Generic Drugs In Short Supply
Cheap Generic Drugs are in Short Supply
A recent survey of pharmacists across Canada showed that 93 per cent of them are currently having problems stocking basic generic drugs. We are talking about ten basic drugs a week. Of course there is no shortage of very expensive newer drugs that have replaced them over the years. What we have here is a situation in which pharmaceutical manufacturers are purposely holding back production of inexpensive generics while they use factories to produce the more expensive brand name drugs.
In Ontario, the provincial government sets the price of all drugs in the Ontario Drug Benefit formulary and they have recently slashed the price of generics in half to 25 per cent of the brand name drug. So if you were a manufacturer, what would you do?
Pharmaceutical companies keep merging with each other, producing just a few giant firms. More than 90 per cent of prescription drugs are manufactured in foreign countries such as China, India, Pakistan, Indonesia, Mexico and Puerto Rico. These countries do not have the same strict environmental laws that we have in North America and in many cases there may be only one plant dedicated to the manufacture of a very important drug such as Penicillin V.
In the pharmaceutical manufacturing process, it is extremely important that there be absolutely no contamination so that the pharmaceuticals are 100% pure. In a perfect world this would mean a separate manufacturing facility for each drug. However, in the real world, the drug company estimates the usage and produces enough drug for a fixed period of time. Every few days, the machinery is totally cleaned and decontaminated and a different product is produced. If the product manager estimates too low, there will be a shortage of that product until its manufacturing turn comes around. Or in many cases, its place in the production line is taken by a more expensive and hence more profitable drug and people are left with a world-wide shortage.
Just last year a huge manufacturing plant in China that produces Heparin, (an important clot-busting drug for people rushed to the hospital with a heart attack or stroke), did not clean their production line and contaminated heparin was shipped to the United States which caused a number of deaths.
When you import a drug from abroad, you do so on what is called a ten day letter of credit. This means that you have ten days to test the drug and determine its efficacy and safety and if there is the slightest thing wrong you dump the drug and do not pay for it. However, because of the long shortage and the desperate need for Heparin, they skipped over this step and innocent victims died.
There is still a great demand for antibiotics and a large number of our most dependable ones have been in short supply in the last year. These include: •Penicillin V: Probably the best antibiotic for treating a strept throat and for most bacterial infections of gums and teeth.
•Tetracycline: A very effective antibiotic for pneumonia and excellent at treating H.Pylori infections that cause stomach ulcers.
•Erythromycin: another very effective antibiotic for upper respiratory infections such as bronchitis and pneumonia.
•Cephalexin: An antibiotic for ear infections and infections of the skin.
Of course there is no shortage of the newer more expensive antibiotics that belong to the class of quinolones, especially if they do not have a generic substitute.
Years ago, long before we had the SSRI’s (selected serotonin reuptake inhibitors) and the even newer ones that interfere with norepinephrine, another neurotransmitter, we had a class of antidepressants known as tricyclics that included amitriptyline and imipramine. These drugs were never very effective as antidepressants and are used primarily today for people in severe pain. They are taken at night to block electrical brain stimulation causing pain and as a side-effect they cause drowsiness which in turn helps the patient sleep. There are no substitutes for these drugs because they have been genericized and they are cheap. The new antidepressants do not work for people with fibromyalgia or severe arthritic pain so we see the use of drugs like gabapentin and Lyrica (pregabalin) that cost hundreds of dollars a month in abundant supply while the generics are rarely available anymore.
In order for physicians to prescribe the new and mostly very expensive antidepressants, the pharmaceutical companies have convinced most physicians that anxiety drugs such as diazepam (Valium) Lorazepam (Ativan) and clonazepam (Rivotril) are dangerous and habit forming and therefore antidepressants should be prescribed for anxiety. If the drug companies can convince physicians to pass over these older drugs, then they have succeeded. But in order to guarantee their success, they have the power to reduce production to such an extent that these drugs become unavailable for long periods of time.
Even very old drugs like chlorpromazine that can very easily calm down a psychotic patient and those suffering from schizophrenia are in short supply only to be replaced with very expensive antipsychotics like Zyprexa. Chlorpromazine was also a very effective drug for people who actually wound up in the hospital with uncontrollable hiccups. Hopefully you never find yourself in that position because this drug is becoming rare.
Many of you may be familiar with the drug Thiopental Sodium (truth serum if you watch the old spy movies). It is a short acting anesthetic to put patients under for surgery but is no longer even available in Canada. It has been replaced by the much more expensive anesthetic, propofol (the one that killed Michael Jackson). Now even that drug is in short supply forcing our hospitals to buy extremely expensive anesthetics because they are the only ones available and most operations should not be postponed.
Forcing Physicians to prescribe Expensive Alternatives
For more than thirty years, ACE (angiotensin- converting- enzyme) inhibitors have been very effective in controlling the blood pressure of hypertensive patients. The principle side-effect was a dry cough that did affect a number of people. Pharmaceutical giants ignored this side-effect for years until finally all the ACE inhibitors were genericized with cheaper substitutes. At that time the drug companies introduced ARB’s (angiotensin-receptor-blocker) which are just as effective but do not have the dry cough side-effect. No doubt they had these drugs in their pocket for years just waiting for the right moment to introduce them. Their success was demonstrated in a recent article published in the Canadian Medical Association journal showing that in the year 2006, if physicians continued to prescribe the less expensive ACE inhibitors rather than the more expensive ARB inhibitors they would have saved us $77 million dollars. That was the extra profit produced by convincing doctors to switch to the newer drugs.
Most of the old ACE inhibitors lost their patents and were replaced by generics by 1996. By 2006 the use of angiotensin-receptor-blockers rose by more than 4000 per cent. Over the same period of time, overall costs of cardiovascular drugs in Canada increased by more than 200 per cent.
In Ontario physicians can prescribe whatever they want (or what the pharmaceutical companies convince them to prescribe) and this costs the taxpayers of this province untold millions of dollars. In British Columbia, a physician can only prescribe the more expensive ARB inhibitor only if the ACE inhibitor causes side-effects or is not effective. At least in B.C., the government is proactive about keeping down the cost of prescription drugs.
Chemotherapeutic Drugs: Drugs that fight Cancer
This is the sickest category of all. Drug manufacturers always claim there is a shortage of raw materials to make the product and this was the main reason for the lack of supply of the drug. The fact is that just as very ordinary drugs such as antibiotics lose their patent and are replaced by generics, the same process happens with drugs that are used to treat cancer. Of course hospitals would love to use the less expensive generics and not keep asking for more money each ear. In this case a drug that may cost $1000 a month to treat a patient may become unavailable and have to be replaced by one that may cost from $15,000 to $30,000 a month. What is the hospital to do? Stop treating the patient? Ask the family to pay for the only drug available? When drug companies do this to our healthcare system and put our people at risk, they should be charged with homicide if the patient died because the drug was in short supply. One of our most prominent cancer hospitals, the Princess Margaret in Toronto has been having severe problems getting a drug called Caelyx to treat patients with Ovarian Cancer.
What a world when profits take precedence over the lives of human beings.
I have always tried to make my clients understand that conventional medicine and alternative medicine are not opposed to one another but should be used to compliment each other to maximize your health. In other words, you eat healthy nutritious foods; take your supplements and exercise daily in order to prevent any illnesses. However, things happen. You may have a defective heart, not because of your own neglect, but because of the genetics of your parents. You may be a schoolteacher who picked up a dangerous pneumonia or even an infection of tuberculosis from one of her children. You may be someone like me who never had any surgery for the first 65 years of their life, then had 5 operations in two years (4 on my eye and one for a deviated septum). In all of these cases we would need a drug of one kind or another and it’s a good thing that there are drugs out there that can take away our pain, put us under for operations, and treat our bacterial and viral infections. It is not a good thing that pharmaceutical companies manipulate the supply costing our governments, our insurance companies and people that have to pay their own way hundreds of millions of dollars because of their own greed. Not only is it terribly unethical but it is probably against the law. Hopefully one day, some government lawyer will have the courage to take these people to court and make them pay and be accountable for their actions.