Last Friday I saw a headline in The Wall Street Journal that gave me significant pause. “FDA Lets Pharmacies Substitute Branded Insulin With Knockoff Product, in First for a Biologic Drug.”1 The content of the article was uncontroversial, but my eyes fixated on the word “knockoff.” I expressed my opinion to some peers, but thought that the issue deserved a little more in-depth exploration.
I’m going to make the assumption that everyone growing up has been instructed that their words matter. Or maybe you heard during a journalism lesson that “the pen is mightier than the sword.”
If you’re religious you may recall the verse “Death and life are in the power of the tongue, and those who love it will eat its fruit.” Society has vested those skilled with great oratory the ability to connect to others which in turn can grant great power, and if you don’t believe me look at the 44th and 45th Presidents of the United States. When we are careless with our language, we never know who we end up hurting, but when we’re intentional with our language it can be a tool used to heal.
I try to choose my words intentionally and speak in an inclusive manner. Not because I’m some bleeding heart (that’s what we used to called “snowflakes” back in the day), but because we live in a more interconnected world and that everyone’s perspective has the potential to add value to our discourse. Our numbers are Arabic; the English language has been influenced by French, Latin, Greek and Spanish. Our cuisine is practically a model UN, and none of our major sports are uniquely American. Baseball was influenced by cricket, gridiron football was influenced by rugby, basketball was invented by a Canadian, and modern ice hockey was developed in Montreal.
The monotony of opinion in our echo chambers can have the effect of magnifying the worst in us. While speaking with people from generations past, I can’t help but notice the dismissive attitudes they have towards people who they deem unworthy. Be it the immigrant or the less fortunate, I can’t help but notice the subtext that unless you’re the right kind of person you’re unworthy of assistance. Even if it’s assistance their family had benefited from previously. I have no idea how the character trait of caring for our fellow man became so controversial. I’m not the greatest Catholic, but I’m pretty sure one of Jesus’ teachings was to love your neighbor as you would yourself.
You may be wondering why I spent 300 words expounding upon the power of language, how small our world is, and why we should be kind to our fellow citizens of the world when the triggering headline was talking about insulin. Had the headline used another word instead of knockoff, I likely wouldn’t have even read it because it was already old news to me. But this isn’t some fake designer purse you find at the flea market; this is a sophisticated, thoroughly studied and evaluated biotechnology meant to save the healthcare system money.
I’m no stranger to the drug approval process. For a little bit of professional background, I did a 5-week rotation during my last year of pharmacy school at the Office of Generic Drugs at the FDA, and then finished with a yearlong fellowship in regulatory affairs at Mallinckrodt Pharmaceuticals. Both experiences opened my eyes to the sheer amount of effort that goes into the approval of medications, branded and generic.
Throughout my career as a community pharmacist, I’ve spent much of my time serving lower-income patients. I’ve personally delivered medicine to their homes and seen the conditions that they live in. They’ve told me their struggles, and I’ve seen how a simple medical recommendation or counseling point isn’t so easy for them to implement. Our society has had a shameful history of treating people with low income as somehow less than. Calling them lazy, or poor, or bums, or welfare queens. Language like that is lazy and simplistic and doesn’t encompass the societal and systemic factors that prevents people from building wealth. People with low income aren’t any less prideful than the rest of us; they don’t want to be talked down to; and they certainly don’t want to feel like they are getting something that’s “less than” or “inferior.”
In my personal experience with patients who are low income, I’ve heard them request for branded drugs because they were “the best” or “the good stuff.” Never mind the fact that it wasn’t covered by their prescription insurance or that the copay for a branded product would be over $400. The patient would inevitably choose the generic medication because it was the rational thing to do. Knowing that they were probably disappointed by this reality, I tried to reassure them that they were making the right choice. I told the patient that they were making the same choice that I would have made. I said that if my mother had to take this medicine, I would tell her to take the generic. I would give them a simplified overview of what the process for generic drug approval was and how rigorous the controls were.
Taking the generic medication was almost always the smart decision, and I made it my mission to convince my patients of that. Not only was it smart for the patient, it was good for the healthcare system as well. In our narrow perspectives, we sometimes forget how keeping drug spend down keeps premiums, copays, and deductibles down.
When consumer media refers to this new insulin as a “knockoff” they are poisoning the well against it. Typing in the phrase “knock off” into Wikipedia redirects to the page for “Counterfeit consumer goods.” The article states, “the colloquial term knockoff is often used interchangeably with counterfeit.” If you Follow that slippery slope, the next thing you know there will be a critical mass of the public will actually consider Semglee® as an inferior product to Lantus® when the studies for approval will say otherwise.
I’d love to live in a world where the public’s perspective was only influenced by objective truth, but until we reach that promised land, it’s important to be mindful of the language we use, lest we unknowingly influence the public perception in a way contrary to what we actually believe. It’s even more important that those in the media are mindful of the language they use. When your platform is as large as The Wall Street Journal, I feel like there’s an added responsibility to be cognizant of the power of our words and the meaning behind them. My pie in the sky dream is that the author of that Wall Street Journal article sees my words and changes the headline. But my realistic goal, and challenge to anyone reading this is to follow this simple quote from Indian business leader Subroto Bagchi — “open your mind before you open your mouth.”
References
- https://www.wsj.com/articles/fda-lets-pharmacies-substitute-branded-insulin-with-knockoff-product-in-first-for-a-biologic-drug-11627589200
