You might turn to Consumer Reports when it comes to purchasing appliances or even automobiles. Yet, would you trust them for ADHD-related medical advice? I certainly hope not.
Let me explain, in this updated version of my post from 2009.
CR: “Parents, be skeptical of free samples from your doctor”
A July 8, 2009 press release from Consumer Reports caught my attention. I grew concerned that mental healthcare consumers would be forced to accept cheaper—but inferior—generics instead of more reliable brand-name medications.
Next thing I knew, Consumer Reports has followed it with equally misguided information and advice on ADHD.
The 2009 press release from Consumer Reports starts with this:
Parents should be skeptical if their doctors offer them free prescription drug samples, especially for the treatment of attention deficit hyperactivity disorder (ADHD). Free samples can hook consumers on high-priced brand name drugs that are not any better or safer than less expensive generic medicines.
Note the lurid term “hook” when speaking of ADHD medications. I can make no sense of it. How can you get more “hooked” on a brand medication but not the generic? That’s ridiculous.
This sets the tone for the skewed information that follows, including this:
Consumer Reports Best Buy Drugs notes that many young patients who take ADHD drugs either do not have ADHD or have only mild symptoms.
No research or data is cited. So, what is the motivation for CR to issue this ADHD-stigmatizing disinformation? I wondered that, too.
The Trouble with Generic ADHD Rx
Back to the generics vs. brand medication issue. We know that generic stimulants and other psychoactive medications are absolutely not the same as brand. They might work well for some people, but they do not work as the brand works. that’s the difference.
I addressed this topic in this and other follow-up posts: Update on Generic Rx: Approach with Caution
Yes, sometimes generics work okay for some people. When it comes to affordability, sometimes it’s the only option. For many other people, however, they create more side effects and cause them to stop treatment altogether.
One workaround: Try the brand name of the medication to make sure it works for you, before switching to generic. At least, you will have then eliminated one variable.
Cost-Cutting Conflicts?
Consumer Reports medical advisor, John Santa, (below) has a background in cutting statewide medical costs (for example, the Oregon Health Plan [Link no longer works]).
From this perspective, he claims you don’t need expensive medications such as Concerta, Adderall XR, and Strattera. (You know, the medications that might have made all the difference in your world).
He says you will do just as well with generic dexedrine and methylphenidate. (You know, the medications that give many folks the heebie-jeebies or other intolerable side effects—even if they work well for others.)
- Does Santa have any experience treating ADHD?
- Did he talk to any ADHD scientific-medical experts?
- Does he have any clue as to the negative impact of this broadside?
To me, it’s an obvious no.
Listen, it’s hard enough to find competent medical treatment for ADHD and it’s common co-existing conditions. It typically involve lots of trial and error, balancing benefits with side effects.
When you try only generic medications, you add a whole other layer of problematic complexity.
The Grinches That Stole Clarity
Santa and his Consumer Reports elves, it seems, want to be the Grinches that Stole Clarity. Their over-arching goal? Santa Claus-sized cost-savings for states.
Omitted from their calculations: The long-term costs they risk in leaving ADHD untreated or poorly treated. Even worse, the short-acting medications they favor are more likely to be abused (not typically by people with ADHD but others).
Can people with multiple advanced degrees truly be this bone-headed? Or is this willful denial of the facts?
Whatever the case, this is also a problem in some countries where nationalized health systems based treatment decisions on cost alone. Just ask adults with ADHD in Australia (those that managed to get a diagnosis) about their experiences with generic dexedrine.
Recapping Problems with Generics for ADHD:
Here are just a few reasons why generic medications for ADHD can be problematic:
1. Roller Coaster Effect
- Most of these generics are immediate-release, not time-release.
- The start-stop, up-down nature of activation and deactivation can feel like a neurochemical roller coaster.
- If you do well with the short-acting stimulant medications, good for you! But know that many other people with ADHD do not.
2. Hassle of Remembering To Take Multiple Doses
Then there’s the pesky matter of having to remember to take four or more short-acting pills daily. For children, this often involves trips to the nurse’s office and enduring stigma because of it.
3. The Narrow Therapeutic Window
- Generics can wreak havoc with that narrow “therapeutic window”—the dose that works best with the least side effects.
- A few milligrams up or down can mean trouble, and the FDA allows a wide window of efficacy. In the U.S., the FDA requires the bioequivalence of the generic product to be between 80% and 125% of that of the original product.
- Bioequivalence, however, does not mean that generic drugs must be exactly the same (“pharmaceutical equivalent”) as their original product counterparts, as chemical differences may exist. No matter what a physician or pharmacist tells you.
4. Different Dyes, Fillers, Binding Agents
Branded drugs and their generics almost always contain different dyes, fill materials and binding. These are ingredients to which many people are allergic or have other adverse reactions.
(I have no scientific proof, but abundant anecdotal reports indicate that people with ADHD seem more prone to these sensitivities.)
Imagine what happens when your pharmacy changes suppliers on a regular basis (and this happens at many pharmacies). First, know that different manufacturers will have variable amounts of the active ingredients. More to this point, however, imagine no one clueing you into the filler potentially being the problem and not the medication—or some “unmasked” co-existing disorder, such bi-polar. Talk about neurochemical roller coasters!
I welcome your comments!
Gina Pera
Thank you for this article. I am an adult with ADD and stasted taking generic Adderall XR 3 months ago (by global pharmacy). The first month I felt great. It actually helped my anxiety which I have never found anything else that has done that. The prescription ran out and I refilled it. This time it wasn’t the orange pill but the blue pill made by Teva. I tool it and didn’t like it at all. Made me anxious, jittery and feeling weird. I thought it was in my head so I took it a couple more days and had to stop.
Then I found out I had to wait a months to refill my prescription because I had just filled. The dr said since it’s controlled he can’t write another prescription or I would have to pay full price. I didn’t take it for a month. I just refilled it again with a different pharmacy and it was an orange pill only smaller. The weird thing is it was the same company that worked the first time, but the pill was actually the real Adderall XR, not generic.
It works better than the blue pills, but still not like the first ones I had. Also, the blue pills have lots of dyes in them. Why do they put dyes in medication where they already know ADHD people are sensitive to them them? My son takes this med too and was telling me he didn’t feel the same with the new meds. I looked at his and it’s different too.. it’s Teva brand. Looks like that one doesn’t work for us.
hi TC,
I’m not as familiar with the particular issues on other generics (Adderall, etc.), but I know there are universal problems toe generics when it comes to ANY medication for ADHD and co-existing conditions (e.g. anxiety, etc.).
One reason, with the stimulants anyway, is that dosing is very precise. And with generics, you just don’t know what you will get — 80 percent, 120 percent, or something in between!
As for why they put in annoying dyes…I guess it is to make them visually distinct. And, maybe they could use less offensive dyes that are more expensive. With generics, cheapness is the guiding principle.
Good luck sorting it out.
g
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I was not aware of this report until I read your blog so I’d like to thank you first for sharing. For me, ADHD is a serious illness and in critical conditions like this utmost care and proper medication are needed. I do not know of anyone suffering from ADHD but when I talk to my friends who suffer from diabetes I always tell them to go for trusted (although) expensive brands and never to trust articles or reports you read online on expensive and generic brands having similar effects because it ain’t true. Branded medicines are way much, much better.
Mark
Thanks for chiming in, Mark.
I have never whished Bad things on strangers before but this definitely takes the cake.
Let’s hope when he gets Cancer that his Insurance Company will pay for the rite radiation not just a couple X-Rays and 2 aspirin for the pain.
Merry Christmas Santa
Thanks Jeff, Paul, Scott, Dr. Parker, and Sue. I appreciate you joining me in speaking out. A “report” like that gets picked up by many papers and blogs, and there should be a counter-balance somewhere.
Just in case readers miss it here, I added a closing post to the CR blog: http://tinyurl.com/l479h7
Gina,
Thank You for allerting us all! I can give an example from personal experiance about Brand name-vs-generic(not adhd med). I must take Dilantin to prevent asymptomatic seizures. I must have blood tests regulary to maintain Dilantin level, or risk a life threatening seizure.
The short story is…generic Dilantin was not keeping me at a safe level, after I switched to it. My Dr. was very concerned(me too). Switched back to brand name, and next blood test was good. Thats all I know about this subject. In my case,the old saying “You get what you pay for” is a matter of life and death.
Scott
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Right on, Gina. When I first heard about this Consumers Report on ADHD meds, I thought I was mishearing. How could they get it so wrong — and so confidently think they’re right? It boggles the mind. The height of irresponsibility.
If these are the kinds of “gifts” delivered by Santa…I think it’s time to change our iconic image for the next Christmas Season.
Thank you again, Gina, for alerting us about issues that are vital to the ADHD community.
Gina,
Thanks so much for keeping those of us who work everyday with ADHD up-to-date with the superficial vagaries of economic priorities, pop science, and unverified street gossip! For Santa, quality, titration, medical specificity, compliance, and good patient care appear to reside downstream from the priorities of casual platitudes.
Maybe we should simply forget about the needs of the real people who suffer with inadequately treated ADHD for years, having taken the medications Santa suggests should become the ‘best consumer choice.’
His conclusions simply do not match the opinions of informed street consumers who regularly report with painful clarity the problems with those outdated medications that encourage capricious dosing, occasional use, irresponsible diagnostic/treatment strategies, and, as you accurately point out, drug abuse.
I submit for Consumers this Report: Those immediate release medications have significantly set back the accurate diagnosis and scientific treatment of ADHD, and have fostered many derogatory beliefs regarding those who suffer with ADHD. Given the choice, far more in my office prefer the newer medications for their efficacy, their duration, their precision and their increased safety. Immediate release medications are not considered first choice even by the most autocratic and penurious managed care companies who make their living denying adequate patient care.
C’mon Santa, your ‘consumers’ are obviously not patients, but those who are still in denial that ADHD is an actual disorder, – and think it’s a belief system.
Thanks, Gina, for precise reporting… – and for the concerned consumers: caveat emptor!
cp
How irresponsible for an agency like this to make medical recommendations such as this without consulting the experts. In this case they’ve thoughtlessly and recklessly used their power of consumer persuasion. As a Consumer Reports subscriber, how can I trust their opinion again?
Consider my Consumer Reports subscription canceled!