New Orleans   In the fight against the Affordable Care Act much was made of so-called “death panels,” as many may remember. Years go by and now we have something in place a lot like that now, and there’s not much never mind. When it comes to money or life, pretty much everyone has become resigned to the realization that money will win almost every time in such a contest.

Nonetheless, recent news that there were as many as 150 different drugs in critically short supply was not sobering, but shocking. The rationales were across the board, and they included production and manufacturing problems, abandonment by companies of drugs because of puny sales, supply line problems, and probably hoarding, though I don’t remember that being on the list. Some of it also had to do with predatory pricing on some drug therapies by companies charging exorbitantly for new treatments, like Hepatitis C, where almost $90,000 per year was standard, based on the companies’ argument that the cost was cheaper than transplants. The stories of hospitals unable to get enough chemo and other cancer drugs so they were having to lower dosages, deny access, try something else, or choose between the old and young in a deadly triage based on these shortages were horrible.

Having recently interviewed James Lieber about similar issues, many of which he had researched in his book, Medical Error, I reached out for him to give me a better understanding on whether the problem was the way I was looking or what I was seeing. Lieber’s finger pointed right at the drug companies:

 

Yes, these shortages and triaging are highly conducive to medication errors. Big Pharma plays a lot of games with pricing, and shortages which are often artificial is a main one. Another, which is related, is for hospitals to get kickbacks when they order high priced drugs, especially chemo agents, which can be in short supply. The dangers are real when physicians can’t order and nurses can’t administer the right medicine. It’s unethical practice in both professions. For people to sit in hospitals compounding by hand basic medicine is a crude throwback. Modern medicine requires adequate supplies of pre-measured drugs in the correct dosages. And where is the FDA which should be guarding our safety in this space? In bed with Pharma that’s where.

Yeah, good point! Where the heck is the Federal Drug Administration, supposedly a watchdog and regulatory agency of the US Government? Shouldn’t they be watching over this and both talking and swinging a big stick? How about some executive orders on this, President Obama?

Lieber has a recommendation, though it’s in the “pay me now or pay me later” vein. He says, let’s put clinical pharmacists in the mix right at the point of care:

I’m a big fan of clinical pharmacists who should round with doctors in hospitals and long term care making sure that patients get the right meds from the start. This cuts way down on errors, but is often considered an unnecessary expense.

Lieber also pointed me in the direction of my brothers and sisters at ACORN Canada, where they don’t have this problem. As Lieber says,

Truth to tell we’ll probably always lose this battle as long as all providers have to compete for and in formularies that rarely have complete stocks, a byproduct of our dysfunctional multi-payer system.

 

Maybe that’s not much comfort to us now, but it’s worth remembering that we don’t have to live – or die – this way.