A chemist can swap one small chemical tablet for another because it is like swapping one identical grain of rice for another—the formula is simple and exact. But a biosimilar is like a living recipe, such as curd made from milk; even with the same method, each batch can differ slightly, and the body might see it as a stranger and react. This reaction is immunogenicity—when the medicine triggers the body's own defences to attack it. I say this because when a patient from our village was given a different brand of insulin, it was like a sudden storm in his blood, and his sugar became a wild horse I could not rein in for weeks.
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