difference are also always questions of pharmacology and physiology, of economics and politics, of morality and belief.

Generic is the first book to chronicle the social, political, and cultural history of generic drugs in America. It narrates the evolution of the generic drug industry from a set of mid-twentieth-century "schlock houses" and "counterfeiters" into an agile and surprisingly powerful set of multinational corporations in the early twenty-first century.

The substitution of bioequivalent generic drugs for more expensive brand-name products is a rare success story in a field of failed attempts to deliver equivalent value in health care for a lower price. Greene's history sheds light on the controversies shadowing the success of generics: problems with the generalizability of medical knowledge, the fragile role of science in public policy, and the increasing role of industry, marketing, and consumer logics in late-twentieth-century and early twenty-first century health care.

Author Notes

Jeremy A. Greene is a professor of medicine and the history of medicine and the Elizabeth Treide and A. McGehee Harvey Chair in the History of Medicine at Johns Hopkins University School of Medicine. He is the author of Prescribing by Numbers: Drugs and the Definition of Disease and the coeditor of Prescribed: Writing, Filling, Using, and Abusing the Prescription in Modern America.

Reviews 3

Publisher's Weekly Review

Greene (Prescribed: Writing, Filling, Using, and Abusing the Prescription in Modern America) turns the concept of generic as ho-hum on its head with this jam-packed survey of the effects culture, medicine, and politics have exerted on todays ubiquitous generic drugs for the last 50 years. Painstakingly documented and researched, Greene, an associate professor of medicine at Johns Hopkins School of Medicine, infuses plenty of drama into the tale of American consumerss shift from suspicion to support for drugs that are the same but not the same as brand-name medicines. From black-market medicines controlled by the mafia to the risk-taking pioneers of generic enterprise to the intense resistance of pharmaceutical producers-and doctors-to the rise of consumer rights and a patients right to know what he is buying and how much it costs, Greene laces this history with intrigue, ambiguity, and scandal. Students of the history of medicine will be intrigued, but his message is farther-reaching. In coming to grips with the future of our health care, the past, Greene writes, helps to orient us to the present, and the concept of same but not the same can also help us better understand biomedical innovation as well as the risks and rewards of debranding. (Oct.) (c) Copyright PWxyz, LLC. All rights reserved.

Library Journal Review

Greene (history of medicine, Johns Hopkins Univ.; Prescribing by the Numbers) reviews how the generic drug industry came into being in the United States, with some information about the development of generic drugs in India and Brazil, and how governmental regulation has affected the development of generic pharmaceuticals. As with many aspects of modern society, the part played by generic products has been driven by economics. Greene carefully details how various interests, traditional drug developers, generic drug companies, insurance companies, consumers, and doctors have shifted the role of generic medicines in society. It is important to know that these drugs are only similar to, not identical to, their brand-name components, a factor that adds significantly to the difficulty of regulation and oversight. The author also describes the emerging role of "me too" drugs, created when multiple manufacturers produce similarly purposed medicine to gain market share. VERDICT This is an excellent and recommended history of how the generic drug market came to be, but it is missing information about the current situation, which may be better addressed in Greene's previous work.-Eric D. Albright, Tufts Univ. Lib., Boston (c) Copyright 2014. Library Journals LLC, a wholly owned subsidiary of Media Source, Inc. No redistribution permitted.

Choice Review

Physician/historian Greene (Johns Hopkins) provides a thoroughly researched discussion about generic products derived from innovative or brand-name drugs, focusing on their "social, political, and cultural history." Most laypeople have no concept of the rigorous testing behind generics and often think of these products as they do aftermarket car parts-similar but not as well made. This is false. Although generics and brand-name drugs are not identical, they are bioequivalent, and generics are cost-conscious choices for consumers. Interestingly, the public misperception is a desirable outcome for pharmaceutical companies that lose revenue from innovative drugs when generics become available. They argue that generic drugs crush research innovation and that developing drugs that consistently outperform previous products will eventually become impossible. One chapter discusses "me-too" drugs produced by Big Pharma in its bid for consumer dollars. The concept of pharmaceutical company-driven brand preference is buttressed by data showing that companies persuade physicians to promote brand medications through free samples, thus tempting patients to request the brands when samples are finished. Greene ably argues for generics by providing inside details about the drug approval process; he also discusses economic issues and how health care is micromanaged by those who seek to profit the most. See also Prescribing by Numbers (CH, Jul'07, 44-6261). Summing Up: Recommended. All health sciences collections. --Jennifer G. Schnellmann, Medical University of South Carolina

Table of Contents

Acknowledgmentsp. ix
Introduction. The Same but Not the Samep. 1
I What's in a Name?
1 Ordering the World of Curesp. 21
2 The Generic as Critique of the Brandp. 39
II No Such Thing as a Generic Drug?
3 Drugs Anonymousp. 53
4 Origins of a Self-Effacing Industryp. 64
5 Generic Specificityp. 77
III The Sciences of Similarity
6 Contests of Equivalencep. 93
7 The Significance of Differencesp. 110
IV Laws of Substitution
8 Substitution as Vice and Virtuep. 137
9 Universal Exchangep. 155
V Paradoxes of Generic Consumption
10 Liberating the Captive Consumerp. 173
11 Generic Consumption in the Clinic, Pharmacy, and Supermarketp. 191
VI The Generic Alternative
12 Science and Politics of the "Me-Too" Drugp. 211
13 Preferred Drugs, Public and Privatep. 231
14 The Global Genericp. 243
Conclusion. The Crisis of Similarityp. 261
List of Abbreviationsp. 277
Notesp. 279
Indexp. 343