Below, a guest post by Paul Raeburn, a journalist and author, and a media critic at the Knight Science Journalism Tracker
This weekend, those of us who live in New York and on the East Coast were treated for days to front-page news about Hurricane Irene. Meanwhile, other important stories were mostly ignored or relegated to back pages. (I use the term “front and back pages” figuratively, to refer to the emphasis given to stories in newspapers, radio and television, and on the web.)
Over the past few weeks, scattered stories have begun to appear in the media about one particular event that should, in my view, be front-page news. The U.S. is suffering from a serious shortage of cancer drugs, particularly generic drugs given by injection and used in hospitals to treat serious conditions such as breast and testicular cancer. Patients whose cancer requires a regular schedule of drug administration over a period of weeks are being forced to delay treatment, quit early, or skip treatments. There’s little question that this will cost lives. It’s unilateral disarmament—while treatments are stopped or delayed, tumors take no notice. Their unrelenting growth continues.
Yet the story has received only middling coverage.
Two weeks ago, Ezekiel Emanuel, a noted oncologist, biologist, and former White House adviser, wrote an Op-Ed on the subject in The New York Times. The story—which I critiqued on the Knight Science Journalism Tracker—noted that 14 of the 34 generic cancer drugs on the market were in short supply. “Most of these drugs have no substitutes, but, crazy as it seems, in some cases these shortages are forcing doctors to use brand-name drugs at more than 100 times the cost,” wrote Emanuel. In my view, the Op-Ed was insufficiently backed up by sources or important details about the drug shortage; focusing instead on past legislation that makes generic drugs unprofitable for companies. And it received little follow-up.
The next story I found was by Gardiner Harris, a journeyman at the New York Times. For starters, the Aug. 19 story, headlined "U.S. Scrambling to Ease Shortage of Vital Medicine," is far broader than Emanuel's. As I wrote on the Knight Tracker blog, the story “talks about shortages of antibacterial agents, as well as cancer drugs. Harris lays out the case nicely, he interviews patients, he talks about efforts in Congress to give the FDA more power to fight shortages, and he hits a key point head on: Why are these shortages occurring?”
More than half of the recent shortages, Harris writes, have occurred because government or company inspectors found problems like microbial contamination that can be lethal on injection. Others have occurred because of capacity problems at drug plants or lack of interest because of low profits, according to the F.D.A.
Around the same time, others weighed in on the story, including the San Francisco Chronicle and USA Today. Coverage by USA Today has continued as the drug shortage problem worsens; yesterday another story on the crisis reported that “some people” are suggesting that the FDA is causing the problem itself by not quickly inspecting plants fast enough and allowing them to get back to manufacturing needed drugs.
Responding to that charge, Valerie Jensen, associate director of the Drug Shortage Program in FDA's Center for Drug Evaluation and Research told USA Today, "If the company is having a quality issue, the company doesn't have to wait for an FDA inspection to restart the manufacture." The article adds that the “agency attempts to work with the companies to get drugs back into the market or tries to locate other sources for these drugs.”
“Jensen noted that since most of these drugs are generic, companies don't make much money on them and may, in some cases, opt to discontinue them.”
What would be the benefit of discontinuing them? Otis Brawley, chief medical officer at the American Cancer Society told USA Today that although manufacturing problems are causing some of the shortages, concerns about profits may also be playing a role. If a drug is taken off the market, it can be re-priced once it comes back on, says Brawley; "there are instances where I am certain that manufacture was stopped because they wanted to raise the price."
To my mind, this should have been front-page news everywhere. Inexpensive, effective cancer drugs—as well as injectable pain medications and some nutritional products—are being denied to patients with life-threatening illness because of inept management or profit seeking? This is real drug rationing—not the “death panel” kind imagined by foes of health reform, but the type that can occur when market forces control the supply of necessary drugs.
When we're trying to control medical costs and save lives, we're getting, instead, a shortage of the cheap drugs, and even price gouging. Lives in the balance, possibly criminal price gouging, and manipulation of the market: Why wasn't that bigger news?