WhiteCoat

Drug Shortages

Just got word that several additional medications have been added to the national list of “drug shortages”. Doctors better start learning more about wilderness medicine at this rate.

I can see the management of our next unstable patient now …

[Call comes in on telemetry line]
“We’re coming to you with a 44 year old male hypotensive and unresponsive. Short transport time.”
[15 minutes later, the crew arrives]
“Sorry it took so long, our ambulance ran out of gas because we couldn’t afford to fill the tank due to the high gas prices and low Medicare/Medicaid reimbursements. We had to call for assist with transport from the Amish Ambulance Service with its horse and buggy. By the way, do you know where I can get a broom and a very large shovel?”

[Patient is hooked up to the monitor. Wide complex bradycardia. Pressure 60/40. Dialysis graft is noticed in his arm.]
“Dialysis patient. He may be acidotic and hyperkalemic. Give him an amp of bicarb STAT.”
“Sorry doc, we’re out. There’s a national shortage.”
“Keep that fluid bolus going. Let’s start some Levophed on him to raise his blood pressure.”
“Sorry, doc. We don’t have any of that either. National shortage.”
“Well let’s at least give him some Vancomycin in case he’s septic.”
“I’d like to, but I can’t. That’s on national shortage, too.”
“Well, he’s not responding very well. At least let’s get him intubated. Can someone push some Rocuronium?”
“Don’t have that, either. National shortage.”
“Vecuronium?”
“Nope. That’s out, too.”
“Pavulon”
“Nope. National shortage.”

[patient now loses his pulse]
“He’s CODING! Start CPR. Give him an amp of epinephrine, STAT.”
“Sorry, doc. National shortage. Don’t have any.”
“OoooKayyy. Give him an amp of atropine, then.”
“Don’t you know that atropine isn’t part of ACLS protocol any more? Besides, we don’t have any and there’s a national shortage of atropine, too.”
[patient is unable to be resuscitated and dies]

Six weeks later, the doctor receives a letter from the Arizona State Nursing Board [for those who don't regularly follow this blog, this is parody -- background here] informing him that he is being investigated for failure to properly manage the patient and failure to properly look out for the patient’s best interests, too. He must submit to a psychiatric evaluation, must submit to a genetic test to assess his future intellectual capacity, and must submit to a hearing in front of the whole nursing board to explain himself or else his name will be posted somewhere on the Arizona State Nursing Board’s web site and he will never be allowed to be a nurse in Arizona.

“I think I’m going to be sick.”
“Hope not. We’re out of Zofran, too. National shortage.”

[fade to black]

UPDATE
Good thing I had extra coffee and some old jumper cables laying around to jolt my heart back into a normal rhythm after seeing the Instalanche! Thanks, Glenn!

39 Responses to “Drug Shortages”

  1. I work in a pharmacy says:

    DON’T JOKE ABOUT VANCO ON SHORTAGE!!!!!!!!! That is about the only thing on your list that ISN’T on shortage!! You have just cursed us!!!

  2. ThorMD says:

    At least you can sedate the doc with Ativan. Oh wait, no you can’t it’s on shortage too

  3. ivan the terrible says:

    that is exact description of modern medicine in russia! except doctor would go to patient’s relatives and ask them to get some medicine if they can…

  4. SeaSpray says:

    WHY???

    How can they not have enough of the measles/mumps/rubella?

    and have shortages for so many drugs?

    Nice touch with the Amish Ambulance. :)

  5. Hamhock says:

    kinda funny…kinda funny

    in serious nerd mode: all you really need here is electricity and chest compressions (+/- calcium chloride)

    however, i also soon anticipate that there will be a national shortage of chest compressions, as no one is going to work for medicaid wages

  6. Ardosa says:

    This is my every day life.
    I spend about 30h/week on shortages –

    Leukovorin, Metoclopramide, Vancomycin, Rocuronium, Bupivicaine, Lidocaine, Alfentanil, (and Fenanil), Lorazpeam IV is getting critical for us too… but the rumour is Hospira is releasing some in the next 2 weeks (haha, believe it when I see it)…

    Oy vay.

  7. Nurse K says:

    I specifically like the ongoing shortages of Reglan and Compazine…more reason to use Droperidol AKA The Best Medication Ever Made. Everyone is calm and pleasant and not just free of nausea.

  8. MamaOnABudget says:

    Out of curiosity, is there a reason why it appears the vast majority of the shortage drugs are injections? I know there were some oral/tablet meds, but it seemed there were a LOT more injections.

    • throckmorton says:

      The FDA pushed through a bunch of new regulations as a result, the companies have to wait to be inspected and have to retool to meet these new regulations. When there is not much of a profit in the medication and the risk is increasing, why make the medication.

      The new regs on oral meds have just started. They are also now requiring older medicaiton to meed the new regs. One of the first meds to have this hit was for gout [colchicine].

  9. Robert says:

    I’m disturbed that a doctor doesn’t know the difference between it’s and its. (that would be ‘its horse and buggy’) I would suspend your medical license for this error alone.

    Corrected. Thanks for your confidence. Could I perhaps entice you to next help with my daughter’s english homework on transitive verbs?

  10. ThomasD says:

    Bicarb is bicarb, dissolve some Arm & Hammer in sterile water, run it through a .22 micron filter then give it to the patient.

    Is it ideal? No, but it is damn sure better than not treating the acidosis.

    Same goes for the magnesium sulfate shortage.

    Sure, the the hospital’s legal eagles will have a collective MI, but hey, we’ve still got Activase in stock…

  11. bobby b says:

    Why?

    No, seriously.

    Why is this happening? My pharma just gives me a few mumbles trailing off into . . . nothing. He says random things about ordering in bigger lots to beat the shortages, or “demand’s way up . . . ” which I know is not the explanation.

    When I ask him if government involvement is causing this, he makes some other vague and noncommittal joke, wanders off, and goes away in the back.

  12. Chuck Pelto says:

    TO: All
    RE: Here We Go Gathering

    Doctors better start learning more about wilderness medicine at this rate. — article

    No need to go gathering herbs in the wild.

    Become familiar with homeopathic and other natural treatments. And you can get them at most good vitamin stores or Whole Foods.

    This household has been using them effectively for the last 20 years. From bad burns, venomous insect bites and sports injuries to gout, colds/flus and diarrhea, if homeopathics don’t cure the problem they at least mitigate the acute symptoms, making life easier.

    RE: Why These Meds?

    I’m curious about the ‘disappearing’ meds myself. And whereas another commenter notes they are mostly injections, I notice that many of them are for disorders that are long-term and expensive to treat.

    Do I detect the heavy hand of the alleged ‘Death Panels’ at work?

    Regards,

    Chuck(le)
    [If you want to know what the 'other guy' is up to, pay attention to the 'indicators' relating to their activities. -- Army Intell Staff Puke Axiom]

    • Chuck Pelto says:

      P.S. If we can find treatments for many minor ailments and disorders in Nature, wouldn’t that relieve the production system of that ‘burden’ in order for it to focus on the more complex issues that we DON’T have a known treatment available for in Nature?

    • An actual scientist says:

      If, for myself, given the choice between homeopathy and letting nature run its course I would choose the latter rather than dignify pseudomedicine with any respect. Homeopathic ‘medicine’ is a placebo at best and outright dangerous at worst.

      This is not the same as herbal medicine, some of which is actually useful. (And some ‘homeopathic’ preparations are actually not homeopathic at all but contain herbal or even conventional drugs in therapeutic doses. If this isn’t cheating to you I’ll sell you whale meat as vegetarian.)

      • Chuck Pelto says:

        TO: An actual scientist
        RE: You Are?

        If, for myself, given the choice between homeopathy and letting nature run its course I would choose the latter rather than dignify pseudomedicine with any respect. — Aas

        Soooo….

        ….what happened to your intellectual curiosity?

        I recall it being an important part of ANY ‘scientists’ personality.

        Being a microbiologist in my undergrad studies, I seem to have retained mine. So when someone challenged me to prove its efficacy for myself, I took them up on the challenge. And I found it worked.

        RE: Placebo Effect

        Homeopathic ‘medicine’ is a placebo at best and outright dangerous at worst. — Aas

        Explain placebo effect with the following:

        Case #1 – Tummy Troubles

        Do six-month-olds experience the placebo effect?

        My youngest daughter came off breast-feeding to formula. That night she woke up screaming about the new ecology going on in her troubled tummy.

        My ‘witchy’ wife who introduced my skeptical self to homeopathy broke out her books and selected something.

        The little baby girl didn’t want ANYTHING more added to her troubles and resisted. But wifey finally prevailed and ten minutes later, our daughter was her happy self again.

        Case #2 – Bad Burn

        I make my own candles. One day some wax spilled onto the burner unit I used to melt it. It burst into flames.

        I attempted to smother the fire with a towel I had on hand. Unfortunately I had not protected my little finger properly and it made direct contact with the red-hot heating element. Instantly crisped the flesh for about 1/2″ square.

        After the fire was out, I took cantharis. Fifteen minutes later the pain was GONE. The pain returned four hours later. I took more cantharis. The pain disappeared.

        No burn scar tissue.

        RE: Bottom Line

        You’re welcome to choose your own course of action. But claiming you’re a ‘scientist’ and have no scientific curiosity to test things for yourself…..well…..I’d say there’s something of a cognitive dissonance going on.

        I suggest you take a moment. Go get some cantharis. Keep it in your medicine cabinet against some burn accident in the kitchen.

        All you’ve got to lose is either (1) $6 for a vial of the materia medica and (2) your skepticism.

        Regards,

        Chuck(le)
        [God made the Earth and everything therein for Man. Our challenge is to figure out how to use it all....properly.]

      • Chuck Pelto says:

        TO: An actual scientist
        RE: Homeopathic Materia Medica

        This is not the same as herbal medicine, some of which is actually useful. (And some ‘homeopathic’ preparations are actually not homeopathic at all but contain herbal or even conventional drugs in therapeutic doses. — Aas

        Yes. Homeopathic materia medica are not just ‘herbal’. They can also be ‘bacterial’, ‘viral’ ‘animal’ and ‘mineral’. They’re everything available in nature. As well as some chemical compounds, e.g., cadmium sulfide.

        They come in doses so minuite that many so-called ‘scientists’ claim they couldn’t POSSIBLY have any effect whatsoever. But oddly enough, they DO have an effect. It’s as if they alert the human body to the nature of the disorder. Mobilizing it’s defensive response.

        Another ‘odd effect’ of homeopathy is that when you mention homeopathy and a bunch of so-called ‘scientists’ react like Dracula to a crucifix {nudge-nudge, wink-wink}.

        It’s as if a LOT of the scientific community has become like serfs during the Middle Ages. They listen to the priesthood and accept what they are told without the benefit of using their own minds to think for themselves.

        Heavy sigh…..

        Regards,

        Chuck(le)
        [Curiosity is one of the most permanent and certain characteristics of a vigorous intellect. -- Samuel Johnson]

  13. Bob Rakov says:

    Is it just me – or is Atlas shrugging.

  14. Xmas says:

    Mama,

    The EPA has been hitting manufacturing facilities hard recently. Canada is having a terrible drug shortage problem because one plant caught on fire while another, Sandoz?, was shut down to implement EPA demanded upgrades.

    That’s just one thing. There seems to be a convergence of issues, manufacturing, regulatory, political, legal, economic, and scientific, that’s producing some sort of positive feedback loop pushing drug manufacturing towards collapse. Like a grandmother with her foot on the wrong pedal, we are all pushing harder in an attempt to fix the problems.

  15. This parody would be hilarious if it weren’t so sad.

  16. contifi says:

    This is pretty funny. Isn’t back to nature supposed to be good for us anyway?

  17. Chuck Pelto says:

    TO: All
    RE: Speaking of Herbals

    Has anyone here had experience treating cancers with Graviola or Pawpaw?

    I ask because research done at Princeton back in the mid-to-late 90s indicated that a botanical agent found in the stems and leaves of Graviola killed cancerous cells while leaving healthy cells in the in vitro tissue test, alone.

    I looked into this some time back. Then a few years later the former president of my garden club—not former because she passed away, but rather I’m now the president—developed an aggressive squamous carcinoma on her lower arm, near the elbow.

    She’d had these sorts of experiences before. And had the surgically removed. But this one would interefer with a schedule major surgery: requiring a re-scheduling into future plans.

    I told her to look into the Pawpaw, a North American version of Graviola, which is grown in the Amazon River basin. And it has four times the botanical agent.

    She researched it and got some.

    Later, at a meeting, she told me that the insane itching stopped within 24 hours. And then, over a period of weeks, the growth—which had shot out of her arm a quarter inch in the diameter of a BB, shriveled up and sloughed off. Later, she said a small reddish object about a quarter the size of a BB popped out of her skin, held on by a single narrow blood vessel. It too sloughed off. We suspect that last item was a cancerous lymph node.

    Regards,

    Chuck(le)
    P.S. If the pharma companies knew about this research over a decade ago….why haven’t they come out with a version of it? Is it that they can’t reproduce the effect? And if they can’t, why haven’t they admitted their failure and told the world about this effective but inexpensive treatment?

    Could it possibly be that oncologists and radiologists aren’t willing to give up their lucrative practices to open a tea shop?

    • DensityDuck says:

      I had terrible pains due to the toxins in my body. Then a kind man at a street fair sold me some Magic Bean Extract. This marvelous natural medicine purged the toxins from my body and boosted my immune system and I am now PAIN FREE. The medical industry is suppressing this news because THEY DO NOT EANT YOU TO KNOW about Magic Bean Extract!!!!!

      • Chuck Pelto says:

        You cannot patent naturally occurring substances….

        It’s not just a fact….it’s the LAW!

    • RSDS says:

      “Has anyone here had experience treating cancers with Graviola or Pawpaw?”

      Yes
      Pawpaw is awesome. When I took 1 bottle (1 month of treatment) for stage 4 dysplasia, it also cured the basal cell carcinoma on my lower eye lid. I also switched to a mostly vegetarian diet (for health reasons, rather than for ethical or religious reasons).

      • Chuck Pelto says:

        What was it you paid for the pawpaw?

        The lady I referenced (above) paid $40 for a one-month supply.

      • Chuck Pelto says:

        P.S. It’s kind of funny…..

        ….that pawpaw grows naturally in many places east of the Mississippi and in some states just to the west of it as well, e.g., Arkansas.

        All it takes is to gather the leaves and their stems, clean them, dry them, grind them to a fine powder and encapsulate them a gelatin capsule.

        Talk about ‘gathering medicine in the wild’…..

  18. Chuck Pelto says:

    TO: DensityDuck
    RE: Heh

    On the one hand….

    ….buy ‘magic beans’ and you get what you paid for.

    On the other hand….

    ….are you another non-serious ‘scientist’? Like the one I encountered above?

    On the third hand….

    ….maybe you’ve got more moxie than Aas and don’t care for the pain from a bad kitchen burn. And will buy yourself some cantharis to see if it actually works.

    Regards,

    Chuck(le)
    [Inquiring minds want to know. Closed minds just listen to their 'bosses'.]

    • Chuck Pelto says:

      P.S. I’m eager to hear your response to the disappearance of crucial ‘drugs’ as prescribed by the Obamacare system of dealing with prolonged/expensive medical care…..

  19. Steve says:

    So a plant burned down, eh!?!?
    This happened when the gas price started going up….supposedly a refinery burned down…..fertilizer prices started going up……supposedly a fertilizer plant burned down.
    Seems too conveniant to me….these excuses.
    Or did the government push the plant owners too far and……their plants burned down.
    Easier to bury a smoldering mess then make them EPA compliant.

    Steve

  20. Amy says:

    I predict the next shortage will be oxygen. We’ll just all huddle around the hypoxic patients and collectively breathe into their faces so that they can at least get high flow.

    • throckmorton says:

      Amy:

      I think we will do ok with oxygen. A couple of years back the FDA banned the cheap, generic propellant that is in asthma inhalers. As a result you have to use this extremely costly one that tripled the cost. It is so pricey that many asthmatics cant afford them, so they arent able to breath and therefore use less oxygen.

      • Chuck Pelto says:

        The ‘imaginary’ Death Panels strike again!

        Their Godless thought being that asthma sufferers are a ‘burden’ on society. So they think we must be rid of them.

        Removing their medication shortens their life expectancy and their ‘burden’ on their society.

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