WGBH Radio; The Callie Crossley Show

I'm Cally Crossley This is the Calla Crossley Show. We're looking at the prescription drug shortage politicians physicians and patients are characterizing this as a full blown crisis. According to the FDA there are close to 250 drugs that are in short supply. These include drugs that can lower blood pressure or treat childhood leukemia. The shortages mean a growing number of Americans aren't getting the medications they need. In extreme cases some patients have died. The shortages are opening a door for so-called gray markets. Companies are exploiting the shortages by buying up drugs stockpiling them and selling them to hospitals at massive markups from the pharmaceutical industry to the FDA. We examine the forces that are causing the shortage. We also explore how this is playing out in Massachusetts home to some of the world's leading hospitals. Up next the war on prescription drugs. First the news. From NPR News in Washington I'm Lakshmi saying the Senate has turned

back an attempt to kill the Obama administration's new rules requiring most health insurance plans to provide contraceptives without additional cost. As NPR's Julie Rovner tells us the 51 48 vote was mostly along party lines. The amendment sponsor Missouri Republican Roy Blunt said its goal was a simple one. I believe what this does is protect First Amendment rights the first freedom in the founding document is freedom of religion. But Democrats like New Jersey's Frank Lautenberg said the language was so vague it would allow employers to deny coverage of any benefit to which they had a religious or moral objection. Imagine that. Your boss is going to decide whether or not you're acting morally. The Obama administration weighed in on the language last night with Health and Human Services Secretary Kathleen Sibelius calling it quote a cynical attempt to roll back decades of progress in women's health. Julie Rovner NPR News Washington.

Two American soldiers have been killed possibly by an Afghan soldier and a teacher at a joint base in southern Afghanistan. Officials say it's the latest in a string of casualties resulting from anti-American protests over Koran burnings at a U.S. base. Syrian authorities are giving Red Cross workers the green light now to enter the Baba Amr district of home side of a three week old military offensive. The decision came down after rebel forces said they had withdrawn. But NPR's Kelly McEvers says it's uncertain how long opposition fighters will stay away. The rebels say that this was attractive coverts role whether they're going to regroup and fight somewhere else and remains to be seen I think. Baba Amr we've seen as the sort of psychological heart of the Syrian revolution at the arm Duwayne let's say at the Syrian revolution. NPR's Kelly McEvers reporting from Lebanon near the Syrian border. Back in the U.S. more positive news on the employment front today. NPR's John it's he tells us the number of people applying for first time unemployment benefits fell again last week.

Three hundred fifty one thousand people made their first application for jobless benefits last week. That matches a four year low reached three weeks ago when first time applications dropped below the three hundred seventy five thousand level consistently it usually means hiring is strong enough to bring down the unemployment rate. The rate has dropped rapidly in recent months to eight point three percent in January one two hundred forty three thousand jobs were added to payrolls. But according to another report the added jobs boosted income and spending only modestly. John in the NPR News Washington. Seeing gains in U.S. stocks this day with the Dow up 47 points at last glance at twelve thousand nine hundred ninety nine in trading of just over a billion shares. Nasdaq gaining 24 points it's a twenty nine ninety one and the S&P 500 up 8 at thirteen seventy four. This is NPR News. And from the WGBH radio newsroom in Boston I'm Christina Quinn with some of the local stories we're following. Republican presidential candidate Rick Santorum says Mitt Romney's initial reaction to a question about the contraception measure in the U.S. Senate shows he's not conservative

at the core. At a rally in Atlanta Santorum said the former Massachusetts governor's gut reaction should have been to support the bill by Senator Roy Blunt of Missouri. The measure was defeated today in the Senate. Romney told one interviewer the he opposed the measure. He reversed himself in a follow up interview saying he misunderstood the question. The interim director of Harvard's New England Primate Research Center is stepping down. The Boston Globe reports that Dr. Fred Lang who was appointed in September after an internal investigation found patterns of problems at the center announced his resignation in an e-mail sent this morning. The news comes after the death of a cotton top tamarin monkey was disclosed Wednesday and that his death was likely linked to the absence of a water bottle in its cage. It was the fourth monkey death at the center in less than two years and the third death during Wang's short tenure. The state's utilities aren't reporting any significant power outages from the winter storm but that could change of heavy snow brings down branches and power lines. Parts of western and central Massachusetts could see eight to 14 inches of snow before it ends. President Barack Obama is

speaking this afternoon at Nashua Community College about his energy policies. Obama last visited the state in November to promote his jobs bill. Two conservative political groups unhappy about the economy are planning a joint rally after the speech. In sports the Bruins take on the Devils tonight at the garden and we can expect more snow this afternoon with a mixture of rain and sleet. Cold temperatures sticking around the mid 30s and tonight cloudy with more snow mainly in the evening there will be patchy fog during the commute home with the total snow accumulation of two to four inches. Temps will drop into the mid 20s. Right now it's 37 degrees in Boston 34 in wester and 37 in Providence. Support for NPR comes from IBM working to help midsize businesses become the engines of a Smarter Planet. Learn more at IBM dot com slash engines. Good afternoon I'm Kelly Crossley. Today we're looking at the National Prescription drug shortage. According to the FDA there are close to 250 drugs that are in short supply.

Many patients can't get their prescription drugs. It can be a drug to treat cancer or an antibiotic or an I.V. medication doctors need to bring down soaring blood pressure. Joining me to talk about the forces that are behind these shortages and how this crisis is playing out in Massachusetts are Bill Churchill executive director of the pharmacy at Brigham and Women's Hospital and State Representative Jeffrey Sanchez. He's chairman of the Joint Committee on Public Health. Welcome to you both. Thank you sir. Right Bill let me start with you. Crisis is a word that's thrown around in some circles a lot but not typically too much in the medical circles and this drug shortage has been referred to as a crisis is it. Yes absolutely I believe it's a very significant public health crisis largely because not so much on the volume of shortages for sand but the type of drugs that are involved as you mentioned earlier these can involve oncology drugs cancer drugs for patients. But many of the drugs that I've seen commonly used

generic drugs that can be lifesaving. They're the types of drugs that we use to resuscitate patients in the emergency department. Drugs that we used to sedate patients and paralyze them during surgical procedures they pose a significant threat to our ability to care for the patients. The way we need to. And I think when we're forced to look for alternative agents it puts an enormous amount of pressure not only the pharmacists the physicians and the nurses but the organization to make sure that we have the capacity to obtain there to teach people on how to properly administer that monitor that prepare that dose that and make sure that we do this in a safe methodology as we can. So we want to talk about you know some of the reasons for this shortage and at first glance and in fact before I really looked at you know some of the research about the story I just thought OK greedy drug companies. So they made expensive drugs and you know the patent ran out. And so they don't fund them anymore and so that's the end of the

story turns out it's much more complicated than that. Can you just you know without going to the weeds give us a few high points of of some of the other factors and really put the drug companies. Cup ability if you want to describe it as such in the context of that. Sure Representative Sanchez and I were just talking about that. The problem is very multiply multifocal. There is not one single issue that's driving this. The issue can be as you say the drug companies have decided to get out of the market. That's certainly one aspect of it. And right now they can exit the market when they make that decision to do so and other companies cannot ramp up to supply that. However there are other factors that come into play such as FDA actions with recalls on drug due to poor quality problems reported with that drug in the manufacturing facility or the process. That's the Food and Drug Administration and Drug Administration. We also have issues with shortages of raw materials raw

chemical or powder that you need to make that drug cannot be obtained. And that has occurred many many times. Natural disasters play a role and do it as well I can recall a few years back when Puerto Rico was hit with a very severe hurricane and there were several drug companies had their prime manufacturing plants down there and they're knocked out of action once that happens who are in deep trouble facility pharmaceutical companies frequently take facilities off line for preventative maintenance and refitting and things like that. And that's an important aspect of how drugs can be out of supply intermittently. In addition for example with some control substances of what we caught ex opiates the FDA has very strict limits on how much drug a company can provide and produce. So like an OxyContin or something and when they reach that limit they're shut down and I think that's something that you know we can we can impact the legislative activity.

That's my guest Bill Churchill He is executive director of the pharmacy at Brigham and Women's Hospital. Let me turn now to State Representative Jeffrey Sanchez. You held some hearings not long ago. What I mean you had to be hearing these stories but what at this moment made you say OK we need to bring some folks in and talk about this. Since I since I entered in the chair since I was appointed by Speaker DiLeo to be chair of the Committee of Public Health. It was one of the it's one of these issues that you hear every time you bring up bills relative to treatments or bills that are relative to chronic diseases and. Bills that are relative to directly to prescription drugs. And I thought as you know going through bills the session with my staff we thought OK what it would do that one of those issues that that are really rising to the top and this one just continued to rise to the top. Each time we would talk about it. We know that the federal government this this this issue lies in the purview of the federal government

certain certain things but we think in state government we might be able to address certain pieces of it especially in particular the idea the secondary market of where drugs are purchased. You know this so-called gray market I just talked about that if you will what's a great market. Well you know the manufacturers the manufacturer of the drugs you know essentially sell will sell directly to you know over the Brigham and Women's but they'll also sell to other folks you know other companies that are distributors private distributors and being private distributors that they may see it you know may calculate the market in a way that they see that there be an increased demand and in some cases we've heard that they've purchased they stockpile drugs and not only stockpile drugs they sell it back in you know they'll still try and get it. The hospitals and others to purchase up to six hundred fifty percent higher than the market less priced so it is. It's dramatic what could happen with the supply that's in the market but also the market itself in terms of

prices. So we're trying to figure out where we're trying to figure out right now what can we do we know that there's some work that's happened in Texas and Kentucky relative to price gouging. I think some work in New in New York as well. And we're also looking at what other states have done relative to the issue of the actual drug pedigree. Imagine there's a lot of drugs out there that are being bought but do we actually know is it coming directly from the from the manufacturer and it after it leaves the manufacturer or is it tampered with in any way you know is there you know how do we keep the quality. How do we keep the quality and the integrity of the supply chain. Strong Well in fact I would say that you know before I became aware of this shortage issue of prescription drugs the thing that I kept hearing about are fake drugs appearing in drug stores and pharmacies faced with trying to figure out you know do I have the real thing or not so that's you know also something that you have to pay attention to. It plays closely into it because again and know that we don't know who

we don't know who's buying from the gray market and we don't know who the gray market is and you know one thing that we heard in the hearing was from different hospitals and providers were that you know they will get in their e-mail box 50 e-mails a day from outside vendors saying that they have x y z drugs because they it seems that they know where the market is going every particular you know every day and they based their prices based on what they see happening on that day. So they'll get you know the you know the pharmacy managers of you know will get you know 50 advertisements to purchase from them for a particular drug or a series of drugs. And imagine. For me it comes down to you know. Imagine you're with your doctor and your doctor says to you you know well you know we think you should go this course of action but we can't find the drug. Or yeah we have a but you know you're going to be affected when you go to purchase it directly you know it's it's a mess it's pretty dramatic you know. There was once

the one thing that stuck out with me with with patients with with the patients stories was that particularly and with with the drug I think was meant to trucks a drugs a cancer drug you know just to to treat a pediatric pediatric leukemia. I mean there were stories that we've gotten you know written stories from parents that said you know that shortage you know is life or death for my child. And you're thinking imagine that we could we can save lives. But because the problem is happening it could affect the life of a child. That's my guest State Representative Geoffrey Sanchez chairman of the Joint Committee on Public Health. Back to you Bill Churchill executive director of the pharmacy and bringing in Women's Hospital. We've heard Representative Sanchez say you know you might get 50 e-mails a day are solicitations from various folks saying hey I've got the drug you're looking for. Describe for us what a typical week now is for looks like for you as you

navigate this shortage at your hospital. Well Representative Sanchez is correct. We do get it. A ton of emails and flyers and faxes from these gray market distributors offering us to supply the drug. Supreme Lee inflated prices. We've made a decision at Brigham and Women's to not purchase from the grey market suppliers largely because of the issues that he outlined about the question ability of the pedigree and where the drug has come from and whether or not it was tampered. Recently we were notified by the company that a drug called a vast and that is in the marketplace now that they have warned all the pharmacies that they counterfeit drug is now in the marketplace and they gave us tips on how to determine whether we have the genuine drug or whether we have the counterfeit drug. But right now a great deal of my staff's time is spent seeking out where drugs can be obtained and the legitimate process. For example if if we have an oncology patient who needed a dose of

chemotherapeutic agent that we didn't have we would then get on the phone and contact all of our sister institutions within the city and try to attempt to borrow that drug for the patient. Frequently we'll call suppliers and our primary wholesalers to see what they can do for us and attempt to get the drug from another part of the country. A good part of what we then would do would be to make arrangements to get that dragon no matter where it was going to come from and then make sure that it was obtained for all of our patients if we were getting a larger shipment or if it was a specific drug for that patient getting and then reserving and coordinating the appointment with the doctor and the patient and then preparing the track and getting the drug administered to the patient so it's taken a great deal of work that we hadn't planned on over the past couple years and a lot of people are doing and spending countless hours doing it and doing it at every pharmacy in the country. Now if you hear the expression black market we know that's illegal gray

market. It's neither black nor white is it. Why is that legal. It's obvious and it's I'm glad you asked that. Yeah because it's at the end of the day it is a bar. It's it's an open market. You know the commerce laws are what dictates the market. But it's weird because the FDA is also involved so that's why we think the broad problems need to be addressed in Congress but given the gridlock that exists in Congress on so many other things. There's a lot. And the Obama administration did certain things to you know to try and to try and scratch the surface of the issue. You know like telling manufacturers that if they know that they're going to have a problem they request them to let the FDA know that they're going to have a problem within a determined time period. But they're not really mandated to do it. So some of the this a lot of these is an executive order but that's not a mandate so they don't have to do it. They can and they do because the because of the issues relative to the

copyrights and you know the rights and the actual product itself you know imagine you know a large pharmaceutical company says that they're going to experience a large shortage could that affect their stock price. You know I think yeah all these other things that are more regulated within the commerce clause than you know and all say securities laws than you know than the actual physical needs of the population. And what we're trying to say is this is a population health concern a public health crisis that we need to address at the federal level but also we can figure out if there's a way to do it here at the state level as well. And to add to that a lot of these gray market suppliers. Are able to obtain drugs because they're willing to pay a price. Most hospitals have contracts in place to offer us lower prices so if you're a supplier soon you have an opportunity to sell you know X amount of dollars at a lower price to Brigham and Women's and X

plus 10 at a much higher price to this gray market supplier. You're going to do that because it impacts your profitability as well. They're there in the I think what I would call the futures game. So they're counting on and hoping that these kinds of things are going to come up and I actually have a colleague who says to me I think that the grey market suppliers are actually creating some of these shortages because what they do is they put it out there the shortage is coming and I have the product and then people buy it all up and then bingo there actually is a shortage. I mean I think we should also mention that to some degree inadvertently that the federal government also created an atmosphere for this marketplace because the Medicare Act of 2003 that was signed by Governor George Bush was supposed to lower the prices so that your so that your hospitals and patients are actually paying the actual average price of the drug plus 6 percent for us for handling. But you know if you

somebody else can gather up some and add some money to it and say hey we got it you know there. There you have it so that wasn't supposed to be the result of that who you know I'm always amazed at the people who come up with scams based on whatever is out there. But there we have it. So here we are the perfect storm. We've got government trying to regulate to reduce the amount of storage shortages we've got. Hospitals in a grip based on prior contracts having to add more people to try to navigate this every single day. We've got a gray market that's getting bigger and bigger which is not illegal. We've got state House folks trying to figure out what can happen here in Massachusetts at the site of the world's leading hospitals. And that's where we are. And we're going to continue this conversation. We're discussing the prescription drug shortage crisis with a look at how this is playing out locally. Coming up we'll be joined by Patient Advocate Betsy Garcia Nizer. She's also a cancer patient who is being directly affected by the shortages. You can join the

conversation at 8 7 7 3 0 1 8 9 7 8 8 7 7 3 0 1 89 70. Are you a medical professional or a patient who is being affected by these shortages. Are you on a medication that could be in short supply. 8 7 7 3 0 1 89 70 8 7 7 3 0 1 89 70. By the way your gray market person call in your listing the eighty nine point seven WGBH Boston Public Radio. This program is on WGBH thanks to you and the Harvard innovation lab a university wide center for innovation entrepreneurs at Harvard the Austin Community Boston and beyond. Engage in teaching and learning about entrepreneurship. Information at II labs at Harvard dot edu. And American experience with a groundbreaking series that establishes native history as an essential part of American history. Watch Wounded Knee enjoy on we shall remain. Thursday at 8 on WGBH two.

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I'm Carol Miller this week on innovation women at the top of their fields talk about why they are the exception. Saturday morning at 7:00 on eighty nine point seven. Welcome back to the Calla Crossley Show. If you're just joining us we're discussing the National Prescription drug shortage with a focus on how it's affecting our medical institutions and patients here at home. I'm joined by Bill Churchill executive director of pharmacy at Brigham and Women's Hospital State Representative Jeffrey Sanchez chairman of the Joint Committee on Public Health. And Betsy Carson Nies there she's a patient advocate and executive director of cancer connection a community Cancer Support Center in North Hampton Massachusetts. She also has Stage 3 ovarian cancer. Betsy thank you for joining us. Thank you. You can join the conversation at 8 7 7 3 0 1 8 9 seventy 8 7 7 3 0 1 89 70. Are these shortages affecting you. Are you a patient doctor nurse

pharmacist who is wrestling with these shortages. 8 7 7 3 0 1 89 70 8 7 7 3 0 1 89 70. You can write to our Facebook page or tweet me it at. Kelli Crossley So Betsy you suffer from ovarian cancer when when were you diagnosed and at the time what were you prescribed and was it available. Yes I was diagnosed in the summer of 2002. And the normal course for someone. Diagnosed is to go through a major surgery and then to be treated with the gold standard drugs which is still gold standard today. A platinum combination called carboplatin and Taxol and I should point out there wasn't any shortage then. But they're both on the the shortage list now and when it was then that was 2002 right. OK so now just. And that long. I know that. And if you're lucky when you get that treatment you go into remission which I did for two years then I had to treat again.

Again with Carbo platen plus Taxol after another drug that I got was too toxic for me and that I had a three or three year remission and they tried the platen again. My numbers went down my tumor the one that was visible reduced. But as soon as I went off chemo the numbers started jumping and the tumor started going so they put me on Doxil which is the drug of choice for recurrent ovarian cancer when the couple plan stops working. And so what about Doc Searls availability now. Then there was no problem. But in July of 2010 I had been on it since 2011. I was put on it Naipaul of 2010 and received my infusion monthly and when I went in for my monthly chemo in July of 2011 my doctor said I have some bad

news. There is none. There was they had enough for one patient they had 12 patients waiting for it and I was number two on the list. Now could you get your head around that at them. At the moment had you to that point heard about shortages. No no this was what I had heard that there had been shortages in the past. But you know it didn't affect me. No I hadn't realized they were so widespread and I hadn't realized that it would affect so many patients I think there was a study that came out that said five hundred fifty thousand cancer patients will be affected by drug shortages this year. So he tells you that and what do you what do you think. What I mean and that moment I just would have I don't know what I would have said. Well it's the deer in the headlights response that everyone has to their diagnosis too. To their learning that there's a

recurrence. I said well what are the options. And I was told I had three options. The word from the manufacturer was that the supply might but might be replenished into the three weeks so I could wait. Waiting is always difficult because not only is scared but if you don't get a drug in time for cancer the cancer will get worse. Yes it will return. And sometimes if it returns that even if you get the drug later it won't work. So I could have waited. I could have had a drug called Adrian Meissen which has the same effect of kernel of medication as Doxil except it's much more toxic. Or I could have tried something else and I elected to wait and I waited two or three weeks

and then my doctors recommend that I have the alternative to at the AGM I said which was terrible. And as I understand it when pharmacists and doctors work in tandem bill to try to find an alternative drug. The reason that the patient is on the drug that choice is because the alternative one has some awful side effects and if you're already sick then your system is compromised. Is that not correct. That is correct. The choice is for her for patient's treatment regimen are really clearly designed around that patient's tumor and how they are physically and how they react to the various drugs that they receive so it puts all of us in a bind So when patients. Queued up for their next dose and they they really need to get it particularly when they're on their last dose of a treatment cycle. It puts a lot of pressure on us to really try to go out of our way to do the very best that we can to get that drug for them. We've had instances

where we've shared drug that we've had with Mass General and with Dana Farber and Dana Farber has done the same with us. We had a patient down on the Cape and the islands that needed one more dose of oncology drug and we were the only people that had it and we were made a decision that this patient came first and we gave that drug to that patient so that they could treat their cycle but it puts kind of an undue pressure on a pharmacy leader to say gee should I hold this in the banks here so that I can treat my patient or do we do for the greater good to make sure that a patient who does need it right now and is waiting for it and needs it immediately gets it. And I think all of us particularly in the Boston area of my pharmacy leader colleagues have felt that way. If people haven't gotten it this is truly a life and death situation. Let me take some calls. Janeane from Holbrook you're on the Calla Crossley Show. Eighty nine point seven WGBH Go ahead please.

I am. College is sitting there and I had a situation not myself personally but of patients in the last two. I think it was meant either just that the drug Doxil became unavailable in the middle of her cycle she opted to wait and I actually don't know if we come because we discharged him from my service but it was very stressful and the only other choice was something with side effects that they didn't think she would tolerate. And but the thing I was calling was mostly because I was wondering if distributors really have these sort of grey market distributors. If the law is in place now from the FDA could maybe target the distributors if if people responded to these emails for selling the drugs on the grey market and they inspected the distribution facilities. If they didn't comply. Current manufacturing standards that are required for the drug. If they could target them that way. Geoffrey Sanchez again. You know the Fed the FDA this falls under federal laws and the FDA will target will target. From what we understand

the manufacturers when there are quality but not relative to market. So nothing to impact the market. We have nothing relative to the market. We heard relative the quality which is a part of this discussion as well right. You know we heard we heard one one person talk about the manufacturer met a truck say the quality issues were so big for that plant that they ended up actually going out of business. And there's only two other two or three other manufacturers right that make that make it and they don't make it in the same dosage. So again for the strain on the system and I should mention in this conversation that we reached out to the FDA many times to try to get their input in this conversation and could not get anyone to speak to it. They were extremely helpful with us but we my my research staff spent a lot of time trying to get the trying to make sure that they were there but they were when they were there. She came in from D.C. and she did a great job explaining the overall problem there. Right. All right Jane and it means it's marketplace it's so far that's not a way to go. Thank you so

much for your call. Thank you. The other thing I was going to add is that these distributors are not benefactress so they licensed as a wholesale drug distributor so when they issued the drugs out there really isn't a lot that you can hit them with them unless they're just completely failing to comply with the regulations for them as a business. So there's that whole issue about quality and things like that doesn't come into play. All right John from Boston Go ahead please you're on the Kelly Crossley Show eighty nine point seven. Yeah the point I wanted to raise was that when Greenmarket drug distributors get involved in the picture one of the downsides is that that can be an avenue for the introduction of counterfeit drugs into the supply chain. Right. We've discussed that yes you were talking about that. OK. OK. There was a point I just thought it was worth covering more Greenmarket usually means more avenues for the kind of hit drugs that are affected.

Yes my guess. Bill Churchill made the point that the Brigham and Women's for that matter does not deal with grey market suppliers because they cannot be certain you know where the drug came from and whether or not it has the potential to be counterfeit. All the people that we spoke to thank you for call. OK everyone that testified outside and inside of the hearing that on February 13th that we had at the State House. We didn't have anyone who said yes we were active purchasers and we couldn't find any of the gray market distributors that would come to speak to us either. So if there's any out there please give us a call let us know your perspective. Yeah gray market distributor is you can our right to our Facebook page or tweet me or call in we don't know who you are. Listening to eighty nine point seven WGBH an on line at WGBH dot org I'm Kalee Crossley If you're just tuning in we're talking about the national prescription drug shortage. We're looking at how the shortages are playing locally. I'm joined by Bill Churchill executive director of pharmacy at Brigham and Women's Hospital State Representative Jeffrey Sanchez chairman of the

Joint Committee on Public Health. And Betsy Garcia nice dinner. She's a patient advocate and executive director of cancer connection a community Cancer Support Center in Northampton Massachusetts. You can join the conversation at 8 7 7 3 0 1 8 9 seventy 8 7 7 3 0 1 89 70. Or you can write to our Facebook page or send us a tweet at Kelly Crossley. So here's something I wanted to point out because we've talked about the cancer drug shortage which is really horrible but there's a lot of drugs that are in short supply. Very different ones we mentioned at the top. Drugs that lower but blood pressure drugs that treat AIDS related to skin cancer. There are Adderall which is a drug to treat age aged attention. That center also might get the letters mixed up but I thought it was interesting looking at some stats that in 2004 there were fifty eight drug shortages 2011. Two thousand two hundred eleven. And by

2012 now we're talking upwards of twenty two hundred fifty. I printed out a list and I just went on and on and on and I haven't you know I have right in front of me you know probably about 15 of us that's you know July 2011 American Hospital Association surveyed its member hospitals. Ninety nine percent of them reported experiencing one or more drug shortages within the first six months of 2011 and nearly half reported shortages and over more than 21 drugs at the time and 82 percent of hospitals reported that they delayed treatment and more than half of them weren't able to provide the patient with the recommended treatment. So again yes you go to the hospital to get the medication a medication to get the help and then I imagine that and or if you're a patient as Betsy has explained you hope that the medication is not going to make you worse. There's a reason why the doctor has assigned you certain kinds of medication. So let me put on the table the word that I just can't put together with a first world country like the United

States rationing. Yeah. So we're at rationing now. It's happening three out of the last bottles report rationing or putting restrictions. Bill Yes we absolutely have done that. We have spent a lot of time putting together a formal process to deal with drug shortages which largely starts with once we find out a drug shortage is going to occur. We make an effort to try to attempt to estimate how long that will last. And then once we can get a handle on that is it going to be short term month or is it three months six months or undetermined. That case we have to put this plan into action where we now meet with our clinicians our nurses and our physicians to say OK what are we going to do now. We don't have drug X are we going to switch to drug Y Is that safe is that makes sense if we can we do that if we can't do that what are we going to do and how are we going to distribute this drug and how we're going to determine who needs to get it. And these conversations take

quite a bit of time and can be quite emotional as you can imagine. Everybody wants to advocate for their patient but we end up forcing clinicians and the pharmacists and the nurses to make decisions about how to do that. In our experience most cases here we have not had to cancel surgeries we have not had to deny a patient access to a medication although many cases they've had to get an alternative medication that would be otherwise not the first choice but would be the second choice. So Betsey you're at the end of the line when rationing happens and you've experienced some part of that. Tell me what that is like share with everybody who's listening. To be faced with understanding that the drug that could potentially save your life is really being rationed. Well it's it's scary. It makes me angry but not angry isn't usually my first reaction. My family is

angry my friends are angry my colleagues are angry. But it it's funny my first reaction was let's get the Doxil back. I can continue to get doubtful for some time longer because there have been women and other patients who have died because they couldn't get the Doxil and because some of the clinical trials that required a regular dose of Doxil had to be cancelled. So I I can now get Doxil for a few more months I hope because of the sacrifices of other people other patients and that's not a very pleasant feeling. Yeah that must make you feel terrible when when my my doctor called me. Right now it's month by month I have to. I find Basically I find out whether I'm going to get docs or when I walk in the door at the hospital. I walk in the door after a two and a half hour drive from where I live in Western Massachusetts. So that day day's drive is

he is very uneasy but. Thank you to me that's a lot but that's a lot weighing on you thinking about other people. Yes you know when my doctor called me two or three months ago and said we got some extra Doxil in because the distributor had made a mistake. The distributor was supposed to send say 20 vials of Doxil and they only sent maybe eight. And so the pharmacy at the hospital called the distributor and said we were supposed to get 20 instead of sending 12 which was the difference between what they got and what they should have gotten. They sent the full 20 again. So there were extra vials and they said so you're going to get it. And my my response was Well is there anyone else who needs it more. Those are those are ethical questions and mass mass general has put me on the drug shortage task force that is looking not

only into the the logistics of how to deal with the drug shortage how to find more. More supplies when there when you go through lean times but also how to deal with it. The ethical questions of who gets it. If there is going to be a shortage How is that determined how to do it fairly and the the research that we're looking at today to help solve those ethical questions have to do with nuclear disasters and third world countries. It's just so out of place in you know the Mecca for medical expertise and humanitarianism in Boston. Yeah. Let me take your call. Cathy from Providence. Go ahead please you're on the Kelly Crossley Show eighty nine point seven. Hi I'm one of the people for time that I have to deal with oncology problem. But I do have asthma and an irritable bowel. The most reasonable drug for me to take is an inhaler when I have to was asthma Court no longer produce didn't make enough

money. I have a really hard time taking medication. So the next med I took made me totally crazy. And I couldn't take it anymore and it goes on and on there's another one for your double bowel called Live Rock. It's an old can Eric. Thirty pills. About $15 until nobody wanted to make it anymore now it's at least 60 for the same amount. So it's affecting everybody and it has to do with profit. How do you feel about it. What can I say on the radio I'm angry. It's very upsetting to have to go looking for what the most reasonable medication is. I hope that you can tolerate it and don't end up with another set of symptoms that are worse than what you're treating Is it your sense that you know most people don't have don't have a sense of this crisis. Yeah it is unless you have to go to the pharmacy and find out that what you have accustomed to taking and not very much money has suddenly become scarce. You wouldn't know this existed. That's how I found out as McCourt was based

out of a brac started getting really expensive. Oh and I forgot about Darvocet I can't take painkillers that's the only one I can take it's not made anymore. Wow I didn't know that. My position. Wonderful guy looked at me sort of cross-eyed. So what are you planning now that garbage that's not around anymore and I know what he was talking about. So it's not just the really big guns that are in trouble but the stuff for chronic diseases also because there's not enough money involved and this has to stop. Thank you so much for your call Cathy. Thank you. Cal you've been asking about how patients respond to this. I and the director of community Cancer Support Center and since I've been working there for four years people would walk in the door. Some of them would have ovarian cancer. And I'd say. Well what you know. Are you going to get carboplatin and Taxol and then they'd say Oh how did you know. And I'd say

well life I've been through it I'm doing really well now I can't even ask than that because I'm afraid to hear that they can't get that those drugs. I can't say oh well these are the drugs you're going to get. And these are the side effects and here are some ways that you can cope with them because I don't know what's in store for them. Cancer is it. It throws you for a loop. You've had control over your life for many years and you get a diagnosis of cancer and you can't even say if you're going to be able to attend your daughter's wedding in three months. You can't say whether you're going to be able to work. You don't know what's going to happen to your kids. Are you going to go to their graduation take it go to the kindergarden recital and then to have this uncertainty as well about the drugs which you know will work. Is it's just astounding it's cruel. Thank you for sharing that.

We got much more to talk about on this subject I'm Kalee Crossley We're discussing the prescription drug shortage with a look at how this is affecting Boston from our hospitals and medical institutions to our patients who can't get the drugs they need. You can join the conversation at 8 7 7 3 0 1 8 9 seventy 8 7 7 3 0 1 89 70. Are you surprised that this is happening in the U.S. the land of 24/7 plenty. 8 7 7 3 0 1 89 70 8 7 7 3 0 1 89 70. You can write to our Facebook page or send me a tweet at Kelly Crossley. This is WGBH Boston Public Radio. From. WGBH programs exist because of you and Comcast Internet essential Internet essential is available to help families in need. Families with students qualified for free school lunches may be eligible for Internet essential. You can learn more at Internet essential dot com. And Boston baroque performing in all Mozart program with Robert Levin and Yoffe H1

forte pianists. This Friday and Saturday at 8 p.m. at any CS Jordan Hall. Tickets at Boston baroque dot org. When storms in Mongolia whip up clouds of yellow dust the sound travels a thousand miles from the Gobi Desert and threatens the health of millions of people downwind in Korea. Now Korean a Mongolian activist are attacking the problem by planting trees along the edge of the Gobi Desert. Fighting sandstorms next time on the world. Coming up at 3:00 here on eighty nine point seven WGBH celebrate St. Patty's Day with Brian O'Donovan a St. Patrick's Day. Nothing so sure. An extraordinary show featuring some of the world's finest Celtic singers dancers and musicians. Be there for opening night. March 17 at the site here in theater in New Bedford for Saturday March 24th at Sanders the editor in Cambridge joined WGBH Celtic love the gift of $120 and.

Two of the best seats in the house will be set aside just for you. Details on WGBH dot org slash Celtic software. Green Devo innovation is what we in Massachusetts are about pharmaceutical The WGBH an ex-con he reported Friday during MORNING EDITION. The partnership between X company dot com and eighty nine point seven WGBH. I'm Kalee Crossley If you're just tuning in we're talking about the prescription drug shortage. Lawmakers physicians and patients are calling this a full blown crisis. According to the FDA there are close to 250 drugs that are in short supply. We're look at how these shortages are playing locally. I'm joined by Bill Churchill executive director of pharmacy at Brigham and Women's Hospital State Representative Jeffrey Sanchez chairman of the Joint Committee on Public Health. And Betsy Garcia nice dinner. She's a patient advocate and executive director of cancer connection a community Cancer Support Center in North Hampton Massachusetts. You can join the conversation at 8 7 7 3 0 1 8

9 seventy 8 7 7 3 0 1 89 70. Before we take another call State Representative Sanchez let me ask this question because trying to figure out entry points for. Legislation that could be effective I think about organ donation. I mean that in effect is regulated and rationed. I mean organs are rationed and there's a system in place that not everybody is happy with but there are some rules and some laws that apply to that. We just passed the law last year into law this year. I'm sorry. So is there something to be learned from the way that's handled to apply this to the prescription drug shortage the first time that I ever thought of it but yeah in certain ways. But at the same time again the market the market you know this isn't remember the when it comes to organ donation it's purely volunteer and there's the follow up aspect here Massachusetts. You know if something happens to any of us and you are an organ donor and you get a phone call asking you know asking if you could follow through on that commitment

if the family can will follow through on the commitment that was made by the person who passed away not necessarily the case here again because there is a market involved. OK Bill. Well Representative Sanchez and I were talking about this and I am not so confident that legislation is the only way that we can fix this because I just see too many behaviors that are going on for example pharmacists when they find out that there's going to be a drug shortage order as much as they can so they hoard it. So one hospital has a three month supply to hospitals down the street have none. Drug companies have done really nothing to figure out how to prevent pharmacists from doing that. All of the behavioral type things. I'm convinced. Which is what I told Representative Sanchez is that until we get a coalition of pharmacists physicians big pharma companies drug distributors regulators legislators and patients together that work collaboratively to

work through this process so that we can assure that drugs are made available in an appropriate way and no hoarding is going on. Drugs are not being diverted to grey market suppliers so the prices can be risen you know greatly by 600 percent once this all gets done. I mean I think legislation of regulation is part of it. But part of it is that we have to come to some agreements as health care providers and the hospitals and pharmacies that we're going to try to do the right thing here and abide by a code that we have that we're not going to create these shortages by doing these bad behavioral things that only feed into it. This is what showing that is an ethical code for people to to buy into and to actually act out and not just you know everybody do their own thing in middle of this. Let's take a call Walter from Winchester. Go ahead please you're on the Calla Crossley Show eighty nine point seven. Thanks for taking. Call my question is. How many drugs are

manufactured overseas or components for trucks manufactured overseas. All of these that are in shortage or maybe drugs as a whole. And we have a manufacturing capability here in the US. Well well actually that's a great question. I was really surprised when the. You may remember the heparin crisis that we had where we had tainted heparin. There was a couple two or three years ago. And tell me what happened to coagulate the right to know that blood prevents clotting. And I was shocked I have to say to find out that the vast majority of it was made in China overseas and it was not made in this country. Subsequent to that I found out that a great many of the products that we use are made in European countries or in the Far East and I think well some of that is contributory to that. I for one would have never bet any money on that. The

vast majority of our drugs were made out of this country is that because the cheaper labor costs primarily I can only take a guess at that that's probably true in cheaper manufacturing costs but I personally if I had my way would love to have the drugs manufactured back in this country and. It was jobs for a lot of jobs for people and stimulate the economy and do a lot of things but what we're not in control of that stuff. All right Walter thank you very much for the call. I wonder if I could have a follow through question there. OK. I don't think I've talked to the FDA accounts like hardly any of our drugs are 100 percent manufactured here in the U.S. including over the kind of drugs you take a look at the over kind of drugs. It doesn't say the place of manufacture. Well yeah that's what that's what Bill Churchill was saying so what's your point. Hello. OK all right well I guess we lost Walter All right. Joel from Boston Go ahead please you're on the calendar. I'm I'm a pharmacist and again we're in a blast in high school and I'm going to spend a fair portion of

my day suggesting other drugs as they position their writing a what they think is on the shelf and is no longer are is currently not on the shelf and then this begins to cascade. They can't get the first line drug. So there is a second there and it may be equally effective it may not. Usually it is. And and the situation is that that drug because that second line is perhaps on the shelf the lowest the by and disappears even asked right at work you way down the chain and the manufacturers are not over producing a second line drug because it's just not efficient to do so. And with each of these drugs. The first thought disappears. That's right. Thank you very much Joe for the call. We should note with regard to drug companies I mean it makes financial sense for them to do this if they limit production on older generic drugs say that don't really turn as much of a profit for them and put more emphasis on a newer drug that has perhaps the

potential of bringing in some profit. I mean that it from a business standpoint as you said Geoffrey Sanchez is a market question for some that makes a lot of sense. But then we are faced with a larger societal slash ethical question about people's lives and it should be noted that at least 15 people that I know have died in this drug shortage there are more I'm sure. So this is not a theoretical could happen. People are dying as we speak because of the shortage of the correct drugs and the effect that our caller just made of having to go down to the next one to the next one. And sometimes that second to third line drug actually as Betsy has explained cause more harm than good on a person who's already quite ill and the gridlock again. And this is a national issue. This is a national issue. Yes we want to look at that locally because if you look at what's happening in Washington. The shift the responsibility to state governments right now is probably more than ever right. Because of this gridlock that exists and this is an issue that I would

hope that every you know every constituent of every of every you know federally elected you know anyone is elected to national office would bring this forward so that we can try and address it because it is something that's not going to go away. You know hear me at one time I sat as a vice chairman of economic development and we were working on an act to promote biotechnology here in the Commonwealth. And it was incredible the amount of pharmaceuticals that were coming saying yes we want to you know we want to expand here in Massachusetts we want to expand. But at the same time we have to diversify our portfolio where we do things right so we have to look at England we have to look at Singapore we have to look at here we have to look at California. You know we lost you know we lost well from your point as you point out that makes sense. Them from a market perspective and that's how it goes at that and the FDA cannot. The FDA cannot make any company manufacture anything as what is one of the biggest things that I got a hearing.

We can't make them do something I can understand the bill last word from you. Well I'm really counting on legislators to really help work with us in the clinicians and the pharmacists and the nurses and the patients to try to to try to solve those but I also put a call out there to all of us you know in the in the profession to start using good judgment here and to not really be buying in and feeding into these these shortages and making the MORRIS I think the caller who called in Joe who is the pharmacist and talks about going to the second third line we were talking about that earlier. It does create other shortages. So not only do I have one drug in shortage now I have two and potentially three. Well I appreciate all of your comments thank you so much for joining me today. We've been talking about the prescription drug shortage with a focus on how it's playing out locally. I've been speaking with Bill Churchill executive director of pharmacy at Brigham and Women's Hospital State Representative Jeffrey Sanchez chairman of the Joint Committee on Public Health. And Betsy Garcia nice dinner. She's a patient advocate and executive director of cancer connection a

community Cancer Support Center in Northampton Massachusetts. You can keep on top of the Calla Crossley Show at WGBH dot org slash Calla Crossley follow us on Twitter. Become a fan of the Calla Crossley Show on Facebook where a production of WGBH Boston Public Radio.