A widespread shortage of prescription drugs is hampering the treatment of patients who have cancer, severe infections and other serious illnesses. While some Republican politicians have railed against the imaginary threat of rationing under health care reform, Congress has done nothing to alleviate the all-too-real rationing of lifesaving drugs caused by this crisis.And if the plans by the president, the Congress, and the FDA to remedy the shortage of vital drugs are not favored by the pharmaceutical companies, the government officials will face intense opposition from the drug company lobbyists, who are amongst the most powerful in the country.
The Food and Drug Administration says that some 180 medically important drugs have been in short supply, many of which are older, cheaper generic drugs administered by injection that have to be kept sterile from contamination.
A survey of 820 hospitals in June by the American Hospital Association found that almost all of them had experienced a shortage of at least one drug in the previous six months and that nearly half had experienced shortages of 21 or more drugs. As a result, more than 80 percent of the hospitals delayed needed treatments, almost 70 percent gave patients a less effective drug, and almost 80 percent rationed or restricted access to drugs.
From the article in the New York Times linked above:
“These shortages are just killing us,” said Dr. Michael Link, president of the American Society of Clinical Oncology, the nation’s largest alliance of cancer doctors. “These drugs save lives, and it’s unconscionable that medicines that cost a couple of bucks a vial are unavailable.”So it goes when the free market runs free. The profit margin on cheap generic drugs is small, so the incentive to produce the drugs hurts the bottom line of the drug companies. Of course, Republicans will counter that the situation is the result of too much government regulation. You decide.
....
A group of leading oncologists has started a not-for-profit drug company that it hopes will soon be able to import supplies of some of the missing medicines. The company will eventually manufacture the drugs itself, according to Dr. George Tidmarsh, a pediatric oncologist and biotechnology entrepreneur who will lead it.
“We have a meeting with the F.D.A. next week,” Dr. Tidmarsh said. “This unfolding tragedy must stop, and right now.”
UPDATE: Please read IT's post on why we need the FDA. IT is a working scientist, and she knows whereof she speaks. One word should be enough to get your attention: Thalidomide. I'm old enough to remember the tragic results of inadequate testing of a new drug.
Disgusting but not surprising. Brighter note UK trials of an experimental prostate cancer drug have been halted because the drug is so effective that it would be “unethical” not to offer the treatment to all 922 cancer sufferers taking part in the trial.
ReplyDeleteThe same thing happened with Tamoxifen, the drug I took after I had breast cancer some 26 years ago. By my time the trial had ended.
ReplyDeleteI work in Home Infusion. For close to a year now we have been dealing with shortages of the chemotherapy drug we often provide as well as essential eletrolytes for TPN therapy. Just yesterday the hospital discharged a patient home on two needed IV antibiotics. However, one will stop after only 4 days because that is all that we could procure. This is how things work when we worship capitalism, the free market, profit and the bottom line. There are only six companies that manufacture the cheaper generic IV meds. Insurance companies often will only approve coverage for generic drug. However, there is no profit in the manufacture of these drugs. Our health care system is in collapse. If the proposed cuts in Medicare and Medicaid are successful - despite hospitals being portrayed in the media as these dollar hungry institutions - mark my words it will get even uglier. More hospitals will close.
ReplyDeleteIn Massachusetts where the a universal coverage type option was implemented...there are significant wait lists to be seen by a doctor because there aren't enough general practitioners practicing anymore (that will accept Medicare/Medicaid patients).
As we apply this corporate paradigm to all aspects of our lives we will see this collapse in many areas of our lives.
Welcome to the last days of the Roman Empire...
renz, thanks for your on-the-scene report.
ReplyDeleteOur health care system is in collapse.
I agree. And I worry, too, about the cuts in Medicare and Medicaid, even though we are told that the cuts will be only to providers. More and more doctors will no longer treat patients covered by the plans, and hospitals will be adversely affected. One reason hospital care is so expensive is because those of us with health insurance have to pay for those who have no coverage, even as the hospitals must absorb the cost of no reimbursement.
And other areas of our lives will be affected, too, as attempts proceed to shrink government down to the size of a bathtub.
For months I've been wondering why there was no coverage of the drug shortages. I am relieved that it is finally coming to light. I will say that when you read of folks talking conspiracy - that this is a plot to force the use of more expensive drugs - I would question that. I think that much of the capitalist model is just a stupid giant with its dogmatic principals (think middle management out of control). In a "market" that is only driven by profits and stock prices - factors that affect those measurements rise to the top and take precedence. As we allow government intervention and subsidy to be further and further belittled - shrinking it down to a size where it can be drowned in a bathtub - other factors such as ensuring an adequate drug supply fall by the wayside. There was a reason we fought against monopoly - because when too few corporations controlled a product, they could control the price. Yet we live in an age that is encouraging merger upon merger, creating too big to fail institutions that have us by the short hairs. We hear all this chatter about opening up Alaska to oil drilling - how this will improve gas prices here - yet we ignore the fact that there are no directives saying the companies that drill there must sell that oil to the US. Presently a significant amount of oil pumped in Alaska is sold to Japan where they get a much better price.
ReplyDeleteCapitalism is evil - it is an ever hungry monster. Until we wake up and begin to fight, we are doomed.
Sadly, I don't have much confidence that the situation will improve with government intervention.
ReplyDeleteAnd when we wake up, how do we go about stopping market-driven capitalism? And what do want in its place?
I am painfully recovering from a 2 day bout of withdrawal sickness. Why was I ill? Because I am in the coverage gap and could not pay for my prescription medication. This is the system the idiot Republican candidates want to CUT!
ReplyDeleteAmazing.
FWIW
jimB
Jim, I am so sorry. It's up close and personal for you. Too many forget that the mess affects the lives of real people.
ReplyDeleteWell, Mimi, let's start by slashing our military budget, focusing mainly on the weapons systems we sell to the world. Lets up the ceiling on social security income, in fact, eliminate the ceiling. Increase the tax rate on wealthier earners, while eliminating most tax loopholes. Declare corporations, non-humans so that individual investment income is separate from corporate income. Then adjust corporate tax to stimulate business growth. Provide universal health coverage for all...nationalize the generic pharmaceutical industry. Nationalize the petroleum industry...how is that for starters?
ReplyDeleterenz, sure I'd like it if we'd do some of those things, but I don't know that I want the government running everything, for instance nationalizing the drug companies. We could fix Part D of Medicare to allow for negotiation of drug prices.
ReplyDeleteAnd if we slash military spending, it will cost jobs, but, if we're smart, we'd put those folks to work repairing our broken down infrastructure. I'd like to see universal health care and health insurance companies for only those who want elite health care. Why do we need the middle man?
Eliminate the tax loop holes. Eliminate mortgage deductions for all but the primary home. And yes, corporations are not people. What are the chances of all or any of that happening?
Mimi, as the quasi-conservative here (not Republican--God give me the grace to never fall that low!)
ReplyDeleteI'll point out why government regulation--or in practical terms, FDA and Medicare--have contributed greatly to this problem
[soapbox]
1)FDA and patent rules that keep generics off the market for as long as possible so that pharma. companies can profit as much as possible
2)FDA rules that prohibit importing medicines even from places where we know they are manufactured safely, and FDA rules that in effect force would be manufactures of generics to prove their medicines work, mostly without regard for the previous work that went into proving efficacy and safety by the original manufacturer
3)Medicare and insurance reimbursement policies that keep generic prices at a price that's too low to make a profit
So you have a situation where, thanks to the government, it's hard work for little profit to make a generic in the first place, and then limit the potential supply even further by forbidding imports. Without those government obstacles, there would be more opportunity and incentive for small manufacturers to produce a generic, and a wider group (ie, international) of manufactures to which hospitals could turn if they couldn't get what they need domestically. Government regulation created the environment in which Big Pharma can screw everyone over (pardon my language)
This is a good example of why there should be limited government regulation--because almost invariably the objective of regulation changes from protecting the public for unsafe products to protecting the producers from potential competition and lower prices.
[/soapbox]
kishnevi, the government does some things poorly and some things well. Despite what you hear conservatives say, Social Security is a success story. Raise the caps, and the program will be secure into the long term. VA health care is a success story, and it's a government health care plan.
ReplyDeleteThe FDA rules that keep generics off the market and the ban on imports are both wrong. Why do you think the FDA has those rules? Because of pressure from the pharmaceutical companies. Have your heard of ex-Rep. Billy Tauzin, R-LA? He and his associates at Pharma wrote the rules for Medicare Part D. And we are to permit these people to run wild and free? I don't think so.
It's pick and choose for regulations, but the picking and choosing must be done wisely. Please don't ask me to put my trust in corporations to regulate themselves, when their main concern is to give investors a good return in the short run so as to run up the price of their stock. A good many of them are not even interested in running a good business. The execs want to get theirs now and have little concern for their workers or even the future health of the business.
Okay, before you all go bashing that Evil FDA and its Over-Regulation of Drugs, I want you to go read this:
ReplyDeletehttp://friends-of-jake.blogspot.com/2011/09/government-regulation-does-it-block.html
The problem is not govt regulation. It is about a system that puts maximum profit above everything, that fails to find a middle ground that balances the two.
Pharma finds no profit in making people better. They'd rather make viagra then cure disease...because men using Viagra will keep needing viagra. If you cure an orphan disease, or cancer, you lose your market.
What we need is a structure that will give companies a reasonable incentive for making low-profit drugs, because the free market ain't going to do it.
Mimi, I actually agree with just about everything you say. I could easily live with a government that spends more on social and domestic programs and less on military programs. I think tax increases will have to come, and I'm certain that most of the Tea Party rhetoric is motivated on the leadership level by political partisanship, not real concern with what the country is doing (The grass roots level, however, is certainly upset about what it sees as ever growing government spending.) My griefs involve government regulation on all levels--federal, state and local.
ReplyDeleteYou and I, in general, have the same attitude to corporations. It's hwo you see government that I differ. You trust government to control corporate nastiness as long as the public can keep a grip on it. I don't trust government because invariably the corporations make government their ally or puppet. Tauzin's antics are a good example. They will happen in any government, because it's the interest of corporations to do so. There has been no failure of the free market in health care because there is no free market in health care--government has intervened continually for decades in ways that benefit the manufactures and insurance companies and hurt both the public and frontline providers (meaning hospitals, doctors, etc.)
Invariably the people who have the money will do their best to make government their puppet and put power in their own hands. If you try to get rid of people with money, like they did in the Communist countries, you simply reverse the quest--the people with power will try to put the money in their own hands. The only solution is to limit government as much as possible, because that way the mischief the people with money can do is limited as much as possible, so that we individuals are not forces to pay or otherwise submit to them.
So it's not that I trust Business; I simply trust Government less, and don't think it can really protect us from the immoralities of Business.
Okay, enough soapboxing for one night. Enjoy church in the morning!
To IT (who I see posted while I was typing the above)--the only way to give incentives to companies is either direct government subsidies or loosening up the regulations and patent laws so that there is more profit. Merck or whoever may go on pushing Viagra, but lower the regulator barriers to new companies entering the field, and you'll find manufacturers who decide to target the markets and diseases Merck ignores because, while the profits won't be on the scale of Viagra, there will still be profits. That's how the free market would do it. But always remember that we don't have a free market nowadays in phramaceuticals. We have a government imposed regime that intentionally favors Big Pharma.
Getting rid of the barriers means a couple of specific things that have been mentioned.
ReplyDeleteGet rid of patents. Libertarians, the real kind, tend to favor eliminating this gross interference with the Smithian free market, which it really is; this, in fact, is one of the few points on which I tend to agree with them. But apart from the problem with achieving that, do we truly want it? I have doubts; patent law has its uses.
Or reform it for our special important purpose; see later.
And get rid of the FDA entirely. Does anyone really want that? Do I need to whisper "Thalidomide"? In fact, not having an FDA has been tried. It was that way a century ago, and one may want to read the literature of a century ago on how well that worked.
Regulatory capture, the official term that includes drug companies writing the drug regulations, is a long-standing problem. The conservative-libertarian solution of dropping all regulation just doesn't make it unless one has an odd sense of values that puts a sacred principle of Free Markets above all other values.
For tonight, I'll spare you the discussion of how far most of our corporate economy is from the (economic, as opposed to political propagandistic) free market, and how little we'd like to make big changes in that situation.
Wishy-washy liberal reformism for me as the only solution that might be workable if real effort were put into it. That means an unending struggle to keep corporate power, actually economic power generally, under control. Eternal vigilance is the price of liberty and all that. Nasty prospect, all that struggle, but that's what we've got. Short of Bloody Red Revolution, which is distasteful and also a tried and failed solution.
BTW, in honor of Sunday, and Anglicans, I recommend a reading on unrelenting stuggle: the essay "De Futilitate" by C. S. Lewis.
IT, right on. I added an update to my post linking to your post on the FDA at The Friends of Jake.
ReplyDeletekishnevi and Porlock, thank you for your long comments. I welcome them. What we have at the present time in the global economy is a situation where the corporations come close to running the world. The politicians are, all too often, bought. Certain countries in the West seem to do a much better job of standing up for the welfare of their own citizens in the face of pressure from the global corporations than we do here in the US.
And I trust government somewhat more than I trust large corporations, but that's not saying much. What distresses me the most is that here in the US, we seem to have largely lost the concept of the common good. Even for selfish reasons, we should be aware that you can't have a decent country with such wide disparities in income as we see now in the US, and the situation seems to be going downhill at a rapid pace.