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BMJ 2008; 337 doi: (Published 10 December 2008) Cite this as: BMJ 2008;337:a2947

Brand name cardiovascular drugs look no better than generic alternatives

Generic drugs are often cheaper than brand name alternatives. Many doctors remain reluctant to prescribe them however, possibly because opinion leaders don’t always support a switch. More than half the editorials found by one systematic review were largely negative about generic cardiovascular drugs (23/43; 53%). Only a quarter clearly encouraged substitution (12/42; 28%). The review’s authors found no evidence that branded drugs were better or safer than generic equivalents in a pooled analysis of 38 randomised trials comparing the two. They looked at nine classes of cardiovascular drug, including β blockers, diuretics, statins, calcium channel blockers, angiotensin converting enzyme (ACE) inhibitors, and warfarin. Generic and brand name drugs in the same class had similar effects on a range of clinical outcomes, although evidence of equivalence was best for β blockers, calcium channel blockers, statins, and warfarin.

Editorials were particularly likely to warn against generic versions of drugs with a narrow therapeutic index, such as warfarin (12/18; 67%). It is unclear why opinion is so at odds with the evidence, say the authors. The power of anecdote may have something to do with it. Opinion leaders may also be influenced by undisclosed financial ties with the manufacturers of brand named cardiovascular drugs.

Surgery is an underused treatment for temporal lobe epilepsy

Temporal lobe epilepsy is common and often fails to respond to medical treatment. Surgery is also possible, and observational evidence suggests it can work well. The latest evidence comes from a modelling study that suggests resection of the anterior temporal lobe can extend a patient’s life by five years (95% CI 2.1 to 9.2 years) and improve quality of life. The authors used data from individual patients and from a systematic review to model outcomes for a “typical” patient aged 35 with a long history of intractable temporal lobe epilepsy and an identifiable epileptogenic focus. Compared with …

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