Last week, I spoke with my father about drug shortages - whether they really exist in our hospitals.
The brief answer is YES. Drug shortages not only exist in hospitals, but also in "the field", as seen by EMS providers. There was a radio program today on NPR, in which the host interviewed James Augustine, MD. Jim Augustine currently works in GA/FLA, but used to be an ER doctor at Miami Valley Hospital in Dayton, where I regularly saw him when I was volunteering as a paramedic on my local fire dept.
Augustine is a "real world" physician, not somebody working in a fantasy land. In addition to being an ER doc, he maintained his EMT certification, and volunteered as a fire fighter on his local fire department. I trust his judgement.
The radio program documented the fact that Oregon paramedics may carry and administer EXPIRED drugs to their patients. Not as any sort of grand cost saving measure, but due to the fact that new (unexpired) drugs are not available. Welcome to the new 3rd world nation....the USA!
"In the Las Vegas, Nevada area, public health officials extended the expiration for drugs on the federal shortage list for up to a year" (somewhat amazing, since we put lethal injection executions "on hold" when the drugs expire, yet it's apparently OK to use expired meds on non-criminals).
"In Arizona, nine EMS agencies or the hospitals where they're based have told the state they can't get all the drugs they need to meet the state's minimum supply that ambulances are required to carry. "
I see drug shortages on a regular basis in my ICU. The shortages range from pain killers (morphine, fentanyl) to paralytics such as Zemuron to sedatives (Versed) to basic electrolytes (salts like magnesium sulfate...Epsom Salts, sodium bicarbonate...Baking Soda, and potassium and phosphorus compounds). These drugs are very basic - not complicated at all.
IMHO, what complicates the availability of basic drugs are several factors:
- FDA stringent regulations controlling the manufacture/testing of the drugs
- low profit margin/selling price of basic meds
- high expectations (perfection) demanded by drug customers & their contingency based, fee-seeking attorneys, and the large financial liability to which drug makers are exposed.
Given these factors, why SHOULD a drug maker continue to supply basic, low profit, high financial risk meds to consumers?
Sad, but true.
Welcome to the Third World!