Generics have indeed become economically, clinically, and culturally relevant objects and subjects. But they will never have the emotional and intangible force of the brand.
I grew up in a household chock full of pharmaceutical objects, the flotsam and jetsam of a grandfather and father joined in family practice, their offices practically in our back yards and managed by my grandmother and mother. From clocks to refrigerator magnets to soap to Q-tip dispensers to pens to stuffed animals to paper products of every conceivable size and shape, the form of the brand-name pill pervaded my youth. Ours was a family constituted around delivery of cradle-to-grave medical services, and so these pharmaceutical objects were as familiar to us as M&Ms or Tang. Brand loyalty was equated with quality you could trust. There were only a few bad words in my parents’ household—one was “chiropractor,” one was “stupid,” and the other was “generic.”
Somehow, the politics of pharmaceutical manufacturers were integral not only to the practice of medicine but for political identity and subject formation, just as surely as if we were the children and grandchildren of Parke Davis, Merck, or Eli Lilly employees. No more does that tight-knit corporate subjectivity of the global North exercise the same powerful hold. Undone by downsizing and globalization, I buy my cut-rate prescription via Ranbaxy or one of the other generic Goliaths hailing from the global South. Having shed the brand loyalties of my youth, no longer cued by the ephemeral domestic detritus of Big Pharma, I treasure my “It’s Time for Viagra” clock (though the minute hand is sadly broken) and the tiny Asendin teeter-totter bequeathed to me by my father to see me through the vicissitudes of adolescence that rests upon my office window sill reminding me to gently ride the vicissitudes of middle management. But somehow sildenafil and amoxapine just don’t have the same poetic ring to my ear as Viagra and Asendin.
My pharmaceutical-brand-name-free existence is punctuated when I tune into the tube. But I confess to a sense of nostalgia for the comfort brands as evocative for me of the 1970s and 1980s as the pre-Walmart smiley face. That says something about the “intangible qualities” to which pointed Henry DeBoest, an Eli Lilly VP testifying before Gaylord Nelson and quoted in Jeremy Greene’s blow-by-blow account of the kaleidoscope of rapidly reconfiguring “interests” that emerged in the course of these decades-long disputes. There was ample fear and loathing on all sides, whether anti-genericists or “rabid” or “frothing” consumerists.” There are “cults” and “crusaders,” but surprisingly few clear-cut demons or heroes in the land of the generics, which appears shadowed in many shades of grey. Sometimes specificity matters; sometimes it does not. In the end, it may not matter whether we think of the questions posed by generic “substitution” as unresolvable or not, because it seems that questionable resolutions will be our only answers in the unreasonable rationalities of marketized healthcare to which we must adapt. Perhaps it isn’t the hard evidence, the “actual proof,” the experiences of “actual patients” that we truly value. Perhaps value lies elsewhere in the intangible qualities of the brands we live by.
Nancy D. Campbell is Professor of Science and Technology Studies at Rensselaer Polytechnic Institute. She is the author of Discovering Addiction: The Science and Politics of Substance Abuse Research (University of Michigan Press, 2007) and (with JP Olsen and Luke Walden) The Narcotic Farm: The Rise and Fall of America’s First Prison for Drug Addicts (Harry N. Abrams, 2008).