Supply and Demand
U-M pharmacists, doctors collaborate to ensure patients get drugs they need, despite shortages, con't.
Doctors also work with the pharmacy to ensure that no amount of drug is wasted, said Harry Erba, M.D., Ph.D., a Cancer Center oncologist who helped plan for the cytarabine shortage. If a vial is opened for one patient but the entire quantity is not needed, the team works together to figure out who else can use it so the excess does not go to waste.
In the case of the cytarabine shortage, Erba and his colleagues went a step further than typical conservation efforts. They reviewed the results of many studies to determine whether lower doses were equally effective. Lowering doses would allow more people access to the short supply of the drug. Given what they had found in recent medical publications, they found that they could cut doses in half in certain cases without any risk to patients.
"This was an opportunity to have a candid discussion about what is an adequate dose," Erba said. "We unanimously agreed that based on the most recent data, we could give patients the therapy they needed by limiting the doses by 50% of what we commonly give."
And as a result, no patients went without.
Why Are Drug Shortages Occuring?A number of problems cause shortages, said Allen Vaida, executive vice president for the Institute for Safe Medication Practices. Consolidation among pharmaceutical companies has had a major impact. If only three companies manufacture a drug, and two of them merge, often the third company can't keep up with the resulting demand. Even if a company has additional production lines available to produce a drug in demand, they cannot be used unless those specific production lines have federal approval to manufacture that specific drug.
In addition, Vaida said, the U.S. Food and Drug Administration recently stepped up inspections to ensure drug quality. Some manufacturers had to halt manufacturing temporarily to improve processes; others decided it wasn't worth the cost, so they stopped manufacturing certain drugs altogether. And since pharmaceutical companies have no obligation to notify anyone that they plan to stop manufacturing a drug, shortages often occur unexpectedly.
To help prevent this, Sen. Amy Kobuchar (D-Minn.) recently introduced a bill that would require companies to provide six months' notice to the U.S. secretary of health and human services of any manufacturing interruptions that would likely lead to a drug shortage.
"We are trying to advocate for more transparency because then at least practitioners could plan for shortages," Vaida said.
Learn more on our Drug Shortages Resources page