"Berkowitz picks up a box of sodium bicarbonate, which is crucial for heart surgery and to treat certain overdoses. It’s being rationed because there’s so little available."
Huh? US hospitals have a shortage of Baking Soda?
Huh? US hospitals have a shortage of Baking Soda?
There weren't many days where the hospitals I've worked at weren't short on something. (And these are like, big name academic medical centers in big U.S. cities.) I've run into a shortage of normal saline before. Yes... salt water.
Sometimes hospitals will even stockpile basic supplies to keep from running into shortages... which only makes the whole situation worse.
It causes a lot of patient harm, even if it's usually not catastrophic because we usually have redundant meds. Recently my hospital was out of a common, generic, cheap antibiotic. For many infections in many patients, this meant we had to switch to the second-line drug -- which was more expensive, had more side effects, and was less effective against the bug. This type of thing happens to chemo drugs, to drugs you give after a heart attack, to drugs you need for planned surgeries or procedures.
I don't know how to solve this. Less regulation? More regulation? Subsidies for manufacturers of essential medications / supplies? I mean, normal saline is already ridiculously expensive enough [2].
For more reading: http://news.medill.northwestern.edu/chicago/hospital-drug-sh...
[1]: https://www.nytimes.com/2017/05/21/health/sodium-bicarbonate...
[2]: http://www.nytimes.com/2013/08/27/health/exploring-salines-s...
They are in shortage because it takes a long time (six-ish months) to certify a factory as producing something safe for consumption[1], and in the normal course of things, there is very little point in setting up a second line to produce medical grade sodium bicarb- no company is going to show a profit from it. So you get one place producing the national supply, just large enough to handle the normal demand. Then they have a problem (in this case, Pfizer was unable to source the glass ampules) and now there is no production.
[1]: And with good reason. Producing mass quantities of sterile, consistent, things with the correct amount of material is hard.
Source: wife is a pharmacist tasked with doing her hospitals contingency plans on bicarb.
In point of fact, most drug companies have faced what are called patent cliffs, where due to troubles in the R&D pipeline[1] drugs lose patent protections far faster than new drugs come online to replace them. While this is probably bad for society overall- we really want lots of new drugs getting discovered and making us healthier![2]- it means that patents protect smaller and smaller portions of the overall drug market. IOW, playing games with them has less and less overall value as the years have progressed.
Need to find new levers to have influence on this market.
[1]: A totally different subject with a lot of theories as to why, but not much in the way of solid evidence.
[2]: Yes, the 1k USD/pill Solvadi is amazingly expensive. By the same token, it actually works, and cures you after three months. This is the sort of medicine that improves humanity, even at that price. There are plenty of other drugs (especially cancer drugs that extend lifespan by averages of <4 months) that do not improve humanity, but Solvadi does. It just costs a ton.
Decentralization and redundancy of medical production lines would make our country safer and more robust to unforeseen events. It would certainly be a benefit. I agree, however, that it would be more expensive.
Most of these medicines are like sodium bicarb- the national population doesn't need that much, but if you need it, it's hard to get a good substitute. Snake antivenom or daraprim are good examples of these niche products that are even more crucial than bicarb, but still probably not used enough for any one organization to be able to justify a second-source contract.
That doesn't sound like the cost of the saline is much of a problem. It sounds like hospital billing is the problem.
EDIT: https://www.usatoday.com/story/money/2017/05/31/how-baking-s...
You can't just take a box from the baking supplies shelf in Walmart.