Comment on NY Times article on drug rationing
By Chris Procyshyn
CEO, Vanrx Pharmasystems
Looking at the reader comments from the recent New York Times article “Drug shortages forcing hard decisions on rationing treatments,” you see the frustration and anger of both medical practitioners and patients. Clinicians forced to make ethical decisions about who gets medicine. Patients that are getting less than optimal outcomes because of reduced dosing.
I’m not going to weigh in on whether this is the fault of the free market, Big Pharma or Obamacare. That’s charged ground and the resulting argument doesn’t help find a solution. The author, Sheri Fink, is a trained physician and neuroscientist herself, and deals with these issues with some finesse. It’s a complex environment, and there is no silver bullet to solve the issue.
Having worked in pharmaceutical manufacturing for my whole career, and been responsible for making oncology products—a focus of the article—I will attest to the need for modernization of manufacturing facilities.
The old ways of making drugs are not the best way with therapies like Jazz Pharmaceuticals’ Erwinase, mentioned in the article. The drugs of today—biologics, cell therapies and personalized medicine—are 100 times more complex to make than the therapies of 20 years ago. The new treatments address smaller patient populations. As the speed of drug development increases due to new discovery, analysis and modelling technologies, the downstream manufacturing facilities need to be more agile—both fast and flexible—to be able to manufacture smaller quantities of drugs more efficiently.
The case could even be made for older drugs recovering their economic viability (another problem described in the article) if manufacturing facilities were built with the the agility to produce orphan, or even on-patent drugs in quantities that reflected market demand. Everyone in the industry knows what I’m talking about: the shift from high-throughput with correspondingly high downtime to lower throughput and exceptionally low downtime. It’s what the manufacturing experts in semiconductors and automobiles have done for decades—lean manufacturing that is more efficient and less wasteful in meeting market demands.
The “lean” approach could extend to the hospital, where like the Cleveland Clinic, in-house compounding pharmacies could produce dosages on demand for use within the hospital or hospital network. In the interim, this would fill the gaps in manufacturing, as Fink states. It could also be a more permanent business model for hospitals to develop and license proprietary formulations for use by other hospitals.
The problem of rationing doses isn’t sustainable. It is leading to sub-optimal patient outcomes. It means pharmaceutical companies are leaving money on the table, which will go toward the next generation of therapies. I’m welcome to your input about solutions, and a vision for producing adequate drug supplies for a growing, aging population.