Wednesday, January 3, 2001

By MELODY PETERSEN
NEW YORK TIMES

Doctors, pharmacists and federal regulators are concerned about what they say is a growing number of drug shortages, particularly at hospitals.

Where a few years ago a hospital might see a shortage of one or two drugs a year, the number in the past year has been closer to two dozen at some hospitals, doctors and pharmacists say.

"This past year's shortages have been the worst I've seen in 26 years of hospital practice," said Dr. Burnis Breland, director of pharmacy at Columbus Regional Medical Center in Columbus, Ga. "We have not had any life-threatening cases, but it certainly could have happened."

As one example, women giving birth at Brigham & Women's Hospital in Boston no longer routinely get a drug that had long been used in almost every one of the hospital's 10,000 annual deliveries.

In October, doctors found they could not buy enough of the drug, Pitocin, or its generic equivalent, oxytocin. Like many hospitals, Brigham & Women's had regularly used Pitocin, not just to induce labor but also to reduce the likelihood of bleeding after delivery.

Alarmed about the shortage, doctors quickly changed their procedures to use less, said Dr. David Acker, the hospital's chief of obstetrics.

No patients suffered, Acker said, and the drugs soon became available again. But the shortages, as well as a similar shortage of Hemabate, also used in deliveries, startled the hospital's doctors, and they continue to use these drugs sparingly.

"Something strange is going on," Acker said.

Some shortages, such as the nationwide delays in production of flu vaccine, have had public health consequences. As flu season began in December, thousands of elderly people and others at high risk had still not received vaccinations.

Other shortages have meant that patients may get a substitute medicine their doctor may not be as familiar with. When there is no alternative, patients may have to do without.

There is no single reason for the shortages. Some stem from the drug industry's rapid consolidation, which has led to fewer companies making each drug or supplying the raw materials.

In some cases, such as this year's shortage of flu vaccine, federal regulators found problems at factories making the drugs and shut down production until processes were improved.

And some big drug companies have stopped making the older drugs and have instead reserved factory capacity for newer drugs, which bring them higher profits.

James Jorgenson, director of pharmacy at the University of Utah's hospitals and clinics, said, "You can't just order drugs any more and just assume they will be there."

Seattle P-I

-- Anonymous, January 03, 2001