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.
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!