My SSRI Sent Me to the ER, But Not for the Reason You Think
Unexpected Side Effects, Generic Medications, and My Aversion to Doctors
Curled up on a black leather couch I cradle my bloated stomach. My partner begs me to let him call the nurse hotline. Bailey the dog sits on her brown bed with her stuffed monkey. I named the stuffed animal Business Monkey because she intently chewed its butt, as though was her job. The last several days my abdomen had been cramping, aching, and growing increasingly distended. I was pooping very little. I drank copious amounts of water, warm beverages, ate oatmeal, vegetables, and the discomfort persisted. Stabbing pains slowed me down while climbing the hills in North Beach dog walking, and I had no appetite. My whole body ached and then the dizziness started. I felt sweaty and nauseated all of the time. I worried I would have to end our girl’s week early, call Bailey’s owner and tell him I was in the hospital for a mysterious stomach ache. Inconvenient, embarrassing, and not fun.
That morning, after taking Bailey out for her breakfast walk I am in so much pain I have to cancel the remainder of my clients. If I try to do my job in this state, I will faint and/or vomit. My partner comes over to monitor me. Elderly brown and white Bailey is happy to have visitors especially if they will give her attention and let her rub her head in their lap. She wanted so badly to be a couch dog but her nails scratched up the leather, which her owner does not like. Her chin and tail were nearly bald from skin issues, and she was dandruff-prone, which does not look nice on the couch either. But Bailey was an incredibly good girl even when she sneaks on the couch when alone in the apartment, which is easy to recognize because of the aforementioned skin and hair evidence. Bailey’s poops were so round they went careening down the steep North Beach hills, making me chase after them with a plastic bag of my hand. It was never not funny. But by far my favorite thing Bailey did was the sound she made when she wanted attention. She would sit upright, wag her tail so hard it would smack against whatever was behind her, open her mouth slightly, and moo. Sure, it wasn’t technically a moo, but it sounded more like a moo than a groan. But she wasn’t trying to pull any couch heists today; instead, she watched me from her bed by the sunny deck door. My girl can tell I am not feeling my best
As I try to convince my partner not to call the nurse hotline, my abdomen starts to spasm. The jig is up. My partner calls the hotline, and after a handful of questions the nurse instructs us to go to the ER immediately. I start to cry. I argue that my stomach is fine because the last time I had been to the ER I had been in worse pain and the doctor’s hadn’t fixed the issue. My experiences with the medical system and my abdominal pain had shown me that if it had any possibility of being related to my period, doctors just tried to ameliorate the symptoms and not find the root cause in order to treat it directly. If I went to the ER, the doctors would give me an IV, pain medication, direct me to follow up with a gynecologist and then bill me $1500.00. Even though I wasn’t on my period, I was certain I had ridden this carousel before and it was demoralizing.
My partner grew up with parents who would take him and his sisters to the ER or doctor if they said they were having an emergency. His dad even took him to the doctor as an infant because my partner’s baby tongue stuck out of his little baby mouth all of the time. His dad had camcorder videos to show the doctor, but my partner was just a lazy baby who didn’t keep his tongue in his mouth. In my family, we didn’t go to the ER unless we thought we were going to die, or we were gushing blood. As the kid of a doctor parent, I’ve concluded that there are only two styles of parents in the medical field: the kind that will take their kid in for anything, and the kind that don’t believe their kid is actually sick or injured because they are used to seeing gory and disturbing things at work. My dad was the latter, working with gangrenous limbs and plaque-filled arteries, and my mom was cheap. I pretty much only went to the doctor for annual checkups. I’ve never had an official eye exam or been to an optometrist and I’m 29. My vision seems fine; I can read all the letters on the charts at the DMV but no medical professionals have ever thoroughly examined my eyes.
My other experiences trying to solve abdominal pain at the ER or with doctors appointments left a bad taste in my mouth. It felt like nothing was ever adequately addressed. In high school, my period always arrived with a vengeance: pain and usually vomiting. But one day, when I couldn’t feel my legs, I begged my mom to take me to the hospital. I gripped the brown handrail on our stairs, pitched myself over and slowly knocked one leg in front of the other, hoping they wouldn’t give out underneath me. When we arrived the attendants at the drive-in put me in a wheelchair. They asked me if I could be pregnant. Even though I was in delirious pain, I couldn’t resist joking. I weakly responded “I’m not that popular.” The attendant gave me a puzzled look, I guess she didn’t understand my joke about being a virgin. I do not remember what happened in between when I answered that question and when I was in a hospital bed attached to two IV’s and a morphine drip, in a paper gown, with a little plastic admittance wristband on my arm. When I was feeling clear-headed after the morphine and hydration kicked in, I asked if I could put on some of my clothes. The staff told me I couldn’t wear my clothes so I just bled onto myself, the paper gown, and the paper thin bed sheets. It was humiliating and I was cold. I was given another blanket. I can’t remember the order of events but a nurse unceremoniously shoved a gloved finger up my vaginal canal and felt around for blockages while talking about her daughter who was my age. At some point I got an ultrasound. They had given me a pregnancy test and knew I wasn’t pregnant but wanted to check for cysts or fibroid or other abdominal issues. The ultrasound tech was genial, and a breath of fresh air. I had already become used to feeling like I had no agency over my own body. She moved the wand over my lower abdomen, taking photos, examining my uterus. I wanted her to find something, anything I could show the doctors to prove that I wasn’t just weak and intolerant of pain.
I knew something was wrong with my body, but for years I was told my period pain was normal or inconsequential. It created this vacillating opinion of myself that switched between feeling like I had a menstrual disorder and needed help, or that I was incredibly weak and making a mountain out of a molehill. I wanted the doctors to to validate my pain and other symptoms so I didn’t feel unhinged. There were times in high school when I was writhing around my bed that I wished for someone to kill me to end the pain. A person can only be told so many times that their pain and issues don’t matter before they reject medical help entirely, stop advocating for themselves, and try anything to stop existing in pain.
Unfortunately the tech didn’t see anything unusual in the sonogram. I returned to the bed, discouraged. Eventually a handful of male doctors came in to my room, stood around and shrugged…because periods. Then I was discharged and went home. Nothing was solved, and as I would later find out, we were only a hundred or so dollars away from hitting my health insurance’s deductible. My mom made sure I knew this. I told her that if there was a next time I would try to slice myself on something to add to the bill. On the whole it was a very expensive, dehumanizing, and frustrating experience. My period pain continued through the rest of high school. I was active, eating healthy, and getting acupuncture. Any time I would mention how bad my period was to my friends they would raise their eyebrows in confusion, nobody else was in that much pain and vomiting. My best friend said her period made her vomit once.
When the hotline nurse told my partner to take me to the Emergency room immediately because of my abdominal pain all I could think about was how it would be expensive, uncomfortable, and dehumanizing experience with no conclusive diagnosis or solution. However, I also knew that I was possibly endangering myself by not going to the ER. Still, all I could imagine was getting mansplained by doctors. They would say that whatever was hurting had to do with my uterus, which they were sure was fine because none of my primary care or gynecologists had ever found anything of note. They would say I was overreacting to symptoms of ovulation or whatever because even though I wasn’t technically on my period, if it was around my abdomen it had to be my period. Time and time again, I had been shown that the stigma of having a uterus and periods justified not to treating my pain like it was serious. Inferring that my pain wasn’t that bad and that I was weak, was an easy label that doctors used to excuse them from looking into something further. After all I was just a teenager, just a college student, just a young woman, a physically and emotionally sensitive demographic — so I couldn’t ever be in that much pain, it had to be psychological.
I wipe up my tears, say goodbye to Bailey and Business Monkey, and my partner drives us to the ER. The waiting room is crowded, though no one is visibly bloody, which I appreciate. People are mostly quiet, and elderly, keeping to themselves in the carpet chairs. A sweaty man wearing a giant winter coat charges in and asks me where the bathroom is. I point to the far wall next to the entrance. When he emerges from the bathroom, he runs up to the receptionist and declares that he is having a “psychiatric emergency.” He is taken through the doors and I don’t see him again. I feel sad for him that he feels so bad he needs to be at the ER. It is an overcast day, so the waiting room, with a small wall of windows facing the street, is gloomy. A man sits with his daughter behind us. At one point he asks the receptionist when the doctor will be able to see her, since she has stomach ulcers. The receptionist has no answer besides that it is very busy. The man’s daughter breathes through the pain, hunched over. We wait for a long time in the dark low-ceiling room on the first floor, hours passing, each indistinguishable from the next. I don’t have high hopes about my visit so far.
In my sophomore year of college I hobbled to the health center in immense period pain. While I’d never found a “cure” to my pain and the symptoms it included, I would occasionally get desperate enough to ask a medical professional. But in my sophomore year in college, after years of throwing up, pain, and wavering consciousness, I was desperate enough to go to the glorified drunk tank of a health center. Maybe they would have morphine, or something that would just put me to sleep for a while. The doctor wasn’t in but the nurse took my vitals and said she had to call the EMS. My blood pressure and heart rate had dropped to the degree where she was legally required to get an ambulance. I lay still, resigned to my fate as we waited for the ambulance to arrive. The EMTs walked purposefully up to the examination table where I was reclined and took my vitals, which had since bounced back, but suggested I come to the hospital regardless. I declined, thinking about the cost of the ambulance and how my mom advised to always avoid ambulance rides because they were so pricey. I also doubted this hospital would do any better at assisting, diagnosing, or treating my issues than the other doctors and hospitals I had visited. I let the EMTs know that on the first or second day of my period, sometimes these things just happened, and if I waited another few hours the symptoms would subside. I laid in a tiny bed in the health center for a couple hours, took a nap, and then the nurse told me to drink a soda. I took a sip or two and walked back to my dorm.
At around 20, I had already cycled through several gynecologists and GPs. I had tried taking oral birth control, some medication for people with muscular issues, balms, and herbal medications. I had tried Tylenol with Codeine only to find out that Codeine makes me barf, no matter if I have food with it or not. One gyno told me to take a lot of Tylenol before the pain started. If I knew when my pain was going to start, of course I would pre-dose with pain killers so they would kick in at the right time. A few doctors floated the possibility of Endometriosis but in the mid-2000’s they were hesitant to give me a diagnosis without seeing the displaced tissue itself. Ironically, external and even internal ultrasounds (where they go up inside the uterus with a the wand) don’t always find anything in patients who do have Endometriosis. These technologies can only identify cysts that could be a result of Endometriosis. The best way to see this tissue is with a laparoscopy, where a tiny camera is inserted in an incision in the abdomen. Cameras are better than sonography for details, and can spot endometrial tissue outside of the uterus, literal implants of Endometriosis. One gyno told me I had Retrograde Menstruation, which is a theory where the period materials go the wrong way and into the ovaries(?). As you might expect, the existence of condition is contentious, especially with the Endometriosis community. From the beginning it struck me as glorified “Wandering Womb” bullshit. Another doctor told me I had a tilted uterus. The same gyno who prescribed me large dose of Tylenol said that even if I got a diagnosis of Endometriosis, she would still treat it the same, with pain meds and birth control, so it didn’t matter. Tylenol only ever sorta helped and the birth control didn’t fix anything and made me gain weight. Then there were all of the comments about how pregnancy and giving birth would “reset” everything in my cycles, as if bringing a kid into the world was the most efficient and ethical way to treat my pain.
My partner accompanies me into the triage room where a doctor checks my vitals and has me stand still. I ask if he is doing this to test if I will faint. He says no. I say that I am fainting. The doctor and my partner lower me down to the exam table as I lose consciousness. When I come to, I expect I might get treatment but instead I am put in a wheelchair and then rolled back into the waiting room. I’m not sure how long my partner and I wait after that, an hour if not two. My body, ever tenacious for attention when in pain, makes me faint again. My partner tells me that the father whose daughter has ulcers helped him keep me from falling over. The receptionist makes some calls and I’m wheeled into an examination room.
In my junior year of college I fainted in line at a Walgreens while picking up my prescription. The pharmacy tech had been goading me to sign up for the rewards program. Part way through signing up and checking out a wave of intense dizziness came over me and I knew I was going down. I told her I was going to faint, but she urged me to finish signing up. I warned her again, maybe twice. I woke up surrounded by a yellow plastic privacy screen, having hit the area beneath my eyebrow, but still on my eyebrow bone, on the counter. I wretched and a trashcan appeared to my right. The employees gave me a Band Aid for my bleeding eyebrow bone that said “Walgreens, at the corner of happy and healthy.” I declined when they asked if they could call an ambulance. I probably should have at least gotten checked for a concussion, but I didn’t think of it at the time. My period had just started and I wanted to get home before the pain got too bad to move or I actually puked in the pharmacy. I have a small scar under my left eyebrow now.
There is still no open bed in the emergency department. I am wheeled elsewhere, examined again, x-rayed, and then put on an IV in a large blue chair in the hallway. My dad comes down from his rotation on a different floor to check in on me. Not long after, an ER doctor comes out with my x-ray and the results of my blood tests. He tells me that I am at an unsafe level of Ketosis, and am massively dehydrated, all because I am constipated. Dangerously constipated. He lifts the x-ray image to the light board and points at my intestines… and all the poop. He is almost impressed at the extent of my backup. My best friend’s sister’s guinea pig died of constipation. When my best friend told me I couldn’t stop laughing. I guess my cruelty had come back to haunt me. I am embarrassed, especially because I don’t understand how the constipation has gotten so bad so quickly. The doctor gives me a spiel about eating properly, exercising, and hydration. It is bizarre. I tell the doctor that I eat roughage, grains, and beans all the time and am a dog walker, going through large quantities of water every day. He tells me to keep drinking fluids, take laxatives, and follow up with a visit to my own doctor. I am discharged shortly after with a packet about constipation that has such helpful tips about staying regular like: avoid large quantities of meat and dairy, and eat salads occasionally instead of hamburgers. I am dairy-free and essentially Pescatarian. I know this constipation has to be symptom of a larger problem. I think about what has changed recently in my life. It wasn’t my diet, or exercise, but I had refilled my prescription…
I find my new SSRI bottle and compare it to the empty one from the month before. The pills are both labeled as generics, but the new one is a different shape and color, suggesting it is from a different manufacturer. The pharmacy label on the newer bottle had be slapped over the the name of the manufacturer, so I delicately peel it back. I can see part of the logo. After googling pharmaceutical company logos and confirming it is from a different company than my regular generic, I google whether SSRI’s can cause constipation. I learn that certain SSRI’s can trick your body into thinking you don’t have to poop, and physically prevent it from doing so, or doo-doo-ing so. I call my psychiatrist and ask if it is possible that my new generic made me constipated. He agrees that it is a possibility and suggests I find a new pharmacy where he can call in the prescription that use my old manufacturer. Thus begins several hours of calling pharmacies all over San Francisco. Apparently the new generic I had gotten was cheap enough that they had convinced all the large pharmacy’s to exclusively stock it, in addition to the name brand, which would cost several hundred dollars for a thirty day supply. Many pharmacists don’t know which generic their pharmacy carries and have to put me on hold to check in the back or ask a coworker. I find an independent pharmacy that has the generic I need and my psychiatrist calls in the prescription. It is a mom and pop pharmacy where the wife has a cloche of homemade cookies on the checkout counter. Once I start taking the new (old) generic of my medication, I can poop again without any issues.
When I look more into the manufacturer of the generic that had made me constipated I discover that they have a terrible track record (If I listed how many times they have had to recall medications, this piece would have to be updated every few months). Not only have they distributed medication that was moldy, but also medications that were contaminated with lethal materials. They have been flagged several times by the FDA for 483’s with “microbiological failures.” However, year after year, these warnings go unheeded by the company, and the labs are struck with more handling violations in regards to the compounding materials. These failures take place in their American and International labs. I don’t understand why this company hasn’t been shut down.
Not long after my constipation incident I encounter an NPR interview with an investigative journalist about her book covering the dicey and flawed production of generic drugs. This book, Bottle of Lies by Catherine Eban documents decades of fraud and malpractice in the generic drug industry. The interview and later articles on the book are how I learn that the pharmaceutical lab where my medication’s generic originated is not even the worst of the bunch. Consequences for manufacturing failures and other issues at international labs inspected by the FDA do not often result in closure, but warnings and fines. It can take years for the FDA to find out that a medication is flawed. Pharmaceutical companies producing generics have been caught distributing “generic” medication that are not at all chemically similar to the name brand, making them completely inefficient and possibly harmful. Employees have been seen running from FDA agents with bags of fraudulent records, destroying obviously contaminated drugs, and hurriedly cleaning work spaces, etc. While the FDA has the right to visit and inspect these labs at any time, they often alert the labs months prior to their arrival in order to avoid “diplomatic tensions” in the globalized generic industry. One pharmaceutical company was revealed to have wiretapped the hotel rooms of the inspectors in order to get details on the inspection plans. Eban even uncovered that some pharmaceutical companies poisoned American inspectors with Indian tap water, knowing it would make them sick as a way of “running out the clock” on inspections. This list of the dangerous and nefarious greed-centered behavior of generic drug manufacturers goes on and on.
There is a commonly held belief that generics are always the same as name brand drugs. While this may be the case for some medicines, like regular over-the-counter acetaminophen and ibuprofen, anti-acids, and allergy pills, it is less so with newer prescription drugs. From what I have researched, it is most common when labs are creating generics of expensive drugs, like drugs that cost over a few hundred dollars for a thirty day supply. The name brand of my SSRI is almost a thousand dollars for a thirty day supply, while my other medication’s name brand counterpart costs over 1500.00 for a thirty day supply. I have to mention here that I live in the United States; if I lived almost anywhere else in the world, government regulations on price gouging for medications would prevent this absurdity. When medications are inspected to be certified as generics, chemists are looking for a certain range of percentages of active ingredients that would make them “bioequivalent” by FDA standards. They want the generics to have the same dose of active ingredients, with the same release rate, resulting in the same effect on a patient as the name brand. However, the FDA does not require that generics go through the same clinical trials as name-brand medications, and they are not required to have the same “inactive” ingredients. Additionally, it is not always the FDA doing the testing, as some generics are tested through “research contracts and grants.” While the FDA claims generics are the same as name brand drugs and are safe, the testing done on these generics can be outsourced, generics don’t go through the same amount of testing, generic production is often outsourced internationally where the labs do not go through the same amount of rigorous inspection, and the generics themselves can have different ingredients (as long as they are deemed “inactive”). This waterfall of outsourcing for inspection and production calls into question the FDA’s claim that generics are the “same quality, same safety, same strength” and “not made in substandard manufacturing facilities”. I believe the growing amount of brand name medications jacking up their prices in the United States will create an even larger need for generic drug manufactures to provide a discounted alternative, and quickly, resulting in more issues. According to the FDA website, eighty percent of prescriptions filled in the United States are for generics, and that number is expected to keep growing.
When generics are manufactured, in order to stand in for another medication but at a significantly discounted rate, it creates the incentive to cut corners for profit. As Eban demonstrated in her book, the regulation and consequences for inspection failures in these labs is inadequate, allowing them to continue to make dangerous products. Similar to other industries where the product can cause harm and death, for example the auto industry, capitalism motivates companies to weigh the cost efficiency of lawsuits and fines versus correcting a design or material flaw. Companies all over the globe sit down and calculate whether it will be cheaper to pay the fines, juggle a few lawsuits, let some folks die, instead of admitting fault and paying to fix their product. A few years ago, myself and most of my friends and family had to get their car airbags replaced. After a sufficient number of deaths and investigations, it had been proven that some Takata airbags could spontaneously deploy and shoot metal shrapnel everywhere and/or shoot metal shrapnel everywhere when deployed. Soon after this recall, it came to light that Takata was aware of the issue with their airbags for years but said and did nothing. I was made aware of the airbag recall and then, because Takata had to re-manufacture these airbags, was expected to just live with a car whose passenger side airbag might kill them, for months on end. I asked my dealership whether I should remove the airbag entirely until a new one could be provided by Takata. They indicated that statistically speaking, it was more dangerous to just remove the airbag entirely and drive without one, because only a certain percentage of the airbags were death balloons. At the time, I wasn’t surprised at all by any of this airbag bullshit which really demonstrates how much abuse customers are used to fielding by profit-based corporations. We shouldn’t have had to accept driving around with a car that was possibly a ticking time bomb.
I can’t afford to pay for the name brand of my medications so I am forced to get the generics. If a person lives where there aren’t any independent pharmacies that can order small batches of generics from specified manufacturers, they are stuck with whatever generic their chain pharmacy exclusively purchases from whichever manufacturer gives the pharmacy the best deal, even if that manufacturer has been cited dozens of times for unsafe practices and distributing hazardous products. This was the issue I encountered with the generic that made me constipated. My big chain pharmacy had switched generic manufactures without my knowledge and did not tell me. Then, after calling around to other pharmacies, I realized that all the chain pharmacies in San Francisco had also transitioned to carrying the same constipation-inducing generic. This subpar manufacturer was the cheapest and allowed the chain pharmacies the most profit.
A couple years after I switched to the mom and pop independent pharmacy, they got had to close. I ended up needing to get my medication from a pharmacy almost an hour away from my home in order to avoid the constipation-inducing generic. In a major city! After I moved to New Jersey, I had to cold call pharmacies for a third time, although it is much easier to find independent pharmacies here because the religious diversity requires that medications conform to different diets. While it may not matter to the FDA what is some of the inactive ingredients are, those who keep kosher, cow-free, or vegetarian do not want certain ingredients in their medications. You don’t want to buy your romaine lettuce from the company that keeps giving people E.Coli, or dog food from a brand that has a long history of distributing contaminated kibble. You can check your generic manufacturer on the FDA’s Orange Book if you suspect it may not be up to par. While frustrating and counter to the arguments of the FDA, the generic drug manufacturer matters.
No one had ever told me that I had to be this careful around generic medications. How was I supposed to know that one of the side effects of some generics for my medication was literally instructing my body not to poop? I am angry that my previous pharmacy did not disclose that they provided me with a new generic. Prescription generic drugs aren’t like grocery pantry items, where store-brand options are often from the same factory as the name brand but repackaged, Honey Maid Graham Crackers becomes “Safeway Select Honey Graham Cracker Squares.” People who who take these generic medications could find themselves mysteriously constipated and possibly needing invasive medical intervention. Elderly or disabled folks, anyone who takes several medications will have a harder time narrowing down side effects down to one medication and could think it was their own fault. I knew it wasn’t my fault that this constipation had happened because I lived a healthy lifestyle, did not have a history of constipation, and I could narrow side effects down because I only took one prescription. But there are millions of people who would not be able to figure this out, with other medications with other side-effects, possibly lethal ones. Americans are at the mercy of the generic drug industry, a profit-motivated enterprise where it is difficult to regulate price and quality.
A week or more after the emergency room visit I see my GP. She suggests I eat a big raw kale salad every day because back in who-knows-when people ate more raw vegetables. I nod along while fuming on the inside. There it is, the medical system blaming me for an illness. I actually never learned about these giant raw kale salads when I took an anthropology class on Prehistoric Europe, although diets did include a variety of grains. No one was really listening or fighting for me except my psychiatrist who I had connected with on my own. I was thankful that the hospital x-rayed me and saw that I was constipated and impacted, but if I hadn’t done my own inquiry, who knows how long that constipation would have lasted, regardless of however many kale salads I ate.
As of today, several years later, my period issues have neither been diagnosed nor solved, although I don’t regularly throw up anymore. Over time my pain has decreased as I discovered effective tools and approaches, like switching from Tylenol to Ibuprofen, changing my diet and minimizing my food intake on day 1, etc. My body has shifted to favor fainting instead of puking. Honestly, I prefer fainting because when I throw up it comes out of my nose and I know when I’m about to faint and have enough time to call for my partner to help me, or lower myself to the ground. Of course I wish my period wasn’t like this; when I am planning trips or get invited to social gatherings, I check my menstrual app to if my period might get in the way. If the events are really important, I will still try to go, but I will likely dip out early or be illusive because I am in the bathroom with gastrointestinal distress. I consider it a win that I no longer have pain so bad I wish someone would kill me for relief.
If you’ve read my piece about mothers and body image, you may know that my family also has a history of being concerned about pooping and pooping enough. My mom used to tell me to eat my vegetables incessantly because our family has a history of colon cancer. It was all about the colon: she said it to my friends too. Unfortunately I adopted a few of these neurosis after this hospital incident, but nothing as obsessive as keeping a bowel movement calendar, taking unnecessary laxatives, or traveling with dried prunes. I’m hyper-aware, I’m scared, and I only trust independent pharmacies. However, this uneasiness around the medical system and medications hasn’t prevented me from being vaccinated for all things, including the flu and Covid-19. I still go to the doctor to get my blood tests and whatever else done. I’ve learned that pain management can be an unfair personal burden, not all generic medications are the same as their name brand counterparts, and most importantly that I need to trust myself if I know things about my health don’t make sense. In no way is this piece meant to dissuade individuals from taking generic drugs, I still take a generic because that is all I can afford.
My story and Eban’s reporting exemplify how the FDA’s due diligence for generic drugs is lacking. It is unethical that the FDA tells Americans that generic drugs are the same as their name brand counterparts while repeatedly flagging generic labs for unsafe practices and not disclosing this openly to the public. If I had been told to check inspection and recall reports for the labs where my generic medications originated before switching to a new one, I would have done so, and avoided pain, stress, and hospitalization. It is unfair for the FDA to keep Americans in the dark about the varying quality and safety of one Pharmaceutical company’s generic to the next while quietly placing the onus on patients and consumers to vet the generic manufacturers of our own medications and keep track of which generics we take and are provided with at the pharmacy. The FDA’s rhetoric around generics has permeated medical care so much that only my psychiatrist was receptive to my theory that my new generic medication was at fault for my constipation, while all the other medical professionals were telling me to eat more salad. In order to advocate for themselves, patients must be taught what to watch out for from their doctors and pharmacists. Doctors and pharmacists need to learn that which labs a generic medication comes from effects its safety and quality, and most of all they need to listen to patients expressing concerns about their health and side effects from medications.