MD Advises Against Generic Drugs Chosen By Cost Pressures

To the Editor:

I write in support of Dr. Tinker in the letter to the editor (Spring, 1999) regarding the "new propofol brand." It seems to me a great leap backward rather than an advance forward for our profession to consider using any product containing a potentially lethal ingredient such as metabisulfite.

Unfortunately, hospital pharmacy committees place so much focus on drug costs that Anesthesia departments are pressured into using less expensive "equivalent" generics. Generic succinylcholine was substituted for Anectine at our hospital several years ago. Although many in our department voiced concern, the pharmacy committee pointed to the potential savings, and conducted a biased study designed to prove the equivalence of the two drugs. We recently switched back to Anectine after several adverse clinical events. The pharmacy came over to our side after we offered to withhold elective anesthesia.

I don’t plan to use generic propofol in my practice because I’m concerned that it has not been tested in human trials. I’m sorry to have to take this stance, but patient safety should always take precedence over cost.

Edward McKenzie, M.D. Attending Anesthesiologist Durham Regional Hospital Durham, North Carolina