Do Doctors Tend to Recommend the More Expensive Medicine?

kzl on 23/04/2016 - 21:20
Last edited 25/04/2016 - 22:22

Hey guys,

A few days ago, I found out that I have Vitamin D deficiency. I went to the GP, had a blood test and was recommended the Ostelin pills, which cost around $25 for the 250 capsule pack:
https://www.priceline.com.au/brand/ostelin/ostelin-vitamin-d…

Knowing nothing about Vitamin D pills, I bought it (from the pharmacy next to the GP's place, NOT Priceline, but the price was similar).

Just today I went to the pharmacy for something else, and found out that Ostelin is actually the most expensive brand of Vitamin D pills. The cheapest one I saw is only $14:
https://www.priceline.com.au/brand/biosource/biosource-vitam…

The price difference seems substantial, given that the two bottles seem almost identical with the same ingredients. (Yes, as an OzBargainer $11 is substantial for me :D) I did a bit of googling and found that if anything, soft gels are better than hard capsules, as they are slightly easier to digest.

So my questions are:
- Does anyone know if/how the Ostelin Vitamin D pills are better than the other ones, which may explain their price difference?
- Has anyone had a similar experience of being prescribed/recommended expensive medicine, and later found out about cheaper, almost identical alternatives?

Thanks

Edit: Thanks for all the responses guys, this has been very helpful. I thought I'd do a TLDR version for anyone new to this thread:

  • It is worth asking your pharmacist/chemist for cheaper alternatives to recommended medicine, as it can potentially save you some money.
  • Doctors mostly just recommend the brand they are most familiar with, which is not necessarily the most cost-effective brand.
  • Doctors do NOT get kickbacks (at least not allowed to).

If anyone is interested, here is the full Code of Conduct from Medicines Australia. Sanofi, the corporate owner of the Ostelin brand, is a member of it.
https://medicinesaustralia.com.au/wp-content/uploads/sites/5…)

Health & Beauty

Comments

  • PVA on 23/04/2016 - 21:26
    +18

    the pharmacist usually asks if you want a cheaper alternative, or maybe you should ask if there is one.

    dont just choose what you think is the same, ask them and they will advise.

    • [Deactivated] on 25/04/2016 - 19:54
      +15

      The pharmacists usually asks if you want the generic alternative. They do this because the profit margins are typically higher on generics. I worked in pharma.

      • macrocephalic on 26/04/2016 - 11:00
        +8

        Sounds like a win-win to me.

      • fruit on 26/04/2016 - 15:27
        +1

        Needs a citation.

      • trev likes bargains on 26/04/2016 - 20:00
        +2

        100% true. One of the KPI's for some pharmacies is the amount of generic substitutions that they have done. Generics have a much higher GP%.

      • belongsinforums on 26/04/2016 - 20:22
        +2

        as an ex-large supermarket chain employee, i can tell you that it's the same go in supermarkets for generic medicine

    • [Deactivated] on 23/04/2016 - 21:32
      -8

      Absolutely! It is about time the bloody government / health minister forces doctors to disclose what commercial arrangements they have (pretty much how the morning TV shows disclose at the end of screening what partnerships they have with commercial businesses)

      • resubaehtgnolhcs on 23/04/2016 - 21:57
        +3

        I am not sure it needs to be even at the level of commercial arrangements. Simple marketing also works - maybe Ostelin is better marketed to doctors (in medical media, journals etc) and this was what the doctor recalled/is familiar with?

        • MrTweek on 28/04/2016 - 12:35

          Most doctors aren't idiots. They can tell wether something simple as vitamin pills are much different or not. (I assume they are all the same).

          Drug companies spend lots of money on making doctors recommend their brand instead of others. I don't know which ways of doing so are legal, but I'm sure they are creative in finding legal or gray area ways to do so.

    • StewBalls on 23/04/2016 - 21:55
      +39

      This is one of those comments that contains a kernel of truth, but in practice it is actually pretty insulting to the legions of hardworking Doctors out there just trying to do the best thing by their patients in a pretty cut-throat industry with serious ramifications for mistakes. Just FYI…

    • subydooby on 23/04/2016 - 22:09
      +3

      Yes there are a lot of good hardworking Dr's out there especially when they are young and working in public hospitals and they have huge HECS debt's to take care of. Sorry if I have offended any of those but they are probably working a 15 hour night shift so they wont see this. The opposite is also true.

    • May4th on 25/04/2016 - 16:56
      +22

      maybe back in the old days. now there are strict rules about what drug reps can give..you are not even allowed to give out water bottles as it is. a lot of it is subconscious, for example when a new product is available it is marketed by their brand name. it is also easier to tell patients to buy 'nasonex' than to say 'buy a generic brand corticosteroid intranasal spray' for your allergic rhinitis.

      unless you are one of those professors who appear in promotional videos who get paid tens of thousands dollars to present compromised research data, the majority of drs get nothing from prescribing one product over another

    • Pratty on 25/04/2016 - 19:38
      +19

      Absolutely not true. Look up the Medicines Australia Code of Conduct (of which 99% of pharmaceutical companies operating in Australia are a member of) and it will spell out clearly the limits in which pharmaceutical companies operate.

      Completely false statement. Ostelin is an over the counter product for goodness sake. It is marketed well as others have mentioned. A GP tells a patient a brand name because that's what they remember. There isn't something sinister going on.

      • kzl on 25/04/2016 - 20:10
        +3

        Look up the Medicines Australia Code of Conduct

        Thank you for the source! This is very informative.

      • Serapis on 28/04/2016 - 12:13

        This finally explains why doctors and stuff get a crap ton of free stationary with medicine name branding on it! So they remember the name of the medicine

        • Pratty on 28/04/2016 - 13:28
          +2

          I mentioned this in a comment below, but it doesn't happen anymore. What you do see lying around medical centres are relics of a time gone by. The Code of Conduct no longer allows brand name reminders to be given to doctors (eg pens, hand sanitizers, anatomical models etc).

    • MessyG on 25/04/2016 - 21:44
      +35

      Not true. I'm a doctor and there are thousands of us who do not get any of that. A huge proportion of doctors are not in private practice for a start and another big proportion are in fields that drug companies aren't making new drugs for. And drug companies aren't ALLOWED to do that stuff in Australia anyway.

      Secondly, because the federal government negotiates drug prices here on behalf of the consumer, there is less incentive for drug companies to pay doctors off like they do in the US - 'big pharma' over here, is hugely different to 'big pharma' over there.

      Thirdly, I don't recommend brands. In medical school we are all trained not to use brand names, only generic names. Sometimes we get lazy and use the brand name when the generic is too long to say sensibly and quickly but no one is paid to do that.

      I don't care which version my patients take as long as they take it and get better.

      Please don't tar all doctors with the same brush. We work our asses into the ground and see really bad stuff happen to people all day long, and often feel like our best is never enough.

      • parisienne on 26/04/2016 - 18:19
        +1

        Respect as always comrade….for the 1 or 2 that may be like that,dozens and dozens are not.Be proud of what you are and what you do (from a fellow medical professional).

    • icyprincess on 26/04/2016 - 00:37
      +1

      We have recently received a box of ostelin samples. If a patient was to have low vit D, they would get it. You would then find the patient would purchase the same brand because it's what they are now marketed to know. if the cost is too high, the pharmacist will assist in finding one that is of a lower cost.

    • nikey2k27 on 27/04/2016 - 16:04
      -4

      Yes my boyfriend is a Dr we get lots of kick back.

  • Settero on 23/04/2016 - 21:48
    +23

    they probably just recommend what they are familiar with.
    google a drug and in most cases you can find 10 + different brands that sell the same thing.
    hence why we have pharmacists , its their job to know what the differences are between brands and which ones can be replaced safely by what other ones.

    • [Deactivated] on 27/04/2016 - 18:06

      they probably just recommend what they are familiar with.

      Correct, on a cut you should put a BAND AID not "woolworths select plastic patch 20 pack" etc

  • sarham11 on 23/04/2016 - 21:52
    +8

    The Ostelin brand Vitamin D tablets are the same as any brand of Vitamin D sold in pharmacies or supermarkets but they carry a brand price premium, and are probably the most expensive brand of Vitamin D I've seen in pharmacy. All brands should be 1000IU (often higher strengths can be obtained online) and come in a gel tablet form. Brands like Swisse, Fauldings, Healthy Care, Blooms and so many others contain the same active ingredient in the same concentration as the Ostelin at a fraction of the price per tablet. Be mindful that Vitamin D in combination with magnesium or calcium is unlikely to be 1000IU.
    Ostelin tends to be the doctors 'go-to' Vitamin D supplement - possibly just a part of their prescribing software.

    Doctors prescribing expensive medications, even off the shelf ones, happens fairly frequently. However by asking a pharmacy assistant/pharmacist, they can often provide a cheaper equivalent. :)

  • shanakatak on 23/04/2016 - 22:02
    +11

    Doctors often recommend what they know. My GP often says panadol but I know any paracetamol will do. Ask your pharmacy if a generic is available.

    • altomic on 23/04/2016 - 22:13
      +10

      and if pain persists then see your Doctor.

      • shanakatak on 23/04/2016 - 23:23
        +6

        Its a vicous cycle

  • red-hot on 23/04/2016 - 22:03

    Sunshine UVB on skin everyday, without sun screen = Vitamin D3.

    This was very interesting reading-
    http://www.independent.co.uk/life-style/health-and-families/…

    • teardrops21 on 23/04/2016 - 23:35
      +9

      Do you care to provide any further details to back up your claim.

    • cDNA on 23/04/2016 - 23:36
      +17

      That's not how it works. That's actually pretty insulting and derisive.

    • revacious on 24/04/2016 - 01:02
      +9

      please tell me where I can sign up to receive this commission because I don't get anything

      • Settero on 24/04/2016 - 08:29
        +5

        its called america…
        thats how the system works there i belive

        • Deridas on 24/04/2016 - 23:40

          A lot of other places as well, I know in Hong Kong where I was born GP dispenses their own medications, thus each GP will dispense what they have agreed with pharmaceutical companies rather than based on best evidence.

      • [Deactivated] on 25/04/2016 - 16:29
        -4

        Maybe that's because you need to have specialised in General Practice.

    • StewBalls on 24/04/2016 - 09:02
      +2

      every time a GP prescribes a medication, another angel gets it's wings!!!

      There…now it's slightly more accurate.

    • parisienne on 24/04/2016 - 11:45
      +3

      You are obviously an uninformed sheep who believes whatever c@p is fed to them.Insulting doesn't even begin to cover this malicious claim you are making,and it really says more about you than the thousands of good,hardworking,intelligent,self sacrificing medical personnel who prescribes a medication to save your a$e…NOT earn them some imaginary commission.Yes,there may be those who have a personal gain to be made by "selling" you some brand,but that is by far the exception.Maybe you should discuss with your Dr his commercial endorsements next time you see them BEFORE wasting an appt.spot.

    • JIMB0 on 24/04/2016 - 10:27
      +4

      Woolworths Homebrand is made in Australia as well. I've bought the 100 packs from Chemist Warehouse which are made in India and they have been fine too.

    • kzl on 24/04/2016 - 14:22

      Both the $25 Ostelin bottle and the $14 Biosource bottle are made in Australia.

    • [Deactivated] on 25/04/2016 - 15:16
      -4

      Compared to China probably so.

    • iridiumstem on 25/04/2016 - 15:24
      +2

      QC depends more on how the company does the QC process in my opinion. I do kinda agree that products manufactured from developing countries tend to be dodgy, but that in my opinion is more because of the companies trying to get it done in the cheapest way possible (if you reduce the amount of QC the product is going through, you reduce the production cost). That said, if the company enforces QC (due to brand name, regulations or whatever reasons), then I don't see any reasons to worry about QC.

      Of course, if the product is targeted for the market with less regulations, it's slightly different story. That said, they are sold in Australian market, imported and regulated by Australian government agencies (as it is imported and sold in Australian market, not just grey imported). I trust that the quality will be up to the standards set by the government for generics at least.

      • macrocephalic on 26/04/2016 - 11:08
        +2

        Exactly. Chinese (or Indian in this case) factories can normally make products at whatever quality level you're willing to pay for.

    • cwongtech on 26/04/2016 - 03:59

      But remember, not all medicines are created the same.

      True. However, every drug that has the "AUST R XXXXX" label where XXXXX is some number, means it has gone through regulation testing.
      Not everything is created in the same factory, however the standards that Australia has protects us. There's a lot of scare campaign tactics that pharmaceutical companies will use to try to sway a patient away from buying a generic.

  • A Driver on 24/04/2016 - 07:48
    +10

    I have to wonder if they also recommend brands like Ostelin or Panadol as they know they are highly marketed and advertised so then there is a better chance that the patient will also be familiar with it?

    • Pratty on 25/04/2016 - 19:40
      +1

      You're on the money.

      • ItsMeAgro on 26/04/2016 - 15:26
        +2

        Yep, and since the pharmacist will ask if they want the generic version anyway, is it really such a big deal?

  • Juvi on 24/04/2016 - 08:45
    +10

    Often its as some of the comments above have said. GPs will say a drug name they're familiar with or which a patient may be familiar with. GPs don't actually receive any kickbacks or benefits from the drug companies, they may get a free pen at a conference or when a drug rep visits - usually when they're being told about a new drug. An yes they do talk to drug reps and go to conferences where drug reps are (the conference is usually for medical learning and courses that they have to do as part of their continual learning requirements they have to meet for every calendar year), the drug reps pay for stalls at these conferences and talk to the doctors or give out flyers on new products like a new form of inhaler for asthma for kids, or a new version of a drug with less side effects. They don't pay for the conferences for doctors. Also often GPs don't have access to the costs of the medications as well, the software on the computers they prescribe from don't list the costs, that you find out from the pharmacist, and often they will offer you a cheaper generic brand as well. As for generic brands there's nothing wrong with them generally, they do the same thing chemically - i.e paracetamol from coles for $1 will do the same thing in helping with pain and fevers as the rapid access capsule panadols from the chemist with the nice packaging - but the later may have slightly fater bioavailability and easier to consume and other factors i.e side effects etc… Like any product that you are paying for shop around and ask the pharmacist they are usually very helpful, build up a relationship with one you go to regularly. Often the pharmacy at the actual GP clinic have slightly higher prices (possibly to do with higher overheads) but they do have the convenience of just being there.

    • Pratty on 25/04/2016 - 19:41
      +6

      Everything you've mentioned here is pretty spot on - except the mention of pens. Pharma companies aren't allowed to give out pens anymore! Highly regulated nowadays.

      • thirtysixd on 27/04/2016 - 19:41

        Maybe you need to be more friendly with the drug reps?

        My partner (a GP) receives chocolate muffins/sweets nearly every week.

        • Pratty on 27/04/2016 - 23:10

          Modest food provision is very different to pens (an example of a brand name reminder). ;)

        • thirtysixd on 28/04/2016 - 12:06

          @mpratty10:

          Exactly, sweet baked goods are not only much more delicious but can be addictive thanks to high sugar content.

          Eat one too many and big pharma practically own you.

  • charzy on 24/04/2016 - 09:14
    +3

    GPs will usually recommend the 'brand name' as it sticks to the patient's memory, as it has stuck to theirs. Unfortunately branded names of medication usually are a higher cost. Also those made by 'reputable' companies (by reputable I guess those that are involved in developing new drugs etc e.g. Pfizer) will have a higher premium.

    On a different tangent however with brands, I am sometimes skeptical of some generic brands. I usually opt for the cheaper, but only if I know if it's made by a reputable brand. Ranbaxy was in big trouble in the US inside one of their manufacturing plants, and they're a made in India brand. However some popular generic brands e.g. panamax made by sanofi-aventis, are also made in India. Chemist own cold flu pseudo tabs are made in Australia, while Codral cold flu original branded equivalent are in south america or south africa from memory.

  • darkb on 24/04/2016 - 09:14
    +6

    So much misinformation and as others have suggested it's unfair to insinuate that there is a hidden agenda.

    The truth is "Ostelin" is much easier to remember and prescribe for both patient and medical health workers than "Insert company/Chemist's own brand Vitamin D". Also "Ostelin" came to market way before "own Brand", do you expect in addition to god knows what else they have to do for them to remember every x/y/z of the same product? Another example would be Panadol.

    Patient's need to take charge of their own health and choices. Ask questions, health workers are transparent.

    • Deridas on 24/04/2016 - 23:42
      +4

      Yeah… you can remember "Ostelin"… or you can remember "cholecalciferol"…

    • fruit on 26/04/2016 - 15:29
      +1

      Why not just "vitamin D3 pills"

  • gawait1 on 24/04/2016 - 09:53
    +30

    So much misinformation all right… I'll start by saying that I'm married to a GP (and know a few pharmacists), so I can give you some "facts" from that side:
    1. There are essentially ZERO kickbacks or benefits for GPs any more. Years ago there certainly was, but the government changed the rules and this all stopped some-time ago. These days if they manage to get a cheap crappy pen or some post-it notes, they are doing well. Some specialists may still get "subsidised" to go to or participate in conferences, but not GPs.
    2. Pharma companies have no way of knowing which drugs a specific Dr prescribes, or whether they actually recommend name-brand or generic. So the pharma-reps cannot "reward" a GP for high prescribing of their drugs - can't get the info and illegal to do so anyway.
    3. For many medicines there are differences between brand-name and generic, even if the nominal content of xxxmg is the same. Firstly, there is a tolerance on the content of the active constituents - name-brand will always be spot-on to just over spec to ensure that correct minimum dosage is achieved, whereas generic are not as tightly controlled and more often a slightly under (though still in tolerance). Secondly, the other contents of the medicine (additives and fillers) are often different. Name-brand drugs can often have other, not mentioned, additives to help with absorption or improve effectiveness. Others have different fillers that may cause reactions or side-effects in SOME people. I know that when my wife prescribes, she will explain to her patients if she thinks a generic is fine or if she has a specific reason for deliberately choosing one brand over another - they are not always the same thing, even between name-brand products.
    4. However, who does have a financial incentive to sell generic medicines - your friendly pharmacists!!! Not only are their profit margins higher on generics (even though they sell them cheaper), but in addition the government pays them a bonus each time they sell a generic instead of name-brand! So they are getting a direct financial incentive to push you into buying no-name medicines.

    So yes, patients do need to take charge of their own health care, but they also need to know that the general perception of "blame the Doctor as they get all the kick-backs, but I'll trust my pharmacist" is exactly the opposite to reality. The doctor has no incentive other than the patient's health outcome for prescribing one way or another. The pharmacist is affecting their personal profit margin by the "advice" they give you… I know who I'd trust!

      • MessyG on 25/04/2016 - 21:52
        +1

        Very flawed logic. I am exposed to McDonald's ads all the damn time and you don't see me eating it or recommending it. Secondly I know that someone has studied the effective of marketing on doctors and that's where you've got that information from but you're confusing American drug company marketing with Australian. Completely different situation, American marketing rules for drugs are criminally lax.

        I am well aware that the Viagra marketing had a red paw print and red colouring, I remember it well. I'm not going to go out and prescribe it for erectile dysfunction just because I remember the marketing because you know what I remember more? The generic name, Sildenafil. Drug companies rely on doctors prescribing the brand names, and as I mentioned in an earlier post, we are taught from day one in medical school to prescribe generic names.

        There is a huge difference between drug company effect in Australia and drug company effect in the US.

    • kzl on 24/04/2016 - 11:45
      +1

      For many medicines there are differences between brand-name and generic

      For Vitamin D this is certainly not the case. The $14 Biosource bottle is not a generic brand, but a (less) premium brand, and the price difference just seems too high. Also, both the Ostelin and the Biosource bottles list the exact same ingredients: Vitamin D3 1000Iu (Cholecalciferol). As I wrote in my original post above, my understanding is that if anything, the Biosource one is actually better, as it is soft gel and may be easier to absorb than Ostelin's hard pills.

      However, who does have a financial incentive to sell generic medicines - your friendly pharmacists!!!

      I know you are referring to premium vs. generic medicine, but I just want to point out that my visit to Priceline (World Square, Sydney) paints a different picture. There Ostelin seems to be promoted as a major brand name. They had their own shelves of various types of supplements, and each shelf had the Ostelin logo painted above it. In contrast, the Biosource Vitamin D bottles were wrongly placed in the corner of the women's health section. Given these observations and the price differences, it is hard to believe that Priceline makes more money from the Biosource pills than Ostelin ones.

      You seem to be very informed about the medical industry, it'd be great if you could provide some links/sources to support your claims.

      • jzdhgkd on 25/04/2016 - 16:25

        There wouldn't be any sources or links without having the price list direct from the supplier.

        I'll vouch for generics having a higher profit margin most of the time compared to the premium brand.

        You are probably correct in your assumption that Ostelin is making that particular pharmacy more money vs other brands however that's the exception rather than the rule. It might be an ongoing marketing campaign the pharmaceutical company has with that chain.

      • jeffjj on 25/04/2016 - 20:41

        It is confusing- substitution of generic medications generally refers to prescription medications. With Vitamin D, this is not the case. I think it is simply a case of familiarity- as has been mentioned above, Panadol is probably the first brand of Paracetamol which comes into the doctor's mind, so that is probably what he/she recommends. Likewise with Ostelin…any brand of Vitamin D is OK, and the pharmacist is not really "substituting" if he/ she recommends a different brand

    • oztite on 25/04/2016 - 20:22
      -6

      May I ask why you are on ozbargain if you are married to a doc? ;)

      • mooboy on 27/04/2016 - 10:41

        Probably so they can spend their big pharma money wisely!

    • cwongtech on 26/04/2016 - 04:12
      +1
      1. For many medicines there are differences between brand-name and generic, even if the nominal content of xxxmg is the same. Firstly, there is a tolerance on the content of the active constituents - name-brand will always be spot-on to just over spec to ensure that correct minimum dosage is achieved, whereas generic are not as tightly controlled and more often a slightly under (though still in tolerance).

      The name-brand one is usually the company with the original R&D that developed the drug. Developing drugs costs a fortune, many tests fail, and the human trials take forever. Generics can use a different method of preparation that may not be the same as the original method of preparation used for the "original"/name-brand drug.
      Medicine (Including generics) with the AUST R XXXXX label mean they have been tested to be within a certain tolerance.
      https://www.tga.gov.au/community-qa/whats-medicine-label

      Usually if I buy generics, I check who the manufacturer is. There are cases of the SAME company producing generics of their own product.
      Antroquoril is the generic of Celestone M, a steroid cream for eczema, have a look at the ingredients, exactly the same.

      http://www.mydr.com.au/medicines/cmis/antroquoril
      http://www.mydr.com.au/medicines/cmis/celestone-m-cream-and-…

      but in addition the government pays them a bonus each time they sell a generic instead of name-brand!

      Not aware of this happening - my partner is a pharmacist. However if you are able to obtain something called an "Authority Script" where the doctor has to call up PBS to get a script for large quantities of a certain medicine, the amount you pay will be a fixed $38.30, and where there is a generic of a drug, that is the price for the generic. If you want to go for the name-brand one, you'll have to pay more. Be happy that you even got an Authority Script that's reduced the cost for you by PBS (Govt subsidy for your medicines, paid by Medicare).
      People in America don't have this and some reddit users resort to Amoxycilin from their Vet (for animals) because of the sky-high prices over there.

      https://www.reddit.com/r/pharmacy/comments/3lhphz/people_tak…

      The pharmacist is affecting their personal profit margin by the "advice" they give you… I know who I'd trust!

      This part is true, generics have a lower cost from the distributor/supplier, although chemically speaking, if the active ingredients are the same, then it should be fine regardless of the fillers unless you have a reaction to them (not common).

    • Oliver on 26/04/2016 - 09:58
      +11

      As a pharmacist I'd like to pull you up on a few points that I think you have unintentionally misunderstood and mis-explained.

      1. Generics and original brands both have the same small percent tolerance/error margin that is acceptable when testing their batches. For example a medication with 100mg of active ingredient could have an error margin of approx 2% so the tablet could have anywhere between 98-102mg of active ingredient in it. This is true for both generics and original brands alike. Generics ARE as tightly controlled as the original brand.

      2. People often think that the excipients (fillers) are these big spooky evil ingredients. Really they're typically inert (unreactive) plain old boring ingredients that give the drug enough mass to bind into a visible, tangible tablet to swallow. Ingredients like lactose make up the bulk of each tablet. They are plain old basic things that you could somewhat equate to the flour of a chocolate cake.
        The majority of reactions people have to medications are to the active ingredient (the medicine) itself. Not the excipients. Still, most generic companies try to remove non-essential fillers such as colours etc from their brand of the medicine. Their intention is that the fewer ingredients in the tablet, the less chance of having a reaction to one.

      3. You didn't distinguish between employee pharmacists and pharmacists who own (but rarely work in) the pharmacies. Employee pharmacists don't get any kick backs or incentives either. Never have and never will. Doctors used to get paid vacations to "learn" about new drugs coming out.
        The number one rule of being a pharmacist is that the patient's interests come first - before your own job or the financial viability of the pharmacy.

    • rolypoly on 27/04/2016 - 00:03
      +3
      1. For many medicines there are differences between brand-name and generic, even if the nominal content of xxxmg is the same. Firstly, there is a tolerance on the content of the active constituents - name-brand will always be spot-on to just over spec to ensure that correct minimum dosage is achieved, whereas generic are not as tightly controlled and more often a slightly under (though still in tolerance). Secondly, the other contents of the medicine (additives and fillers) are often different. Name-brand drugs can often have other, not mentioned, additives to help with absorption or improve effectiveness. Others have different fillers that may cause reactions or side-effects in SOME people. I know that when my wife prescribes, she will explain to her patients if she thinks a generic is fine or if she has a specific reason for deliberately choosing one brand over another - they are not always the same thing, even between name-brand products.

      Name brand being alway spot on is plain wrong. There is no incentive. No one cares and no one checks to see who is closer. If paracetamol 1000 mg is the recommended dosage for anyone over 12 with no contraindications or interactions and that works for a 45kg teenager and a 100kg adult then the differences in SD are practically negligible. SD matters if the TI is low which leads to the next point…

      Being just over is a negative trait. The mean should be the specified dosage. Your spouse should know about TD50, LD50 and TI.

      Having additives that help with absorbtion or improve effectiveness over other medications makes them un-substitutable and hiding it is even worse. The point of brand substitution is to substitute with a something whose efficacy (and toxicity) is the same. Excipients, binders, preservatives, etc are meant to be inactive.

      Some inactive ingredients can cause reactions but there is no distinction between brand name medicines having fewer reaction than generics for the general population. If you have a paper that shows that I would really like to see it.

      These are very simple concepts. I'm almost certain if you check with your wife she will say you have misrepresented her.

    • abh_gup on 27/04/2016 - 22:47

      TLDR:
      inter-alia… and that's why I go for generic.
      generic medicine is cheaper for patients generally, for the same use(s).

  • Emli on 24/04/2016 - 10:06
    +3

    Absolutely agree Gwait1.
    I have recently had pneumonia. The doctor prescribed brand A which was changed to s generic brand by the pharmacist. When first taking it, it made you feel nauseous and took a while to recover from each dose. When I went back to the doctor, he gave me the same prescription again but insisted I tell the pharmacist no brand substitution as the brand recommended gave the pharmacist a lower profit margin and for me was a lot better as it was a slow release and did not make me I'll for three hrs after taking it.

    I went to the pharmacist and said I wanted the brand prescribed, he asked why and then said he was not sure if he had it. He then remembered he had it. The tablets were much better for me and did not make me feel worse than I already was.

    Ask your doctor if the brand substitution will work the same for you with any side effects.

    • StewBalls on 24/04/2016 - 10:20
      +5

      This is a very salient point. For some people, some classes of drugs cannot be successfully exchanged for generics.

      Often, it's not so much the primary active constituent in the generics that cause the issue, it can very much be the difference with the inactive or secondary excipients in the formulation that may cause a problem.

    • ascorbic on 26/04/2016 - 00:36
      +2

      That's very interesting, do you mind me asking which class of drug that was (completely fine if you'd rather not, I'm just wondering because I'm a pharmacy student)? Was the generic in the same form, route, dose and strength as the brand you later bought? For most drugs, the brand name and generic would have the same effect because the TGA (Therapeutic Goods Administration) only allows generics that are bioequivalent to the existing medicine to be sold in Australia. They also have to meet the same Australian standards for quality, safety and effectiveness.

      For some drugs, as StewBalls pointed out, the excipients can make a difference but this mainly applies to drugs with a narrow therapeutic index like statins. What usually matters though is switching from brand to generic or generic to brand once a suitable dose has been established.

      Side note, that doctor should have marked the "Brand substitution not permitted" box on the prescription instead of telling you to pass on the message to the pharmacist.

      • Emli on 26/04/2016 - 00:48

        Ascorbic, from memory and excuse the spelling, the initial prescription was doxycycline at double dose. This is the one that gives an instant "hit". The next one was Doryx and was the slow release tablet also at double strength. By double strength, I mean taking it twice a day as per normal instead of once a day.

        I can normally handle antibiotics for sinus infections but these ones really knocked me around (but it was pneumonia also). Yes, I know the particular box on the script. The second time it was definitely ticked but I also insisted, especially when the pharmacist said ,oh did the doctor say to only ask for this particular brand.

        • ascorbic on 26/04/2016 - 22:36

          I'm guessing it was a matter of higher blood concentration causing adverse effects. The brand would have probably caused similar effects in the standard non-controlled release form and vice versa for the generic. Maybe it could have been intolerance to one of the excipients used specifically in the generic but nausea is a common side effect of tetracyclines so it was probably just an amplified effect from a higher bloodstream concentration of doxycycline.

        • charzy on 27/04/2016 - 14:14

          @ascorbic:
          Ex-pharmacist here
          The Doryx brand are slow release pellets in capsules.
          Other Doxycycline branded generics can range from the same company (if made by mayne-pharm, they will be the exact same formulation as Doryx) or by other companies (normally hard-coated film tablets).
          I would expect the pharmacokinetics for the two formulations (if the generic is non mayne-pharm) to be different. Bioavailability 'should' be the same as they are subsitutable, but they don't test bioequivalence in human subjects, only machine controlled trials.

        • ascorbic on 27/04/2016 - 17:38

          @charzy: I wasn't aware that bioequivalence testing not performed on humans would be acceptable. I can't seem to find what you mean by machine controlled trials but how do these indicate bioavailability in vivo?

        • charzy on 27/04/2016 - 20:46

          @ascorbic:

          Learnt it in uni 3rd year, pharmacokinetics, before USYD introduced the new syllabus
          Our labs had the actual testing station where a cylinder full of fluid is meant to simulate the human physiology. There's a device inside that gyrates the fluid around to mimic peristalsis, and that's how they're meant to perform the tests to show break down is the same.

          Clearly our government isn't too strict about how absorption can vary; they want to save money in the end with generics.

  • JIMB0 on 24/04/2016 - 10:41
    -3

    I can't believe no one has suggested making your own vitamin D. Just go outside and get some free sun onto your skin, this is OzBargain after all.

    • StewBalls on 24/04/2016 - 10:56
      +1

      They did, 12 hours before you…this might work for some folks; unfortunately, just increasing safe exposure to the sun doesn't always do enough for everybody, many will need to address issues with their diet, and even then some others with malabsorbtive disorders may still require supplementation.

    • Diji1 on 24/04/2016 - 11:16

      You don't think the doctor realises this?

    • try2bhelpful on 24/04/2016 - 11:41
      +3

      You obviously haven't spent much time in Melbourne in the dead of winter.

      The problem is trying to get a balance between enough sun and skin cancer exposure. I have very low Vitamin D and I have also had a melanoma removed. A do the dance as well as I can, but I take the Vitamin D just to make sure.

      • JIMB0 on 27/04/2016 - 22:09

        I live in Melbourne. There is ample sunlight in the winter months, although for most people it would occur when they are at work. You don't need to spend long in the sun, certainly not enough time to get burnt.

        • try2bhelpful on 29/04/2016 - 07:14

          I get out and go for a walk, but even in high summer, and with taking the Vitamin D tablets, I still have consistently low to very low readings.

    • howsthat on 24/04/2016 - 21:15
      +1

      Great idea, but, doesn't work for everyone. I had an extremely low Vitamin D about 5 years ago, couldn't understand why as I spend half my time outside. My doctor prescribed Ostelin brand, back than, I didn't ask too many questions, but was told it was the best Vitamin D supplement. After being on them for over 12 months my Vitamin D levels were up to a normal level. Anyway to cut a long story short, in my case, I was diagnosed with Rheumatoid Arthritis about 12 or so months later. For me, my low Vitamin D level was one of my earliest signs of Rheumatoid Arthritis/disease. In amongst my constant blood tests, my Vitamin D level is monitored. Thankfully it has stayed up by it's self for a bit over 2 years now. My dietitian told me that in India you can get a Vitamin D injection, don't know if it is available in Australia yet!

      All the best to op, hope your levels pick back up.

      • jzdhgkd on 25/04/2016 - 16:33

        Afaik they're not bringing injectable vitamin d to Australia. Don't know why.

        It's been available overseas for like a decade now and is equivalent to taking like 500 tablets of vitamin d or something ridiculous like that.

        You can actually do something similar yourself and take higher doses over a longer period of time. Usually what's recommended is 50,000iu (yes fifty tablets) once/month.

        Source: http://www.ncbi.nlm.nih.gov/pubmed/18544622

        • fruit on 26/04/2016 - 15:33
          +2

          You can, I know an endocrinologist in NSW that does the micronised D3 injections.

    • Pratty on 25/04/2016 - 19:44

      Some people can't synthesise Vitamin D no matter how much they stand in the sun, JIMB0. :)

    • fruit on 26/04/2016 - 15:30

      I've been low my whole life before I started taking 2000IUs… and I'm tanned like crazy.

  • His_Holiness on 25/04/2016 - 14:21

    Doctors often just write the common brand name on the prescription. Like if they were to prescribe paracetamol, they'd simply write 'Panadol'. There's no conspiracy here. You've just got to ask for the generic version from the pharmacy.

  • [Deactivated] on 25/04/2016 - 15:02
    +6

    If your doctor start prescribing homoeopathy then you should start to worry.

      • bobkin on 25/04/2016 - 23:57
        +7

        https://www.nhmrc.gov.au/_files_nhmrc/publications/attachmen…

        Summary: "Based on the assessment of the evidence of effectiveness of homeopathy, NHMRC concludes that there are no health conditions for which there is reliable evidence that homeopathy is effective."

        Homeopathic remedies, by their very nature, are essentially water. There is no plausible mechanism (other than placebo) through which they can work.

        • amsaini15 on 26/04/2016 - 08:00
          -5

          All those haters, have you tried homeopathy ever? If yes and it did not work, you have point.
          But if you are negging only because a document says, good luck having Allopathic with side-effects for common problems.
          Reading these papers without trying yourself is like believing:
          Donald Trump is actually going to build the wall and recover money from Mexico.
          Pakistan is a responsible nuclear state,
          US does not have a agenda in de-stabilizing middle east, etc ,etc

          I am writing this because I have not read a document but because homeopathy works for me and million others in UK, France, Germany, India. It is safe and less intrusive.

          PM me with your symptoms when you have common issue and I will suggest you the homeopathy medicine. One things you all agree is that it does not have any side-effect. So give it a go. But I guess we have got so used to sit at GP knowing he would give anti-biotic without even looking at you that we are afraid to believe other treatments which works.

        • [Deactivated] on 26/04/2016 - 08:50
          +4

          @amsaini15:

          Embarrassingly incoherent response.

        • scupper on 26/04/2016 - 09:14
          +5

          @amsaini15: the basis of the "hate" is because the science doesn't support it. Is there a peer-reviewed scientific paper that corroborates the results that homeopathy declares? The core premise of homeopathy already defy what we know in chemistry. Believe me, big pharma would sell water if they knew it works, and they have the funds to do a proper field trial.

        • stealthpaw on 26/04/2016 - 11:08

          @amsaini15:
          Enjoy your sugar water amsaini15 - just don't recommend it to anyone else, they don't need or want it.

        • May4th on 27/04/2016 - 20:26
          +2

          @amsaini15:

          by that logic i can tell you that there's absolutely no harm in jumping off a 10 storey building and you'd have to do it to prove me wrong

          and to keep things interesting let's be open minded. say i'm a 67 year old morbidly obese smoker who suffers from type 2 diabetes. since this afternoon i've been having this terrible pain in the chest and am sweating like a pig. what homeopathy treatment would you suggest?

      • mooboy on 26/04/2016 - 12:24
        +1

        Who takes any medicine for just cold or runny nose? You should give your body credit for fixing you up, not some water…. sorry, homepathic medicine.

        https://www.youtube.com/watch?v=HMGIbOGu8q0

        "OK, so you kill the odd patient with cancer or heart disease, or bronchitis, flu, chickenpox or measles; but when someone comes in with a vague sense of unease; or a touch of the nerves or even just more money than sense; we'll be there for them. A bottle of basically just water in one hand, and a huge invoice in the other."

        • salbee28 on 26/04/2016 - 14:55
          +5

          Especially taking antibiotics for a cold or a runny nose, that's just stupid. Colds & Flu's are caused by viruses, not bacterial infections - which is what antibiotics are used to treat.

          Antibiotics are not effective against Viruses, which is why doctors won't usually prescribe them for Colds/Flu's. A lot of doctors are also trying to prescribe antibiotics less & less to try to reduce antibiotic resistance.

    • scupper on 26/04/2016 - 08:54

      Or if you get prescribed antibiotics as placebo.

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