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Antisubstitution Laws

David W. Duhme, MD
JAMA. 1973;226(2):200-201. doi:10.1001/jama.1973.03230020046028.
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To the Editor.—  I must object to the logic employed in Dr. Schiffman's recent EDITORIAL supporting antisubstitution laws1 and in the Joint Statement on Antisubstitution Laws and Regulations2 in the same issue. The essence of their argument is that a physician is better suited than a pharmacist to specify the brand of a drug to be used. The factors that should enter into choosing a brand of drug are assurance of adequate quality (usually supplied by the Food and Drug Administration) and comparative shopping to find the lowest price. The Joint Statement says, "Since drug product selection entails knowledge derived from clinical experience, the physician's role in product selection remains primary." No physician's clinical experience is adequate to make valid distinctions between different brands of the same drug! Dr. Schiffman says, "Without automatic and absolute control over the exact regimen of therapy, the physician cannot possibly utilize all


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