Recently, I addressed first and second year residents in the Queen’s University family medicine program, during their annual retreat at Camp Oconto, near Sharbot Lake, Ontario. Roughly every other year for some time now, I’ve been asked to talk to them about my work on drug shortages and what drives them, my website (which I mentioned in my previous blog), and the mysterious causes, harms and frustrations of drug shortages.
The session, which is held in a gorgeous post-and-beam dining hall, poses a discursive challenge. The 130 young doctors flushed and hungry from their day of outdoor activities --- hiking, canoeing, swimming, archery—were more than ready for dinner, which they could smell and hear being prepared in the kitchen behind while I spoke.
The residents come from MD programs all across Canada and several other countries too. Only about a third had ever heard of the drug shortage; a handful thought that they had had to deal with it to help patients. They listened politely, laughed in the right places, and asked tough questions that I could not answer.
- If it is only generics that are affected, why do doctors tend to blame ‘big pharma’?
- How can it be that generic prices are said to be both too low and too high? And how do we determine the right price?
- Do laws surrounding patents need to be revisited?
- Why don’t we measure the problem in Canada as is done in USA?
Their leader, Dr. Karen Schultz, pointed to the CanMEDS competencies that, she felt, my “activist history” work addresses: communication, collaboration, and advocacy.
In the scrum, I learned of a fiancée working with Dr. Gordon Guyatt on evidence-based medicine techniques that could be used for access to medicines. A resident from Guyana, who had worked in the stock market, had several original ideas about what might be behind the industrial and business causes of drug shortages. But business, industry, and pharmaceutical laws tend to lie right outside the realm of the average family medicine curriculum.
With their great intelligence, diversity, and energy, these young colleagues might uncover the causes and find solutions, but first they need to be motivated to learn about the problem, and somehow, somewhere, they have to see it as a genuine medical issue worthy of doctors’ time and interest.
Raising awareness of drug shortages is one of the greatest difficulties. Sadly—it seems to take a crisis (or a disaster) before the problem is noticed by the mainstream media, while the steady stream of serious complaints cruises beneath the radar of those in a position to investigate and demand answers. Politicians do not act until they sense a groundswell of public opinion.
To test the extent of the hurdles in raising awareness, I counted the number of news reports, press releases, and statements in the Canadian Business and Current Affairs (CBCA) Reference and Current Events database over time, and contrasted it with the number of reports that had appeared in Canada's Globe and Mail.
There is a direct correlation between the number of reports and the Globe’s response; however, the Globe’s coverage seems minimal for a problem that continues unabated and unmeasured for at least six years. The big kerfuffle in 2012 arose with the acute shortages provoked by closure of the Sandoz plant in Boucherville, Quebec, owing to manufacturing problems and a small fire. It was the much-publicized tip of a massive iceberg.
This month two reports—one international and one national--are relevant. The United Nations released its high level report on Access to Medicines that purports to address “the policy incoherence between the justifiable rights of inventors, international human rights law, trade rules and public health in the context of health technologies.” Should some nations be exempt from patent protection? Simultaneously, Canada’s Patent Medicine Review Board is rethinking its Guidelines and inviting submissions from ‘stakeholders.’ Canada pays more than most other countries for patented medicines (with the exception of USA and Germany), but we know too little about how these prices are established.
All citizens, including doctors and their patients, are stakeholders in the access-to-medicines issue– not only in the developing world, but also right here in Canada. Pricing of drugs and patent laws are only two of many possible causes behind drug shortages and unavailability. Doctors should be informed. Access depends on having drugs available as well as affordable.