The below is submitted as a letter to the editor for publication regarding the 12/19/09 /New York Times/ article “Not All Drugs Are the Same After All” by Lesley Alderman. You may edit as necessary.
Regarding /The New York Times/ article “Not All Drugs Are the Same After All” 12/19/09 by Lesley Alderman: the necessity to use generic medication first should be tempered by whether generic versus non-generic is safer or even more economical: e.g., the most effective of the generic statin medications for treating high cholesterol is simvastatin (generic Zocor). If the goal is to achieve the most heart protective level of cholesterol, the non-generics Lipitor or Crestor are documented to be more effective, have fewer drug-drug interactions, and can be used in lower & more economical doses than the required generic. States and payers are resistant to the logic that would permit Lipitor or Crestor as as a first choice without burdensome economic penalty or appeal process. That generics-first policy has also recently been documented to result in more frequent adverse reactions with simvastatin due to its metabolic pathway than Lipitor or Crestor, medical encounters including calls to payers or doctors, as well as more heart disease. A more reasoned and readily available approach is to listen to experienced practicing physicians before finalizing policies.
H Robert Silverstein, MD
J T Guy, MD
Preventive Medicine Center
1000 Asylum Ave # 2109
Hartford CT 06105
860-549-3444