Many people (including physicians) believe that newer drugs are better. While that's a natural assumption to make in a society that puts a premium on new things (and is barraged with advertisements for them), the fact is that it's not always true when it comes to prescription and nonprescription medicines. Studies consistently show that many older medicines, including generics and nonprescription drugs, are as good as—and in some cases better than—newer medicines.


Prescription drugs come in two basic forms—brand-name drugs and generic drugs. Generic drugs are copies of brand medicines whose patents have expired. A generic drug has exactly the same active ingredients as the brand drug it copies. The only difference is price and how the pills look: generics are much less expensive and by law are not allowed to look exactly like the brands they copy (a certain color or shaped pill, for example).

Generics are widely misunderstood. Many people believe that because generics are older, they are not as potent or effective. The truth is that the vast majority of generics continue to be useful medicines even years after their approval, and many remain the preferred first-line treatment even after newer brand competitor medicines emerge. That is why today about 47 percent of all prescriptions written in the U.S. are for generics.

Another misconception is that generics are less safe or more likely to be tainted.

This, too, is not true. As the Food and Drug Administration attests to in the information it provides on its Web site and in print, generics are every bit as safe as brand-name drugs. A generic copy of a drug is no less effective, either. The FDA applies the same set of strict rules to generics as to brands. Both must meet exacting specifications for their ingredients and manufacture. The FDA requires generics to have the same quality, strength, purity, and chemical stability. And generics must work the same way in the body. Both are tracked for their safety over time. Instructions to doctors and patients about the use of generics must be the same as for the brands they copy.

Indeed, a good way to think about generics is as "tried and true." They have met the test of time—most generics come on the market 12 to 15 years after the brand-name drug they copy was first approved.

In contrast, it's not uncommon for doctors and drug companies to find problems with new brand-name drugs that come to light only after they are approved. That's because even though new drugs undergo years of study to prove they are safe and effective, those studies may have involved only several thousand people; once a drug is used by millions of people, new problems can and do crop up.

In some cases, of course, new brand-name drugs eclipse older generics in terms of both safety and effectiveness. That is to be expected, and it reflects medical innovation and progress.

But such advances are not as prevalent as you might believe. In fact, a growing number of experts, doctors, medical and health groups, and pharmacists believe that some newer and more expensive brand-name drugs are overused, while many generic drugs are underused.

The reasons for this are complex, but the main ones are:

• Brand-name drugs are widely promoted and advertised to doctors, while generic drugs are only minimally promoted. Brand marketing includes one-on-one sales pitches from drug representatives.
• Brand-name drugmakers give doctors millions of doses of the newest drugs to hand out to patients-free. This gets people to take the newest medicines, which can be the most costly. Some of these will be better than available generics. But many will not.
• Brand-name drug companies, but not generic companies, give doctors free gifts and often pay their way to seminars and lectures, or even to out-of-town conferences, to hear about new drugs.
• Brand-name drugmakers pay thousands of doctors every year to either give lectures on the newest drugs or use them as part of clinical studies. Both can be useful enterprises, but doctors often get used to prescribing the new drug instead of older, reliable drugs.
• Brand-name drug companies spend tens (or even hundreds) of millions of dollars advertising their drugs directly to the public. Generic firms hardly advertise their drugs at all to the public.

Federal and state laws in the last 20 years have encouraged the development of more generic drugs and their wider use. For example, most states allow pharmacists to substitute the generic version of a drug when a doctor has written a prescription for the more expensive brand. But in many states, the pharmacists must ask the consumer permission to make the switch. Fearing they will get a drug their trusted doctor did not intend, many consumers still say no.

Our recommendation is that you talk to your doctor about your prescription when it is being written in his or her office. You should inquire whether the prescription is for a brand or generic, and learn why your doctor has prescribed one or the other. If you pay for your medicines out-of-pocket because you lack insurance coverage for drugs, you should ask your doctor if there is a less expensive generic drug that would work for you.

If a pharmacist suggests substituting a generic, there is no reason to object. We suggest you call your doctor if you are concerned about this switch.

It's wise to keep a written list of all the drugs and supplements you are taking and to periodically review this list with your doctors.

There are four main reasons to do this:

• If you see several doctors, each may not be aware of medicines the others have prescribed.
• Since people differ in their response to medications, it is very common for doctors today to prescribe several medicines before finding one that works well or best.
• Many people take several prescription medications, nonprescription drugs, and dietary supplements at the same time. These can interact in ways that can either reduce the benefit you get from the drug or be dangerous.
• The names of prescription drugs—both generic and brand—are often hard to pronounce and remember.

Always be sure, too, that you understand the dose of the medicine being prescribed for you and how many pills you are expected to take each day. Your doctor should tell you this information. When you fill a prescription at the pharmacy, or if you get it by mail, you may want to check to see that the dose and the number of pills per day on the pill bottle match the amounts that your doctor told you.

Talk with your doctor about splitting your prescription tablets. Pill splitting (usually just in half) is an increasingly common practice and can be a powerful way to save money, especially if you have to take a prescription drug for a long time.

But not all pills can be safely split. Some of the drug reports on this Web site contain a section that pertains to pill splitting, while others do not. If a report does not contain such a section, you should assume that most (or all) of the pills in that drug class cannot be safely split.

You should not split your pills without first talking to your doctor. Pill splitting also is best accomplished with a low-cost device (around $5 to $10) designed for that purpose, and not with a knife. The device assures that the two halves you produce contain equal doses. With many medicines, taking the correct dose is critical to the drug's effectiveness and safe use.