The Shortage of Vital Drugs: A Nationwide Epidemic
By Kevin O'Brien
A nationwide shortage of vital prescription drugs is detrimentally affecting the proper treatment of cancer patients. It is especially impacting those with serious bacterial infections or illnesses. These patients, already combating serious maladies, are now forced to combat drastically rising prices for the scarce supply of drugs that remain available.
In response to this underestimated and looming threat to United States healthcare, which has only very recently been recognized by various media, President Obama issued an executive order this past October. The administration hopes that this action will help resolve a growing number of critical shortages of vital medicines used to treat life-threatening illnesses (including several forms of cancer and bacterial infections). 1 This order mandates that the Food and Drug Administration (F.D.A.) requires drug manufacturers to: provide advanced reports of shortages of specific prescription drugs; expedite evaluations of applications to modify the production of these drugs; and report likely cases of illegal cooperation or the sale of scarce drugs at highly inflated prices directly to the Justice Department. 1
The F.D.A. estimates that approximately 180 vital drugs are in an inadequate supply to be effectively distributed to hospitals. The hospitals are, therefore, ill-equipped to properly service the patients whose lives are dependent on them. 2 In fact, a survey conducted by the American Hospital Association of 820 hospitals (all experiencing drug shortages) revealed that over 80% delayed needed treatments, 70% resorted to prescribing less-effective alternatives with increases and/or worse side-effects, and 80% both rationed and strictly limited access to certain drugs. 2
The drugs administered as an alternative to the ones in short supply are less effective and, consequently, the patients, such as those being treated for cancer are now at a greater risk of fatality. The shortage of chemotherapy drugs, such as doxorubicin, has been particularly critical. 2 (Alternative drugs are also usually more expensive, which results in less coverage by patients’ insurance companies). The BBC reported that 15 deaths have been attributed to these drug shortages and the ensuing complications they present. 3
Due to the national shortage of these drugs, healthcare providers are forced to purchase their supplies from wholesalers that, during these times of economic strife, have increased prices by an estimated 650%. 1 For example, the New York Times has reported that a certain leukemia drug normally sold for $12 per unit was price-gouged to $990, thereby indebting the hospitals already experiencing the vital drug shortage. 1 By taking advantage of the supply and demand paradigm, these wholesalers are exploiting their limited supply of medication in order to maximize their profits from hospitals across the U.S. A vast majority of the documented shortages correspond to obscure drugs; however, these drugs have been identified to perform crucial roles in chemotherapy treatments, anesthetics for patients in surgery and antibiotics for acute infections. 3 As a result of the shortages, the costs of alternative treatments have risen significantly, patient care has become hampered and long delays in performing clinical trials for the novel drugs to replace those in short supply have been observed. 3
In the most extreme cases, some hospitals such as Brigham and Women’s Hospital in Boston were one week away from calling off heart surgeries scheduled over this past summer due to insufficient supplies of medication. 4 58-year-old California resident, Maggie Heim, had been diagnosed with ovarian cancer in July. She was informed, by Cedars Sinai Medical Center, that they would have to postpone her chemotherapy treatment indefinitely until they receive a sufficient supply of the drug doxorubicin. 4 Three months past, and Cedars Sinai still had not received enough doxorubicin; therefore, Heim agreed to receive treatment using a more expensive alternative drug, which was successful, despite raising her insurance co-payments exorbitantly. 4
The consolidation of the pharmaceutical industries is a chief reason for the drug shortage. 3 For instance, should a safety issue arise within one of the industries holding a monopoly over a certain drug, that drug will no longer be produced and will no longer be distributed to hospitals requiring it, thus resulting in a shortage.1 To date, there are 178 shortages. 4 Recently, the issue of bacterial contamination, for example, forced several drug industries to halt production in response to the resulting poor quality of the product. In response, some of these industries have set out to increase the amount of the drug they are able to produce in the effort to assuage the possible occurrence of such an infection. 1 However, this will not take effect for a number of years, and it will not prevent or mitigate the repercussions if an industry shuts down for safety reasons.
In addition to this, the price for manufacturing some of the drugs are greater than that for selling them to hospitals—due to the introduction of cheaper generic brands of certain drugs—and so manufacturers are less likely to produce those non-profitable drugs (much less to increase the quantity of such). 3 Even plans to develop new, effective drugs to replace those in shortage do not look promising—the F.D.A. estimates that novel medication can take about 18 months to enter the market, and even longer to conduct clinical trials. 3
1. Harris, Gardiner. “Obama Tries to Speed Response to Shortages in Vital Medicines.” The New York Times, 31 Oct. 2011. Web. 2 Jan. 2012.
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