Researchers from the University of the French West Indies, Laboratory of Epidemiology and Analysis in Public Health and the University of Toulouse III Paul Sabatier carried out an observational study from October 2015 to February 2016 in Guadeloupe and Martinique. The first qualitative phase involved a diversified sample of 14 general practitioners (GPs) who underwent semi-structured interviews. The second phase involved a random sample of 316 GPs (response rate = 74%) who were administered a structured questionnaire developed from the results of the first phase.

The results showed that 78% of participants defined a generic drug as a drug containing an active substance identical to a brand-name drug, but only 11% considered generics to be equivalent to brand-name drugs, and the same proportion believed that the generics were of doubtful quality. The primary recognized advantage of generics was their lower cost (82%). The main drawbacks cited were the variability of their presentation (44%), the confusion that they caused for some patients (47%), frequent allegations of adverse side effects (37%) and a lack of efficacy (24%), and frequent refusal by patients (26%). These negative perceptions from patients led to 74% of doctors stating that they adapted their prescribing practices to the situation, and of this group 47% prescribed the originator product on demand.

The authors concluded that most of the surveyed doctors were not hostile towards generics. They were caught between the requirements of health insurance regimes and the opposition of numerous users and suggested that the patient information provided by health authorities should be improved and that drug composition and packaging should be made uniform.

Previous studies have suggested that generics substitution may confuse or make people suspicious when, for example, the names, colours, packaging; of their medication is changed [2, 3]. Other studies have also demonstrated the negative impact of changes in pill colours and shapes on adherence [4]. The US Food and Drug Administration has even stated that generics should ‘look the same as the innovator as much as possible’ [5]. The agency also carried out a survey to investigate the effect of the shape, colour and size of different generics [6] and issued guidance on the issue [7].

Conflict of interest
The authors of the research paper [1] declared that there was no conflict of interest.

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References
1. Riner B, Bussy A, Hélène-Pelage J, Moueza N, Lamy S, Carrère P. "No generics, Doctor!" The perspective of general practitioners in two French regions. BMC Health Serv Res. 2017;17(1):707.
2. GaBI Online - Generics and Biosimilars Initiative. Generic substitution causing confusion [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2018 Jun 15]. Available from: www.gabionline.net/Generics/Research/Generic-substitution-causing-confusion
3. Andersen ML, Laursen K, Schaumann M, et al. [How do patients evaluate the newly introduced system of substituting prescriptions?] Ugeskr Laeger. 2000;162(45):6066-9. Danish.
4. GaBI Online - Generics and Biosimilars Initiative. Patient adherence and generics [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2018 Jun 15]. Available from: www.gabionline.net/Generics/Research/Patient-adherence-and-generics
5. GaBI Online - Generics and Biosimilars Initiative. FDA to release guidance on generic tablet size [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2018 Jun 15]. Available from: www.gabionline.net/Guidelines/FDA-to-release-guidance-on-generic-tablet-size
6. GaBI Online - Generics and Biosimilars Initiative. FDA to carry out survey into affect of generics shape, colour, size [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2018 Jun 15]. Available from: www.gabionline.net/Guidelines/FDA-to-carry-out-survey-into-affect-of-generics-shape-colour-size
7. GaBI Online - Generics and Biosimilars Initiative. FDA wants generics to be physically same as originators [www.gabionline.net]. Mol, Belgium: Pro Pharma Communications International; [cited 2018 Jun 15]. Available from: www.gabionline.net/Guidelines/FDA-wants-generics-to-be-physically-same-as-originators

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