I Approve My Tax Dollars to do that: Bring Back Tetracycline

Attending a conference on small animal dermatology yesterday, one of the veterinarians asked the speaker about what drug to use as a substitute for one that is currently unavailable. To my surprise, the unavailable drug was not some obscure, esoteric medication. It was tetracycline, one of the most common broad-spectrum antibiotics used in human and animal medicine. I was shocked. How can such a drug be unavailable?

The current drug shortage is not a new problem. Since 2007, the number of unavailable drugs has been on the rise, peaking at over 280 as of October 2012. It is unclear as to when the shortage will be resolved. 

Photo credit: http://online.wsj.com/article/SB10001424052748704680604576110613604195324.html

Tetracycline joins the list of over two hundred drugs currently unavailable; a crisis over two years in the making. The entire list of unavailable medications can be accessed here. For the most part, the drugs on the list aren’t your unusual, random, rarely prescribed medications: they are your cancer treatment drugs, nutritional aids, anesthesia drugs, and antibiotics (http://onpoint.wbur.org/2011/10/04/prescription-drugs). The FDA cites manufacturing and quality issues as the main cause of the shortage. These include regulatory violations such as incorrectly printed expiration dates on bottles and sterility issues during production, and shortage of raw materials required to make the drugs. Though companies are required to inform the FDA of an imminent shortage and the estimated duration of the shortage as part of the Food and Drug Safety and Innovation Act passed in July, the FDA cannot force them or other companies to manufacture the drug. (http://www.fda.gov/Drugs/DrugSafety/DrugShortages/ucm050796.htm). The shortage affects a large number of suppliers but the majority of the drugs on the list only have one or two sources of supply (http://www.imshealth.com/portal/site/ims/menuitem.edb2b81823f67dab41d84b903208c22a/?vgnextoid=a6fbcc0f68f73310VgnVCM100000ed152ca2RCRD&vgnextfmt=default&vgnextrefresh=1)

How drug shortages affect patient care. While some drugs can be replaced with near equally-effective substitutes, such as doxycycline for tetracycline, others cannot. Even in the case of replacing tetracycline with doxycycline, increased use of one antibiotic risks creating increased resistance to that particular antibiotic. The last thing we need to do is to create more antibiotic-resistance super bugs such as Merca. 

Photo credit: http://online.wsj.com/article/SB10001424052702304584404576442211187884744.html 

Despite what the FDA claims, the shortage stems from more than manufacturing and quality assurance problems. Like most other shortages, the current drug shortage has as much to do with business as production. As more drugs became available in cheaper generic versions, companies quit producing brand-name versions because they could not earn a profit turning out more expensive drugs that neither hospitals nor insurance companies would pay for. They then switched to the less readily prescribed drugs. The switch ensured protection of their business venture, as financially it made no sense for generic companies to take up production for smaller quantities. Shortages arise when the generic companies producing the drugs experience material shortages or are shut down by the FDA for production violations. No factories, no drugs  (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60414-0/fulltext).

Health care should not follow free-market policies, especially not when people’s lives are at stake (I refer specifically to the availability of cancer drugs). What my body needs should not be at the mercy of companies more interested in making a dollar than my health. It’s absolutely ridiculous to me that such basic drugs are inaccessible to the public. Congress should exercise increased authority over drug manufacturers, holding them to tougher, and more stringent and ethical standards. At least fifteen deaths have been reported as a direct result of the shortage (http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)60414-0/fulltext). Congress needs to do something. Medicine is not about money: it’s about getting better.

I approve my tax dollars to do that: bring back my tetracycline. 

Some of the more popular drugs currently unavailable and their uses. Uses range from nutritional supplements, such as electrolytes, to cancer treatments. How would you feel if you went to the hospital and were told you couldn't be treated because the drug was not available? This is why we need to improve and increase federal overnight of drug manufacturing. 

Photo credit: http://sfmedicalsociety.wordpress.com/2011/08/22/prescription-drug-shortages-forcing-physicians-and-pharmacists-to-scramble/

Romney and My Tax Dollars

Opening Safari this morning, I noticed that my homepage, nytimes.com, displayed an intriguing headline: "The Mitt Romney Who Might Have Been"

Huh?

He’s the Republican presidential candidate and a former governor. He is already a very well known and publicized figure. As such, most if not all Americans around or above voting age know his name. What else could he have been? Curious, I shoved my current homework aside, clicked on the link and began to read.

In a two-second summary of the article, author Robert Draper evaluated Romney’s role as an informal McCain advisor during the 2008 race and his performance as Massachusetts governor. The point? Romney aimed to please.

I highly recommend reading it if you wish to see a preview of President Romney. 

Rather than remain steadfast to his promises or convictions, Romney preferred to go along and do what would win him support and favor. A perfect example of this is his revelation about Roe vs. Wade. Once the potential of a presidential campaign emerged mid-way through his term as governor, his position on a woman’s right to choose reversed from support to opposition. His loyalty never lay with Massachusetts. One of his environmental officials told the Times, “Clearly, in retrospect, he was weighing what was right for Massachusetts with how it would play nationally." (nytimes.com) 

Melanie's Law, a law targeted at getting more drunk drivers caught repeatedly off the road, is seen as one of the big success stories of Romney's term as Massachusetts governor. While it has been successful at getting repeat offenders off the road, seeing as it was introduced as a result of the tragic death of a young girl by a repeat offender drunk driver, there was little political resistance to its enactment. IID stands for ignition interlock device: you must blow into it and pass or else the car will not start. 

photo credit: http://www.mass.gov/rmv/rmvnews/2008/iid_removals.gif

Now imagine a president weighting what was right for the United States with how it would play on the international stage. Not good. 

I do acknowledge that the Times tends to lean toward the left and therefore this evaluation of Romney is somewhat biased. However, as a Massachusetts resident, much of its criticisms about his performance ring true. Who wants a governor who spends the last two years of his term away forwarding his own presidential campaign? Should he get elected, will he spend the latter years of his term focused on his re-election campaign instead of our nation’s current crises? I want my president here and actively engaged in the needs of the United States. I want him to take a decisive stand on issues and not allow his hopes for re-election to taint his decisions. He must preside in the present: not in the prospects of the 2016 race.

Funny how he approved a similar health care system in Massachusetts that took effect while he was governor that is viewed as one of his other big successes and he now rejects such a system on a nation-wide scale. You no longer hear Bostonians complaining about the state-wide health insurance requirement. Massachusetts also has some of the best health statistics in the nation. 

Photo credit: http://s.wsj.net/public/resources/images/OB-TO311_0628sc_G_20120628120827.jpg

Obviously the 2012 presidential election is a huge determinant in the future of my tax dollars over the course of the next four years. I make no secret about the fact that I am a liberal: I favor big government, I support a woman’s right to choose and I applaud universal health care. But in some ways, I view myself as a fiscal conservative. I dislike when my hard-earned tax dollars are wastefully and ineffectively spent. I especially grapple with the concept of welfare systems. My philosophy is simple: live within your means. If you fail to do so, then that is your financial problem, not mine and certainly not my tax dollars’.

That being said, obviously I will not vote for Romney.  But in addition to our ideological differences, I do not trust him to be responsible with my tax dollars because he flip-flopped so many times on issues and policies as governor. If elected president, which Romney are we actually going to get?