Three Hundred Drugs Are in Short Supply in the United States

There are shortages of two dozen drugs that are used in chemotherapy in addition to many other kinds of medications. Methotrexate is one of those drugs. Methotrexate is one of the medications that saved my life in 1990 when I had diffuse large cell lymphoma. It was part of the MACOB-B protocol at the time. Methotrexate is also an important drug for treating autoimmune diseases like rheumatoid arthritis. It is a proven product, but it is generic and very inexpensive. I think that is the problem. Our system is entirely driven by money and profits. Everyone talks about patient-centered care, but it is a rare thing. If our system were really patient-centered, we would make certain that proven inexpensive medications are available.

Here is a list of the drugs that are in short supply. Like methotrexate, all are generic, proven products that have been around for a long time. Many of them are critical. Amiodarone injection is used for heart rhythm disturbances. Clindamycin is for serious infections. Dexamethasone is used to reduce swelling due to brain tumors. Epinephrine autoinjectors are lifesaving in allergic reactions like bee stings. As you can see, these are vital parts of the medical toolkit.

This is an example of why this is critically important to you. There is a serious disease called pseudomembranous colitis that occurs in patients who have been on antibiotics. Their antibiotic treatment changed the bacteria in the large bowel so that another bacteria could take over and cause very serious illness. Vancomycin and Flagyl are the first line treatments for this condition but they are generic and low cost. They are on the list of drugs that is not available. Vancomycin is $45 for ten vials. Flagyl is $37 for 24 doses. Fidaxomicin, a brand-name drug costs almost $5000 and is “non-inferior to vancomycin.” It is not on the list of drugs with shortages.

Lisinopril and losartan are on the list of drug shortages. These are among the most commonly prescribed drugs in America. They are proven products that are effective and have few side effects. They are central to our hypertension protocol. If patients cannot find these medications, dose adjustments for substitutes are an unnecessary burden.

There is a pattern here. Methotrexate is cheap for rheumatoid arthritis. There is a shortage. Humira is also for rheumatoid arthritis. It is very expensive. There is plenty of it. Vancomycin and Flagyl are cheap. Fidaxomicin is extremely expensive. Why would you make a cheap drug when you could make a very expensive one. Why would you sell iron if you could sell gold?

The biggest reason to have a democracy is to protect citizens and this is a national security problem. It is a supply chain problem. During most of my career, the active ingredients in our drugs were made domestically. Shortages were rare. As of 2019, only 28% were made here. Nearly one third are made in India and China. The first duty of a clinician is to be an advocate for our patients. What could be more important than a reliable supply of proven, low-cost medications for our friends and neighbors?