The old proverb “For Want of a Nail,” having numerous variations over several centuries, reminds us that seemingly unimportant acts or omissions can have grave and unforeseen consequences. Two inexpensive cancer drugs, costing under $25 per vial, cisplatin, and carboplatin, remain in short supply leading to delayed treatments and increased morbidity as oncologists substitute second-line drugs associated with more significant toxicity.
According to a report in the NY Times, the American Society of Clinical Oncology advises doctors to ration the available medications by administering them to patients with a higher probability of a cure and denying them to others with more widespread diseases and a lower chance of obtaining benefit.
For many patients, the probability of cure drop from over 90% to less than 50%. Although the recent introduction of breakthrough immunotherapies increased survival rates, these generic, first-generation cancer drugs remain essential tools for oncologists.
As a physician, I empathize with every oncologist who must tell their patient that although there is a cure for their cancer, it cannot be administered because the $25 vial of the medication is out of stock.
These shortages of critical drugs are not new. I reported them previously in earlier posts. Medication shortages remain a massive problem in the U.S., yet we must take meaningful steps to address them. In a $4 trillion healthcare system, there is enough money to maintain a reliable and adequate supply of critical medications. Reliance on offshore, single-source manufacturers has yet to work.
Our government requires “Made in America” for everything from military equipment to municipal automobiles to train cars. It may be time we did the same with medications and considered their supply a public utility. We must establish a marketplace that ensures multiple suppliers, competition, high-quality products, and reasonable profits for the companies involved. At least one of the suppliers must be in the U.S. The time to secure the medication supply chain has arrived.