Druggists scramble to find medicines

Tetanus and flu vaccines have been in short supply, and there are others.

By MARY CHALLENDER Register Staff Writer 05/24/2001

-------------------------------------------------------------------------------- When floodwaters swept through eastern Iowa recently, health officials had to scramble to find enough tetanus vaccine to protect emergency workers.

Securing adequate amounts of many essential drugs has become a familiar struggle for health care professionals across Iowa.

While the national spotlight has focused mainly on two drugs in short supply - tetanus and flu vaccines - that's only the tip of the iceberg, according to Iowa pharmacists.

"The market situation is probably the worst I've ever seen it in my 25-year career as far as drug shortages," said Don Hanson, the assistant director of the pharmacy department at University Hospitals in Iowa City.

At Mercy Medical Center in Des Moines, pharmacy director Greg Young regularly distributes a list of drugs he has trouble obtaining. The current list includes 10 drugs that are unavailable - including tetanus toxoid - and four that are so limited in supply that use is restricted.

Many of the drugs on the list are staples in emergency rooms and surgeries. They include Isuprel, a bronchodilator used to increase heart rate and cardiac output in heart patients, and the intravenous form of dexamethasone, a corticosteroid given prior to chemotherapy to lessen nausea and vomiting.

So far patients have not suffered from the shortages because pharmacists have been able to locate appropriate alternatives to the medicines, said Sharon Meyer, executive director of pharmacy for Central Iowa Health Systems.

There are times, though, when the alternative drug doesn't work as well, may have more side effects or may be a lot more expensive, Young said. Using drugs they're unfamiliar with also adds an extra level of stress for doctors and nurses.

"It definitely makes both physicians and pharmacists have to think in a different way," Young said. "Occasionally it causes a real concern: "Are we going to be able to treat this patient?"

Health care professionals don't expect things to get better soon, especially because the shortages can't be blamed on a single, easily reparable cause.

In some cases, raw materials have been the problem. Corticosteroids, for instance, are made from animal tissue, and supplies have been endangered by foot-and-mouth disease in Europe. Manufacturers are trying to switch to plant-based drugs, but it could be a while before they show up in the marketplace, Young said.

Other times, the problem is on the manufacturing end. Temporary shortages, as with the flu vaccine, have occurred because the U.S. Food and Drug Administration discovered health violations at a plant and halted production.

Mergers in the industry have also played a role. Over the past decade, the number of new drugs approved annually by the FDA has nearly quadrupled, Young said, while the consolidation of drug companies has limited manufacturing space.

"Manufacturers know they can't make everything in the same quantities they used to, so some select the products they can make the most profit on," Young said. "Those tend to be newer drugs. The ones in shortest supply seem to be the generics, the ones with the least profit margin."

The FDA and the American Society of Health-System Pharmacists have created Web sites to help guide pharmacists in dealing with the shortages.

Hospitals aren't the only ones affected. John Forbes, past president of the Iowa Pharmacy Association, said local pharmacies have seen shortages as well.

Among the drugs Forbes has trouble getting at the Medicap Pharmacy he owns in Urbandale are Albuterol inhalers, the generic form of a drug to fight asthma. This has forced asthma patients to switch to the name-brand product at a cost of $30 per inhaler instead of $15.

"For people on a fixed income or someone without insurance, it really puts a burden on the patients," Forbes said.

http://www.dmregister.com/news/stories/c4788998/14775946.html

-- Martin Thompson (mthom1927@aol.com), May 24, 2001

Answers

Health department experiences vaccine shortages

Thursday, May 24, 2001

By Stacy Kess Staff Writer

Michigan health departments are imposing strict rules on the distribution of the adult tetanus and diphtheria vaccine because of a shortage.

"I think the shortage has lasted longer than they thought and the CDC is making tighter regulations on tetanus and diphtheria vaccines," said Mary Ricciardello, clinical services manager at the Jackson County Health Department.

Wyeth Lederle, a Pearl River, N.Y., pharmaceutical company, last year announced production shortages because of factory problems in making the vaccine that protects adults against tetanus and diphtheria.

Drug manufacturer Aventis Pasteur of Swiftware, Pa., stepped up production, but the effort was not enough.

The national Centers for Disease Control and Prevention reported in its Morbidity and Mortality Weekly Report that only half of the normal amount of vaccine was available in 2000. Although the article announced the shortage would not last long, expecting it to clear up early in 2001, the shortage has continued.

"I think this is going to get worse before it gets better," Ricciardello said.

Under guidelines from the CDC and from the Michigan Department of Community Health, dosages of the vaccine will not be distributed to private health-care providers until the shortage ends. Michigan reserved its supply for hospital emergency rooms and for health department offices across the state. Private health-care providers and clinics cannot tap those reserves, according to state guidelines.

Doses of the TD vaccine are available only to those traveling to areas with endemic diphtheria if that person has not received a TD vaccine for at least 10 years; those needing treatment for a dirty wound up to 72 hours from the time of infliction; those without a complete vaccination series; and people not vaccinated for 10 years or more.

Ricciardello said it is important to remember that tetanus infects only dirty wounds. Diphtheria is uncommon in the United States because immunization is required for school-aged children, and is mostly a concern for travelers to some foreign countries, including former Soviet states.

Ricciardello said she does not expect outbreak, but there may be future health implications.

http://ja.mlive.com/news/index.ssf?/news/stories/20010524jtetanusjnewj .frm

-- Martin Thompson (mthom1927@aol.com), May 24, 2001.

Do you remember 1999 and all the warnings we had about impending drug shortages? This sounds like y2k all over again to me. Talk about a delayed reaction. This is really delayed.

-- Uncle Fred (dogboy45@bigfoot.com), May 24, 2001.

Uncle Fred,

This is NOT Y2k related, it is just well, it's just because of well, um, er, mergers. Yeah that's right mergers and those grubby profit seeking bean counters.

The truth is something that would never be told, so folks it's okay everyone keep moving along and follow the herd, er um, the crowd.

-- (perry@ofuzzy1.com), May 24, 2001.

Thanks for the explanation, Perry. Now I understand.

-- Uncle Fred (dogboy45@bigfoot.com), May 24, 2001.

There seems to be plenty of Viagra, Claretin and Ambien. There is no shortage of the heavily advertised drugs!

-- K (infosurf@yahoo.com), May 24, 2001.

I can report "from the trenches" that the tetanus toxoid shortage continues. My wife is a physician, specialist in Emergency Medicine, i.e. at night she runs the local Emergency Department (Chambersburg Hospital, Pennsylvania). She reports the tet toxoid supply is indeed still severely limited and they are under instructions to use it only "when necessary."

This is a problem as many wounds seen in the E.D. are dirty and patients really should receive a tet booster. My wife reports that the way the limited tet supply is distributed by the manufacturer is not sensible: licensed docs are apparently allotted the same (small) amount regardless of what they do. As my wife heard it, most of the local docs are giving (selling at cost, I supppose) what they get to the hospital pharmacy so that it can be used where needed most, i.e. the one local hospital Emergency Dept.

Oh yes, this is perfectly normal, this happened all the time before Rollover...not.

-- Andre Weltman, M.D. (aweltman@state.pa.us), May 25, 2001.