Economics in health: Brand-named drugs and Generic drugs

I. Introduction

A thousand years ago, in some populations just like the French one, when individuals felt ill and seemed ill, the main solutions were to bath these individuals in water and pray for them to get better. These main solutions were solicitated due to the lack of knowledge in the subject of health, which was and still is a complex subject. At that time, a lot of people eventually died because people didn’t know what diseases were, they didn’t understand that there are many different ones and what to do to stop them. With time, scientists tried using natural herbs and different other substances to try to cure the ones who had illnesses. In some cases, the patients would get better, in other cases it could be ineffective and the patients would not get better. Later on, due to the multiplication of scientists, means and research different diseases were detected. With this knowledge, scientists understood that every illness is made out of a different virus or not and so, the solution to an illness had to be specifically made for it. Acknowledging this, scientists studied each and every case precisely and created something that would change the humanity’s health problems, at least most of them: medication drugs. Once medication drugs were created, when someone was ill the first instinct was to take the drugs made specially for that illness. At the end of the day, it was easy to get better as you just had to buy the medical drug specially made for your disease and wait for it to make an effect. Obviously, as these drugs were unique and only them could get you better, the prices to get them were high. But with time once again, the government made it possible to lower the prices so, the drugs would be affordable to many but the price still remains a little high. Today, when someone is ill, he or she still takes drugs to cure its illness but once at the pharmacy the individual is confronted to two different categories of medication drugs in the market: the brand-named drugs and the generic drugs.

Brand-named drugs are drugs composed by excipients and by an active ingredient or more precisely an active substance that has been isolated by a pharmaceutic laboratory and is being used for the first time. They are considered the “original” drugs as the active substance they use has never been used before. The laboratory actually uses it before anyone else and for quite some time due to the 10 years of obligatory research and experimentation, then due to the drug patent that assures the laboratory has an exclusivity to its exploitation and commercialization for 10 years once they obtain the marketing authorization (MA) by the National Security of Drugs and Health Products Agency. The first 10 years of experimentation and research actually cost a lot of money to the ones investing in the drug, so once in the market the price of the brand-named drugs must be high to re-pay all the investor’s money and still create some benefits.

Generic drugs on another hand, only see the light of the day once the brand-named drugs patent comes to an end. This is due to the fact that the generic drugs can be considered as an imitation of the brand-named drugs as they use the same active substance. Generic drugs must have the exact same quantity of active substances, the same pharmaceutic shape and the same therapeutic efficacity (bioequivalence) which means that they must act exactly the same in a human’s organism. Generic drugs may have some differences from the brand-named drugs but these ones cannot affect the bioequivalence of the drugs. There is actually one big difference between the two types of drugs which is the excipients (other ingredients). The excipients actually have the power to change the appearance of the drugs, their taste, the rapidity of dissolution and the therapeutic form. Another difference between the two drugs is that generic drugs are sold under their international non-proprietary name (chemical name of the substance) or under a new commercial name. But just like the brand-named drugs, before getting into the market the generic drugs must get the marketing authorization from the National Security of Drugs and Health Products Agency. The difference here is that it takes less time as there is no need to do pre-clinic and clinic studies as they have the brand-named ones already. Besides this, the generic drugs must only provide proof of their bioequivalence. As we can see there is much less research to do for generic drugs and for that reason they are sold at a much lower price in the market which presents an economy for patients and public health organizations.

II. The problematic

The consumption of brand-named drugs or generic drugs, has been the fruit of many debates in France since generic drugs were introduced to this country 25 years ago (more less). As they have many similarities but also many differences as we just saw, the consumption of both has created a polemic and is source of many questions not only from the ones who take medication drugs but from the specialists who prescribe them. People are worried that one might be less effective than another, or that one might be better than the other for some type of diseases. Taking these polemics, questions and doubts into consideration, we considered it would be interesting to study the consumption of these two types of medication drugs. To be able to have a more accurate representation of the consumption of both medication drugs we decided to study this case in the city of Lille where we are both based most of the time. Through this project we will try to answer the question: Which type of medication drugs are most consumed in the city of Lille, the brand-named drugs or the generic drugs?

III. The plan

After a lot of reflection, we decided that the best way to get the answer to this question would be asking people what they thought about the consumption of both drugs, what were their drug habits between other questions that would allow us to study more less the percentage and the type of individuals that consume each drug and why. This would give us a small representation of the actual consumption of drugs in the city of Lille. Once we decided to ask people these questions we had to decide how. We had the idea of going through the streets and ask random people the questions we had prepared (in the annex). We actually tried that out but it was unsuccessful due to lack of time of people walking in the streets. So, we thought a little harder and decided to make a survey, that way we would only send it to people in Lille, only the ones who wanted to do it responded whenever they had time in the meantime we would receive the responses right away and could study them anytime. So, we created the survey with Google Forms (link in the annex), we wrote our questions and published it on Twitter and Facebook precising that only individuals from Lille should answer. We also sent it to our relatives living in Lille, who sent it to their friends. We also asked a nurse if she could pass it on to some doctors and patients so we would have responses from a variety of individuals. When we finished creating the survey and sent it to everyone we knew, we established a due date to stop receiving answers and start studying the responses of the survey in order to respond to the real question. So, we gave it two weeks, starting from the 28th of march and finishing the 11th of April. At the end of the two weeks we had collected 250 responses, very interesting ones. The first thing we did once we got the responses was to create an Excel document and put those responses into graphics so we could have a visual representation of people’s responses. We will now, show you the questions we made, also the graphics and the responses while commenting everything. All of this will help us understand which of the medication drugs is most consumed and why. The “why” part is not very clear in the survey we created as we did not ask many questions about it. But taking in account the results of the graphics and with research we made we will explain why.

I. The survey

First of all, as in any other survey it is very important to make demographic questions as they allow us to understand who we are targeting. In this case, we can understand who are the people that consume brand-named drugs and generic drugs or even none of these two. The first and most common demographic question that we made concerned the gender of the person responding to the survey. As we can see in the pie-chart above, half of the pie is composed by Male and the other half by Female, which means that there is exactly the same percentage of men (50%) and women (50%) that responded to our survey. But this exact symmetry is not a coincidence, actually at the end of the second week of the survey when we started studying the responses we had received 300 of them, from which 128 were from men and 172 were from women. We decided that even if the difference between both of the genders was not enormous it would not give us the right equilibrium and so, we narrowed the women’s responses to 125 and men’s responses too, which narrowed our responses to 250 in total. We did this because, even if people don’t think it is important, a person’s gender can actually have an effect in a person’s way of thinking and responding, and that could affect the entire survey. Once we had the same amount of responses from men and women, we knew that in the following questions of our survey it would be impossible to have a weighting problem with the genders. But the gender of the individuals is not enough to actually know the individuals we are targeting.

The second most common demographic question that we asked was the age of the person responding. For many this might not seem as something that relevant to answer but it is actually very important to know the age the people responding so, we have an idea of which group of age is more likely to consume more or less drugs than others, or one drug or another. So, in our survey we created five different groups of ages and we will explain why. We firstly created the group of individuals whose age is under 18 years old (17%) because they represent the future generation who is still being taken care of by their parents or legal guardians, it is interesting to see if they know the difference between the two types of drugs we are studying and if they are aware of what drugs people give them when they are ill. Then we created the group of individuals whose age is between 18 to 30 years old (24%), which corresponds to the young adults who are studying (at the university), starting to work or have started working for a while. People from this group of ages usually start having their own money and taking care of themselves so they understand more less the subject. We also created the group of individuals whose age is between 31 to 40 years old (16%) which represents a range of ages where you usually are totally independent and you think of building a family. In this case, people usually already know how to take care of themselves, what to take etc. There is also the group of individuals whose age is between 41 to 60 years old (24%), a range of ages where usually adults get to the best position they can in their work area and approach the final years of employment. This range of people are usually parents (both our parents find themselves in this range of ages) or grand-parents that take care of themselves and their children so they understand the subject very well. And finally, we created the group of individuals who are older than 60 years old (19%), the range of age where people are most likely retired. This range of people are the ones that usually understand the subject better as they have to consume more drugs than others because they are weaker and so, they get ill faster. As we can see in the pie-chart above, we received very heterogenic responses, but the two groups of ages that responded the most to our survey were from 18 to 30 years old and 41 to 60 years old. On one side, the young adults who are learning how to take care of themselves and learning more and more about the subject we are studying. On another side, the individuals that not only take care of themselves but of their families too. These two groups of ages represent 24% of the pie-chart each which means that both reunited represent almost half of the pie-chart while the other three other groups surround the 17-19%. This question gives us a good image of the individuals who are responding to the survey but we felt as we should know a little more about these individuals.

Another important demographic question we asked was the employment status of the person who is answering. This question actually completes the age question as there is a correlation between the two, what you do at what age. Not only this question completes the previous one but it also allows us to differ individuals much more than the age question because it corresponds to what they do and who they are in the everyday life. Before analyzing the results, we find that is important to say that there is a perfect coherency between the different pie-charts. As we can see in the age pie-chart there is 19% of individuals who are more than 60 therefore they must be in retirement and in the employment status pie-chart there is exactly 19% of individuals that declared they are retired. Moving on, the pie we distinguish the most from others is the one that represents the students. The students represent 32% of the pie-chart, which is more than a quarter of the pie-chart (it is a lot once there are so many categories). These 32% of students include the 17% of people under 18 years old that are still in school and the other 15% are individuals between 18 and 30 years old. The second biggest pie we can see is the one that represents the employees which corresponds to 30% of the pie-chart, once again this pie has more than a quarter of the pie-chart to itself. These 30% mainly represent the 16% of individuals between 31 and 40 years old but also includes a part of the individuals between 18 and 30 years old and between 41 and 60 years old. The 13% of individuals unemployed are also representative of these last two groups of ages. This is due, on one side to the lack of work offer once individuals finish their studies and on the other side to the fact that some companies prefer employing young and more active individuals and to do that they have to fire the elder ones. For the 2% who represent directors of companies, these 2% must be in the 41 to 60 years old group of age because it takes time to reach that position. The 1% of athletes, instructors, housewife, person who has disease and 2% of nurses also figure in this group of ages. Now we know, that a majority of the individuals responding to our survey study or work, two very different cases as on one side the individuals get money from their legal guardians to live and the on the other side individuals must work to earn their money.

Most times in surveys, individuals chose to ask a question about the employment status or about the monthly income of individuals but we decided to do both to study at the same time what people do and how much they earn. We wanted to know how much people earn due to the fact that a part of the choice of the consumption of generic drugs might be linked to different monetary means. The biggest pie of the pie-chart (30%) is the pie representing the individuals receiving less than 500 euros per month. These 30% percent represent most certainly the 17% of individuals under 18 years old who are students therefore do not receive an income but also the 13% of unemployed individuals who do not work either, usually not by choice. In this case it would be possible that unemployed people would want generic drugs as they do not have the money for brand-named ones. The 13% of individuals receiving between 500 and 1000 euros per month must be the rest of the students that are not under 18 years old which are 15%. These individuals must be university students or individuals between 18 and 30 years old who have started working not so long ago and receive a small income. The 2% left of individuals between 18 and 30 years old that do not receive 500 to 1000 euros per month must receive between 1000 and 1500 euros per month and the rest of these incomes (8%) must go to individuals in retirement as in average the monthly retirement earnings are 1070 euros for women and 1740 euros for men in France. The 3% of retired people not included in this income group must be men that earn between 1500 and 2000 euros per month with their retirement money. The 19% left of people receiving 1500 and 2000 euros per month are mostly employees but there are also the instructors, the person who is attained by a disease (who receives financial aid) and the athlete. The 23% of people receiving more than 2000 euros per month are once again are employees, individuals who have a better position like the directors of companies who rule a company and all the individuals that work in the health domain. This question shows us who would absolutely need to save money on simple things just like drugs and who does not need it but wants to take generic drugs or not.

Before getting deeper into the subject and asking actual questions about the two types of medication drugs we felt that it was important to ask if individuals answering the survey actually knew the difference between the two types of medication drugs. We did not do this in the aim of judging people for not knowing, we actually wanted to explain them the difference if they did not kwon so, the next time they would need it they would know. At the time, when we opened the survey for the first time and discovered the responses this pie-chart might be the one we were most surprised about. As we can see in the pie-chart above, 40% of the people answering to this survey responded that they did not know what the difference between the two types of medication drugs is. It came as quite a shock at first, once almost half of the 250 people who responded did not know what the difference between the two drugs was. Later, we decided to see who the individuals that had responded that they did not know the difference, were. We looked at every response singularly and noticed that these answers belonged to all the under 18 years old and most of the individuals who are between 18 and 30 years old. No one between 31 to more than 60 years old had responded no, only the younger individuals. All of a sudden, this made sense. The two groups of ages that did not know the difference are mostly individuals that live at their parent’s house or that are taken care of by some legal guardian. For this reason, whenever they felt ill or seemed ill, they had an adult that would buy them their drugs and take care of them. The only role these individuals have in this situation is to take whatever the adults give them to get better. Only once you live alone or become independent in a way or another, you start buying your drugs yourself and then discover that there are two types of medication drugs and what their differences are. Anyways, these unexpected responses were not problematic for our survey as we had anticipated that some people would respond that they did not know the difference between the two types of medication drugs. This anticipation, lead us to write a very short text to resume the main difference between the brand-named drugs and the generic drugs:

Brand-named drugs, are drugs that incorporate for the first time an active ingredient that has been isolated or synthesized by a pharmaceutical laboratory. It is considered the "original" drug as it is protected by a patent that ensures that the laboratory has the exclusivity of its exploitation and its marketing for 10 years.

Generic drugs on another hand, are drugs that only go out on the market once the drug patent of the brand-named drug has come to an end as they use an active ingredient already known and already previously used by a brand-named drug. The big difference between these two drugs, are the excipients (other ingredients) that might change the taste, therapeutic form between other things.

The easiest way to differentiate the generic and brand-name drugs is by their names. The generic drugs have the chemical name of their active substances while the brand-named drugs have a marketing name on their box. For example: Doliprane is a brand-named drug while Paracetamol is a generic drug”.

Doing this, the 40% that did not know what the difference between the two drugs were would be able to continue answering to all the questions, as you did not need to know much more to answer them.

The first question we asked regarding something linked to the health of individuals was the times they went annually to the general practitioner’s office. This might not seem like a question linked to the consumption of the two types of drugs but this question is actually very important to study because individuals go to the general practitioner’s office to see how their health is. The general practitioner has the power to detect an individual’s disease, to tell them to go see a specialist in some precise cases and to prescribe them drugs if needed. Once these general practitioners can prescribe them drugs, it is interesting to see how many times individuals actually see them. This will later, allow us to see more less if it is them or other people that told them to take generic drugs or brand-named drugs and who are the ones that need more medical attention and drugs. Looking at the pie-chart, we can see that there are 28% of people that do not go to the general practitioner’s office, looking more precisely to the responses these ones represent almost all of the under 18 years old and some of the unemployed people. But this actually makes sense, when you are young you do not need to go to the doctor that much unless you are really sick but most times at this age you only have headaches or the flu which can easily be cured with drugs bought at the pharmacy. Then, we can see a really big pie that distinguishes itself from all others, which corresponds to one visit to the general practitioner’s office per year which represents 41% of the pie-chart. This pie that almost represents half of the pie-chart, corresponds mostly to the visits of individuals that are between 18 and 30 years old and between 31 and 40 years old. This pie is logical after all, once you begin your adult life it is advised to go at least once a year to a general practitioner’s office to see if everything is well, just as an annual check-up. We can also observe that there are 12% of people who answered that they went to the general practitioner’s office 2 to 3 times a year, these answers were mostly from people from 41 to 60 years old. But several individuals from this range of ages responded that they went 4 to 5 times too. There are actually 10% of individuals who go 4 to 5 times to general practitioner’s office per year, in this case we also find elderly individuals but these ones are more representative of the more than 5 visits to general practitioner’s office per year. Once again, we can notice that there is a perfect coherence between the pie-charts. After all this question reveals a logical response. The more you grow up the more you have to be careful with your health because your immune system slowly weakens itself and the general practitioner is the one who can tell you what to do to protect yourself, prescribing some type of drugs or other things.

The following question we asked in our survey was about the times individuals went to the specialist doctor’s office annually. This question actually completes the previous question we asked as the general practitioner might advise individuals to go see a specialist doctor when they have a specific disease. An individual can also decide to see a specialist doctor by itself if he or she wants to check something more precisely about himself or herself. Once we look at the pie-chart there is a pie that distinguishes itself the most from others which corresponds to no visits at all to a specialist doctor’s office in a year which corresponds to 41% of the pie-chart. This pie is mostly composed by under 18 years old that once again do not need to see one (most of the time) because they do not have very important and different diseases that need that kind of attention. In this pie we can also find individuals between 18 and 30 years old and individuals between 31 and 40 years old. But this last range of ages also responded that they went to the specialist doctor’s office once a year to check if everything is alright. There are 23% of individuals that only go to a specialist doctor’s office once a year, these people as we said earlier are people who are thinking of creating their families and make sure everything is really well to do that and to anticipate any diseases. Then, we can see that 15% of individuals go 2 to 3 times to this kind of doctor in a year which corresponds to individuals that are between 41 and 60 years old. These individuals are the ones who already have families, their bodies have changed and have to pay more attention to their health, there are people of this age that also go more often as 4 to 5 times but that is rarer. Usually people that go 4 to 5 times a year to the specialist doctor’s office are individuals that are more than 60 years old. But these last individuals also responded that they went more than 5 times a year (10%). Individuals that go that often to the specialist doctor’s office are usually elderly people because they have conditions that imply them to go to this kind of doctor obligatorily to check specifically everything and more precisely chronic diseases.

As we just mentioned individuals often consult a general practioner or a specialist doctor when they have a chronic disease (which is a disease that lasts a long period and that usually slowly evolve) or when they want to see if they have one or have the probability to have one later. Individuals consult both types of doctors, not only because these are the individuals who recommend their drug treatment if they have a chronic disease but because they are the ones that check their evolution. Then, we thought that following the questions about the number of annual visits to both doctors it would be interesting to ask if individuals have a chronic disease because these people are entitled to an obligatory long-term drug treatment to cure them so we would be able to see what kind of drugs they are recommended and take later. We were very shocked once we saw the results of this question as we were not expecting these much positive answers. In 250 individuals that answered, 46 had a chronic disease, in percentages that corresponds to 18%. Looking individually to the answers we noticed that most of the positive answers were from elderly people but that there were also people between 18 and 30 years old and between 41 and 60 years old that had a chronic disease.

As we said earlier, it was interesting to create a question concerning the percentage of people that had a chronic disease (a disease that last a long time and slowly evolves) to analyze what type of drugs they were recommended and take to cure themselves so, that was the question we asked after. Before analyzing the responses, it is important to notice that once again we have a perfect coherence between the two pie-charts as we had 82% of individuals who had responded that they did not have a chronic disease and we have once again 82% in this pie-chart that responded that they do not have a chronic disease. The ones that have a chronic disease, responded to the three types consumption of medication drugs we proposed. As we can see in the pie-chart, there are 4% of the individuals that have chronic diseases who responded that they only take generic drugs while 8% so twice as much responded that they only take brand-named drugs. We also created a third type of consumption of drugs that consisted in taking both generic and brand-named drugs and 7% of the people that have a chronic disease answered that. Through these results, we can say that individuals that have chronic diseases usually take more brand-named drugs. To complete this pie-chart, we asked three different doctors if they could give us some patient’s (who have chronic diseases) prescriptions to illustrate the percentages we found. From these three doctors we only obtained three different prescriptions for individuals who have long-term diseases that slowly evolve (you can find them in the annex). Doctor Vincent Lasaffre’s prescription, the first one, was given to a patient who has a debut of Alzheimer which is a very complicated condition that consists on the progressive loss of memory. For this particular condition the doctor prescribed its patient both generic and brand-named drugs for hers or his treatment just like the 7% of individuals that answered the survey. But if we look more precisely at the quantity of both drugs prescribed, we can see that there are much more brand-named drugs prescribed than generic ones (you can see it yourself, the name of generic drugs is the same as the active substance you can find in front of the drug prescribed). Doctor Philippe Urbain’s prescription on another hand, the second one, was given to a patient who has a very complicated disease over the brain which makes him or her involuntarily do some movements. In this case, the doctor prescribed its patient only brand-named drugs just like 8% of the individuals answered in the survey. Doctor Patrice Herbin’s prescription, the third one finally, was given to a patient who has high cholesterol problems which consists on the increase of a waxy substance in the blood of the individual which can lead to heart problems. In this case, the doctor prescribed his patient both generic and brand-named drugs. But just like Doctor Vincent Lasaffre did, Doctor Patrice Herbin prescribed more brand-named drugs than generic ones. Once again, these prescriptions have shown us that individuals who have a chronic disease actually take more brand-named drugs than generic ones.

We thought it was interesting not to ask only the individuals that have a chronic disease what type of drugs they took, so we also added a question for the ones that do not have a chronic disease. This way we would know what types of drugs every type of individuals consumes. We re-created the same three types of medication drugs that could be taken and we added a “none” so the individuals that are not concerned by this question could answer too. Once again, we can proudly say that there is a perfect coherence between this pie-chart and previous one, there exactly 18% of individuals that responded none and there are exactly 18% of individuals that have a chronic disease. In the meantime, the ones that do not have a chronic disease have predominantly (40%) answered that they took both generic and brand-named drugs. Even if 40% of the individuals responded that they took both type of drugs, there were more people that answered that they only took generic drugs (28%) than people that answered that they only took brand-named drugs (14%). Even if many people take both drugs, there are exactly two times more people that take generic drugs than brand-named drugs.

After asking the individuals who have a chronic disease and the ones that do not have one which type of drugs they took, we found that it was interesting and that it would complete the previous questions, to ask to the ones that take generic drugs who recommended them. This question is very important for our study as the person who recommends generic drugs has a big impact in the evolution of its consumption as we will see later on. First of all, we have to say that once again there is a perfect coherency between the different pie-charts as the 12% who answered that they were not concerned combined the 8% of individuals who have a chronic disease and only take brand-named drugs and the 14% of individuals who do not have a chronic disease but that also only take brand-named drugs. For the rest of the individuals that take generic drugs, 12% answered that they did not mind taking them, the ones responding to this were mainly individuals that had answered previously that they took both brand-named and generic drugs. There were 13% of individuals that answered that they chose to take it themselves and 2% answered that their parents chose it for them. 20% of the individuals answered that they were actually recommended by a doctor once at the doctor’s office, just like the individuals whose prescriptions we saw earlier (in the annex). The most common answer to this question was that pharmacist recommended it (32%). As we can see, the ones who recommended it the most are individuals who work in the health area but more precisely pharmacists and we will see why after the last question of the survey.

Once we asked all the individuals what type of drugs they took and who recommended them in the previous questions, we know what they actually take but we do not know how they feel about them. And that is exactly what we decided to ask as the last question of our survey: what type of drugs they prefer. It is a simple question but it allows us to know how they feel about these two types of drugs. When we look at the pie-chart the first thing we notice is that there is not an enormous difference between the preferences of each drug. On one side we have 61 person of individuals that answered that they prefer taking generic drugs, these answers came from people that answered who actually recommended it to them. While on the other side there are 39% of the individuals that answered that they prefer to take brand-named drugs, the ones who answered this were mainly the ones who do not take generic drugs and the individuals that responded I do not mind in the previous question. Even if the difference is not enormous, there are more people that prefer taking generic drugs.

We can conclude that the survey we made was a great success from our point of view. We received more answers than we expected and we counted the same exact amount of men and women so there was no disequilibrium at any point. The groups of ages and the backgrounds (that have different monthly incomes and employment statuses) were also very heterogenic which allows us to have different points of view on the subject and so, have a more accurate representation of the actual consumption of the medication drugs in the city of Lille. The most important information we take from this survey to continue our project are that the more individuals grow of age the more the visits these ones to both types of doctors multiply. Also, doctors, pharmacists and individuals working in health domain are the ones that recommend the most the consumption of generic drugs.

But they mainly recommend it to individuals that do not have a chronic disease. Once we looked at the pie-charts, we noticed that in this case individuals consumed mainly both types of drugs, but the consumption alone of one of these drugs was major for the generic ones. While individuals who have a chronic disease actually consume more brand-named drugs. But the preference for the consumption of drugs of both types of individuals is majorly for generic drugs.

Now that we know that the consumption of drugs in the city of Lille is mainly based on both types of drugs but that there are more and more people that only take generic drugs even more than ones who only take brand-named drugs and that a large majority of the individuals actually prefers taking generic drugs, we will see why individuals are more and more attracted to generic drugs and why there are still individuals that dislike or distrust this one.

IV. The explanation

As we have just seen, nowadays in the city of Lille there are more and more individuals taking generic drugs and preferring them to brand-named ones but this was not always the case. Actually, when the generic drugs came out 25 years ago patients, doctors and pharmacists distrusted the drug and used to take and prescribe brand-named drugs only. These individuals were scared that the generic drugs would not be so effective as the brand-named drugs, or that they would not have the same effect on some kinds of diseases etc. But once the yearly reports of the General Inspection of the Social Affairs (IGAS), the National Agency of Drug’s Security (ANSM), the National Academy of the Pharmacy and French mutuality came out and responded to all the questions and doubts that individuals had, they showed precisely that there is room for improvement but that generic drugs are as efficient than brand-named drugs. With this, individuals started accepting the generic drugs but still kept some distance from them. So, in the aim of motivating individuals to trust and take generic drugs, the Government and Public authorities put in place three strategies. The first strategy the government adopted was to drastically reduce the prices of these generic drugs. The Economic Committee of Health Products (CEPS) have been reducing the prices of generic drugs since 2000, while generic drugs costed 80% of the price of brand-named drugs, today they only cost 40% and the brand-named drug’s prices have reduced too so the generic drug’s prices are very low. The second strategy that the Government and Public authorities had and still have is a marketing strategy. Since 2010, there have been thousands of campaigns encouraging individuals to take generic drugs, reminding them that they have the same efficiency and that they are less expensive. The lower prices might be very attractive for everyone and the campaigns might keep the individuals reminded about the subject, but individuals are still too scared of paying for something that they have never taken before and that they are not sure of. For that exact reason, the government found a way to encourage the consumption of generic drugs through someone that individuals usually trust their lives to: doctors and pharmacists. To motivate pharmacists and doctors to encourage their patients to take generic drugs, to prescribe generic drugs and replace brand-named drugs, the government found a monetary mean that would lead them to do exactly that. In 1998, the government conceded a right of substitution to the pharmacists, which gives them the right of replacing a brand-named drug prescribed by a doctor by its generic equivalent. Eleven years later (2009), the National Union of the Health Insurance Funds put in place an agreement in which this one promised a prime to pharmacists and doctors if these ones prescribe generic drugs or replaced brand-named drugs by generic ones with the goal of replacing at least 80% of the brand-named drugs. The ones who really followed the deal were pharmacists and because of that last year the National Union of the Health Insurance Funds distributed a prime of 6000 euros per pharmacy in Lille. With the influence of monetary savings, marketing and their health advisors, individuals started to think that they did not want to pay more for a drug if the other has the same efficiency and so, they started taking more and more generic drugs. In Lille, the percentage of issuance of generic drugs is 46,34 % and the percentage of substitution is 84%. These percentages are very good, but what’s even better is the fact that the decrease of the prices of drugs allowed the Health Insurance to save billions of euros every year in reimbursements of drugs which allowed it to finance the development of new drugs. According to the Social Security, in 2010 due to the consumption of generic drugs, 1.3 billion euros were saved. Taking all of this into account, we can conclude that more and more individuals are attracted to generic drugs because these drugs have been shown to have the same efficiency than brand-named drugs but they are sold for a lower price. Also, individuals who work around drugs all day and know them well (doctors and pharmacists) actually prescribe them, so individuals that trust doctors and pharmacists start trusting generic drugs and taking them as the ones working in the health domain encourage them to.

Even if there are studies proving that generic drugs and brand-named drugs have the exact same efficiency, that generic drugs are cheaper and that doctors and pharmacists prescribe them, there are a lot of individuals that still dislike or distrust this type of drugs. The source of this particular distrust comes from the fact that generic drugs and brand-named drugs have some little differences that for some individuals are representative of some kind of danger due to the fact that they could modify the efficiency or even be improper for individuals. The first difference that makes individuals not trust generic drugs is one of the reasons actually attracts most individuals to take generic drugs: their low prices. The prices of generic drugs are so low because they do not have to do as much research than for the brand-named drugs. In fact, they copy the research of the brand-named drugs. And for that reason, individuals feel that these low-cost drugs are not trustworthy as they might have a problem that was not detected due to the lack of research of this one. Generic drugs might not do the research on the active substance because they copy it but they have to pass some bioequivalence studies which analyze if the two types of drugs act exactly the same in the human’s body. Once the results are out, they are compared to the brand-named statistics already established to see if the results match. For the generic drug to be accepted in the market, this one must have at least 90% of bioequivalence similarity to the brand-named drugs. For some individuals this 10% margin of acceptance can be a 10% margin for problems. Also, these studies are done in volunteers who do not have any diseases, who are young and that do not smoke so, the effect of the drug might not be the same on someone who really does have a disease. Not only these drugs are tested on individuals that are not ill, but to have lower costs they are tested in South of Africa or India, where the inspections have shown some falsifications in the results which is worrying. In the bioequivalence studies the major point scientists study are the excipients, the “other ingredients” in a drug that are responsible for taking the active substance where it is supposed to act and because it is responsible for the stabilization of the drug. These excipients have the power to change some elements of the drugs, their efficiency and they can even give allergies or intolerances. These allergies and intolerances due to excipients in generic drugs can be worrying once again, but these problems are notified on the box you buy when you are buying generic drugs and you can also find these problems in the brand-named drugs. Sometimes individuals blame their problems on little things, like these little dysfunctions are blamed on the excipients but it can also actually be the placebo effect. The placebo effect corresponds to a reaction of the human body when it is used to a drug and suddenly it is replaced by another drug with a different flavor, appearance, or color. Individuals sometimes judge things to fast, the body takes time to adapt to new bodies in its organism. With all of these little problems that the generic drugs have or seem to have, there are a lot of individuals that refuse to take them and a lot of individuals that work in the health domain that refuse to prescribe them. A lot of doctors have chosen not to encourage the consumption of generic drugs, on the contrary many of them have done everything they can to keep individuals away from them. The first way to do that, is prescribing only brand-named drugs but once at the pharmacy the pharmacists has the power to replace the brand-named drug by a generic one. This can happen unless the doctor writes ‘’non-replaceable” on the prescription just like in the third doctor’s prescription we can find in the annex. As the government is trying to encourage individuals to take generic drugs and doctors are impeaching some of the individuals from doing that, from 2020 doctors will have to write next ‘’non-replaceable” why it is not. This has been determined due to the 9% of prescriptions who had that written on them without any specific reason. The other way individuals in the health domain found to not encourage individuals to take generic drugs is through the decrease of the price of brand-named drugs but doing that the laboratory responsible for the drug does not make any benefits on the drug.

We can finally conclude that the medication drugs that are most consumed in the city of Lille are the Brand-named drugs. This type of drugs is consumed by 53,66% of the entire population of Lille. Even if brand-named drugs are more consumed than the generic drugs, we have seen through this project that the generic drugs are taking a more important place in the population of Lille every day. Technically both medication drugs are good, there is no such thing as a best drug. It is not because one is cheaper than the other that it is automatically worse. Both have the same efficiency and both can make allergies or intolerances. Risks can be found in both drugs, but there are tests, studies and inspections to verify everything so at the end of the day, they are busted and shut down or accepted and are considered good. The only thing that must happen, is rules must be respected for everyone’s health. If you know to what you are intolerant to, if you know to what you are allergic, and you can read a box then you can take any kind of drugs, but the generic ones will be cheaper.

V. Bibliography

· https://forms.gle/aitWSZR93D61eXh39

· https://www.bleuepil.com/generique-ou-original.html

· https://www.medisite.fr/medicaments-et-risques-sante-difference-entre-medicament-generique-et-princeps.800426.70.html

· http://www.lavoixdunord.fr/60465/article/2016-10-16/vingt-ans-de-medicaments-generiques-peut-mieux-faire

· https://www.lemonde.fr/sciences/article/2013/12/10/les-medicaments-generiques-suscitent-toujours-la-mefiance_3528210_1650684.html

· https://www.huffingtonpost.fr/elise-soli/medicaments-generiques-ce-que-cache-la-mefiance-des-francais_b_2487670.html

· https://journals.openedition.org/nrt/3501

· http://www.aveclesgeneriquesyapasdehic.fr/excipients-et-medicaments-generiques-petit-guide-pratique/

· https://www.sciencespo.fr/research/cogito/home/ce-que-les-medicaments-generiques-ont-change-dans-notre-systeme-de-sante/

· https://www.allodocteurs.fr/se-soigner/medicaments/generiques-princeps-ont-ils-la-meme-efficacite_5042.html

· http://www.doctissimo.fr/html/medicaments/articles/15847-securite-medicaments-generiques.htm

· https://www.lexpress.fr/actualite/societe/sante/medicaments-generiques-le-cri-d-alarme-des-medecins_1236973.html

· https://www.wikidependance.fr/comment-reconnaitre-medicaments-generiques/

· http://www.biogaran.fr/dossiers/medicaments-generiques/

·https://www.acadpharm.org/dos_public/RAPPORT_GEnEriques_VF_2012.12.21.pdf

· https://www.bfmtv.com/sante/de-nouvelles-dispositions-pour-inciter-les-medecins-a-prescrire-des-medicaments-generiques-1530331.html