Why doctors choose the cheapest over-the-counter drugs

Over-the-counter medications are often products with different branding but the same components, a Canadian pharmacist says on the heels of an Australian court ruling.

This week, the Australian Federal Court ruled that Britain's Reckitt Benckiser deceived Australians. The company marketed various Nurofen painkillers to relieve specific ailments, such as back pain. But all contained the same active ingredient, ibuprofen lysine.

The country's competition bureau, which brought the court action, said the price of Nurofen's specific pain products was nearly double that of the company's standard ibuprofen.

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In Canada, brand and generic products available to buy off the shelf are regulated to ensure they contain the same drug.

"Sometimes they really just change the box and the name," said Mina Tadrous, a pharmacist and researcher at St. Michael's Hospital in Toronto, who also works at a community pharmacy.

Tadrous advises people to read the side label to know what active ingredients are in the medication and what they're for.

"Sometimes I think people are concerned if they see just two or three dollar difference, they're like 'is this going to be the time I cheap out?'" Tadrous said. "I tell my patients let's split a cup of coffee and you take the cheaper one."

For example, acetaminophen 325 milligrams contains the same drug whether it's brand or generic.

Some people may prefer to pay more for a certain formulation, such as gel caps instead of tablets, or a particular flavour, he said. But he opts for the generic for most drugs.

It's the same at the pediatrics practice of Dr. Daniel Flanders in Toronto.

"When it comes to over-the-counter medications, brand names and generic names, it's the exact same chemical. I always recommend saving the money and buying the generic brand," Flanders said.

Earlier this year, marketing researcher Jean-Pierre Dub of the University of Chicago Booth School of Business and his co-authors published a paper titled Do Pharmacists Buy Bayer? Informed Shoppers and the Brand Premium.

The case study of headache remedies found pharmacists chose branded nine per cent of the time compared with 26 per cent of the time for the average consumer.

"When you look at non-drug categories, things like food for example, suddenly doctors and pharmacists don't look any different from the mainstream market," Dub said in an interview.

In a similar case study of pantry staples such as salt and sugar, chefs devoted 12 percentage points less of their purchases to national brands than non-chefs.

"That's an example of occupational expertise leading to a much lower rate of buying branded goods."

Dub said the price premiums for branded drugs might fall "quite a bit" if everyone bought the same way pharmacists do.

When purchasing medication for children in particular, both Tadrous and Flanders advise caution, such as when little ones have the sniffles.

"Our bodies are extraordinarily good at defeating viruses that cause these kinds of infections and giving your body the time to fight it off is really the most effective thing you can do," Flanders said.

His other suggestions:

• Keep a child comfortable during the process, and use acetaminophen or ibuprofen if they're struggling.
• Keep them well hydrated.
• Sometimes honey for kids over age one might have some effect on their coughing.
• "Cuddles seem to help a lot, TLC," Flanders said.

When choosing a medication for a child, Tadrous also suggests seeking advice from pharmacists. Some drugs shouldn't be given to children because they are unsafe or there is no safety information.