GENERICS - WHATS IN A NAME

Historically, the most common intervention performed by physicians has been the writing of a prescription. Often the prescription was a comb ination of active agents and an inactive base. This art is no longer p racticed in the United States. Currently, most prescriptions are writt en for specific ''drugs.'' As the prescription is being written, the p hysician must decide to administer a brand-name or a generic equivalen t. Generics are a class of medications prescribed for reasons of econo my, and the physician and the patient expect that the therapeutic effe ct will be exactly the same as for the brand-name. Bioequivalence of s pecific agents can be assessed using the FDA's Orange Book. In additio n to bioequivalence, many other scientific, ethical, and economic issu es should be considered before a decision is made. Prescribing vigilan ce is necessary, because in many instances available information is of ten controlling or insufficient to support rational decisions. Brand-n ames, rather than generics, should be selected when the therapeutic in dex is narrow or if the likelihood of generic switching is high. The p aper will discuss all aspects of the subject.