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.
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