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A drug rep just left the office. These guys are regularly portrayed as the worst people of the medical industry, which is not really deserved. I have personally met a number of physicians who are roughly equivalent to pondscum, for instance. And the executives at Big Pharma are far more morally culpable than these guys on the street who are just trying to grind out a living.

But they are here only to push name-brand drugs, which I don’t often write for. Not when cheap and plentiful generic alternatives line the pharmacy’s shelves. On the other hand, sometimes the name-brand really is the best option for the patient. Here are some examples.

1. Asthma and COPD inhalers: This is a no-brainer because all of these are name-brand, including Qvar up there. Even something as basic as albuterol is name brand (actually, three different competing name brands in the USA). Often, the medical decision of which brand of a given inhaler class to prescribe is made by the insurance carrier and not the physician, and these decisions are often decided by backroom deals of murky legality. For instance, if ProAir-branded albuterol’s manufacturer TEVA is funneling kickbacks to an executive at a state Medicaid carrier, then patients of that carrier will only be allowed to use ProAir instead of one of its competitors. Same with Qvar vs. its competitor Pulmicort, and so on.

2. Eye drops and ear drops: For some reason, the only really effective allergy eye drops are prescription only, even though allergy pills and nose sprays are OTC. And of these prescription eye drops, the best ones are name-brand and, with a coupon, are actually cheaper for the patient than generic. However, many carriers (especially the Medicaid plans) will only cover the generic, so those patients get the inferior drops — at a higher cost to boot. The same scenario applies to antibiotic ear drops.

3. Insulin: The two main classes of insulin (long-acting, and short-acting) each are represented by two competing name brands in the USA. The decision of which brand of a given class to go with is decided by… yep, that’s right, the insurance carrier and not the physician. Noticing a trend here?

4. Suprax: This is a new antibiotic that is interesting because it is the only member of its class that can be taken orally, instead of by injection or IV, thereby making it useful for outpatient settings like mine. Also, it only has to be taken once a day, which increases patient compliance. I don’t write for it very often though, partly because it costs more for the patient even with the coupon and partly because — do I even have to say it? — many insurance carriers won’t allow it.

So I don’t get all holier-than-thou about the use of brand names the way some internet MDs do. Sometimes, brand name meds are the better and/or cheaper option for the patient. But as you can see, the decision on what type of medicine to use is often not made by the physician at all, but instead by some anonymous corporate suit who may or may not be personally receiving bribes from the drug company. Liking your health care system yet?