A NY Times article published on January 29, 2016 addressed the increasingly problematic issue of drug shortages. According to the article authored by Sheri Fink, in recent years, shortages of all sorts of drugs “have become the new normal in American medicine.” Ms. Fink notes that The American Society of Health-System Pharmacists currently lists inadequate supplies of more than 150 drugs and therapeutics. The reasons for the shortages are varied: there may be manufacturing shortages, federal safety crackdowns, or the abandonment by pharmaceutical companies of low-profit products. Although pharmacists and physicians are acutely aware of the problem, the public is not.
The article observes that there are no satisfactory nationwide guidelines to determine who does and does not receive drugs, and what the pecking order is for distribution of scarce drugs to patients who need them. Pharmaceutical companies often sell their products to healthcare providers—doctors, hospitals, and other institutions—on a first come, first served basis, leaving the final decision of who gets what up to the doctors, pharmacists, and hospitals themselves.
In some institutions, there are formal committees to weigh the ethics of scarce drug distribution, but most often, individual physicians and pharmacists decide which patients receive a drug, and which do not. Frequently, the patient and/or the patient’s family are unaware of the shortage, or that a certain specific drug is not being offered to them. Some institutions provide limited drugs to pediatric patients first. In other institutions, a patient’s weight is a factor as it may take a higher dosage of a drug, specifically antibiotics, to be effective in an obese patient than in an average size patient. To some extent, the chances of getting a specific drug may depend upon where a patient lives and the patient’s access to a major medical center.
The consequences of drug shortages and rationing are can be obvious as well as subtle. Clearly, some patients are going to get the drug of choice while others receive a less effective alternative, if there is one, which may result in extended care, pain, and more invasive treatments in the future. In addition, studies have shown that alternative treatments during drug shortages lead to more medication errors, side effects, disease progression, and even deaths.
The federal government is working to encourage hospitals to conserve and substitute drugs to avoid a crisis. The FDA is taking steps to reduce the number of shortages, as well. However, as the article points out, it is clear that ethical and procedural guidelines need to be put in place by various institutions which are without national guidance to address the ethical and practical ramifications of drug rationing.