The turbulent history of generic pharmaceuticals raises powerful
questions about similarity and difference in modern medicine.
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.
