Drugs: Pill Consumers' Report

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Why pay more for a brand-name drug when the identical compound can be bought more cheaply under its chemical name? The question is naturally tantalizing; it is also current because of hearings before the Senate Monopoly Subcommittee last week and a new book, The Handbook of Prescription Drugs, by Dr. Richard Burack.

A specialist in internal medicine and pharmacology at Harvard Medical School, Dr. Burack starts from the premise that too many drugs cost too much because they are prescribed and dispensed under brand names, whereas the identical chemicals, meeting the same U.S. Government standards of purity and potency, are available for less under their generic names. Drug by drug, Dr. Burack lists many of the most widely used medications, gives their brand names and lists the prices charged for them. For example, he cites penicillin G, sold by E. R. Squibb & Sons as Pentids at a price to the druggist of $6.62 per 100, but for 92¢ by Pennex Products Co., and by 15 other companies for less than $2. Or digitalis, sold as Pil-Digis by Davies, Rose-Hoyt at $18.40 per 1,000, but by Merck Sharp & Dohme at $2.50. Dr. Burack urges patients to ask their doctors to prescribe by generic rather than brand name, then ask their druggists to sell them the cheapest approved brand.

Glaring Examples. Private patients are not the only ones who pay higher prices for brand-name drugs; so do many state and local governments. Wisconsin's Democratic Senator Gaylord Nelson last week heard a series of witnesses before his Monopoly Subcommittee testify on the price spreads. William F. Haddad, a former Peace Corps and antipoverty executive, now heading a New York citizens' committee conducting research on city problems, cited the most glaring examples.

New York City and adjacent Nassau County, said Haddad, buy meprobamate (Miltown, Equanil) for $18.90 per 1,000, while Georgia's Fulton County (Atlanta) pays $62.40. New York City buys tetracycline at $25.95 a 1,000, but Chicago pays $50, Fulton County $95, while New York's Onondaga County (Syracuse) pays $90 for a slightly different form. The District of Columbia, buying through the Veterans Administration, equals New York's low prices in most cases and betters them in some. The armed forces do at least as well, buying in still greater quantities through the Defense Supply Agency.

Nonequivalent. Like the lay witnesses, Senator Nelson accepted the claim that a generic-named product, provided it meets Government standards, is exactly the same drug as the brand-name item. Sometimes it is, but not always. Four eminent research physicians in Chicago, headed by famed Anesthesiologist Max S. Sadove, have carefully compared many "generic equivalent" drugs for years and found great differences in the effects on patients. One notable example involved an anesthetic; a cheaper, generic-named form simply did not anesthetize in some cases, and in others the effect wore off too soon. Besides potency and purity, there are 20 to 30 other types of difference between drugs, most of them too subtle for routine Government testing. But some may prove important for certain patients. "Our conclusion," reported the Sadove team; "is that generic equivalency is frequently a fable without basis in fact."