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Drugged out

Science | The number of drugs facing shortages is suddenly on the rise

Issue: "The battle," March 24, 2012

Hospitals had to get creative when the U.S. supply of methotrexate, a key drug for treating childhood leukemia and several other cancers, dipped alarmingly low early this year. At Kravis Children's Hospital at the Mount Sinai Medical Center in New York City, doctors asked multiple patients needing methotrexate injections to come in on the same day, so several children could be treated with each adult-sized vial of the medicine the hospital had on hand. There is no replacement drug for methotrexate, and without regular doses, children with acute lymphoblastic leukemia-the most common childhood cancer-harm their chances of being cured.

The methotrexate shortage began after one of four U.S. makers of the drug temporarily halted production last November, citing quality control problems. A supplier late in February promised to flood the market with over 100,000 vials of methotrexate, but a larger, life-threatening problem remains: There are currently shortages of over 250 drugs in the United States, up from only 74 in 2005. Healthcare workers sometimes resort to rationing medicine or delaying surgeries when drug stocks run low, and they blame the problem for at least 15 deaths since 2010. Most shortages involve generic drugs and are due to production and market constraints, not a lack of raw materials.

The Food and Drug Administration supports legislation that would strengthen its authority to require drugmakers to report an expected shortage. Those favoring broader oversight would like to increase federal regulators' power to prevent "price gouging" or drug stockpiling when shortages occur.

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But that approach invalidates a basic economic principle: When supplies fall, prices rise. Ezekiel J. Emanuel, a former health advisor to the Obama administration, pointed out in an op-ed in The New York Times last August that price controls in the drug market keep the laws of supply and demand from working properly. A federal law from 2003 that was meant to keep Medicare costs low had the unintended effect of keeping manufacturers of inexpensive generic drugs from charging extra during a shortage. Legalizing those higher prices would give drugmakers a financial incentive to anticipate and prevent shortages by increasing their production capacity.

Last year John Goodman, president of the National Center for Policy Analysis, blamed shortages partially on two additional problems: The FDA runs a "rigid, inflexible and unforgiving" quality control regime, and forces drugmakers to apply for approval before changing production timetables or quantities. Also, a federal program created in 1992 forces drugmakers to provide rebates that artificially lower prices. The program, intended to aid hospitals and clinics serving low-income patients, is expanding under Obamacare.

Falling clouds

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Scientists from the University of Auckland in New Zealand reported that the average height of clouds dropped by 1 percent around the globe between 2000 and 2010-a distance of about 100 to 130 feet. The lower cloud cover means extra heat will dissipate into space, acting as a negative feedback to global warming. The researchers, who got their data from NASA's Earth-observing Terra spacecraft, weren't exactly sure what caused the cloud drop. A decade is too short a time frame to "draw hard conclusions" about the phenomenon's relationship to climate change, they said. -Daniel James Devine

Daniel James Devine
Daniel James Devine

Daniel is a reporter for WORLD who covers science, technology, and other topics in the Midwest from his home base in Indiana. Follow Daniel on Twitter @DanJamDevine.

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