You don’t need to be an expert in economics to recognize that when kids get cancer and need either expensive or unprofitable treatments, capitalism clashes with medical ethics and basic human decency. In childhood cancer, unprofitability can actually be the bigger threat than high cost.
Many forms of childhood cancer are curable with cheap, tried-and-true generic drugs — meaning that industry isn’t eager to make these prescriptions, so they aren’t always available when a child needs them.
Sometimes hard-to-get drugs can be ordered from other hospitals, but often patients get a different drug regimen instead, said Yoram Unguru, a pediatric oncologist at the Herman and Walter Samuelson Children’s Hospital at Sinai, in Baltimore. These second-choice drugs don’t always work as well.
A growing body of research is documenting the prevalence of U.S. nationwide drug shortages, and how they pose harm to patients. They have affected cancer drugs for adults, as well as painkillers, anesthetics, IV fluids, heart drugs and antibiotics. In February, The New York Times reported that a nationwide shortage made it impossible for many people to get the anti-anxiety drug buspirone. In the veterinary drug industry, a nationwide shortage has made it hard to get Vetmedin, a life-extending drug for dogs and cats with heart disease.
While lawmakers expressed concern this month in hearings on high drug prices, shortages represent another serious consequence of a free-market system. Makers of patented drugs are entitled to a temporary monopoly, when they can set extremely high prices. But when that ends, competition with generics often collapses prices, giving all the companies less incentive to produce these drugs.
Sometimes patients aren’t even aware they are affected by shortages, because they don’t know they are getting a second-choice drug, said oncologist and hematologist Andrew Hantel of the University of Chicago. He recently led a survey of hospital pharmacy managers to assess the state of shortages and how badly they are affecting quality of care.
Of 719 pharmacy managers surveyed, all reported shortages, he found, and more than half reported shortages of at least 50 drugs within the previous year. Four out of five respondents reported hoarding drugs. More than a third reported rationing.
Aside from the market allowing critical drugs to run short, other triggers can be a scarcity of raw ingredients, a natural disaster or a run-in with regulators. Buspirone ran short after the FDA deemed a West Virginia plant unclean and forced a temporary close. The site had supplied about a third of the nation’s buspirone.
Many shortages stem from a business decision to focus on more profitable products and not even produce a generic that is in demand but cheap. A related problem emerges when drug makers choose to produce a low-priced drug but know they won’t make a fortune doing so: As a report in Clinical Pharmacology and Therapeutics concludes, there’s little market incentive for companies making generics to produce high-quality drugs, and some cut corners.
Peter Bach of Memorial Sloan Kettering Cancer Center, a cancer epidemiologist and now also an expert on drug pricing, said that there are many vulnerable points in the drug-making process.
“Because companies can compete one another down to zero profit, every part of the chain gets squeezed,” he said in an email. “Suppliers of components of drugs, distributors, and manufacturers themselves sometimes just leave the market.”