I am surprised that a newspaper with the reputation of the L.A. Times would use such a misleading title.
In fact, your article is not about the worthiness of generics but about the ability of insurance companies to pressure patients and doctors into accepting less costly alternatives.
Lipitor contains the active ingredient atorvastatin, which is a different chemical from simvastatin. Simvastatin is not a generic substitute for Lipitor but for Zocor.
Your article implies that one should not switch to a generic, when in fact the side effects experienced by the patient were caused by switching to a different active ingredient.
The patient would presumably have experienced the same symptoms had he switched to Zocor. Were generic atorvastatin available, the patient would not have experienced any new or different side effects.
Michael Cannon
Laguna Beach
Dr. Marc Siegel hopelessly confuses generic substitution (in which the same drug, in the same dosage form and strength, is substituted for the brand name drug at substantial savings) with therapeutic substitution.
The fact that the simvastatin caused side effects in Siegel's patient had nothing to do with the drug being generic and everything to do with how a particular patient tolerates one drug in a class over another. I am sure that there are anecdotal reports of patients who had muscle damage with brand name Lipitor yet tolerated generic simvastatin.
Though forced therapeutic substitution is a practice that rightly continues to be debated, substituting an FDA-approved generic drug for a brand name drug is unquestionably safe and cost-effective.
Some of the brand name manufacturers, in fact, sell generic forms of their own brand name products at a lower cost.
Robert L. Stein, Pharm.D.
Irvine
Marc Siegel responds:
I did not choose the headline nor the deck at the beginning of the article, and I have nothing against the use of generics per se — although, as the article clearly states, I do not think alternatives should be automatically substituted for drugs that are already working.
I described a scenario wherein doctors are being pressured by insurance companies to substitute a different drug (in this case generic simvastatin) for a drug, Lipitor, which has done very well in studies and was working well on my patient. The article clearly explains that Lipitor and simvastatin are similar but different drugs. This is not confusing. Forced substitution is the main issue of the article, not the intrinsic value of generics.
Although generic Lipitor (atorvastatin) is not yet available, it is wrong to assume that even if it were available, all insurance companies would turn to it and allow it as an automatic substitute for Lipitor. (Generic equivalents that have the same active chemicals are sometimes tolerated just as well, and sometimes not, but that wasn't the point here.)
The point is that once formularies are established, the insurance companies try to get doctors to comply no matter what the clinical issues are. It is generally assumed that less expensive medicines are more cost-effective, when in fact, a better way to save money while providing better care is to pay strict attention to the established needs of the patient.
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