4 ms·

I'll never forget a coworker telling me that in a previous job hunting round he had interviewed with a pharmaceutical group that was tracking the manufacturing

I'll never forget a coworker telling me that in a previous job hunting round he had interviewed with a pharmaceutical group that was tracking the manufacturing process for batches of drugs and comparing the little tolerance mistakes (heated a little too high or held at temp a little too long or not quite long enough) and finding a market where they can sell that batch. You'd like to think that companies have factories with quality control laws and there are local people trying to ensure that all of their product are up to the local standards. What you don't expect is that they are binning them like Intel CPUs, where they just make a batch and hope for the best, take cream off the top until the priority orders are done and then everyone else gets whatever is left. You might get a slightly better product sometimes but not be so lucky the next time.

xdfgh1112 1y ago
Does that mean that generics really are worse than the brand pharmaceuticals. Or are they binned the same way? In the UK I know the NHS buys generics, which implies they are effective, but I wonder.
- Retric 1y ago
  Generally it’s different companies manufacturing generics. Instead this mostly comes down to how effective each countries regulations are.
  - hinkley 1y ago
    This is also my understanding, but perhaps I am meant to understand that to be the case.
- throwawaysleep 1y ago
  Generics tends to be different companies altogether.
- lmpdev 1y ago
  Generics lack the ownership of the intellectual property, but that’s about it Generics are effective
- nick__m 1y ago
  here in Canada the active ingredient must be identical in identical quantity but the binding agents, excipient, and propellant are proprietary. The generics have to have the same bioavailability +-20%.In some drugs it doesn't matter, in others there is a world of difference. I pay the 2$ it cost for brand name ventolin (my insurance cover the cost generic and I pay the difference) as the generic give asthma attack. But I would not pay one cent more for the brand name Vyvaanse. Effect wise the generic is indistinguishable (but damm the pills colors make them looks like a cheap gray market knock-off). My wife has a paper from her oncologist for original femara because the generic made her faint a few times ( the insurance cover the whole cost because of that paper)
  - vladvasiliu 1y ago
    As a layman who fortunately has never had to deal with any "serious" medicine, how would I know which drug is good-enough is generic form, and which should be the brand name? To someone not in the know, +/-20% bioavailability sounds like a lot. Hopefully, the doctor will account for that when prescribing it, and know which way the 20% goes. You also make it sound like 2$ isn't much to go from the generic to brand-name Ventolin. How much is too much? And is there a difference between generics of the same drug (I assume multiple manufacturers can actually produce generics) and how do you know which is better?
    - matthewdgreen 1y ago
      It’s a huge amount. I have a seizure disorder and I have to carefully increase my dosage by as much as 50% to compensate for the difference between generics and brand-name. The 20% is an average: one of the big differences between the two is absorption before/after you’ve eaten, so taking the medicine on an even slightly full stomach dramatically reduces absorption. The brand-name manufacturer now charges $300/mo for an off-patent drug you can buy generic for less than $25 (without insurance) which illustrates their view of the perceived value.
    - johnisgood 1y ago
      > the doctor will account for that when prescribing it Sadly they do not. I got prescribed 12.5 mg tianeptine to take three times a day, except that amount is minuscule for my brain & body. You would think they take into account that I have fast metabolism, have many brain lesions, and so forth, but no, they do not, and there are no legal frameworks either to do so. They would have to account for these lesions in my brain for many reasons, but they do not.
- Perenti 1y ago
  In my experience as a medically complicated person, generics generally work, but may have different side effects, both in scale and style. One of the worst was a duloxetine generic that came on so hard and strong that I felt serontoninised. My friend the John the Pharmacist explained that the binders etc can accelerate absorption. His advice was be careful the first two days of a new generic formulation. I would assume the NHS (like the TGA here in Oz) looks _very_ carefully at the side-affect profile before they buy any particular generic. Government agencies tend to try not to poison voters.
  - johnisgood 1y ago
    I take dimethyl-fumarate, which is a serious medication for MS, but sadly ever since "Tecfidera" got withdrawn for some reason, I can only get a "shittier" generic. That said, side-effect profile appears to be the same, thankfully. All in all, I think they are "almost" identical, if not identical.
  - hinkley 1y ago
    I’ve had decent luck with slow release generics, but they go out of their way to make SR generics take a quarter of a human lifetime to come out after the original is available.
- Spooky23 1y ago
  There can be variances. I’ve measured it with my blood pressure a few times when the pharmacy swaps manufacturers.
- johnisgood 1y ago
  Generics are not supposed to be worse. They are supposed to have the exact same active ingredient. The binders or fillers may differ.
- phil21 1y ago
  I have sent in drug samples for testing, in my case they were name brand. Variance per dose is about plus/minus 15% across the board. You might get 9mg one day, and 11.5mg another for a drug with a nominal 10mg label. Injectables are typically better than oral tablets it seems but not by a lot. Purity was pretty good though, it was mostly a dosing variance I saw.
speff 1y ago
Is this system not preferable over just trashing anything not perfectly made? Sure it would be nice if everyone can have perfectly manufactured medicine, but that's not reality. I would think something that's still likely good is still better than nothing.
- colechristensen 1y ago
  There's a difference between a few percent difference in efficacy which is understandably still marketed (the same kind of thing happens when you leave meds on the shelf a while) and meds that are no longer effective at all to a reasonable level or toxic.
- Spooky23 1y ago
  Why should a person in Somalia suffer and die from cancer while a person in Ohio, lives, soley on the basis of where they live?
  - protocolture 1y ago
    Why should they not get access to drugs because the drugs would fail some bogus test made up by an american senator?
    - bilbo0s 1y ago
      More accurate to say they should get access to drugs that contain the actual molecules they are advertised to have across markets. You shouldn't be able to sell what is basically sugar water in Somalia and call it cyclophosphamide. That's fraud if I do it as a private citizen. In fact it's even fraud for me if I buy actual cyclophosphamide, and cut it with a bio compatible totally non reactive filler compound. How are these people getting away with it without the president and senators being on the take? When they'd run you or I down in less than a month for effectively the same act? To be clear, I don't believe you or I should be able to do this. But I know what happens to private citizens who try to do things of this nature. So there is no question that this is a crime. The only question is why is it not prosecuted for larger corporations.
energy123 1y ago
The same thing happens in food processing. The low quality stuff gets sold under a different, cheaper brand, or reprocessed into another product. I'm not going to cast stones at this practice because as always the alternative isn't some magical world where all produce is perfect, the real alternative is that it gets thrown in the trash and wasted, and everyone is worse off despite feeling better about themselves.
- SeriousM 1y ago
  Happy to live in a country with very strong food control. Yes we have the alternative labels yet it must be at least as good as the original.
  - energy123 1y ago
    I want more good regulations, and less bad regulations, so I am not necessarily against anything you said here.
  - yorwba 1y ago
    They only need to be as good as the minimum standard for the category they're sold in. If you have a "good" bin and a "bad" bin, and the good bin easily exceeds the minimum requirements while the bad bin just barely meets them, that's fine, too. Or the good bin can be sold as class I, while the bad bin needs to be labeled as class II. Of course those categories usually aren't about safety-relevant aspects of quality, but things like weight or shape or appearance.
- throwawayqqq11 1y ago
  A quality increase does not mean "perfection" and so "magical" turns into "more expensive". Id like to live in that world.
- jorvi 1y ago
  The alternate also happens though. Over here in The Netherlands, the milk for all milk products comes out of the same cows and is processed in the same tanks. When you're paying 2x the price for brand name milk, you're getting seriously scammed.
Neil44 1y ago
This anecdote is interesting, but the article cites poor storage and counterfeiting as the main causes of the issue.
- itsdrewmiller 1y ago
  Thanks for this comment - I didn’t read the article and might have taken away a largely incorrect belief based on the parent. And you handled it so politely too!
  - sigmoid10 1y ago
    The comment you replied to also paints an incorrect picture. The real quote from the article regarding the origin of the poor quality is: >[...] Those causes can include faults in the manufacturing process or product decay due to poor storage conditions. But some drugs are also counterfeit, and that increases the risk of discrepancies between what's on the product label and the actual medicine within. So this is actually pretty in line with the top level comment, since no mention of the actual ratio among reasons is made. It certainly doesn't say that counterfeiting and after production storage are the main reasons.
monster_truck 1y ago
If you've taken a prescription over a long enough time you'll know this to be true even if you've never really considered it. Some time ago I was very frustrated with the massive swings in how well a prescription was working so I started looking into it. Saved a pill from every month, sent 12 of them off for testing. +/- 30% accuracy on that dosage, and that's within spec for the US. Some months your 20mg pills are 26mg. Others? 14mg. Later repeated this test with a family member's blood pressure medication, which has a dosage of just 0.5mg. Same deal, 0.35-0.65
- Hojojo 1y ago
  There are labs where you can just send prescription pills for testing as an end user?
  - nerdsniper 1y ago
    For something like amphetamine, could get it tested at Energy Control lab in Spain. Valisure used to offer this kind of service for most pharmaceuticals in the USA but faced lawsuits and pushback: https://www.bloomberg.com/news/features/2023-12-05/pentagon-is-skeptical-of-cheap-generic-drugs-approved-by-the-fda https://www.bloomberg.com/news/features/2023-12-05/pentagon-... [ https://archive.md/eyWSn https://archive.md/eyWSn ]
- sizzle 1y ago
  Generic amp huh? Thought I was going crazy. Who does name brand? Shire sold to Teva?

xdfgh1112 1y ago

Does that mean that generics really are worse than the brand pharmaceuticals. Or are they binned the same way? In the UK I know the NHS buys generics, which implies they are effective, but I wonder.

Retric 1y ago
Generally it’s different companies manufacturing generics. Instead this mostly comes down to how effective each countries regulations are.
- hinkley 1y ago
  This is also my understanding, but perhaps I am meant to understand that to be the case.
throwawaysleep 1y ago
Generics tends to be different companies altogether.
lmpdev 1y ago
Generics lack the ownership of the intellectual property, but that’s about it Generics are effective
nick__m 1y ago
here in Canada the active ingredient must be identical in identical quantity but the binding agents, excipient, and propellant are proprietary. The generics have to have the same bioavailability +-20%.In some drugs it doesn't matter, in others there is a world of difference. I pay the 2$ it cost for brand name ventolin (my insurance cover the cost generic and I pay the difference) as the generic give asthma attack. But I would not pay one cent more for the brand name Vyvaanse. Effect wise the generic is indistinguishable (but damm the pills colors make them looks like a cheap gray market knock-off). My wife has a paper from her oncologist for original femara because the generic made her faint a few times ( the insurance cover the whole cost because of that paper)
- vladvasiliu 1y ago
  As a layman who fortunately has never had to deal with any "serious" medicine, how would I know which drug is good-enough is generic form, and which should be the brand name? To someone not in the know, +/-20% bioavailability sounds like a lot. Hopefully, the doctor will account for that when prescribing it, and know which way the 20% goes. You also make it sound like 2$ isn't much to go from the generic to brand-name Ventolin. How much is too much? And is there a difference between generics of the same drug (I assume multiple manufacturers can actually produce generics) and how do you know which is better?
  - matthewdgreen 1y ago
    It’s a huge amount. I have a seizure disorder and I have to carefully increase my dosage by as much as 50% to compensate for the difference between generics and brand-name. The 20% is an average: one of the big differences between the two is absorption before/after you’ve eaten, so taking the medicine on an even slightly full stomach dramatically reduces absorption. The brand-name manufacturer now charges $300/mo for an off-patent drug you can buy generic for less than $25 (without insurance) which illustrates their view of the perceived value.
  - johnisgood 1y ago
    > the doctor will account for that when prescribing it Sadly they do not. I got prescribed 12.5 mg tianeptine to take three times a day, except that amount is minuscule for my brain & body. You would think they take into account that I have fast metabolism, have many brain lesions, and so forth, but no, they do not, and there are no legal frameworks either to do so. They would have to account for these lesions in my brain for many reasons, but they do not.
Perenti 1y ago
In my experience as a medically complicated person, generics generally work, but may have different side effects, both in scale and style. One of the worst was a duloxetine generic that came on so hard and strong that I felt serontoninised. My friend the John the Pharmacist explained that the binders etc can accelerate absorption. His advice was be careful the first two days of a new generic formulation. I would assume the NHS (like the TGA here in Oz) looks _very_ carefully at the side-affect profile before they buy any particular generic. Government agencies tend to try not to poison voters.
- johnisgood 1y ago
  I take dimethyl-fumarate, which is a serious medication for MS, but sadly ever since "Tecfidera" got withdrawn for some reason, I can only get a "shittier" generic. That said, side-effect profile appears to be the same, thankfully. All in all, I think they are "almost" identical, if not identical.
- hinkley 1y ago
  I’ve had decent luck with slow release generics, but they go out of their way to make SR generics take a quarter of a human lifetime to come out after the original is available.
Spooky23 1y ago
There can be variances. I’ve measured it with my blood pressure a few times when the pharmacy swaps manufacturers.
johnisgood 1y ago
Generics are not supposed to be worse. They are supposed to have the exact same active ingredient. The binders or fillers may differ.
phil21 1y ago
I have sent in drug samples for testing, in my case they were name brand. Variance per dose is about plus/minus 15% across the board. You might get 9mg one day, and 11.5mg another for a drug with a nominal 10mg label. Injectables are typically better than oral tablets it seems but not by a lot. Purity was pretty good though, it was mostly a dosing variance I saw.

speff 1y ago

Is this system not preferable over just trashing anything not perfectly made? Sure it would be nice if everyone can have perfectly manufactured medicine, but that's not reality. I would think something that's still likely good is still better than nothing.

colechristensen 1y ago
There's a difference between a few percent difference in efficacy which is understandably still marketed (the same kind of thing happens when you leave meds on the shelf a while) and meds that are no longer effective at all to a reasonable level or toxic.
Spooky23 1y ago
Why should a person in Somalia suffer and die from cancer while a person in Ohio, lives, soley on the basis of where they live?
- protocolture 1y ago
  Why should they not get access to drugs because the drugs would fail some bogus test made up by an american senator?
  - bilbo0s 1y ago
    More accurate to say they should get access to drugs that contain the actual molecules they are advertised to have across markets. You shouldn't be able to sell what is basically sugar water in Somalia and call it cyclophosphamide. That's fraud if I do it as a private citizen. In fact it's even fraud for me if I buy actual cyclophosphamide, and cut it with a bio compatible totally non reactive filler compound. How are these people getting away with it without the president and senators being on the take? When they'd run you or I down in less than a month for effectively the same act? To be clear, I don't believe you or I should be able to do this. But I know what happens to private citizens who try to do things of this nature. So there is no question that this is a crime. The only question is why is it not prosecuted for larger corporations.

energy123 1y ago

The same thing happens in food processing. The low quality stuff gets sold under a different, cheaper brand, or reprocessed into another product. I'm not going to cast stones at this practice because as always the alternative isn't some magical world where all produce is perfect, the real alternative is that it gets thrown in the trash and wasted, and everyone is worse off despite feeling better about themselves.

SeriousM 1y ago
Happy to live in a country with very strong food control. Yes we have the alternative labels yet it must be at least as good as the original.
- energy123 1y ago
  I want more good regulations, and less bad regulations, so I am not necessarily against anything you said here.
- yorwba 1y ago
  They only need to be as good as the minimum standard for the category they're sold in. If you have a "good" bin and a "bad" bin, and the good bin easily exceeds the minimum requirements while the bad bin just barely meets them, that's fine, too. Or the good bin can be sold as class I, while the bad bin needs to be labeled as class II. Of course those categories usually aren't about safety-relevant aspects of quality, but things like weight or shape or appearance.
throwawayqqq11 1y ago
A quality increase does not mean "perfection" and so "magical" turns into "more expensive". Id like to live in that world.
jorvi 1y ago
The alternate also happens though. Over here in The Netherlands, the milk for all milk products comes out of the same cows and is processed in the same tanks. When you're paying 2x the price for brand name milk, you're getting seriously scammed.

Neil44 1y ago

This anecdote is interesting, but the article cites poor storage and counterfeiting as the main causes of the issue.

itsdrewmiller 1y ago
Thanks for this comment - I didn’t read the article and might have taken away a largely incorrect belief based on the parent. And you handled it so politely too!
- sigmoid10 1y ago
  The comment you replied to also paints an incorrect picture. The real quote from the article regarding the origin of the poor quality is: >[...] Those causes can include faults in the manufacturing process or product decay due to poor storage conditions. But some drugs are also counterfeit, and that increases the risk of discrepancies between what's on the product label and the actual medicine within. So this is actually pretty in line with the top level comment, since no mention of the actual ratio among reasons is made. It certainly doesn't say that counterfeiting and after production storage are the main reasons.

monster_truck 1y ago

If you've taken a prescription over a long enough time you'll know this to be true even if you've never really considered it. Some time ago I was very frustrated with the massive swings in how well a prescription was working so I started looking into it. Saved a pill from every month, sent 12 of them off for testing. +/- 30% accuracy on that dosage, and that's within spec for the US. Some months your 20mg pills are 26mg. Others? 14mg. Later repeated this test with a family member's blood pressure medication, which has a dosage of just 0.5mg. Same deal, 0.35-0.65

Hojojo 1y ago
There are labs where you can just send prescription pills for testing as an end user?
- nerdsniper 1y ago
  For something like amphetamine, could get it tested at Energy Control lab in Spain. Valisure used to offer this kind of service for most pharmaceuticals in the USA but faced lawsuits and pushback: https://www.bloomberg.com/news/features/2023-12-05/pentagon-is-skeptical-of-cheap-generic-drugs-approved-by-the-fda https://www.bloomberg.com/news/features/2023-12-05/pentagon-... [ https://archive.md/eyWSn https://archive.md/eyWSn ]
sizzle 1y ago
Generic amp huh? Thought I was going crazy. Who does name brand? Shire sold to Teva?