Forgot your password?
typodupeerror
China Medicine News Science

Worldwide Shortage of Barium 270

Posted by Soulskill
from the out-of-our-element dept.
New submitter redhat_redneck writes "The U.S. and Canada has been experiencing a shortage of barium sulfate, which is used as contrast for upper and lower GI studies. It has reached the point where doctors are being asked not to order these exams except in emergencies, and some exams are being cancelled. Here's the letter that's been put out by the manufacturer. The longer this drags on, the more serious this issue becomes, eventually impacting patients and healthcare providers in both cost and quality of care. Some sources point to a dramatic drop in Chinese production. In their defense, it seems China is changing safety regulations. Medical use only make a fraction of the uses of barium sulfate, but it's going to be disproportionately affected by this shortage. We can't go back to our old contrast Thorotrast; it causes cancer. Does anyone know of alternatives to barium?"
This discussion has been archived. No new comments can be posted.

Worldwide Shortage of Barium

Comments Filter:
  • by phagstrom (451510) on Wednesday January 09, 2013 @04:47AM (#42529503)

    1. Use Thorotrast.
    2. People get cancer and die.
    3. Then you Barium...

    • Re: (Score:3, Funny)

      by Megane (129182)

      Barium?

      They cremated 'im!

    • Re:Alternatives.... (Score:5, Interesting)

      by Talderas (1212466) on Wednesday January 09, 2013 @09:21AM (#42530909)

      The question to ask is why iodine isn't more commonly used. I know iodine is used when a rupture in the GI is suspected since the barium would cause irritation.

      • Iodine is used in the illegal manufacture of Methamphetamine. As a resule, Iodine has recently been reclassified as a List I chemical under federal law. Those handling or selling iodine and its compounds must now go through a bunch of bureaucratic red tape with the DEA.

        I found this out right after the Fukushima disaster (when I tried to find some potassium iodide supplement {or other potable iodine compound, such as water purification tablets or tincture of iodine} to take to bump my iodine level before t

  • by gweihir (88907) on Wednesday January 09, 2013 @04:54AM (#42529549)

    The icky-factor aside, Barium is an element does not vanish and can certainly be sterilized to any degree desired. So, why do they apparently not recycle the stuff?

    • by retchdog (1319261) on Wednesday January 09, 2013 @05:31AM (#42529757) Journal

      the icky-factor is it, both aesthetically and practically. barium is excreted in the feces, not urine. so, you have the choice of doing it at the hospital, which will be inefficient (no economy of scale, and unspecialized labor), or you could do it in central locations, which would require the transport and processing of huge shipments of collected human fecal matter, the difficulties of which should be obvious. it's doable of course, but rather unlikely.

      as a side note: several years ago when i went to the hospital at my college town, i noticed the vaulted ceilings and friezes put there to cater to the wealthier residents, and i recalled them quite vividly when i got my bill. i'd rather have modest (but sterile) facilities and pay less, but image is everything i suppose. the point is, not only is there "icky-factor," there's the implicit standard of living which we "must" maintain. asking patients to shit into a jar and bring it back to the hospital would just be unimaginable. for better or worse, quite a few people would literally rather die than shit into a jar for two days.

      • by GNious (953874) on Wednesday January 09, 2013 @05:37AM (#42529787)

        Make "Rent of Barium" part of the bill - if you return the Barium, you get your deposit back.

        • Make "Rent of Barium" part of the bill - if you return the Barium, you get your deposit back.

          Eww, no... I get the refund, but they get to keep the barium AND my "deposit".

        • by Dunbal (464142) *
          Or if you deposit your barium, you get your rent back.
        • Make "Rent of Barium" part of the bill - if you return the Barium, you get your deposit back.

          Good plan. The last time I got a hospital bill that was not covered by insurance... I wanted to take a dump on the hospital administrator's desk.

      • by gweihir (88907)

        Well, first I disagree on the "huge shipments", and no, I do not see the difficulties. Port-a-potty companies do this routinely, if not over longer distances. So collect, dry and sterilize (can be done economically locally) and then ship. As to the patient angle: Tell them they can either buy the stuff (at market rates), or use a chemical toilet for a day or two and bring it back that way. Or give them a laxative and have them use a special toilet in the hospital within a much shorter time. I really do not

        • by LoRdTAW (99712)

          Port-a-potty companies and septic companies use vacuum trucks to remove waste from portable toilets or underground storage tanks. They then truck it to a sewage treatment plant where there are unloading bays with a grate on the floor or a hose to hook to an unloading pipe. So in essence, a port-a-potty is a toilet who's plumbing is truck based instead of pipe based. The sludge is treated at the same sewage plants that serve the local population. Nothing is dried or shipped by them.

          Its the sewage treatment p

      • by AK Marc (707885)

        barium is excreted in the feces, not urine. so, you have the choice of doing it at the hospital, which will be inefficient (no economy of scale, and unspecialized labor), or you could do it in central locations, which would require the transport and processing of huge shipments of collected human fecal matter, the difficulties of which should be obvious. it's doable of course, but rather unlikely.

        We already collect it in a central location, just without the concentration of being only those with barium in it. But if it's so precious, it would be viable to extract it at the large metropolitan waste processing stations.

      • by makomk (752139)

        Also, that wouldn't help much anyway - most the barite mined goes to oil and gas drilling, so sooner or later we'd run into problems getting enough new barium for medical purposes to replenish the stuff lost, and reusing the medical barium wouldn't help delay that by much.

    • by White Flame (1074973) on Wednesday January 09, 2013 @05:59AM (#42529903)

      This is a problem with more than Barium. Tons of nutritionally beneficial trace minerals and other such things are all being flushed into the oceans via sewage treatment & disposal, as our stool doesn't return to local soil.

      • Re: (Score:2, Interesting)

        by Anonymous Coward

        This, this is a huge problem that extends far beyond medical waste.

        The human race as a whole likes to think that their waste just vanishes in to the pits of hell. It doesn't, it goes in a landfill or shat out in to the ocean.
        This is a terrible thing when so much of it can be recycled very easily.

        Biomass in particular is extremely precious for farm and in turn food related stuff, it can turn dying land back in to healthy land, various other useful minerals that can be extracted, methane in particular.
        This m

        • And waste food as well. Setting up a recycle program to put waste food in a box that gets picked up, or even giving people a free (or cheap) blender for the sake of breaking down food to be flushed down the toilet and treated at a recycling plant that would be in your local sewage treatment.

          Many houses already have "garbage disposals" which perform this function. If not, they're not all that expensive to purchase.

    • by Grayhand (2610049)

      The icky-factor aside, Barium is an element does not vanish and can certainly be sterilized to any degree desired. So, why do they apparently not recycle the stuff?

      Why do I get this image of patients being given diuretics and not being allowed to leave until they cough up the Barium they were given? I'm guessing the bulk of it takes more than a couple of hours to pass through their system and 90% of the tests are outpatients. It's not the ick factor it's the practicality of it. I doubt you'd recover more than 10% for all the extra expense involved. I guess you can require them to sit around for 6 or 8 hours and piss in a bucket but even then at best half the Barium wo

    • I don't know offhand whether it's dissolved or suspended, but either way recovering and reprocessing is probably going to be disproportionately expensive. It's not just sterilization either, contaminants of various kinds will have to be removed as well. (And contaminants doesn't just include the obvious stuff - my feces may contain drugs you are sensitive or allergic to, as well as food allergens, etc...)

    • Barium is an element does not vanish and can certainly be sterilized to any degree desired. So, why do they apparently not recycle the stuff?

      Because not much is used in medical practice, so it's not worth it. The main use of Barium is Barite which is a Drilling Fluid [wikipedia.org] for drilling bore holes. You may have heard of white mud?

      • by gweihir (88907)

        So TFA is really about supporting the drilling industry and the medical problem is just a smokescreen? Makes sense to me.

    • by rssrss (686344)

      Because it comes out of your rectum.

      Rectum?

      Barium!

  • Alternatives include (Score:2, Interesting)

    by Anonymous Coward

    Gastrografin and Ultravist. No reason to defer these examinations.

    • Re: (Score:3, Informative)

      Unless the patient is intolerant of iodine, which many people are. Granted, most are intolerant of *IV* iodinated contrast media rather than PO, but if they have "iodine in contrast" in their allergy list, what radiologist wants to risk getting sued for giving them Gastrografin? Not many I know of, for sure...

      • by Stolpskott (2422670) on Wednesday January 09, 2013 @08:03AM (#42530447)

        Quoting from the Wikipedia article for Iodine,
        "Iodine sensitivity is rare but has a considerable effect given the extremely widespread use of iodine-based contrast media".

        So I would say that using Diatrizoic acid/diatrizoate as a Barium replacement (Hypaque, Gastrografin and Ultravist are the trade names) in cases where there is no flagged Iodine sensitivity in the patient is viable, with Barium being used in those rare cases (if in doubt, do a quick Iodine test, as far as I can recall the results are pretty quick - a drop of iodine on the inside of the wrist or elbow, a small rash will form if the recipient is sensitive, and the rash can be treated with standard rash creams (if the recipient is REALLY sensitive, anaphylactic shock is a possibility if a large amount of Ioidine is applied - you dip the person's arm in it - but if the sensitivity is that bad, it should already be flagged). This also has a positive effect for most people, who are generally short of the daily Iodine intake levels they should have.

        Disclaimer, my medical knowledge is limited by the fact that I dated and lived with a med student for 7 years, helping her study and revise for exams. Talk to your doctor if you have concerns about your own potential Iodine sensitivity or Gastro-intestinal issues. Do not come to /. and expect sane medical opinions here...

  • Other countries will ramp up production. It will just take time.

  • Apparently due to increased safety regulations being adhered to in Chinese mines. Damned commies! they'll have unions next!

  • The last time (Last Month, 19th) I got my B12 Injection I was told there is a Nationwide shortage of B12 used for Injections also. It was confirmed when I tried to refill my prescription at some local Pharmacy's. Thankfully I still have some left in my Vial, but those of you that don't and need this, you can be prescribed a Pill that will do the job, though not as good, until production picks up if it hasn't already.
  • I smell oil. (Score:5, Interesting)

    by Anachragnome (1008495) on Wednesday January 09, 2013 @05:30AM (#42529755)

    Barium Sulfate is also HUGELY important in oil well drilling mud.

    http://en.wikipedia.org/wiki/Drilling_fluid#Composition_of_drilling_mud [wikipedia.org]

    China putting a crimp on drilling mud could have some interesting effects, I'm sure. What makes little sense is the complaining about a shortage in hospitals, where a dose is less then an ounce, when oil drillers are pumping the stuff into the ground by the ton...daily...all over the world. Unless of course somebody wants us to get excited about China stepping on the hose without us finding out where the real shortage is.

    I wonder who that might be. I also wonder who submitted this story.

    • by AK Marc (707885)
      Perhaps it's that the market for medical barium runs through a monopoly, and with the increased cost, but fixed contracts, they make more profit by not delivering than delivering at a loss. I've seen dumber elsewhere, and never attribute to malice what can be explained by incompetence.
    • by echucker (570962)
      The stuff in drilling mud isn't pharmaceutical grade.
  • ... or possibly bazium.

  • question (Score:5, Funny)

    by shentino (1139071) on Wednesday January 09, 2013 @05:54AM (#42529885)

    Doesn't anyone recycle this crap?

  • Does anyone know of alternatives to barium?

    I hope you're not considering taking any answers you get from Slashdot seriously. Let's leave this one to medical science.

    • by tverbeek (457094)

      But that's how crowdsourcing works: you get a throng of people who don't really know anything about the subject, a bunch of people with working knowledge, and one or two experts, get them to all throw their ideas out, and then spend the next few years trying them all, in order of which ones got modded "Funny" the most.

    • Does anyone know of alternatives to barium?

      I hope you're not considering taking any answers you get from Slashdot seriously. Let's leave this one to medical science.

      Lo and behold, just a couple of comments below you, there is a medical student who suggests Diatrizoic Acid as a replacement.

  • The price of barium metal at the moment is $150/kg or so - in small quantities.
    Some of the 'unavailable' compounds mentioned above had a weight of around 340g, or 150g of barium, about $20.

    Sure, you need processing - which pretty much amounts to dumping it in a tub, along with sulphuric acid.

    Does the manufacturer of the barium compound have a problem sourcing product in a way that will result in a medically approved product without further applications to the FDA - perhaps.
    But it's not shortage of barium.

  • Diatrizoic Acid (Score:5, Interesting)

    by gee_cee0 (1370689) on Wednesday January 09, 2013 @07:14AM (#42530237)
    Gastrografin is already being used as a viable alternative to barium in radiological studies as contrast for imaging the Gastro-Intestinal (GI) tract, especially in patients where bowel perforation may be imminent (barium spills into the abdominal cavity as a result, causing barium peritonitis; while rare, it is an incredibly deadly complication), in conditions such as intestinal obstruction, for example. See: http://en.wikipedia.org/wiki/Diatrizoic_acid [wikipedia.org] Given that I am but a medical student, this is fairly well known in the medical world. Which makes this an odd question to ask...
    • by jo_ham (604554)

      Given that almost every "expert" on here seems to be going off on one about "rare earth" issues, I doubt they're even aware of what barium itself is, let alone any alternatives to BaSO4 contrast suspensions.

    • by vuo (156163)

      The essential feature of the element is that it has a high X-ray absorbance. But, any heavy metal has a high X-ray absorbance; this is why thorium was used in the first place. The problem is the solubility: barium sulfate is essentially insoluble, but other metals are usually somewhat soluble and thus toxic. In principle you could use any heavy element (iodine, mercury, lead, uranium, thorium, bismuth, etc.). In practice, barium, iodine, bismuth and thorium have been used.

      One alternative that is worth a m

      • by Guppy (12314)

        One alternative that is worth a mention is something that absorbs less that tissue, namely air.

        I believe air is the most common "contrast" medium when doing CT virtual colonoscopies [wikipedia.org]. It works well in cases where you can evacuate the entire compartment thoroughly beforehand, and "inflate" it.

        However, a liquid contrast medium has the ability to mingle with fluids and semi-solids, allows you to imagine structures in a native (non-distended) shape, including natural movement (such as following the movement of food over time). Also, the sharp border produced by Barium's coating property is especially im

  • ...but if you want to know where its being used in large quantities.... Do a google search on Barium and chemtrails.
    No Shit! And for those who do not believe chemtrails exist.... even mainstream news has covered the matter.

  • by trout007 (975317) on Wednesday January 09, 2013 @08:36AM (#42530607)

    There is no shortage. The problem is the price is increasing. But most likely the reimbursement rate by Medicare hasn't gone up to keep pace so they can't fill the orders for the price Medicare is covering. Most of this GI stuff is for seniors anyway. This is most likely a political move to get people scared so they can get the lobbyists to jack up the reimbursement rate.

  • FTFA, "National", and from the summary, USA & Canada. What about the 6 billion other people you forgot?

  • Barium not an option?
    Then Crematum.

  • The price of the ingestible cameras just needs to become cheaper than the barium and some automated processing of the 'footage' needs to become available. Radiologist consults are likely more expensive than either costs to make.

  • There are good alternatives to barium (such as gold), but you can't use them until the FDA approves them.

  • by tgd (2822)

    Oh shit ... it out... and recycle it, duh.

  • Is about the least toxic of the heavy metals (High Z atoms stop X rays best for contrast). Surely some compound of Bi would work instead. Heck, pepto-bismol might work. But it's tough to get the medical community to change anything. Look at the issues with Tc-99. Lots of other stuff would work fine, there is a shortage (Chalk river shut down), but no one will even consider anything else because that's what the sinecure chemists in hospitals know how to do, and don't want to earn their pay learning some

"The pyramid is opening!" "Which one?" "The one with the ever-widening hole in it!" -- The Firesign Theatre

Working...