This is a research letter from the Archives of Internal Medicine that received a good deal of press recently, examining exactly where in the health system we were wasting money.
They focused on the ambulatory setting, used the NAMCS/NHAMCS database, and evaluated for the activities identified in the “Good Stewardship Working Group” identified by consensus to be low-yield and unnecessary. They considered this to include antibiotics for afebrile/non-strep pharyngitis, routine EKGs, CT and MRI for uncomplicated low back pain, DEXA scans for young women, etc. And they found – and this is where the big story comes in – $6.7 billion in these consensus not-recommended activities.
Fortunately for our Internal Medicine and Family Medicine colleagues, they actually weren’t ordering a lot of unnecessary tests – $175 million for low back pain and $527 million for DEXA are a lot of money, but still a drop in the bucket. The majority of the unnecessary activities, $5.8 billion of the total $6.7 billion, was writing for a brand-name statin (atorvastatin or rosuvastatin) instead of one of the generics.
Certainly just the tip of the iceberg. Drug reps are more than earning their salaries, apparently.
“‘Top 5’ Lists Top $5 Billion”
http://www.ncbi.nlm.nih.gov/pubmed/21965814
The same thing works in Congress. Lobbyist groups advertise that they return benefits worth ten times the amount spent on lobbying.
And many of the people, who will criticize big drug companies as evil, will refuse to take a medication that does not have the big drug company's logo on it. As if generics were significantly different.
For some people, it's all about the designer label. Especially, when they think that someone else is paying for it.
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Yep, I'm sure if we did a scientific survey of Americans, they would expect an expensive Brand Name to outperform a cheap Brand Name to outperform an expensive generic to outperform a cheap generic.
Heck, even in Finland, with their relatively socialist and egalitarian attitudes, one in five people doesn't think generics are any good:
http://www.ncbi.nlm.nih.gov/pubmed/21254290