Margaret McCartney: Daily drug shortages place avoidable pressure on primary care
BMJ 2015; 350 doi: https://doi.org/10.1136/bmj.h2514 (Published 11 May 2015) Cite this as: BMJ 2015;350:h2514
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Dr McCartney is right to point out the pressures that drug shortages place on GPs and patients alike. It is a problem that also has a large impact on pharmacists, who are spending hours of their time contacting manufacturers, chasing up shortages, and arranging alternatives.
Drug shortages represent a difficult problem in disseminating information on how to manage them. I have been involved in writing guidance to community pharmacists on how to manage common shortages. It has proven difficult to differentiate between shortages that are due to individual pharmacy suppliers and those that affect the whole market, as well as distinguishing between those likely to pose a long term clinical problem and those which are a flash in the pan. Information on managing shortages also needs to be responsive enough to be useful, yet robust and evidence based. The possibility of causing further drug shortages needs to be borne in mind, as "panic-buying" or "stocking up just in case" may exacerbate the problem.
The PSNC previously used to compile a list of current shortages, but this is no longer maintained due to a lack of reporting: it was no doubt lost in amongst the extra stress and work which shortages cause in an already pressured environment.
Despite these problems, there are some useful information sources on Drug Shortages, which may be helpful to all health care professionals. The UK Medicines Information (UKMi) Service can be an excellent enquiry answering resource, as well as producing useful Shortage of Supply memos found at http://www.medicinesresources.nhs.uk/en/Communities/NHS/SPS-E-and-SE-Eng...
NHS Forth Valley also produce a useful newsletter: http://www.communitypharmacy.scot.nhs.uk/nhs_boards/NHS_Forth_Valley/red...
Competing interests: No competing interests
The problem is NOT the free market. The problem is that there is NO free market competition in generic drugs, devices and supplies in the U. S. This is yet another example of the old saying, "when America catches a cold, the rest of the world gets pneumonia." The global generic drug shortage crisis was “Made in the USA” by giant hospital group purchasing organizations (GPOs), which control the purchasing of upward of $300 billion annually in these goods for about 5,000 U. S. hospitals and other healthcare facilities. Their anticompetitive contracting and pricing practices, self-dealing, kickbacks and other abuses have been well-documented. These cartels have rigged this marketplace, in effect tossing your native son Adam Smith and the laws of economics into the hospital incinerator.
Money and politics are at the root of this public health emergency. It could be fixed with a pen stroke by the White House and Congress, which are well aware of the real root cause. For a primer on this issue, read our Sept. 3, 2013 New York Times op-ed, "How a Cabal Keeps Generics Scarce," which is posted on our website, www.physiciansagainstdrugshortages.com.
Our non-profit, pro bono patient advocacy group was founded in 2012 by physicians who were outraged that they couldn't get the drugs they needed to properly treat their patients. Our mission is to end this crisis by exposing the underlying cause and restoring market competition and integrity to the GPO, generic drug, and hospital supplies industries.
Millions of sick people in virtually every country on the planet are affected by this travesty. The most effective action their leaders can take is to publicly demand that President Obama and the U. S. Congress take immediate steps to stop it.
Phillip L. Zweig MBA
Executive Director
Physicians Against Drug Shortages
New York, NY
Competing interests: No competing interests
Re: Margaret McCartney: Daily drug shortages place avoidable pressure on primary care
Harris@doctors.org.uk
I recognised the drug supply shortage problem raised by Dr Margaret McCartney. As a general practitioner GP in London I note that the unavailable list of drugs is getting longer, also includes trimethoprim, digoxin, sodium chromo glycated (hay season now!) and the different ***vate creams and ointments. Some medications are cheap and cheerful, but similar or equivalent can be elusive or plainly unavailable. This affects us GPs and our pharmacists for some time, and the challenge is getting worse.
Our local pharmacists are valiantly trying to source the medication and having similar experiences: one pharmacist calculated that this added 10% extra work to his week, another pharmacist calculated 5-10% increase with an example of mefenamic acid 500mg has been unavailable for over one year; a third pharmacist gave an example of manufacturers applying quotas to supply pharmacies such as the Parkinson's drug azilect (rasagiline) restricted to two boxes only per month.
As Barnet LMC Chair, I am aware that my GPs and staff are determined to deliver clinical care but their time is diverted by this supply problem. Unfortunately the public appear unaware until it affects them personally, and return to blame the GP.
We should have a campaign to make the public aware of this drug shortage problem- don’t blame the doctor or the pharmacist! We need to reassure patients that doctors are working hard for patients even when the drugs aren't available.
Competing interests: No competing interests