Be warned: The details are seriously frightening.
You don’t have to be diagnosed with cancer yourself to know how essential chemotherapy is to those struggling with the disease — and yet, countless patients are currently facing the very real possibility that they may not get those drugs on time.
That’s because of an ongoing drug shortage in America for dozens of essential medications, including chemotherapy treatment. Unfortunately, this shortage isn’t surprising for those who have been paying close attention to the generic drug industry. Rather, it’s representative of a multiple-year supply chain crisis which has gained momentum over time. From 2021-22, for example, new drug shortages increased by 30 percent, NBC reports.
Now, the widespread shortage is getting worse. As a result, doctors have begun to make existential decisions for their patients, with horrifying consequences.
Here’s the lowdown on what’s causing this shortage, which drugs are being affected, and how doctors — and patients — are coping in the meantime.
Why is the drug shortage happening?
There are two major issues behind this fiasco. The first has to do with an ongoing trend in the generic drug industry: The profit margins are razor thin.
This is especially true for companies based in the United States, which are forced to compete with overseas outfits that have much lower labor costs. (If this concept of pharmaceutical companies losing money sounds a bit ridiculous, here’s the distinction that matters: Brand name drugs are the ones that command crazy high prices, while the generic versions are extremely cheap and therefore much less profitable.)
One such overseas company is Intas Pharmaceuticals, a company based in India, which manufactures numerous highly sought-after chemotherapy dugs.
This winter, Intas paused production of those drugs after a surprise visit from the FDA uncovered “serious quality-control violations,” per the New York Times. Some production of those chemotherapy drugs has since resumed at Intas, but not at the pace necessary to keep up with demand. Deliveries are still behind schedule, too.
The second major issue behind the shortage is that U.S.-based generic drug companies are struggling more and more each year to stay afloat, due to those aforementioned profit margin struggles. For example, one major company called Akorn Pharmaceuticals declared bankruptcy early this year. Akorn was responsible for producing around 100 types of drugs, and it was notably the only company that made a lead poisoning antidote.
Doctors and activists are now lobbying the White House and Congress to create legislative, market-driven solutions to this ongoing drug shortage. Put simply: We need more companies making these generic drugs, and we need to find ways to make it sustainable for those companies to do so.
FDA drug shortage list: What drugs are currently in shortage?
Hundreds of drugs are in limited supply right now. As of the last several weeks, there are approximately 14 cancer drugs in shortage, including carboplatin, one of the chemotherapy medications often used as a first line of defense for multiple types of cancer. Two other commonly used chemotherapy drugs, methotrexate and cisplatin, are also currently on backorder.
It’s not just chemotherapy drugs, though. Other essential types of medicine are also experiencing shortages, including children’s Tylenol and Albuterol, a type of respiratory medicine.
The FDA keeps an ongoing list of drugs currently in shortage, so if you have a specific medication in mind, you can always search their database to check for availability.
It’s hard to overestimate the implications of the circumstances we’re facing right now. If you’re wondering what’s happening to the cancer patients who need these drugs, the answer isn’t pretty. Some have been forced to turn to other medications that aren’t as effective, while others are metering out their medication to stretch it over a longer period of time than it was intended to be taken. Others might just die while waiting for the drug shortage to end.
That’s nothing to say of the panic taking place simultaneously over children’s Tylenol and Albuterol.
One medical oncologist, Dr. Lucio Gordan, spoke to NBC News about exactly how dire the drug shortage is. “I’ve been doing this for 20-plus years,” he said. “This is the worst I’ve ever seen.”
What happens next with the drug shortage?
Unfortunately, there isn’t a silver bullet to fix this disaster, but there is reason to be hopeful that the crisis will lessen as companies like Intas return to regular production pace. Additionally, a spokesperson for the FDA has stated that the agency will do everything in its power to hasten this process.
However, in a surprising move, the director of the FDA’s Oncology Center of Excellence, Richard Pazdur, recently made a public statement clarifying that the FDA cannot stop this shortage on its own.
“Based on current laws, the FDA cannot require a manufacturer to report an increase in demand that may lead to a drug shortage,” Pazdur wrote in an op-ed for a weekly publication called The Cancer Letter. “We cannot require a company to make greater quantities of the drug — specifically, to step-up production… [and we] cannot require that essential drugs, such as cancer therapeutics, have diversified supply chains such that there is not over-reliance on a single facility or country for an active pharmaceutical ingredient (API) or key starting materials.”
The implication here is clear: The FDA’s hands are tied based on current laws, but Congress can create the laws that allow the FDA to do these things.
Per The New York Times, elected officials are considering a number of strategies to address the drug shortage, including providing tax incentives for generic drugmakers and utilizing other financial strategies to support the profitability of their work.
In the meantime, doctors all over the country are facing unimaginable decisions when it comes to treating their patients. One physician from Albany, New York, recently told The New York Times that his practice ran out of chemotherapy drugs weeks ago, and he currently has 25 patients who are in need of those drugs.
“Our patients are in a war, and what we’re doing is we’re taking their weapons away,” he said. “It’s completely ridiculous that we can’t figure out a way, at least in the short run, to get our patients treated, and in the long run to solve these recurring problems.”
