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One more prescribing rule [See “Rheuminations,” September 2009, p. 6], honored mainly in the breach, in our overspending climate: don’t prescribe an expensive brand when generics are as good or better, especially Nexium (which I have never prescribed) versus omeprazole, Lipitor versus simvastatin (which now costs the VA three cents a pill), and—for rheumatologists who are writing 80% Uloric—allopurinol except for the 10% who might need Uloric.