If you were to compare the ingredient lists on the leading brand of ketchup and a store-brand version, you'd likely find little or no difference. According to the label, the two products are virtually identical. Yet many people (including me) have a strong preference for the brand-name product and may even go with no condiment rather than use the imitation. If you're not one of us, you know someone who is.
So why, when it comes to prescription drugs, does the general public not seem to understand that a brand name formulation and its generic are not identical? Sometimes, they're close, but they're never the exact same thing. Vehicles Matter, the supplement to this issue of Practical Dermatology, takes an in-depth look at the formulation development process and FDA approval requirements in order to help clinicians—and in turn their patients, local pharmacists, and even insurance industry executives—better understand the distinctions between a branded formulation and its so-called therapeutic equivalent. Copies of this supplement are being distributed to physicians in other specialties and the content will be posted online at VehiclesMatter.com in order to increase access and optimize the educational value for clinicians and pharmacists.
Patient education is an important element of care, and dermatology care providers must do all they can to help patients be active in their own treatment. There's plenty of misinformation in the general public. Couple that with pharmacies' strong collective advocacy of and significant discounts on generics, and you can see why patients often consent to substitutions. To be fair, generics are not all bad, and they can be especially useful when a patient faces financial hardships. But treatment decisions are best made by the treating physician on a case-by-case basis. Some sub-par generics, reported to produce burning, erythema, and other signs of cutaneous inflammation, aren't a value at any price.
And then, of course, there's the issue of inappropriate substitution and dispensing errors, for which patients must be particularly vigilant. If they can look for a brand name, they can assure they have received the drug you prescribed. If not, there's no telling what they received. If I didn't edit Practical Dermatology, I would not have known that the generic “corticosteroid” I received a few years ago shouldn't have had “-azole” in its name. Patients who are educated and empowered can take a more active role in their treatment. They may even be more compliant, more likely to follow-up as directed, and more likely to follow advice for general skincare and long-term prevention.