Why are there shortages of HRT and other drugs in the UK?
BMJ 2022; 377 doi: https://doi.org/10.1136/bmj.o1183 (Published 18 May 2022) Cite this as: BMJ 2022;377:o1183
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Dear Editors
For the last 3 weeks or so, a large part of the Australian medical community has been directly or indirectly affected by a critical shortage of iodinated contrast media used in CT scans, predominantly GE Omnipaque and Visipaque products, which are widely used in private radiology practices and public hospitals across Australia; the shortage of these products resulted in increased demand for alternative contrast, e.g. Guerbet Optiray and Bayer Ultravist.
The GE product shortfall is attributed to closure/slowdown of production in GE plants based in Shanghai, China, where a lockdown has been in place. The overall result is the nationwide call for more consideration and triaging of iodinated IV contrast in CT scans ordered by doctors and this shortage (and practice change) is not expected to improve until the end of June 2022 (ref 1), contingent to the Chinese authorities lifting the lockdown in late May.
At this time there is some lifting of movement restrictions in the last few days, but nothing like free movement prior to March 2022. It is uncertain if certain workers for essential services like manufacturing healthcare products may be allowed to return to work earlier than those in other industries.
As such, this global shortage appears to have been affecting Australia, the US but not the EU, where some domestic production of alternative contrast products is being used.
In the UK, there has not been any media coverage of contrast shortage locally (including the BMJ) which makes me wonder if the GE products are widely used in UK, the use of IV contrasts in CT scanning is so controlled that sourcing alternative contrast is easier for the amount required used for the last 3 months, or a domestic production of contrast media ensures unfettered supply?
Or perhaps the news was simply not grabbing the kind of frontpage attention of what was happened in Downing Street 2 years ago during the lockdown?
Reference
1. https://doi.org/10.2214/AJR.22.27969
2. https://www.rcr.ac.uk/sites/default/files/Intravasc_contrast_web.pdf
Competing interests: No competing interests
Dear Editor
HRT is ridiculous
Professor Liz Breen wonders why the recent demand for HRT was not predicted. Use has risen and fallen several times since the 1960s as increases in thrombosis and cancers became evident.
Oestrogen only HRT use increased in US America in the 1960s but fell by the mid-1970s because oral or transdermal oestrogens were increasing the risk of endometrial cancer. Adding oral medroxyprogesterone increased combined HRT use but increased the risk of both breast and ovarian cancers.
As the risk of cancers increase with longer use, the biggest increases are likely in women who have taken both hormonal contraceptives and HRT. Less than 12 months of HRT use can increase the risk of breast cancer.[2]
It is ridiculous that carcinogenic HRT is being promoted as a life style choice.
1 Beral V, et al. Use of HRT and the subsequent risk of cancer. J Epid Biostat 1999; 4: 91-115.
2 Collaborative Group on Hormonal Factors in Breast Cancer. Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence. Lancet. 2019;394(10204):1159-1168. doi:10.1016/S0140-6736(19)31709-X
Competing interests: No competing interests
Dear Editor
Why is there panic and menopause mania about obtaining potentially carcinogenic HRT? In Westernised countries HRT use fell from 36 million women to 12 million after the early termination of the randomised controlled WHI combined and oestrogen-only trials. The result was a dramatic fall in breast and ovarian cancer incidence and mortality in Western countries. [1-3]
Women need to be warned of the increased risk of cancers, vascular illnesses including blood clots, mental illness and addiction. [4] Like previous generations, most women do not need extra hormones, especially if they avoid alcohol, smoking, common food allergies and correct any essential nutrient deficiencies (usually of zinc, magnesium and B vitamins) following previous use of these hormones for contraception. [5]
1 Grant ECG. Reduction in mortality from breast cancer: fall in use of hormones could have reduced breast cancer mortality. BMJ 2005 Apr 30;330(7498):1024;
2 Colditz G. Decline in breast cancer incidence due to removal of promoter: combination estrogen plus progestin. Breast Cancer Research 2007;9 108.(doi:10.1186/bcr1736)
3 Beral V, V, Gaitskell K, et al. Menopausal hormone use and ovarian cancer risk: individual participant meta-analysis of 52 epidemiological studies. Lancet 2015;385(9980):1835-1842. doi:10.1016/S0140-6736(14)61687-1
4 Price EH, Little HF, Grant ECG, Steel CM. Women need to be informed about the dangers of hormone replacement therapy. Lancet 1997; 314:
5 Grant ECG. The pill, hormone replacement therapy, vascular and mood over-reactivity, and mineral imbalance. J Nutr Environ Med 1998;8:105-116.
Competing interests: No competing interests
Re: Why are there shortages of HRT and other drugs in the UK? HRT is not risk free
Dear Editor
HRT is not risk free (1-3). Before being swept along by recent publicity, women and their doctors should read reports of the risk of cancers and vascular illnesses, including blood clots. Also, many Western countries found that reduced use of HRT was followed by falls in breast cancer incidence (4). Like previous generations, many women do not need extra hormones, especially if they correct nutrient deficiencies (usually of zinc, magnesium and B vitamins following past use of hormonal contraceptives) and avoid alcohol and smoking.
1. Collaborative Group on Hormonal Factors in Breast Cancer. Type and timing of menopausal hormone therapy and breast cancer risk: individual participant meta-analysis of the worldwide epidemiological evidence. Lancet. 2019;394(10204):1159-1168. doi:10.1016/S0140-6736(19)31709-X
2. Beral V, V, Gaitskell K, et al. Menopausal hormone use and ovarian cancer risk: individual participant meta-analysis of 52 epidemiological studies. Lancet 2015;385(9980):1835-1842. doi:10.1016/S0140-6736(14)61687-1
3. Price EH, Little HF, Grant ECG, Steel CM. Women need to be informed about the dangers of hormone replacement therapy. Lancet 1997; 314:
4. Colditz G. Decline in breast cancer incidence due to removal of promoter: combination estrogen plus progestin. Breast Cancer Research 2007;9 108.(doi:10.1186/bcr1736)
Competing interests: No competing interests