I have a migraine. My son has strep throat. A patient presents to my clinic with signs of pneumonia.
These are all common enough occurrences. When I have a migraine, a good cup of coffee and a few tablets of ibuprofen go a long way towards soothing my throbbing head and general malaise. But not all cups of coffee are equally effective against migraines. I prefer the handcrafted pour-over from my local barista to the Styrofoam cupful that’s been sitting on a warming plate at my local gas station for a few hours; I think it makes me feel better faster. Nor are all pills of ibuprofen the same. I prefer the original Advil brand to generic ibuprofen because, like a well-sourced cup of coffee, it works better at making my headaches go away. Yes, I know that both pills contain the same active pharmaceutical ingredient in the same amount, and I’m a sucker for my neighborhood café. But the particular experience of consuming Advil—its lentil shape, its candy coating—is somehow more soothing than swallowing the slightly acrid, oblong generic versions. In ibuprofen, as in coffee, the materiality of my drug of choice matters.
Migraines are irritating and potentially disabling, but not life-threatening. Untreated strep throat, on the other hand, can lead to kidney failure or cardiovascular complications. Pneumonia can lead to overwhelming sepsis, shock, and untimely death. Yet I don’t give a second thought to spooning generic amoxicillin into my son’s mouth (as long as he gets to pick the flavor), or prescribing generic levofloxacin to my patients if their lung symptoms are accompanied by a chest X-ray that suggests pneumonia. I know that over the past half century the United States Food and Drug Administration has elaborated a complex system for ensuring that the efficacy, safety, purity, and quality of generic amoxicillin and levofloxacin is equivalent to the original brand-name versions. As a patient, parent, and physician, I find myself more comfortable using generic drugs in life-or-death situations and more comfortable expressing my preferences for brand names in more trivial forms of treatment.