When a patient presents at the ER in crisis, a swarm of medical personnel may use a variety of medications to stabilise her, working quickly to control her blood pressure, make sure her airway is open, and address broken bones, potential brain injuries, heart problems, and so much more. Once stable, patients typically need even more medications — anyone who’s visited a friend in the hospital has probably noticed the chart that meticulously notes which drugs patients should be getting and when. Medication is a lifesaving medical intervention that’s made a huge difference in the health care system, whether in emergency situations or the management of chronic illness or the handling of surgical patients.
Which makes medication shortages a big concern. What may come as a surprise to some is the fact that such shortages are on the rise in the United States, and they’re hitting emergency departments particularly hard, with a number of key lifesaving medications growing more difficult to obtain and keep in stock. This has huge consequences for the quality and availability of health care, whether we’re talking generics with a low profit margin that pharmaceutical companies don’t produce or expensive patented drugs with a very narrow supplier pipeline that isn’t producing sufficient amounts to meet the need.
If a hospital is short on a drug that a patient needs, personnel need to make a snap decision about what to substitute. In some cases, such swapouts don’t result in big changes to patient outcomes, as long as care providers have the experience and training to select the right drug and calculate dosages on the fly. In other instances, though, patients really do need the drugs that they can’t access, and the results of not having those medications can be serious when those patients are in a critical medical state.
Medical crises don’t leave time for calling around to neighbouring hospitals to see if someone has the drug and having a runner deliver it. They don’t leave time for ordering the drug, even at a premium, from a supplier. Hospitals must have these medications in stock, or their patients may suffer — or even die, depending on the drug. The fact that they’re having trouble maintaining adequate stock is worrying, and it reflects the fact that the health care system is really struggling, and that reform needs to consider issues like these.
Much of the focus on health care reform in recent years has been about affordability for patients, recognising the skyrocketing cost of medical care and working to address key chokepoints of affordability. While I don’t agree with the approach to this problem (forcing people to buy health insurance doesn’t actually make health care more affordable, and moreover, forcing people to buy health insurance doesn’t guarantee larger changes in the system, as we’re seeing here), that’s why the government has chosen to do. Addressing issues on this side has undoubtedly saved some lives and made health care more accessible for some people, which is undeniably a good thing.
That said, we aren’t addressing key problems within the system itself, like dragging heels on evidence-based medicine and, as we’re seeing here, critical shortages of medication and supplies. Physicians and other care providers cannot manage patients effectively if they don’t have the tools to do so. Wherever you want to seat the blame for inadequate medications, it’s still a problem, and it’s one that is getting worse. That means that outside intervention is clearly necessary, as internal regulation is no longer effective.
One could argue that Obamacare drove more people into the health care system, increasing demand for medications. If pharmaceutical companies were unable to make adjustments to production, they’d be struggling to keep pace, and in theory supply availability would equalise at some point. That could certainly be one factor, especially for medications used to manage chronic illnesses, as some people with conditions like diabetes, for example, can actually visit the doctor and receive more closely monitored care.
However, that’s clearly not the only issue here. One problem is that many drugs used in EDs have been around for decades, and they’ve gone off-patent. Generic medications are not big moneymakers for pharmaceutical companies, and thus, they don’t dedicate a lot of energy to their production — they’re sinking resources into R&D for new medications, and they’re focused on developing the market for their patented drugs and exploring the possibility of expanding their profits. As with vaccines, the profit margin is low, and in fact some vaccines would represent a loss if they weren’t subsidised — something that may become necessary with routine ED drugs if pharmaceutical companies won’t keep up.
There’s actually a law that gives the FDA more regulatory latitude to address drug shortages, but when it comes to acute medications, it’s clearly not working as intended. The shortages of these drugs are going up, not down, as one would expect if the law was functioning as intended. If companies are not openly discussing shortages and production problems and talking about how to address them, the FDA cannot help them, and perhaps it’s time for more aggressive regulation and audition to get to the bottom of this problem.
The United States likes to claim that it has the greatest health care system in the world, which is patently false. Things like this illustrate why — and the fact that we are still struggling to meet a pretty fundamental need is extremely disturbing.
Image: Military Health, Flickr