This morning I was intrigued to learn that the US has been experiencing regular shortages of anesthetics, painkillers, antibiotics, cancer treatments, heart drugs and other lifesaving medications. Doctors routinely deal with these shortages by “rationing.” In other words, deciding which patients are more deserving of treatment.
Although the problem has been going on a decade or more, most doctors don’t inform patients when they withhold clinically indicated treatments. Prior to a January 29 New York Times article Drug shortages forcing hard decisions on rationing treatment, the American public was also totally in the dark.
Did you know there was a Drug Shortages Summit in 2011 to address this public health emergency? I sure didn’t. Nor did I know know about the Food and Drug Administration Safety and Innovation Act (FDASIA) Congress passed four years ago to address the crisis.
The FDA Solution: A New App
A recent examination of the FDA website, which lists nearly 100 current drug shortages, suggests FDASIA isn’t working that well. However taxpayers will be pleased to learn the FDA has created a new app for android devices that sends alerts when the Agency adds or updates shortage information. They are currently working on an iOS version, which will be available soon.
The New York Times article profiles several doctors who talk about the difficulty of deciding which patients are more worthy of treatment. Some institutions have formal committees that include ethicists and patient representatives to decide which patients receive a needed drug — and which do not.
A February 8 Times editorial waffles about the “root cause” of the drug shortage crisis. Their list of possible causes includes “manufacturing quality and compliance problems, raw material sourcing, and drug company consolidation and business decisions that result in the discontinuation of critical drugs.”
M.E. Markowski is far more direct in a 2012 Harvard Law School paper The Problem of Inadequate Profits. Markowski states, in essence, that pharmaceutical companies have no profit incentive to create a sufficient supply of essential medications to meet patient need.
Unbelievable. The US spends twice as much (per capita) as any other country. Drug company profits are soaring. Meanwhile patients are dying because they can’t get medications they need for life threatening conditions.
The Solution is Easy
Although the OECD ranks New Zealand far below the US in economic standing (20th as opposed to 4th), we don’t suffer from major drug shortages here. Like all other industrial countries (except for the US), we have a national health service. In this country, drug availability isn’t determined by drug companies seeking to increase their profits. In New Zealand Pharmac, a government agency staffed by health professionals, makes all our drug purchasing decisions.
Photo credit: J. Troha (Photographer) [Public domain or Public domain], via Wikimedia Commons