Generic: The Unbranding of Modern Medicine

by Jeremy A. Greene

Generic drugs are now familiar objects in clinics, drugstores, and households around the world. We like to think of these tablets, capsules, patches, and ointments as interchangeable with their brand-name counterparts: why pay more for the same? And yet they are not quite the same. They differ in price, in place of origin, in color, shape, and size, in the dyes, binders, fillers, and coatings used, and in a host of other ways. Claims of generic equivalence, as physician-historian Jeremy Greene reveals in this gripping narrative, are never based on being identical to the original drug in all respects, but in being the same in all ways that matter.

How do we know what parts of a pill really matter? Decisions about which differences are significant and which are trivial in the world of therapeutics are not resolved by simple chemical or biological assays alone. As Greene reveals in this fascinating account, questions of therapeutic similarity and difference are also always questions of pharmacology and physiology, of economics and politics, of morality and belief.

Generic is the first book to chronicle the social, political, and cultural history of generic drugs in America. It narrates the evolution of the generic drug industry from a set of mid-twentieth-century "schlock houses" and "counterfeiters" into an agile and surprisingly powerful set of multinational corporations in the early twenty-first century.

The substitution of bioequivalent generic drugs for more expensive brand-name products is a rare success story in a field of failed attempts to deliver equivalent value in health care for a lower price. Greene’s history sheds light on the controversies shadowing the success of generics: problems with the generalizability of medical knowledge, the fragile role of science in public policy, and the increasing role of industry, marketing, and consumer logics in late-twentieth-century and early twenty-first century health care.

Genres: Nonfiction, History Of Medicine, Medicine, Health Care, Science, Health, Business

369 pages, Kindle Edition

First published November 1, 2014

Reviews

[Katie · Rating 3 out of 5]

This book is from John Hopkins University Press so I expected it to be on the academic side, but I was still disappointed by the somewhat theoretical digressions about the nature of "sameness". I also would have liked to see more focus on the specific people involved in the history of the generic, because I find that the people stories are often the most interesting part of microhistories. However, almost in spite of itself, this was a very interesting book. The history of generics is fascinating and the fact that generics only have to show "sameness", rather than undergoing clinical trials is something I think more people should be aware of. The forces that shaped the rise of the generic in America were sometimes surprising and always intriguing. They also offered an interesting perspective on American culture in the 19th century.
Despite the academic asides, this book is mostly accessible to a general audience. The author occasionally introduces chemistry terms without defining them, but most could probably be skipped without losing the author's point and they don't occur enough to make the amount of googling which might be required annoying. I wouldn't recommend this to everyone, because it can be dry and is often wordy, but if you're interested in the subject as I was, I think it could still be a worthwhile and enjoyable read.
This review was originally posted on Doing Dewey.

[Saima Iqbal · Rating 4 out of 5]

(3.75.) quite a comprehensive and nuanced look into the origins of something we might give little thought: generic drugs. understanding how contentious they were makes me feel amazed we have them at all — and in the ways we do.

the book is cleanly written and easy to read, given its shortish chapters, subsections, and ending transitions. a bit jargony but not so bad given the subject, and sometimes came w flashes of personality. i like the permissive quoting bc it gave the feel of digging through the archive with the author. my main critiques would prob be that the author doesn’t weigh in on which sides of a contentious debate we should trust (perhaps these debates are too complex) and his ending chapter felt too abstract to mean anything

[Manu Kanchan · Rating 4 out of 5]

A good book on the history of generic drugs in US.

[Carlos Liu · Rating 3 out of 5]

Too little development in the EBM (evidence-based medicine) and HTA (Healthcare Technology Assessment) era.

[victor harris · Rating 2 out of 5]

Some of the history in how generic drugs evolved into their present dominance is interesting. It is very plodding reading with a great deal of technical discussion and unmanageable clutter of names and acronyms. More of a textbook than a general public style book.