Generic drugs are fundamentally ambivalent, as expertly explored in Jeremy Greene’s book Generic: The Unbranding of Modern Medicine. The ambivalences are articulated in different forms throughout the book, such as the hope for rational prescribing versus the fear of rationing, and the promise of spreading innovation through making pharmaceutical access affordable, versus the worry about impeding innovation through discouraging investment in R&D. For me, the most striking binary was another pleasingly alliterative pairing: that generic drugs can signify both virtue and vice.
In the first few pages, we read about a pair of scandals demonstrating extremes of the spectrum. First, in 1987 an FDA official serves jail time for accepting, and failing to report, a free lunch from businesspeople in the generic industry – an industry which is engaged in egregious fraudulent practices and which he is charged with regulating. This scandal is twinned with another: research showing generic similarity is suppressed by the branded company that funded it, and the virtuous scientist strives to expose the truth against the company that funded her work. These two stories are far more melodramatic than most of what comes later in the book, which is less about outright fraud and valiant science than about the shades of gray that are inherent in the creation and promotion of things that are “the same but not the same.”
To highlight the danger of generic vice, brand-name companies have sometimes blurred the distinction between generic and anonymous. Anonymity feels risky. Greene includes a fabulously paranoid 1967 pharma ad with a creepy image of business people on a sidewalk, their featureless faces and necks completely covered, with the headline “Drugs Anonymous?” I have argued elsewhere that part of the appeal of brand-name drugs is the commodity fetishism that imputes more value to what is more expensive, but of course there is also a serious issue here of trust. In the terrain of consumer goods, pills are particularly opaque, and we rely on regulation and brands in order to trust. The generic industry has sought to cultivate trust, too, sometimes by showing its face. Branded generics emerged to overcome accusations of anonymity, and also take advantage of the association of expense with value with their promise of “cheap, but not risky cheap,” and “reassuringly expensive.”
Frustratingly for the brand-name companies that are the descendants of “ethical manufacturers,” generic drugs are often described in a way that has a sheen of moral superiority over brands. The generic industry is neither inherently moral nor immoral, but rather, as is typical of corporations broadly, it is amoral. The generic sector is a profit-seeking industry like any other. Public health advocates, especially those focused on global access to pharmaceuticals, often highlight the virtue of generic drugs, fostering the impression that companies provide drugs for the poor out of the goodness of their hearts rather than as a commercial venture. Greene both shows why that impression exists and punctures the mystique.
A final thought on vice, in relation to one more term sometimes applied to generics that struck me as evocative: adulteration. Of course there is a technical meaning here: replacing more expensive ingredients with less valuable or inert ones. But it has a resonance with adultery: cheating, stepping out, breaking our loyalty with the brands with whom we have a relationship in order to see if we can find something else to fill our needs and desires. Unfortunately for branded pharma, the logic of savvy consumerism makes it a virtue to be always on the lookout for better offers.
Anne Pollock is Associate Professor of Science, Technology & Culture in the School of Literature, Media, and Communication at Georgia Tech. She is the author of Medicating Race: Heart Disease and Durable Preoccupations with Difference (Duke, 2012).