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, 376 pages

8 halftones, 9 line drawings

August 2014



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The Unbranding of Modern Medicine

Table of Contents

Generic drugs are now familiar objects in clinics, drugstores, and households around the world. We like to think of these tablets, capsules, patches, and ointments as interchangeable with their brand-name counterparts: why pay more for the same? And yet they are not quite the same. They differ in price, in place of origin, in color, shape, and size, in the dyes, binders, fillers, and coatings used, and in a host of other ways. Claims of generic equivalence, as physician-historian Jeremy Greene reveals in this gripping narrative, are never based on being identical to the original drug in all respects, but in being the same in all ways that matter.

How do we know what parts of a pill really matter? Decisions about which differences are significant and which are trivial in the world of therapeutics are not resolved by simple chemical or biological assays alone. As Greene reveals in this fascinating account, questions of therapeutic similarity and difference are also always questions of pharmacology and physiology, of economics and politics, of morality and belief.

Generic is the first book to chronicle the social, political, and cultural history of generic drugs in America. It narrates the evolution of the generic drug industry from a set of mid-twentieth-century "schlock houses" and "counterfeiters" into an agile and surprisingly powerful set of multinational corporations in the early twenty-first century.

The substitution of bioequivalent generic drugs for more expensive brand-name products is a rare success story in a field of failed attempts to deliver equivalent value in health care for a lower price. Greene’s history sheds light on the controversies shadowing the success of generics: problems with the generalizability of medical knowledge, the fragile role of science in public policy, and the increasing role of industry, marketing, and consumer logics in late-twentieth-century and early twenty-first century health care.

Jeremy A. Greene is a professor of medicine and the history of medicine and the Elizabeth Treide and A. McGehee Harvey Chair in the History of Medicine at Johns Hopkins University School of Medicine. He is the author of Prescribing by Numbers: Drugs and the Definition of Disease and the coeditor of Prescribed: Writing, Filling, Using, and Abusing the Prescription in Modern America.

"Greene's brilliant book is the first full-length monograph to trace the history of how Americans think about generics, and it is going to be the key reference for many years to come."

"An excellent and recommended history of how the generic drug market came to be."

"Fascinating and thought-provoking."

"Dr. Greene's gripping and eye-opening accounts of the scientific, social, and political debates that happened along the way keep the reader hooked and engaged... [He] is both scholar and storyteller, interspersing fascinating historical narratives with complex scientific discussion."

"Greene should be congratulated for bringing this subject to life—with a mix of anecdote, scholarship, and elegant prose."

"As Jeremy Greene lays out in his excellent book, the story of the generic drug industry is is far more complicated—and far more interesting than most of us might guess... [Greene] provides readers with a useful framework for understanding how we got to where we are and how we might apply the lessons of the past to the challenges we face today."

"Greene turns the concept of generic as 'ho-hum' on its head with this jam-packed survey of the effects culture, medicine, and politics have exerted on today's ubiquitous generic drugs for the last 50 years."

"Jeremy Greene's Generic: The Unbranding of Modern Medicine fascinates because the very meaning of the key term 'generic' is so unstable. Every time the reader thinks they have a handle on its dimensions, another four open up."

"Greene's book is a dizzying historical-political-social-cultural account of the forms generic drugs have taken over past several decades."

" Generic: The Unbranding of Modern Medicine comes from a physician and historian who offers a history of not just the development of generic drugs, but how they differ from the original. Within his examination are important insights on how drugs are made, what parts of a pill really matter, issues of therapeutic similarity and difference, and more. It's a wide-ranging history that embraces ethical, scientific, health, and economic issues and it provides insights on the history of generic drugs in America and the problems associated with scientific and medical changes in the public eye. The result is a survey that belongs in any health collection and many a general-interest holding."

"This fine, stimulating, and entertaining book offers much food for thought."

"Well written and informative... bring[s] to life a tangled web of competing interests."

"A theoretical and empirical primer that explains the success and failure of generics and what it means to choose between generic and brand name drugs. Extensively researched and documented, Generic is the first book to chronicle the development of generics, and will probably be the key reference on the topic for some time... A book that should be read by anybody with a serious interest in contemporary healthcare."

"The generic drug industry... has been glorified as the antidote to exorbitant drug prices, and vilified as the purveyor of poisonous (or at least less effective) counterfeit drugs. Yet in Generic, Jeremy Greene has a far more nuanced, and far more interested, tale to tell... Greene's vitally important book... explicitly asks us to consider how much the tensions concerning times and places examined in the book are the same as those we face today... or at least similar enough in ways that we should find relevant. The answer is, very much."

"Physician/historian Greene provides a thoroughly researched discussion about generic products derived from innovative or brand-name drugs, focusing on their "social, political, and cultural history"... Greene ably argues for generic by providing inside details about the drug approval process."

" ... Generic is an excellent example of how to intelligently construct a modern material history, grounded in the logics of the everyday."

"... recommended reading for anyone interested in postwar developments in U.S. health care and for scholars and analysts of contemporary pharmaceutical politics."

"An enlightening and passionately written work, Generic opens the 'black box' of the pharmaceutical world. This book will deeply impact the way we imagine and practice medicine in the future."

"An extraordinarily timely and important contribution to our understanding of health practice and public policy. The status of generics is a significant subject in itself, and also a tool to think with, linking physiology and policy, business history and clinical options. Generic is a book that should be read by anyone with a serious interest in contemporary health care."

"Jeremy Greene brings his knowledge and wisdom as both historian and physician to bear on the economics and politics of branding, marketing, and consumerism in health care. Most intriguingly, he asks fundamental questions about what it means to say one drug is the same as another. Fascinating and eye-opening."

" Generic is a gem. Original, multi-layered, and powerfully narrated, the book unearths the history and value of generic drugs. While illuminating the dynamic interface of medicine, public health, and the marketplace in the US and beyond, Greene has crafted a vital compass that can greatly help us to understand and navigate the pharmaceutical present."

"The story of generic drugs is rife with intrigue, deceit, complex scientific debate, legislative wrangling, backstabbing, internecine warfare among health professions and government regulators, under-the-table deals worth billions of dollars, headline-grabbing prison sentences for trusted officials, and power struggles among monied interest groups. But Jeremy A. Greene’s Generic is not just a lurid story: it is also rich with lessons in the negotiating of health policy, the brokering of legitimate scientific disputes to craft the best possible regulatory decisions for the public health, the struggles to make health care more affordable for as many citizens as possible, and the transformation of the global pharmaceutical marketplace. A provocative, thoughtful, and comprehensive look into an industry that took on big pharma and organized medicine."

"Greene’s book is a pioneering work. His study is particularly relevant for historians of medicine and health but will be of interest for readers from history and sociology of science, as well as other social scientists who specialize in drug regulation."

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