Yesterday, I got mail from GlaxoSmithKline. That’s never happened before. I’m not sure where they got my address.

According to Wikipedia, GlaxoSmithKline (or GSK) is the second-biggest pharmaceutical company in the world, so they classify as Big Pharma for my purposes. My gut reaction, of course, was that this little booklet they sent was junk mail, which is obnoxious, but whatever. My second reaction was that maybe it was coupons, which I found troublesome. On the one hand, the idea of trying a medicine just because it was cheap irks the hell out of me—this isn’t a new brand of toothpaste we’re talking about, these are mood-altering drugs. These are brain pills. On the other hand, I could sure use a scrap of paper that would make my meds cheaper.

The booklet has no title. It is simply labeled, “Important information for patients about substitution of your medicine at the pharmacy.” Below that is a picture of a giant bottle of prescription medicine surrounded by a triangle of trade made up of little cartoons marked Doctor, Pharmacist, and Patient. At the bottom, the cover reads, “Working together to manage your treatment.”

On the back of the booklet is a box of bold text. It says:

“How can you help to make sure you receive the medicine prescribed by your doctor and that you have the best response to your medicine?”

“Okay,” I say, “so this is some basic how-to-take-your-pills literature from Big Pharma? Why was this sent to my house?”

The first sentence inside the booklet is this: “Many drugs are available as both a brand-name and a generic.” This is on a page labeled, at the top, “Introduction.” (No other pages are labeled, though, so maybe the whole booklet is just an introduction?)

On that same page, in bold-face type, is this paragraph:

“Did you know that when filling a prescription your pharmacist may substitute a generic drug for the brand-name drug?”

That’s why GSK sent me this booklet. They want me to know to beware of generic meds.

You like how they imply that your pharmacist may try to slip one of those generic drugs into your bag? The booklet insinuates a few times that those slippery pharmacists may end up denying you the “brand-name drug” that your doctor prescribed. “Your doctor can tell the pharmacist to only dispense the brand-name if he feels it is best for you,” says the booklet. What it means is, “Make sure your doctor tells the pharmacist to prescribe the better stuff—the brand-name stuff.”

This thing is fascinating reading, if only to watch how subtly it tries to do its work without breaking any laws. The writer of this booklet jumps back and forth, across the tracks, like an antelope racing a train, trying to imply that generic drugs are bad without actually saying so. We’re told how drugs are tested “in a large number of people with the same medical condition” and how the process “can be very costly and take many years.” By comparison, we’re told that generic drugs are “usually tested in a small number of healthy adults.” You see that? The implication is that you can’t tell if the generic drugs work or not because the were hardly tested, and only on healthy people, anyway.

We’re told that patents for brand-name drugs “expire, or run out, after a certain amount of time.” After which, “generic substitutes can be made by other companies and sold at lower cost.” That’s all accurate, but the writer was us to see it this way: The generic company low-balls the product after the hard-working pharmaceutical company has spent so much time on money on it. They can’t draw the connection, here, that the generic is riding on Big Pharma’s coattails, exactly, because to do that would be to admit that the generic has, on Pharma’s dime, been tested just like the brand-name drug. That would help paint the generic producer as a Johnny-come-lately, but it would also demonstrate that the generic has roughly the same trial history as a brand-name drug (because, of course, it used to be the brand-name drug). They’re trying to have it both ways, and practically doing it.

We’re told how a generic drug “is a copy of a brand-name drug that is approved by the FDA.” See how that modifier dangles just right, so that we can read that sentence two ways?

1. A generic drug is a copy, approved by the FDA, of a brand-name drug.
OR
2. A generic drug is a copy of a brand-name drug, and that brand-name drug has been approved by the FDA.

The writer is hoping we’ll read it the second way and come away understanding that the brand-name drug is FDA-approved and inferring (incorrectly) that the generic drug is not.

The very same page, though, says a generic drug gets approved by the FDA. This is how they do that:

“The amount of drug in the bloodstream and the time it takes to get into the bloodstream must be the same for the generic and brand-name drug. This is called bioequivalence. A generic drug must be bioequivalent to a new drug before the FDA can approve it as a generic substitute.”

Fair enough. They’re saying the two drugs have to work the same for the FDA to approve the substitute. That’s reasonable.

What the writer is insinuating at the same time, though, is this: That the two drugs aren’t equivalent,
they’re “bioequivalent”, a fancy term that means the generic drug is technically close enough to be “a generic substitute.” Remember, this is a writer that, two paragraphs ago, presumed that you didn’t know what the word expire meant. What they want to say is, “But you don’t want a generic substitute, do you? You want the real thing.”

After this the booklet spends the better part of a page telling us that Dispense As Written (DAW) laws exist, under which a doctor can request her patient to receive specifically the brand-name incarnation of a drug. I’m certainly on board with the idea that a doctor can override a pharmacist’s decision to substitute a drug—seems reasonable to me to have that law in place. Below, that, though, boxed and in bold-faced type, it says this:

“Dispense As Written” tells the pharmacist that you must receive the brand-name drug your doctor has chosen to prescribe. Always check your prescription before you leave the doctor’s office.

Those treacherous pharmacists are always trying to slip generic drugs past you, I guess. Good thing the DAW laws are there to protect you. “Also,” the booklet winks, “be sure your doctor has written down the brand name on your prescription so the pharmacist can’t get around those DAW laws.”

After that, the booklet asks two questions. Why questions? To make sure that you’re uncertain. The first is, “Are generic drugs right for me?” The second one is, “How can I make sure that I receive [the brand-name drug] at the pharmacy?” They want you to worry that you might get duped by the druggist.

One of the things the booklet claims it’ll teach me about is “Talking to [my] doctor about treatment choices.” For me, the treatment choice is this: Buy the generics or don’t get treated. My doctor commiserated with me about the sad fact that a couple of the meds I’m on are too new to have generic counterparts. She’d be happy to have me be able to afford my treatment, instead of putting it on the credit card.

So then how did GSK get my address and choose to send this thing to me? I can think of only one thing. Last year, when I first getting treated, I called a couple of phone numbers and put in some information to chase down options for discounts on prescriptions for the recently unemployed. I didn’t qualify for any of them, and forgot about it. Did that put my information into some file at GSK? Am I listed somewhere under the header, “Potential Customers Lost to Generic Drugs”?

Are insinuation and fear really GlaxoSmithKline’s preferred ways to create brand loyalty?