Monday, August 15, 2011
Do you wonder about drug shortages?
The cancer literature is full of articles about shortages of the older (and less expensive) cancer drugs. Outrage even hit the pages of the venerable New York Times in early August, in the form of an editorial by Ezekiel J. Emanuel, MD - an oncologist and professor of medical ethics starting at the University of Pennsylvania in September 2011.
Emanual writes: "Only about 10 percent of the shortages can be attributed to a lack of raw materials and essential ingredients to manufacture the drugs. Most shortages appear instead to be the consequence of corporate decisions to cease production, or interruptions in production caused by money or quality problems, which manufacturers do not appear to be in a rush to fix...You don’t have to be a cynical capitalist to see that the long-term solution is to make the production of generic cancer drugs more profitable. Most of Europe, where brand-name drugs are cheaper than in the United States, while generics are slightly more expensive, has no shortage of these cancer drugs. "
But it's not only cancer drugs that are in short supply.
Simple things like magnesium sulfate (used to lower the blood pressure in eclampsia of pregnancy), Vitamin C in the intravenous form (currently available only at 4 times the price of a year ago), and amino acid solutions (used in cancer patients who are unable to maintain protein intake) are also difficult, if not impossible, to find.
We have switched to Magnesium chloride instead of Magnesium sulfate, because the latter is on "indefinite backorder". And now our suppliers tell us that Magnesium chloride is also becoming more difficult to find.
Emanual notes in his editorial that the newer chemotherapeutic pharmaceutical drugs are in plentiful supply. They don't work very well - they only prolong life by a short time, unlike some of the older drugs which were actually curative. But they are available - for a very expensive price. And insurance covers them.
What is wrong with this picture?
Is it possible that the profit margin in low enough on the generics, and the older drugs, and the chemicals that pharmaceutical companies simply decide not to manufacture them any more?
Is it possible that the Federal Drug Administration has such close ties with the pharmaceutical industry that it is inspecting the manufacturers of generic drugs more diligently than manufacturers of newer drugs still under patent protection?
Is it possible that the pharmaceutical companies have purchased a controlling interest in any of the manufacturers of generic drugs, to get them out of the market? I do note that Hospira appears to belong to Sanofi-Aventis. I have not been able to track down similar information about any of the other companies.
I don't know that we will ever get answers to these questions. But I do find it very curious that for months now we have been able to obtain the pharmaceutical version of leucovorin (used in cancer chemotherapy) but the generic version (at 1/10 th the price) has been unavailable since the fall of 2010.
Something is definitely wrong here. The big question is whether the wrongness is simple incompetence or actually deliberate...