The most important findings of this study showed that patients’ representation of generics is ambivalent; when one perception predominates, it is clearly a negative one. Patients emphasized their doubts regarding the similarity (from ‘partial copy’ to ‘forgery’) and their concern to receive a ‘second choice’ or ‘discount’ medication. According to Horne’s model [2], when the perceived potential for the generic drug to cause problems is exceeding the perceived need to take the medication, then the prescription of the generic drug becomes a source of embarrassment for the patient.

The issue of cost was frequently mentioned by respondents, with a clear emphasis on the benefits of generics from a societal rather than an individual point of view. A number of patients explained that the substitution was not the best option in their particular situation. Thus, economic arguments per se are not sufficient to justify substitution, and may even raise issues calling upon cognitive dissonance. In an attempt to reduce the inner tension, some patients underlined the positive features of the chosen alternative (to take nevertheless an originator medication with a perceived value) and the negative features of the rejected one (cheaper price as a synonym for lower quality) [3]. This is illustrated by a respondent indicating: ‘The xx,which is called the Rolls-Royce in this field, is much more effective than the generic I had before … (…) If a medication has been invented and it’s satisfactory, I don’t believe an imitation can be as good as the real one, the original’.

The economic and public health arguments often put forward in information campaigns emphasizing liable citizenship are not sufficient motivation. The results of this study emphasize the importance of individualized negotiation regarding the prescription of generics. Tailored information and trust between patients and health professionals may convince patients that the prescribed generic drug is just as well adapted to their health problem as the originator medication.

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

Abstracted by Valérie Piguet, Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Center, Geneva University Hospitals and University of Geneva, Switzerland.

Editor's comment
Readers interested to learn more about patients’ perceptions about generics are invited to visit www.gabi-journal.net to view the following manuscript published in GaBI Journal: 

A review of patient perspectives on generics substitution: what are the challenges for optimal drug use

If you are interested in contributing a research article in a similar area to the GaBI Journal, please send us your submission here.

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References
1.   Piguet V, D’Incau S, Besson M, Desmeules J, Cedraschi C. Prescribing generic medication in chronic musculoskeletal pain patients: an issue of representations, trust, and experience in a Swiss cohort. PLoS One. 2015 Aug 3;10(8):e0134661.
2.   Horne RE. Treatment perception and self-regulation. In: Cameron LD, Leventhal H, editors. The self-regulation of health and illness behavior. 2003. London: Routledge. p. 138-53.
3.   Stone J, Fernandez NC. How behavior shapes attitudes: cognitive dissonance processes. In: Crano WD, Prislin D, editors. Attitudes and Attitude Change. 2008. New York, London: Psychology Press. p. 313-36. 

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