William Shakespeare once wrote that “A rose by any other name is still a rose.” And in the pharmaceutical world it is a common occurrence to see that the same medicine can be called by different names. This can prove to be confusing.
Many medicines have two names. The first is the scientific name to the medicine itself – an expert committee decides the generic or common name for it, named for the active ingredient itself. For example, erectile dysfunction is treated by a medicine containing sildenafil, which is a generic name.
The same medicine also has a second name, the brand name. For example, sildenafil is more commonly known by its brand name, Viagra. Pfizer, the company that produces it, has chosen to market it under this name because brand names are more memorable than scientific names, especially at the onset when new products have just been launched. Can you imagine someone going to the pharmacist and asking for the “Silder .. silver … cyber … you know, the thing that gives more bounce and keeps going for longer?”
“Red Bull? Duracell?”
You get the idea.
The company that produces a new medical product is usually granted a patent. This patent grants the company exclusive rights to the product for a standard period usually of twenty years, and allows the company to recoup the investment spent on the development on the drug as well as to financially benefit from sales during the patent period.
While twenty years may seem like an extraordinary amount of time, it is actually not so. Most companies apply for the patent at the initial stages at development, to avoid the situation of being trumped by another company after they have done a few years of research. Imagine you have done five years of research and when you are about to proceed further, someone has applied for a patent for a product that effectively nullifies the work you have done. Or what is worse, they may even draw on your research from various medical publications to further the development of their own product. The time you have spent has been wasted and your intellectual property has been stolen.
The first ten to fifteen years of a patent are hence a covering period for the research into it and to cover the licensing process while the remaining period is the time the company has to solely market the product using as brand name, so that it becomes memorable and commandeers a huge market share after the patent period has expired.
Once the patent protection expires, other companies can produce their own version of the medicine. Hence, pharmaceutical companies are always engaged in a race against time. They have a twenty-year period to research, license, market and profit from their product before the other sharks enter the fray, so to speak.
Take for example, ibuprofen, the medicine commonly used to treat pain and inflammation. There are many branded versions of ibuprofen, such as Nurofen and Hedex. Various supermaket chains distribute their own versions as well, but under the common scientific name. You have Tesco’s ibuprofen or Superdrug’s ibuprofen. We can assume that once a product (such as Neurofen) reaches the mass market, and has been quoted enough times as to “contain ibuprofen”, the scientific name itself becomes somewhat of a brand in its own right.
Having various versions of the same medicine is confusing, but depending on our loyalty we may opt for Neurofen because it is the established brand we know. This of course depends on how it has been marketed; if the pharmaceutical company has done enough advertising to convince us that “Neurofen”, and not “Ibuprofen” is the key to pain-relief, then by association we may go for Neurofen whenever we have a headache. If cost is a more significant factor than loyalty, then we might go for the generic medicines because they are usually cheaper – they have had fewer research and development costs, but they contain the same active ingredient as the branded products.
In some cases latter companies may have simply waited for the patent to lapse, before moving in to reverse-engineer their own version of the product and market it. This is especially true for products that people will always have a need for, such as products offering relief from pain, flu, or colds; or balms of various descriptions.
Generic medicines go through the same detailed safety and quality requirements as the original branded product, but because the significant outlay of research costs have been avoided (the initial company has done the hard work) the latter products are cheaper.
Supermarket chains are already flooded with many versions of the same product. Look at your supermarket chain – how many brands of ibuprofen do they stock? This begs the question of whether chains will eventually simply stick with the products with a big market share (and hence likelihood of sale), stock more cheaper options, or even offer cheaper, newer brands. It is likely that they will do a combination of the first two. New and cheaper brands will find it hard to penetrate the market based on cost alone, as the cost of advertising is too huge. The only way they can hold on to a significant market share is if one of the bigger brands declines, perhaps through negative publicity, and one of the new brands promotes itself by aligning itself with a social cause.
Imagine, for example, there is a medicine called Increasil (scientific name) produced under the brand name Livealongerlife by parent company Healthpharm. Liveralongerlife claims to prolong the life of the terminally-ill and extend their high-functioning years by delaying the onset of infections. After it has been doing well for a few years, towards the end of its patent, it is discovered that Healthpharm conducted unethical drug trials – they tested liquid versions of Increasil by injecting them into corpses to see if it would slow the rate of decay.
Amidst the media storm, the company Fitness21 prepares to produce its own version of Increasil under the brand name Newtrition. They reverse-engineer batches of Increasil, and benefit from the research Healthpharm had previously done. As part of its submission evidence into the safety of Increasil, Fitness21 conducts trials on aging volunteers to see if they experience any increased life expectancy. The evidence gathered by Fitness 21, and also the perceived benefit of Increasil (while it was sold by Healthpharm), contributes to Fitness21 gaining a license to market Increasil in the form of Newtrition.
Fitness21 builds its factories in the impoverished third-world town of Valhalla, promising to regenerate the area. The people of the town benefit from employment, and Fitness21 sells Newtrition to its own employees at a vastly discounted rate, announcing that it hopes to raise the life expectancy of Valhalla from 50 to 75 within two decades, and in doing so, allowing the citizens to have a longer working life and more wealth, with the aim of lifting the town out of its doldrums. Future generations will benefit and the children and grandchildren of those now of working age will have very different futures from their forefathers. Fitness21 announces that its employees are like family, and it has an interest both in elevating their working and life conditions, and the fact that it is distributing Newtrition to its own employees means it has an obligation in ensuring the product itself is of the highest quality. Fitness21 is strongly interwoven and ingrained in the social fabric from which Newtrition is produced.
Whose version of Increasil would you buy? Probably the latter’s. And that is probably the only way for unestablished brands to forge through a packed market, by leveraging on social and ethical links. We have seen various products – not just medicines – marketed using that angle. Do the words Fairtrade and Co-Op sound familiar?
Prescribers (people who prescribe medicines, such as GPs) are encouraged to prescribe medicines by their generic name, not only because it is ethically right to prescribe the medicine costing less if the results are similar – and generic brands can cost significantly less – but also because it gives the pharmacist the widest choice of products to dispense, which can be important, particularly if there is a shortage of a particular product.
If you are switched from a particular brand to a generic, it is standard practice for your pharmacist to explain the changes to you, in terms of side effects, and to address any concerns you may have. In fact, this is not just if you switch brands – whenever you have changes in medication you should always speak to your pharmacist.
Only in rare cases it is important for a patient to stay on the branded medicine previously prescribed for them, rather than changing to a generic medicine. This is usually because of the way the medicine acts on the body.
Some examples of when you should keep taking your brand of prescribed medicine include:
Epilepsy medicines – these should be treated with care because different versions may have slight differences in the way they are absorbed, which can cause big differences in their effect. For example, prescribers may decide the branded version of lamotrigine (Lamictal) is more suitable than the generic version.
Modified-release preparations of medicines – such as modified-release versions of theophylline, nifedipine, diltiazem and verapamil. A branded version may sometimes be a better option than the generic equivalent, as they can be absorbed differently, and suited differently to various individuals.
Biological medicines – these complex medicines are derived from proteins and other substances produced by the body. Copies of biological medicines, called biosimilars, can never be exactly the same so shouldn’t be automatically used as substitutes. Doctors should always reference the brand name so the manufacturer and batch could be identified if there were any problems with the medicine.
Ciclosporin – a medicine that suppresses the immune system (the body’s natural defence system). Different branded versions may cause different levels of ciclosporin in your blood.
Mesalazine – which is used to treat ulcerative colitis (a long-term condition that affects the colon). The way that mesalazine is absorbed varies between different brands.
Lithium – this treats a number of mental health conditions. Different brands vary widely in terms of how much of the medicine is absorbed and becomes active.
Beclometasone dipropionate CFC-free inhalers to treat asthma – there are two inhalers that contain the same active substance (beclometasone dipropionate), but one is much stronger.