May 22, 2013 
Those of you who know me know that I’ve been a huge advocate for generic prescriptions since the early part of my PBM/pharmacy career in 2001. It wasn’t long ago that I talked about unresponsible reporting when slamming generics and scaring the population. But, we all enjoy a good conspiracy theory which is about the only thing that makes sense reading the new Fortune article – Dirty Medicine – about Ranbaxy. Both articles are written by the same author, but this one scares me a lot more than the other one. This article reads like a fiction book but appears to be true. It should scare you also and put a spotlight on the FDA.
Here are a few things from the article.
On May 13, Ranbaxy pleaded guilty to seven federal criminal counts of selling adulterated drugs with intent to defraud, failing to report that its drugs didn’t meet specifications, and making intentionally false statements to the government. Ranbaxy agreed to pay $500 million in fines, forfeitures, and penalties — the most ever levied against a generic-drug company.
The company manipulated almost every aspect of its manufacturing process to quickly produce impressive-looking data that would bolster its bottom line. “This was not something that was concealed,” Thakur says. It was “common knowledge among senior managers of the company, heads of research and development, people responsible for formulation to the clinical people.”
It made clear that Ranbaxy had lied to regulators and falsified data in every country examined in the report. “More than 200 products in more than 40 countries” have “elements of data that were fabricated to support business needs,” the PowerPoint reported. “Business needs,” the report showed, was a euphemism for ways in which Ranbaxy could minimize cost, maximize profit, and dupe regulators into approving substandard drugs.
But, we know that generics have worked. People have gotten better so one has to assume this isn’t a massive fraud especially when 50% of generics have traditionally been made by the brand manufacturers themselves who would never risk their companies to do what Ranbaxy did. So, it made me wonder about the Placebo Effect. Did some drugs work simply because of that? Is there anything else that would make sense for why this wasn’t discovered more quickly?
I’ve talked a lot about the Placebo Effect. There’s now even an app to make you feel better using the Placebo Effect.
- https://georgevanantwerp.com/2013/01/15/saturday-evening-post-on-the-placebo-effect/
- https://georgevanantwerp.com/2008/10/25/prescribing-placebos/
- https://georgevanantwerp.com/2008/03/08/does-price-have-a-placebo-effect/
I’m shocked that the PBMs, pharmacies, manufacturers, associations, wholesalers, and others aren’t out talking about this. I would want to let the public know that this isn’t a systemic problem, but is one contained to one instance and that quality will be maintained…but maybe no one cares?
Enabling Healthy Decisions 
Very thought-provoking to consider the placebo effect in this context. Great point.
Of course, part of the problem is that contrary to your statement, fairly numerous and consistent reports of problems with certain generic drugs HAVE been made for a very long time – but it’s been by consumers, through informal channels, because formal channels were either nonexistent or wholly inaccessible to consumers as a practical matter, or highly, highly unresponsive.
Self-reported issues with generic drug efficacy have been shouted down pretty consistently by virtually every institution and health professional in a position of authority until the last couple of years. Our healthcare system does a pretty good job of quelling out-of-the-mainstream views, for a variety of largely structural reasons.
So we don’t actually know whether Ranbaxy is isolated or not. History tells us that it’s rare indeed to find literally only one occurrence of any given phenomenon, though.