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Medicine United States Science

Baking Soda Shortage Has Hospitals Frantic, Delaying Treatments and Surgeries (arstechnica.com) 250

An anonymous reader quotes a report from Ars Technica: Amid a national shortage of a critical medicine, US hospitals are hoarding vials, delaying surgeries, and turning away patients, The New York Times reports. The medicine in short supply: solutions of sodium bicarbonate -- aka, baking soda. The simple drug is used in all sorts of treatments, from chemotherapies to those for organ failure. It can help correct the pH of blood and ease the pain of stitches. It is used in open-heart surgery, can help reverse poisonings, and is kept on emergency crash carts. But, however basic and life-saving, the drug has been in short supply since around February. The country's two suppliers, Pfizer and Amphastar, ran low following an issue with one of Pfizer's suppliers -- the issue was undisclosed due to confidentiality agreements. Amphastar's supplies took a hit with a spike in demand from desperate Pfizer customers. Both companies told the NYT that they don't know when exactly supplies will be restored. They speculate that it will be no earlier than June or August. With the shortage of sodium bicarbonate, hospitals are postponing surgeries and chemotherapy treatments. A hospital in Mobile, Alabama, for example, postponed seven open-heart surgeries and sent one critically ill patient to another hospital due to the shortage.
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Baking Soda Shortage Has Hospitals Frantic, Delaying Treatments and Surgeries

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  • Is this shortage happening in countries with "socialized medicine", or just in free market America?
    • by MightyYar ( 622222 ) on Monday May 22, 2017 @04:46PM (#54466073)

      There are always shortages - it's just not apparent to the average Slashdotter. This page lists current and past drug shortages going back to 2010. [ashp.org]

      Here's the Canadian version. [drugshortagescanada.ca]

      There seems to be a similar site for the EU [europa.eu], though the page says most shortages are handled by the individual national governments. I'd check the French or German health websites, but I'm not good in those languages. The UK seems to have ceased tracking shortages.

    • Re: (Score:2, Informative)

      by Anonymous Coward

      The "free market" never existed, it's a construct of man's imagination, but let's set that aside for a moment while we talk about something more serious - Life or death serious. Health care. Physicians follow a code to do no harm. Drug companies have no such compunctions. There is no business imperative, regulation, general guideline or established best practice to maintain production of CRITICAL, EVERYDAY PRODUCTS that the world needs lots of. There is NO safety net. There is no planned economy gover

      • Right. So before laws prevented / regulated it you're saying that one person couldn't sell another a person a piece of bread or a cup of coffee?

        Free market is not anarchy. Menger, von Mises, Milton Friedman were not anarchists. You're playing the true Scotsman card and it's really tiring to hear this BS.

        Drug companies have the compulsion of reputation, the same as other businesses Go to the ... shhh ... the "DARK WEB," a place where there is no recourse to gov't and what separates one seller from ano
        • Thanks to regulation, I can safely buy no-name generic OTC drugs at the store without any fear and at an extremely low price.

          I'd rather not be the person who died to mediate a brand's reputation on the market.

        • by bws111 ( 1216812 )
          I guess you never heard of sulfanilamide [fda.gov]
      • ... and Helium.
        https://en.wikipedia.org/wiki/National_Helium_Reserve
    • by Applehu Akbar ( 2968043 ) on Monday May 22, 2017 @04:55PM (#54466151)

      Is this shortage happening in countries with "socialized medicine", or just in free market America?

      We don't have a free market medical system. We have a cronyist monopoly enforced by laws written by hospitals and pharma company. If the medical system produced computers, a PC would cost about the same as a Lamborghini.

      • Re: (Score:3, Insightful)

        by Anonymous Coward

        That is literally the Free Market at work.

        It purchased legislators to bypass the concept of being regulated.

      • by Tablizer ( 95088 )

        We don't have a free market medical system. We have a cronyist monopoly enforced by laws written by hospitals and pharma company. If the medical system produced computers, a PC would cost about the same as a Lamborghini.

        Explains Microsoft Windows: the complexity of a Lamborghini but the performance of a Yugo.

        Monopolies and oligopolies almost always end up sucking. Newly arrived x-opolies may be okay, but over time they grow sloppy, evil, slow, and/or anti-competitive due their size (influence power) and lac

        • by Applehu Akbar ( 2968043 ) on Monday May 22, 2017 @05:38PM (#54466441)

          The problem is that medical services may require economies-of-scale such that having say 7 competitors in a given market, especially rural areas, is just not realistic. Medical services are just not the same market profile as manufacturing light-bulbs.

          Personnel are not even so much the problem. Medical salaries are only a small percentage of total costs, and if a real shortage develops we could always turn on the H-1B spigot.

          It's more about the total opaqueness of all pricing: nobody knows what anything costs. Pharma keeps insisting that "nobody actually pays $120,000 for Harvoni." My brother didn't, for example - but what did his insurance plan actually pay for it, and why aren't we allowed to find out? And if nobody actually pays it, why is that the advertised price?

          We expect higher prices for newly branded compounds, but how can the supply of generic drugs, which anyone can make, be monopolized? What can't we have our prescriptions filled on the world market, through Amazon?

          • A lot of the problem is that even doctors don't always know what the medicines cost. Thus they prescribe something that is more expensive than an alternative because of marketing. Drug A does the job, but drug B does the job with an easier to swallow pill because it's coated, but drug B is double the cost. The doctor not knowing the cost prescribes drug B in all cases.

            Patients also need to learn to question the doctor and ask if there are alternative drugs available, such as generic brands. Even if insura

        • Market size stops being a problem when you look to the entire planet instead of just one country. A multi-national treaty to standardize drug testing would let people buy drugs from any country, and therefore ensure effective competition and low prices. They appear to be dealing with copyright first though, might be a bit of a wait.
      • by martinX ( 672498 ) on Monday May 22, 2017 @06:23PM (#54466661)

        Well expressed. I recently looked into the price of rattlesnake antivenin in the US and was astounded to see it costing up to $10000 per vial. A little searching revealed the cost of production was estimated to be about $14.
        Link to an article discussing the costs:
        http://www.smithsonianmag.com/... [smithsonianmag.com]

        Link to a research paper by the person responsible for creating the antivenin:
        https://www.researchgate.net/p... [researchgate.net]

      • by istartedi ( 132515 ) on Monday May 22, 2017 @07:06PM (#54466861) Journal

        Yeah, but a lot of people would have those Lamborghinis. You wouldn't just buy a computer though. You'd make computer payments. You wouldn't just buy stuff online. You'd make a $0.50 copay for each $100.00 iTunes or Netflix purchase because nobody actually buys directly from online retailers. I'm just guessing at what things cost, because the price list is secret. You could apply for a new computer right around the same time every year, along with a bunch of other people, unless your computer broke down our you got married, or needed a computer for your child, or Congress had gas. Then it's hard to say. You wouldn't be on the internet unless it was in your network. Maybe your state would only support the Bing network, unless you wanted to pay a lot extra. You could Google if you really wanted to; but then your next computer payment would be higher. You get free antivirus though, so you use that to feed some kind of delusion that this is all working out for the best. Sometimes reality intrudes and you get depressed. Then you fork over a copay for a program from Big Gaming that may or may not cause your computer to self-destruct. If that happens, it's GAME OVER.

    • The medical industry in USA is far from a free market. Try buying insulin online from Canada.
      • by PPH ( 736903 )

        The medical industry

        Try every industry. All markets are protected to a greater or lesser extent here. We live behind an economic Iron Curtain.

      • by dk20 ( 914954 )

        try importing text books from overseas and see what happens.

    • by markdavis ( 642305 ) on Monday May 22, 2017 @05:16PM (#54466299)

      >"Is this shortage happening in countries with "socialized medicine", or just in free market America?"

      If we had a really free market (with safeguards to prevent monopolies or near-monopolies), then plenty of other companies would make such "drugs" available, too (in this example, it is not really a drug, it is just a commodity). Besides, even if a shortage occurred in such a market, it would send the price up and other companies would rush to market with completing product and pricing would go down and supply would then increase then eventually stabilize.

      In a perfectly free and elastic economy (and part of that freedom *is* preventing monopolies with take away from free trade), supply and demand and pricing is completely self correcting. If anything, the more "socialized" a place is (with more government controls on supply and demand, limiting competition, restricting price changes, tampering with demand) the more likely shortages will occur.

      No system is perfect. But free markets have generally been proven to work better than anything out there.

      • The whole problem that neither the free market or the socialized system completely solves is the basic reality is that people don't want to work and shucks, no one really wants to compete, either.

        Competition is a lot of work and the simplest way to make money is to try and be in a business that can avoid it. The easiest way to do that is to churn out intellectual property and rely on the regulated monopoly to attract investment in that property. In systems where there is no intellectual property, then, th

        • Scale is very important here. Pfizer has a big leg up because it has already purchased the necessary equipment to make acceptable drugs that pass inspections and testing, even in the case of something simple like sodium bicarbonate. If you want to compete with sodium bicarbonate here as a small provider then the cost outlay to even get started in the market is very high. The profit and margins for such a product is very low at the same time. You basically already have to be a large drug maker just to get

    • by martinX ( 672498 ) on Monday May 22, 2017 @05:22PM (#54466355)

      Happens in Australia, too. We have a large, well developed public hospital system in each state.
      http://www.smh.com.au/national... [smh.com.au]

  • I'm sure US hospitals are hoarding these vials in preparation to ship them to some miserable 3rd-world country with an incredibly underdeveloped healthcare system, but the article misses to tell us which country that is... right?
  • He [wikipedia.org] has been known to do this.
  • by Archfeld ( 6757 ) <treboreel@live.com> on Monday May 22, 2017 @06:59PM (#54466819) Journal

    See, without the great and wise FDA's policies of looking out for the people by allowing the concentration of critical supplies and medicines into the hands of 2 such wise and benevolent entities we'd not be in a position where decisions made entirely for profit could affect the lives of the general public. As much as I hate to see people suffer, I almost wish there would be deaths as a result of this and that forced some legal light onto the situation. Critical basics that are free from patent should required to be multiply sourced to ensure a steady interruption free supply chain, not concentrated into one or two 'most' profitable and controllable streams.

    • As commerce and trade are not in the FDA's jurisdiction, it should be unsurprising that FDA is not taking any particular action to enforce commerce and trade laws.

  • Why not? /s

  • Ridiculous (Score:5, Interesting)

    by Mr.CRC ( 2330444 ) on Monday May 22, 2017 @08:57PM (#54467409)

    I once worked in the analytical laboratory at J.T. Baker as an analytical chemist. I personally tested NaHCO3 among many other chemicals to USP, FCC, and ACS standards. We had a warehouse with plenty of barrels of these kinds of commodities. Also, I seem to recall that the ordinary box of Arm&Hammer on the supermarket shelf is actually very high quality material, almost pure enough to use for creating primary standard grade sodium carbonate by baking out some water and CO2 at a specific temp.

    Note that the costs to certify to USP grade are little different than for the other grades. It is important to understand that many chemicals which come into a chemical plant never require any further purification. In such cases, a portion is split off to be packaged as ACS, another portion goes in the USP bottles, etc. The remainder can be sold off as "Technical" grade if there isn't enough room to store it. If there is room, it might be preferable to store the raw material that meets the higher specs. rather than sell it all off as tech. grade, because the next load that comes in might not meet the requirements for certs. and thus would need to go through a purification process.

    What's sad about this story is that because of the regulatory/liability state, it is impossible to engage in simple acts of innovation ("winging it") that could solve problems such as this "shortage." E.g.:

    Find a chemical company with some barrels of bicarb. that has been tested to one of the specs., or USP if possible. If they don't have the USP, then have them test the ACS or FCC to the USP std., which would probably pass if it already met one of the other stds.

    Then just procure the damn stuff!

    If additional sterilization is needed, have the truck routed to an accessible sterilization service. Ie., a facility with a gamma ray sterilization unit, where the material could simply be put on a belt and sent through the rays.

    Hospitals should have the capability to filter small lots of solution to further remove any particulates if necessary.

    But no, we'd rather incur large risks of an actual death to a patient to stave off some tiny risk.

    What a pathetic thing we have become.

  • by stabiesoft ( 733417 ) on Monday May 22, 2017 @09:57PM (#54467645) Homepage
    hospitals could allocate the pharmacy grade stuff for the open heart and use the industrial/food graded stuff for things like the bandage itching. Have the patient sign off on it. And as an incentive, charge the patient the buck it costs for the food grade product if they are willing to use it instead of the 100 they'd charge for the pharma grade.But oh, common sense, not in medicine. This is why an aspirin costs 10 bucks a pill at a hospital.
  • Highly optimised systems get increasingly fragile. A highly optimised market for drugs will falter on the slightest off-the-regular imbalance. Same goes for IT services. Imagine everything running on and with Google in 3 decades. And Google then having some kind of hickup that puts the entire society of humanity to a grinding halt for a few days. Or weeks.

    A Utopia would have to be built taking this systemic problem into account. But then again, this might not be the best example. As we all know, the US medical system is about as far away from Utopia as it gets.

  • by Required Snark ( 1702878 ) on Tuesday May 23, 2017 @05:03AM (#54468527)
    "the issue was undisclosed due to confidentiality agreements"

    This is the smoking gun, people. The fact that the situation is constrained by secret agreements between players shows that no free market existed.

    The "free market" is a myth, and it has always been a myth. Without some independent mechanism to enforce honest behavior any market will become a criminal extortion enterprise. That is why there are laws against raising prices in emergencies. Otherwise bottled water and cans of food would go up by double digit amounts in case of a hurricane, tornado or earthquake, and people might even die as a result.

    Of course these days it doesn't take a catastrophe for greedy corporations to charge obscene prices. Epi-Pen [wikipedia.org], Valeant Pharmaceuticals [wikipedia.org], and Turing Pharmaceuticals [wikipedia.org] have all engaged in extortion pricing after acquiring existing drugs. This is life threatening and gouges the taxpayer as well.

    The history of food and drug regulation in the US is the history of mass poisoning [wikipedia.org] as a result of ignorance, greed and lack of regulation. All the comments about the "ebil gobment" blocking noble free enterprise are right wing masturbatory fantasies.

    The biggest issue we face is regulatory capture [wikipedia.org] where special interests take over the government agencies that are supposed to keep them in check. Examples are the revolving door between the FDA and the pharmaceutical industry or the end of Net Neutrality at the hands of the telecommunication cartel.

    It's not about the government squashing the free market, it's about corrupt powerful monopolies using the government to enforce their dictatorial control over the economy.

    • by moeinvt ( 851793 )

      "Without some independent mechanism to enforce honest behavior any market will become a criminal extortion enterprise."

      Government is just a criminal extortion enterprise cloaked in a veil of legitimacy. Once you look past the bullshit, government operates on the basis of violence. All of their revenue is extorted based on the threat of violence and all their decrees are enforced at gunpoint. If you don't pay your taxes, government will steal your property and/or try to throw you in a cage. If you resist

      • The problem is that things would be a lot worse without governments. Government is far from perfect, but it's an improvement over what we'd have without it.

  • Is this how he wants to make America great again? Or is that the outcome of his health care legislation: we offer everything, but you won't get any of it.

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