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September 15, 1978

Drug Substitution

Author Affiliations

Southfield, Mich

JAMA. 1978;240(12):1241. doi:10.1001/jama.1978.03290120035020

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To the Editor.—  The article by Wood et al, "Tetracycline: Another Example of Generic Bioinequivalence" (239:1874, 1978), suggests that although some consumers may win in the generic lottery, others will lose. The Michigan generic dispensing law has received extensive publicity in the Detroit News. One editorial was entitled "Generic Drug Law: Consumers Win."In my practice I always prescribe a brand-name levothyroxine on preprinted prescription blanks with the instruction "D.A.W." (dispense as written). Recently eight patients who thought they were taking the brandname product, because their prescriptions were so labeled, had received a generic substitute from their pharmacist. These generic tablets were the same color and the same size as the brand-name product. If these tablets had been a different color or a different size, my patients might not have accepted them. It is still not clear to me whether or not these generic levothyroxine tablets are equal in quality