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Someone wrote in re HMO drug reimbursements in Massachusetts: > .. I have a suggestion: use generics. The American Council on Science and Health published a report "Are Generic Drugs Appropriate Substitutes for Brand-name Drugs? -- No" (see www.acsh.org, click on publcations) citing research by Susan Horn, Senior Scientist at the Institute for Clinical Outcomes Research, University of Utah School of Medicine, who found that HMO patients fared worse under generic drugs. They had significantly more emergency-room visits and hospitalizations. Here's why. The usual test of generic equivalence is this: " ... typically the innovator drug and its generic counterpart are given in a highly structured setting to a small number of healthy subjects--almost always fasting young male adults--and blood concentrations of the drug are measured over time after just one dosage. If it is found that the blood levels for each product are similar (usually within 20 percent of each other), the FDA will declare the generic product equivalent to the innovator product." "In the "real world," however, these drugs will be administered --usually inmultiple doses--to both young and old patients, male and female, bedridden and active, on diverse dietary and medication regimens. Each of these factors--age, sex, etc.--can affect drug absorption. Moreover, the generic drugs that undergo bioequivalence tests are almost always in experimental form. The form in which generics are marketed usually differs somewhat from the form in which they are tested. In contrast, virtually all innovator companies use bioequivalence tests to compare the experimental and final forms of their trademarked drugs before marketing them. "Duplicator companies can repeatedly alter formulations to cut costs, and such alteration can affect drug absorption. Yet the FDA requires only "test tube" tests to determine whether absorption of the variation in human patients will be the same as that of the unaltered generic. There is no appropriate documentation that such tests correlate with clinical experience. "Thousands of studies published in the scientific literature have cited substantial absorption differences between different versions of the same drug. Differences much greater than 50 percent have been observed among some formulations." Such differences in strength may be very significant for PWPs in whom there is a narrow window between PD symptoms and dyskinesia. Phil Tompkins Hoboken NJ age 60/dx 1990