Generic and therapeutic substitution: ethics meets health economics
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To the Editor:
In their commentary on the ethical aspects of generic and therapeutic substitution, AlAmeri et al.  argued that the health economic rationale for promoting substitution, i.e. the creation of cost savings to the health care system, may be harmful to patients and, thus, that substitution is unethical. They then go on to state that the debate on whether or not to substitute must be exclusively informed by the individual patient’s clinical interests and that substitution driven by economic interests is not compatible with patient-centered medicine. In putting these arguments forward, the authors misinterpret the ethical implications of a health economic framework by focusing on the individual patient’s perspective to the detriment of the societal perspective.
The ethical dimension underpinning health economics is that a society wishes to maximise population health subject to a budget constraint. This idea is reflected in the term ‘health economics’, which consists of two...
KeywordsPopulation Health Generic Medicine Medicare Part Improve Population Health Total Health Care Cost