Shame and Anger

Shame and Anger

George W. Sledge, MD, FASCO

Feb 13, 2012
Reading the news about the current shortage of methotrexate filled me with shame and anger and sorrow. Sometime during the past few years my country, which developed the drugs and regimens that cured most of childhood leukemia, became part of the third world. Parents in the United States now know the despair that fills the hearts of those in Somalia or Sierra Leone, realizing that their child has a disease that is readily curable with drugs available for decades, and yet will claim decades of life. Life wasted, decades lost, families ripped apart, unimaginable grief, and all totally preventable and totally unnecessary.

Methotrexate is just one of a myriad of drugs that have gone missing from the pharmacy shelves. We had a shortage of lidocaine in my clinic last week, and we’ve been stressing out over the lack of liposomal doxorubicin. Every day a new drug seems to go MIA.

Where is our shame and anger? Over the past few days I have been reading stories on contraceptive coverage, and the unhappiness of various politicians and religious figures over the requirement that insurance cover contraceptives for women. Why have I heard of no presidential candidate, and no religious potentate, publicly furious over the unnecessary death of an eight-year-old with acute lymphocytic leukemia? Why is it not considered immoral to let these children die and do nothing to save their lives?

The causes of the current drug shortages are complex. We all know that. Medicare regulations on drug pricing, FDA requirements for drug production, material shortages, a growing gray market jacking up the prices, hoarding, and the vagaries of supply and demand for low-margin commodities all feed into the problem. It is complex, and complexity is avoided by our political and moral leaders in this sound-bite, short-attention-span news age.

Our ASCO leadership and staff, especially President Michael Link and our Government Relations Committee, have been central players in keeping this issue alive, and in attempting to promote solutions. Kudos to Michael and the staff. But we need more than our leadership, and indeed more than the ASCO membership, engaged on this issue. We need massive public outrage. We need a furious population, furious over the deaths of innocents.


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Don S. Dizon, MD, FACP

Feb, 13 2012 3:37 PM

George- I share your outrage in this situation. First- pegylated liposomal doxorubicin, then shortages of paclitaxel, and now methotrexate. Its unconscionable that this would be happening today. I do not know what the fix will be, but the conversations we have with our patients and their families should not be about drug shortages. Not in our society. I applaud Michael Liink's leadership as well, but I agree- we need the outrage of our society. D


Feb, 14 2012 11:04 AM

Several years ago leucovorin was a sort of canary in the coal mine. We started blogging about and asking questions. But the recent shortages of medicines that are proven lifesavers for children are truly alarming.

I am outraged! And, we as a country and as a healthcare system, should all be ashamed!

Yes, the problem is complex. It has been patched together for years, but now like a neglected old jalopy, it just refuses to run any longer.

Time for real, concentrated and collaborative action,

As advocates, we are ready to help.

Kate Murphy
Fight Colorectal Cancer

Lucio Nobile, MD

Feb, 15 2012 4:14 PM

Lucio Nobile

Instead on focusing on emotion we should start to realize the limit of extreme form of liberalism without any form of democratic control of the society which is rather characteristic USA. The idea that the capitalism is perfect and problems are going to be fixed authomatically by the system is obviously wrong. The current drug shortage is a good example. The irony is that Erlotinib for Pancreatic Cancer is available and essential drugs are not. Typical result of a criminal form of liberalism.

Dear Dr Sledge, you have been president of a society where many clinical leader are more concern about Erlotinib,Avastin, Procrit and Denosumab than waht is really important. The recent scandal at Duke is the most eloquent example of this type of "weltanshawung".

This is destroying what have been bild with so much effort by hard working collueges. On top here come personalized medicine and the FDA liberalize a testlike the CYP2D6 polimorfism to mess around with Tamoxifen. Even after the presentation at SABCS and at the ASCO breast in SAn francisco by Leyland-Jones, how many oncologist will continue to order this test and take wrong decision?

Here come the question? Freedom on initiative is good but criminal liberalism is wrong. Most american aggree only on the first part of the previous sentence. That is why we have problems.

Richard S. Leff, MD, FACP

Feb, 17 2012 3:54 PM

So why are we all outraged and our senators and congressmen are not?  Their primary interest is reelection and ours is the welfare of our patients.  If their reelection depended on finding a solution to the problem, they would be much more interested. Unfortunately, not enough of their constituents can imagine that they would ever be affected by a shortage of cancer therapy.  If we want outrage and action we are going to have to find a way to make the issue more important to politicians.  If we could find a way for the Republicans to blame the Democrats for the shortages (or, equally effective, the Democrats to blame the Republicans) we would be in business.  If the Speaker of the House and a presidential candidate were to give  empassioned speeches blaming President Obama and health care reform for the shortages, or if President Obama decided to blame the Republican House, ABC, NBC, CBS, FOX and CNN would all mobilize their armies of commentators to analyze the problem, and its effect on the upcoming election.  Politicians would start speaking about the problem on the campaign trail, there would be regular coverage on the Sunday news shows and Americans would become aware and angry about the problem. Once we have elevated the issue above the bureaucratic noise level,  there is some hope for improvement.   We need some effective organized PR drumming up controversy.  We may need to stop thinking like physicians, assuming that the merit of the problem will generate appropriate attention, and start thinking like politicians (as painful as that may be).   

Anees B. Chagpar, MD, MPH

Feb, 26 2012 12:39 AM

Wanna know why the politicians aren't outraged?  Or why there isn't enough fury amongst the general public?  Because it isn't PERSONAL to them . . .  It's quite remarkable what happens when things hit extraordinarily close to home . . . 

I would love them to meet Owen, the 12-year-old son of my friend and mentor, Kelly McMasters.  I hadn't seen Owen in a year-and-a-half since I left Louisville.  He was always a charming, happy, cute kid who could whip anyone in a hand of poker, or whatever other card or video game you fancied.  I just found out that he was diagnosed with ALL a few months ago -- and needs methotrexate.  I can't imagine the frustration of his family and friends with this @#$%! shortage.  Kelly has dedicated his life to surgical oncology -- and is one of the finest surgeons, researchers, educators, mentors and Chairs I have ever met.  One of the things everyone always knew about Kelly was that if there was a problem -- no matter what it was -- he could fix it.  Well, this is one problem that he can't fix. . . . at least not alone. 

We need as a society, and as the American public, to make it abundantly clear to our government that this is UNACCEPTABLE.  No child should be staring down the barrel of the gun called "cancer" because the richest country in the world cannot make available to its citizens a curative drug that costs just pennies a vial.  It is a sad commentary on our social values when the wish of a child with cancer is no longer the trip to Disneyland, but rather the end of a drug shortage that has at its root corporate greed . . .

My heartfelt thoughts and prayers are with Owen, Kelly, Beth, and the rest of the McMasters family . . . and my outrage is with Congress.  If, for no other reason than the selfish one that one day this may affect them or their child, our politicians MUST act NOW to find a PERMANENT solution to the generic drug shortages that affect us everyday.  This is where the power of being the largest professional society dedicated to cancer care is our strength . . . we can make our voice (and our vote) heard.

James Killam

Feb, 28 2012 2:38 PM

I am not a doctor - just a husband of a woman with ovarian cancer who is facing drug shortages.  The U.S. was able to put men on the moon but now it cannot even ensure a steady supply of life extending drugs.  I truly hope that profits are not at the root of this shameful situation.  Radical steps are required and quickly.  In addition to prior notification of impending shortages, I suggest that avoidable shortages result in an immediate loss of patent protection and possibly, in extreme cases, criminal sanctions.  We are dealing with people's lives here.   

Ben C. Creelan, MD, MS

Mar, 06 2012 1:36 PM

I appreciate ASCO's continued efforts towards keeping this issue in the forefront of news. Hopefully if it receives more attention in media, it may help direct changes in policy.

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