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Generic drugs

Generic drugs provide information to doctors, so why is Health Canada promoting pharmaceutical brand names?

Generic drug names are often long, but they can tell doctors what type of drug it is and how it works. But it is the brand names that appear first and most prominently in Health Canada documents.

Brand names are widely used when we want to refer to a specific product – an Apple computer, a Tesla car. Sometimes brand names are used so widely that they take over – we ask for a Kleenex instead of a tissue.

Drugs have two names. The brand name is the one chosen by the company that manufactures it and that company is the only one authorized to use the name. (The name proposed by the company is being reviewed by Health Canada.) Brand names are almost always short and catchy so that physicians will remember them.

Generic names are assigned globally by the World Health Organization in collaboration with national naming authorities. These names are often long, but part of the reason for this is that they tell doctors about the pharmacological properties and / or chemical structure of the drug.

The generic name of the US $ 2 million per patient new drug for spinal muscular atrophy is onasemnogene abeparvovec. The brand name is Zolgensma. Which one will physicians (and patients) retain and use? The answer is obvious.

One of the associate editors of the Canadian Medical Association Journal notes that “some brand names are created to be reassuring or promising – so-called ‘benefit-oriented’ names such as Paxil, Celebrex, and Gluconorm – while they should in fact be prescribed with great care and taking into account the potential effects of the drug on each patient.

Is using brand names the right way to talk about prescription drugs? Apparently, Health Canada thinks so. Do you want information on safety issues with a medicine? On the Canadian recall site, you will see the brand name in CAPITALS and the generic name in lower case and in parentheses.

Want to see if there is a shortage of the drug your doctor just prescribed for you? Go to Drug Shortages Canada and you will find the brand names of the drugs, again in all caps.

If you want to know why Health Canada approved a particular drug, the Basis of Approval Summary document will help you understand. But again, the brand name is the most important, and again it’s in all caps.

What’s in a name?

In medical school, students learn to use generic names. Medical journals require authors to use generic names in the articles they write. Does the name used by doctors matter? The answer is yes.

When Australian anesthesiologists and doctors trained to be anesthesiologists at two university hospitals were given the brand names of the drugs, they could only correctly identify the therapeutic group from which the drug came in just over half of the cases. Without knowing which therapeutic group the drug was from, doctors could have accidentally used another drug from the same group or they could have used the drug incorrectly.

The more money doctors received from drug companies in the form of meals, travel arrangements, and property royalties, the less likely they were to prescribe by generic name. Seeing pharmaceutical company sales representatives more frequently is associated with increased prescriptions for brand name products, resulting in more expensive prescriptions. Sales representatives also typically omit important information about the safety of the drugs they are promoting. Therefore, besides more expensive prescriptions, they can also be more likely to harm patients.

Brand names, drug regulation (the domain of Health Canada) and drug promotion came together particularly blatantly in the case of buprenorphine-naloxone, the brand name Suboxone, an opioid drug used to treat addiction. opioids.

Even though generic formulations of the drug have been available in Canada since 2013 (and even earlier in the United States), the drug is widely referred to by its brand name, including in the media, by policymakers, and by physicians.

Brand education

This happened in particular through the promotion of an “educational” program developed and implemented by Indivior, the company which owns the rights to Suboxone. In some provinces, completing this branded program is a prerequisite for prescribing buprenorphine-naloxone. The same strategy was used for a related injectable form of buprenorphine, also owned by Indivior.

This use of the branded program is the case even though there are already some very good accredited, non-industry educational programs to teach proper opioid addiction care and prescriptions to doctors, nurses and pharmacists.

The inclusion of the brand name in the title of this program is against recommended practices and accreditation standards for Canadian medical education programs.

Yet the brand-name program is fully endorsed by Health Canada through that agency’s review and approval of the Suboxone Product Monograph. This document, which describes the nature of the drug and its approved uses in Canada, includes a description of the requirement to participate in the branded “training program”.

As has been documented in the United States, Indivior and its parent company Reckitt Benckiser have engaged in various unscrupulous practices to promote their multibillion-dollar line of buprenorphine products – ultimately paying some of the largest fines in the world. pharmaceutical history of the United States. From this perspective, a branded “educational” program appears to be yet another vehicle for brand promotion, and one in which Health Canada is directly involved.

When doctors use brand names, they may be less knowledgeable about the medications they are prescribing, their prescriptions cost more, and patients may be more likely to suffer from side effects. When Health Canada prioritizes brand names over generic names, it is actively contributing to all of these issues.

Health Canada should know better and do better.

In 2018-2021, Joel Lexchin received payments for writing a dissertation in a drug side effects action for Michael F. Smith, lawyer, and a second dissertation on the role of promotion in generating orders for Goodmans LLP and Canadian Institutes of Health Research for a presentation at a workshop on conflicts of interest in clinical practice guidelines. He is currently a member of research groups that receive funding from the Canadian Institutes of Health Research and the Australian National Health and Medical Research Council. He is a member of the Foundation Board of Health Action International and the Board of Canadian Doctors for Medicare. It receives royalties from the University of Toronto Press and James Lorimer & Co. Ltd. for the books he wrote.

Abhimanyu Sud has received funding or has been consulted by the Canadian Institutes of Health Research, Health Canada, the Association of Faculties of Medicine of Canada, the University of Toronto, the Center for Effective Practice and the Mississauga-Halton Local Health Integration Network for research and medical education related to opioid use and drug policy.

Joan J. Dean

The author Joan J. Dean