The lack of adequate drugs to treat
patients is becoming a concern not only for US administration officials but
also the general public and clinicians as well. There are several factors that
might explain these otherwise inexcusable shortages. First of all the
ingredients of certain drugs are so rare that the process of sourcing them disrupts
the production process significantly. Secondly some manufacturers like the
capacity to meet the growing demand for drugs while others make profit-based
decisions that put public health at risk. Thirdly federal regulators have
sometimes created such stringent entry requirements that many potential
manufacturers have opted to pull out of the process.
Understanding the Full Impact of Drug Shortages
The immediate impact is that the people
that need this type of medical treatment are left struggling. Some of them go
for untested and sometimes unhealthy alternative medication. At other times
important medical procedures have to be delayed in order to ensure that all the
right medications are in place before the patient is put in a situation of
no-return. The shortages necessarily drive up the costs of medical treatment
due to the forces of demand and supply. In general this trend is reducing the
health outcomes for people who are living in the most prosperous nation on
earth.
Challenges of Developing
Coordinated Strategies
The problem of missing drugs could have
been mitigated if all the agencies involved were working together.
Unfortunately the opposite is true in as far as the definitions of what a
shortage really is differ considerably. For example the American Society for
Health-System Pharmacists (ASHP) focuses on end-user where alternatives must be
found; whereas the FDA focuses on the availability of capable suppliers.
Ultimately these two definitions point towards the same problem but require
solutions that are divergent. Whereas ASHP might consider the supply chain and
affordability; the FDA is more concerned with licensing and safety.
A Statistical and Practical Nightmare in the Making
Understanding the
extent of these trends requires a close examination of FDA drug shortage data. This is often gleaned from a combination of
private and public resources. A lot of information relating to this issue has
been presented by the Drug Information Service at the University of Utah Health
Care (UUHC) trust. By 2010 there were no fewer than 211 separate shortages.
This turned out to be the highpoint of the dire statistics. The following year
the Premier Health Alliance reported that there about 240 separate drug
shortages in the country. Another worrying statistic was that about 400 generic
medications had back-order averages of at least five days, which is equivalent
to a working week. This information complements the FDA drug shortage data which shows that suppliers are failing to
meet demand.
Some Practical Solutions
First of all the
licensing protocols must be liberalized further in order to bring in more
market-oriented participants. This does not mean neglecting safety issues but
rather offering new opportunities to meet demand. Secondly generic manufacturers
should be encouraged in order to supplement the official supply from the
patented companies. Finally early surveillance is of the essence in order to
detect the problems before they become crises.
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