[wowczarek]

I get that the discussion here focuses on doubtful decongestants, but just the mention of acetaminophen makes me think of pharmaceuticals and people's relationship with them in the US. It's a strange world to me, especially how deeply ingrained the brand names are in people's minds - years of evidently successful marketing.

What, to me, should be illegal, is building expensive branding around a group of very basic analgesics - well and other groups like antihistamines.

In the UK I can buy an own-brand 16-pack (8 g) of paracetamol in a supermarket for £0.35 / $0.45. At the same time, I can buy a packet of Panadol (GSK), same substance, same content, same amount, for £2.35, nearly 7 times the price of generics.

How is THAT legal, and how are people so unaware as to actually buy it? "Unaware" may be the key here.

[kelnos]

Same situation in the US. I can buy NyQuil/DayQuil, or I can buy the pharmacy-branded version for a lower price. Here it's usually not such a dramatic difference; probably the pharmacy brand is a a 30-40% discount off the big-name brand.

> How is THAT legal

Why shouldn't it be? Companies are free to set prices to whatever the market will bear. In this case it's based on customer ignorance, which makes it feel icky, but I don't think that's a reason to legislate this sort of thing.

> and how are people so unaware as to actually buy it?

Yeah, I don't know. I do remember that, many many years ago, I didn't know about this, and would always go for the big-name-brand version. At some point I learned to look at the active ingredients and just buy the cheapest one that had the same ingredients in the same dose, but I don't recall when or why I learned that, or why I didn't know that before.

I think there's also an implicit quality judgement sometimes, even if it's unfair. When it comes to groceries, say, canned tomatoes, and I see some fancy-looking Italian brand that I've heard of, my brain will automatically rate it much higher than the grocery store's own branded version of it. Maybe that's an effect of marketing/advertising, maybe it's something else, I don't know. And sometimes it's actually true: tomatoes are not all created equal. I think something similar happens with drugs, even if it's an entirely different kind of product.

People also often assume that something that costs more is automatically higher quality. For some types of things, that can be true (because yes, there is such a thing as a better tomato, and sometimes it costs more to cultivate said better tomato), but for drugs in a regulated environment, that doesn't really make sense. But people pattern match on what they know and what they feel.

[wowczarek]

>> How is THAT legal

> Why shouldn't it be? Companies are free to set prices to whatever the market will bear.

Those are the rules of a free market, I'm not contesting this in general, but we're practically talking deceit here. IMO the pricing for a "crucial subset" of WHO's essential medicine list (as if "essential" wasn't atomic enough...) should be capped, plain packaging enforced and no advertising campaigns permitted. Medical professionals being bound by law to inform of the availability of generics in certain jurisdictions is simply not enough. I'm not saying this is realistic or achievable, but it would benefit the society. That same list also includes common antidepressants and antipsychotics for example, even if it's under palliative care management, and those are biiig money makers.

As to the rest, fully agreed. With own brand groceries quality does often follow pricing, but doubting the quality of pharma generics is doubting the whole regulatory system - not unwise - but if we do, that should equally, and especially, apply to the big names for whom more money is at stake, with the good side that this brings (rigorous testing) and the bad side (shady practices).

[sudobash1]

We see this all over. Generic brands can be on-par with (or even 100% identical) to name-brands, and the name brands still make money. For example at my local grocery store, you can buy distilled white vinegar from Heinz or the generic brand. The generic brand costs half-price (or less if you get the bigger container), but the product should be chemically identical.

There can be some arguments made (maybe you think the generic cuts corners and it is only 4.5% vinegar instead of 5%), and the same arguments can be made for the drugs. But IMHO they come nowhere near to justifying the price gap.

The thing that is particularly frustrating in the case of the drugs is how the brand-name is (for many people) the vernacular name. I grew up in a family that called many drugs by their actual name (eg ibuprofen & acetaminophen), but when I go to the doctor, many of them insist on calling them Advil & Tylenol. Sometimes it seems to take them a second to recognize the generic name.

[awhitby]

FWIW my guess is most people are aware, and do know that supermarket/drugstore acetaminophen / paracetamol is the same, in some relevant sense, as Tylenol / Panadol. It's not like the retailers lack marketing resources. But for these off-the-shelf drugs the total $/£ amounts are small for a lot of people.

Then, there _are_ arguments about whether generics face adequate testing to ensure the same quality as the originally-approved name brand drug. A lot of this is FUD - I'll happily buy generic acetaminophen in the US - but it's not a totally irrational concern. I doubt any regulator ensures generic equivalence to the same degree of conformity that a big pharma companies' own quality control does.

For example, I personally find real differences in the jankiness of different asthma inhalers, even amongst generics. Maybe that's because I don't shake/use/clean them exactly per the directions, but then that's real-world use for you. My personal experience says brand-name Ventolin has solved a "robustness against user error" problem in a way some alternatives often have not, suggesting the FDA does not enforce equivalence on this dimension. It's not enough of a difference for me to go name-brand, since out-of-pocket price differences can be egregious, but I do distinguish between otherwise-unknown generics.

Finally, you may trust the UK regulator and so do I, but traveling somewhere without good regulatory oversight, I'd probably reach for Panadol - assuming it seemed authentic - over a generic brand I'd never heard of. Brands have value and brand owners have a lot to lose, which is a kind of insurance (see 1982 Tylenol recall).