There has been a topic that has been bothering me for quite a while now, and I feel it is time for me to weigh in on it.
One of my favorite shows that has ever been on TV was HBO’s miniseries A Band of Brothers, based on Stephen Ambrose’s book of the same name about Easy Company of the 506th Parachute Infantry Regiment in World War II. In one of the show’s best episodes, the company’s medic is forced to ration medications and supplies so as to provide as best he can for
The result is him having to hoard morphine for the more severely injured soldiers and carefully consider his treatments and who gets them and who does not. I have watched that particular episode many times and thought to myself that I could never imagine having to make those decisions. I always felt that in medicine, everyone deserved the same care, whether it be in the form of life saving medications, supplies, or pain management.
Now, here I am, almost 70 years later, and I am on the verge of being forced to stare at a drug bag with expiring medications that cannot be replaced, and having to choose between morphine and the far superior fentanyl based on what I feel my patient’s needs are. But who really is to blame?
One of the greatest tragedies in this country is the profit machine that is health care. It exists on every level from insurance companies to hospitals to manufacturers of medical equipment to the big bad drug companies and even to prehospital ambulance services. In fact, I am not a fan of any ambulance service being referred to as “for profit.” The fact is whether an ambulance service is privately owned, classified as a non-profit, fire based, third service, or any other model that sends out a bill they are, in fact, in the EMS business to make some sort of profit. But I digress.
Some drug manufacturers have decided to stop producing certain medications because regulations and quality controls have become so strict that without a significant price increase, the profit that they can make from these drugs becomes little to none making it not worth it for them.
So who suffers? While morally, I struggle with the burden of medication shortages every day, this problem is not about me, it is about my patients. I never want to have to look at a patient and say “I’m sorry you’re in pain, but you’re just not in enough pain to justify me using this little bit of fentanyl that I have left. Someone else might need it more. Instead, I am going to give you something else that does not work as well.”
While EMS services are on the verge of being held back from providing the care that their patients deserve, everyone is pointing fingers at everyone else. The FDA blames medication producers, medication producers blame the FDA. Services are forced to go out and buy overpriced medications driving up costs and reducing money that could be reallocated to other more important sections such as employee raises, or the purchasing of updated equipment.
Really though, who is to blame? The “big bad” drug companies are just trying to do what they always did: make a profit. The FDA is doing what they have always done: over regulating. Maybe it is time to loosen the reins of control over quality management. Or maybe it is time to put a cap on profits that any health care entity can generate. Or, as Patrick Lickiss over at 510 Medic suggests, maybe it is time to take a look at our own practices, and better manage the care we are providing so as to make sure that the right patient is getting the right medication for the right ailment.
Thankfully, there is a collaborative group out there made up of entities such as the National EMS Management Association, the International Association of Fire Chiefs, and the International Association of EMS Chiefs to name a few who have published a letter to the US Government that can be read here at the First Responders Network.
All that we can do now is hope that someone listens. This issue is not moving in a direction where things are going to improve without someone intervening, and the first step towards that is the involvement of the EMS community. How is the drug shortage affecting your service? Has it been brought to your attention as a field provider? Don’t be afraid to ask questions of your boss, or your supervisor, or your medical director. See if they have a plan, and make sure that they know that other people are dealing with and working on the same thing that they are. With one unified voice, we will be more apt to get people to listen.
Find out what others are saying about this:
Hyper-regulation is the problem. Hyper-regulation leads to monopolies as only a global-sized corporation has the deep-pockets and political pull to survive the bureaucratic onslaught. Imagine a small pharmaceutical manufacturer specializing in pre-hospital drugs- would they not be filling a need and making a profit right now? But they are not allowed to exist. A global corporation needs a global product- thus diet pills and Viagra become their focus. A small company could focus on a small product line and survive on a smaller profit margin- if that margin was not decimated by inane regulations that have no effect on patient care but instead feed bureaucrats.
Study after study has shown those expired meds are still good, yet cash-strapped local EMS agencies have to throw them out. And agencies become cash-strapped when a culture of dependence leads to people abusing EMS.