Recent headlines highlighting findings that carcinogens have infiltrated our generic drug supply are bringing an important issue back into the spotlight: people do not always know what is in their medicines, and they are trusting their doctors to ensure the medicines they prescribe will be safe and tolerable.
This trusting relationship is central to healthcare, but it comes down to whether doctors and pharmacists can truly trust the drugs that are being prescribed?
The issue is that many do not know the inactive ingredients in the generic medicine that their patient will receive when they fill their prescription. This is in large part because not all generics are identical, and doctors and pharmacists do not have control over the specific generic medicine that their patients will receive. The generic medicine that is dispensed—including the manufacturer and even country where it is manufactured—can be different at each renewal. And the cost of a dispense-as-written script for an off-patent brand-name medicine may be cost-prohibitive for many patients.
The facts speak volumes:
- As much at 50% to 99% of a medicine can be inactive ingredients.
- 93% of medicines contain ingredients known to be irritants or allergens to patients.
- 50% of patients don’t take medicines as prescribed.
From the recent New York Times best-seller, “Bottle of Lies” by Katherin Eban to the recent flurry of coverage about generic Zantac, public awareness and scrutiny about the quality of medicines is growing. The importance of knowing what is in our medicines has never been as important or as relevant a conversation as it is today.
As healthcare professionals, central to this conversation should be “How can we be doing this better? How can we make the medicines that doctors know and trust available to patients without the inactive ingredients that doctors and patients don’t want?”
This is a challenge that dermatologic medicine has taken straight on, and it has been met with a solution: customized medicines. In dermatology, doctors are opting to order the medicines they want, without the inactive ingredients they don’t, at the dosage they need, and dispensing these medicines directly to patients at the point of care. These doctors are taking control of how they are treating their patients.
In the process, they are eliminating layers of back-end handling of medicines, reducing the cost to patients and the health system, and improving compliance—which grows as much as 60% when patients receive medicines at the point-of-care. And best of all, doctors know that the medicines they are receiving are produced at an FDA-registered 503B outsourcing facility here in the United States, complying with current good manufacturing practice (CGMP) requirements.
This physician control of patient treatment is not a new concept. Prior to blockbuster drugs, doctors prescribed what a patient needed and chemists produced the medicines. As a country that has produced the most exciting and important medical discoveries of our time, we have failed in ensuring our patients have the best access to these medicines. We need to rethink the “one-size-fits-all” approach to medicine. We need to know what is in our medicines. We need to consider new options—sometimes, what’s old is new.