RUTHFULLY YOURS

https://www.axios.com/2023/03/21/drug-shortages-upend-cancer-treatments

Supplies of some essential drugs used in hospitals are hitting 10-year lows, forcing rationing and pharmacy workarounds.

Driving the news: Drug shortages are the worst they’ve been in a decade, according to the American Society of Health-System Pharmacists — a sign of how much we rely on low-margin manufacturers with limited capacity for basics like the inhalation drug albuterol and some common cancer treatments.

What they’re saying: Quality control issues, selected plant closures and other manufacturing woes have added up, Michael Ganio, senior director of pharmacy, practice and quality at ASHP told Axios.

Between the lines: Oncology drugs have been hit particularly hard in recent months, putting experts on high alert.

Those in short supply include methotrexate, an injectable chemotherapy drug, and one of several generics produced by Illinois-based Akorn Pharmaceuticals, which shuttered operations last month due to bankruptcy.
Manufacturing delays and increased demand have also led to shortages of the cancer treatments cisplatin, and fluorouracil, per ASHP.
Pluvicto — used to extend survival among patients with metastatic prostate cancer — will take months to be made available to patients again, the Wall Street Journal reports.
“People will die from this shortage, for sure,” Jonathan McConathy, director of the division of molecular imaging and therapeutics at the University of Alabama, told WSJ.
A survey of health systems conducted by the group End Drug Shortages Alliance found the injectable Bacillus Calmette-Guerin (BCG), used for treating bladder cancer, was being rationed or was not available for use at all.
“This is a terrible crisis. We should be doing everything we can to give every single one of these patients the best chance of survival,” Laura Bray, a board member of the alliance, told CNN.

Between the lines: Manufacturing delays and quality problems are blamed for the shortages. But that’s often because there aren’t many alternative sites to pick up the slack in the system due to the challenging economics of the market, experts say.

https://www.wsj.com/articles/doctors-are-losing-their-calling-union-mass-general-brigham-resident-suicide-depression-representation-burnout-7f72ab6?mod=opinion_lead_pos8

Physician-trainees at Mass General Brigham are attempting to unionize. If they succeed, the union would be the largest of its kind in the country with more than 2,500 members, joining the estimated 15% of U.S. medical trainees who’ve assembled under the Committee of Interns and Residents in recent years. At the center of the doctors’ unionization efforts is a desire to reclaim their identity as service-driven providers and to fight for the autonomy and fair working conditions that they’ve lost as their profession becomes more commercialized and centralized.

Doctors are proud of their occupation’s mixture of sacrament and science in service to society. Urbanely trained at universities, these learned professionals once left the city to settle into solo practices or small partnerships in the towns they served. This autonomy allowed them to charge patients what they could afford—some more, some less and some not at all. Meanwhile, their authority allowed them to advocate effectively on behalf of their patients, even on nonmedical matters. Their familiarity with their neighbor-patients encouraged participation in the community, both economically and socially.

But as teaching hospitals were subsumed into larger corporate systems, and healthcare grew more expensive from the mid-20th century onward, hospital systems lobbied for policies that created a regulatory environment too thick and expensive for private practitioners to remain solvent. For doctors, hospital-acquired practices held the promise that as employees they could forget about red tape and bottom lines because the hospital would handle it. Doctors would purportedly get to focus on practice instead of administrative tasks.