The business of medicine…the great doxycycline shortage…

It was with a  tremendous wave of dèjá vu that I watched NY Senator Chuck Schumer calling for the FDA to investigate a supposed shortage and massive price spikes seen for the common antibiotic doxycycline.

History of a doxycycline shortage…

Wasn’t this problem solved last year?  This issue hits close to home because I have a dog that requires intermittent courses of doxycycline for severe Lyme disease.  Last year the price spiked to ridiculous levels  over the summer and the pharmacist looked at me with sympathy when she gave me the bill for my dog.   Suddenly, what used to be about $40 tab skyrocketed to well north of $350.  She told me there was a temporary “shortage” of the drug and that had caused the price spikes.  Seriously?  SERIOUSLY?

Later in the fall, I was able to fill my dog’s prescription at a lower price point, though I noted that it never returned to what had been in the past.  However, I had somewhat naively thought that this was a problem that had been put into the “solved”. I went along my merry way thinking that this was once again a non-issue.  So did the CDC which categorized the doxycycline shortage as “resolved”  in October 2013.

Define supply and demand….price gouging anyone?

Now, suddenly “the problem” has resurfaced with  even more draconian spikes in prices combined with warnings of impending shortages by the CDC.  According to the The Journal News  Westchester pharmacists are reporting a what can only be described as monumental price gouging. One pharmacist reported that the wholesale price for 500 generic pills went from $60 to $1600 – roughly a 2700% increase.  This at a time when cases of Lyme in the northeast are exploding.

The latest missive from the CDC on this matter is simply that doxycycline should ONLY be used for conditions that have no alternative treatments.  So what about efficacy for individual patients?  Forget about it!  The CDC is resorting to underwhelming efforts in damage control.  If the price isn’t harming patient care, then efforts to curtail use of the drug could.  But was this ever truly about patient care?

Why medicine should never, ever, ever be purely a business…

If  anyone is foolish enough to think that this is an isolated incident, let me put those fears to rest. The Globe and Mail  did an excellent synopsis of drug shortages in Canada that would make your head spin.  They include such staples as penicillin, tetracycline, erythromycin, hydrocortisone lotion, heparin, elavil, and pentothal as well as doxycycline.

Lest you think that these shortages are unique to the “socialist Canadian system”,  the US is also facing record shortages of many of these common drugs. The problem is exploding.  In 2006, 56 drug shortages were reported.  That jumped to 251 in 2011. By Dec 2013 that number was north of 300.  Once again  common drugs and even simple basics like electrolytes and injectables used to make baby formula.

There has been real-world fallout to these shortages.  For example,  in the US a 2012 outbreak of fungal meningitis in 20 states was linked to a shortage of injectable methylprednisone used for epidural injections for severe back pain. Hospitals were pushed from the normal manufacturing route to a compounding pharmacy.  The fungus was traced to that compounding pharmacy.  result was 23 deaths and nearly 300 cases of fungal meningitis.  Of course, money is always motivating.  The article in the Globe and Mail summarized it this way:

 It is not a coincidence either that the most acute drug shortages involve products that are cheap (read: not excessively profitable). If you have limited capacity, are you going to use it to make an antibiotic that sells for pennies a pill or one that sells for dollars a pill?

Does anyone still think that medicine should be run on a business model?  Hope not.

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