Earlier this week, we covered the difference between brand named and generic drugs. To be honest, we taped that episode a few weeks ago. It takes us some time to work our magic, add graphics, and wind up with the Healthcare Triage you know and love. But last week, Healthcare Triage intern and pharmacologic expert Rachel Hoffman emailed me about a new study on brand versus generic labeling and its effects on how well drugs work. It was too late to get it into Monday's episode, but not too late to discuss it here. This is Healthcare Triage News.

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The journal: Health Psychology. The paper: Impact of Brand or Generic Labeling on Medication Effectiveness and Side Effects. We've discussed the placebo effect in previous episodes. All clinical effects that we see are part biologic and part belief, and it's that latter part that's the placebo effect. Some people believe that when something has a brand name, either the company or the drug, they have extra reassurance that the drug is safe and effective. But what we don't know for sure is the magnitude of that effect. Does it matter?

This study looked at 87 undergraduate students who said that they had frequent headaches. Over the course of the study, all of them took tablets that were either labelled as brand named "Nurofen" or as "Generic Ibuprofen". They were given them in a random, but balanced, order to treat four different headaches.

An added trick, though, was that half of the drugs were placebos. No active ingredients at all. The other half were generic ibuprofen.  So the four options that they each got were:
1) generic ibuprofen labelled "Nurofen"
2) generic ibuprofen labelled "Generic Ibuprofen"
3) placebo labelled "Nurofen" or
4) placebo labelled "Generic Ibuprofen"

For each of the pills, they recorded their headache pain before taking them, and then again one hour later. They also recorded any side effects they felt.

If we ignore the labelling, then the actual ibuprofen tablets reduced pain more than placebos, and that's good, 'cause otherwise we'd be wasting tons of money on those pills in general.

But when people took the placebos, they found that the ones labelled with a brand name worked significantly better than those labelled as generic. It also turned out that when people took placebos, their side effects differed. When taking the brand name placebo, patients reported significantly fewer side effects than when they took the generic placebo.

This study doesn't mean that we should start giving all generics fake brand names, but it does tell us something important about the way people view generics. They don't seem to trust them as much. They don't think that generic drugs work as well. They also seem to think they may have more side effects. As we discussed on Monday, there's no real reason to believe that's the case. But if people don't believe what we or the data say, then the placebo effect components might wind up making a pretty big difference anyway.

We need to improve the perceptions of generics. That might improve treatment outcomes, both in terms of desired outcomes and undesired side effects. It also might help reduce healthcare spending. Hopefully Healthcare Triage helps.

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