Science Friday - Why Are There So Many Drug Shortages In The U.S.?

Episode Date: July 18, 2024

If you’ve tried to get prescriptions filled in the last year or so, a pharmacist may have told you, “Sorry, we don’t have that drug right now.” That’s because there are some 323 active and ongoing drug shortages in the United States. That’s the highest number of such shortages since the American Society of Health System Pharmacists started tracking this data back in 2001.These drug shortages touch every part of the healthcare system. Doctors are having to reconfigure their treatment plans due to short supply of certain drugs, like cancer treatments. And patients can be left going from pharmacy to pharmacy to get even the most common medications, like antibiotics.SciFri’s John Dankosky talks with freelance journalist Indira Khera and journalist and physician Dr. Eli Cahan, who looked into why drug shortages happen, how they’re affecting the healthcare system, and what solutions are on the horizon.Transcripts for each segment will be available after the show airs on sciencefriday.com. Subscribe to this podcast. Plus, to stay updated on all things science, sign up for Science Friday's newsletters.

Have you had the experience of going to the pharmacy to pick up a prescription and being told, we just don't have that drug available right now? Shortages, they are omnipresent. They smolder along. Now, like we've had, another times, it's a five-alarm fire. They never go away. It's Thursday, July 18th, and you're listening to Science Friday. I'm John Dankoski. Incredibly, there are some 323 active and ongoing drug shortages in the U.S. It's the highest number of drug shortages since the American Society of Health System Pharmacists started tracking this data way back in 2001.

Now, these shortages touch every part of the health care system from doctors who have to reconfigure their treatment plans to account for this short supply to patients who have to go from pharmacy to pharmacy to get even the most common medication. But why do these drug shortages happen in the first place? And what can we do to fix the problem? Journalist Indy Kara and Eli Kahan took a deep dive into the tango web of shortages for us, and they brought back some answers. Indy and Eli, welcome to Science Friday. Hi, thank you for having us. Thanks for having us, John. Okay, so to start, I understand this is a

pretty sprawling issue, but you have focused on a few drugs in shortage to help us get our heads around things. Can you tell me a bit more about that? Yeah, definitely. So as you said, drug shortages are complex. This is, I think, the most challenging thing I've ever reported on. And so having Eli, who is not only an amazing journalist, but also a doctor, was very helpful. You are too kind, Indy, but yeah, John, drug shortages, they're an everyday thing in the hospital. To break the fourth wall for a second, I literally wrote part of this script at 3am in the morning two days ago after admitting three kids to our ICU, and every last one of them had me calling the pharmacy when we got them upstairs to make sure we could substitute this version of the drug for that one.

So no, we're not talking a once in a blue moon toilet paper during the first month of COVID phenomenon. Sh shortages are commonplace in medicine today. Yeah, and for the purposes of this story, we ended up focusing on cancer drugs and antibiotics. But given just how complicated shortages are, it's really easy, I think, to forget who they impact and how serious those impacts can be. So Eli's context is someone who is working around these things in a hospital every single. day was critical, and we also wanted to find someone who had been directly impacted by a drug shortage. Okay, so did you? Did we ever? I took a little trip to the Twin Cities where I met Sarah Louise Butler. When Sarah was in her 20s, she worked with students in a K-12 after-school program.

She kickbox twice a week and walked a few miles every day. Basically, Sarah was on her feet a lot. But around the age of 25, she started noticing some changes in her box. I felt that my feet were starting to tighten and swell and hurt when I walked, and then slowly my hand started to swell and hurt. Then it went to shoulders, knees, hips, jaw, neck, back. Sarah was diagnosed with rheumatoid arthritis, or RA, which is an autoimmune disease that can cause chronic joint pain. Sarah describes it kind of like having a sharp pebble in your shoe all the time. That sounds terrible. I mean, what did her doctors say? Was there a medicine that could help her? Yeah, so Sarah started to take the drug methotrexate in pill form. It's a really common treatment for R.A.

And I understand it's also a really important treatment for certain types of cancer, right, Eli? Yeah, Andy. Methotrexate is a jack of all trades. We use it for lots of autoimmune conditions like RA, but also things like severe psoriasis. Then there are the cancers, leukemia, osteosarcoma, non-Hodgkins lymphoma. There are other conditions, too, like in ectopic pregnancies, methotrexate can stop cells from multiplying outside the uterus. The drug can literally and very quickly be life-saving. Sarah's taking this jack-of-all-trades pill once a week, and it worked for about 13 years,

but she and her doctor decided to switch over to the injectable form of methotrexate in 2018. Okay, Eli, could you break down for us why someone might use the injectable form of this medicine versus a pill? It's hard to know exactly the reasons in her case without talking to her doctor or going through all of our files. But one common reason would be to make sure that our body is getting the full dose it needs. That's because in some cases, a person's gut can struggle to absorb a given drug. It's also possible she had GI side effects that are common with methotrexate. Yeah, well, after she made that switch, it didn't take a little. long before Sarah found herself staring down drug shortages.

Sarah noticed that sometimes her local pharmacy wouldn't have the exact dose or form of metatrexate she needed. And then the pandemic hit. And the whole world, including supply chains, hospitals, pharmacies, was thrown into COVID chaos. And she started having a tough time, not just getting metatrexate, but even getting the needles she needed to inject it. I moved to different drug stores. I gave up on the mail order system. I felt like I was shop. and it would always say unavailable or my favorite is on back order. That's my favorite one because like, all right, well, it's not a pair of pants. Sarah even ran out of metatrexate a few times.

And this scramble for every dose stretched beyond the very worst of the pandemic. It went on for about a year. Sarah said it started to feel like a part-time job. I did break down and I was on the phone with Walgreens at the time. And I told the lady, I said, I'm really sorry. I don't normally cry about my health issues. But this is breaking me. Finally, Sarah and her doctor decided the stress just wasn't worth it anymore.

She started on another drug called Simzia, which has been working great and has been easy to get. But there's one big difference from injectable metatrexate. It's $7,400 a month for two doses. So I think I'm pretty sure I would have. stayed on methotrexate because of the cost. I mean, it was $20 a month for me out of my pocket. Wait, what? It was a more than $7,000 difference? $7,000. Now, Sarah's insurance will pick up most of that bill. Plus, she gets a stipend from the manufacturer to help with the rest, but she told us it was still a roughly $50 per month

difference for out-of-pocket cost between simsia and metathexate. And now she's in a tough place. Because, you know, if something happens and her insurance falls off, well, she could find herself on the hook for that $7,000 bill overnight. If they're both used to treat conditions like Sarah's and they both work, why exactly is one so much more expensive than the other, though? Yeah. Well, methotrexate is a generic drug. Those tend to be older drugs whose patents have expired, which means that multiple drug companies can make the product. They're supposed to work pretty much the same way as brand names, but they're cheaper. they make up about 90% of prescriptions filled in the U.S. In some cases, like for my 3 AM patients the other night, it's pretty straightforward to sub one mid in for another.

It's kind of like Coke and Pepsi at the vending machine. You get whichever one they have. But in some cases, this doesn't fly. The generic equivalent may not work well against a specific cell type, for example, or it may not work well in a certain small corner of the body. By the time you're getting to Dr. Pepper, to say nothing of A&T, or brisk, you're pretty far away from the Pepsi that you started with. And for some cells, John, it's Pepsi or nothing.

But for patients like Sarah, who relied on that generic drug, finding that cheaper alternative was clearly no easy to ask, which left her with quite a few questions. I would like to know how did they get behind or how are their analytics so off that they can't produce enough. Turns out Sarah's questions were our questions, too, and we set off to get some answers. Okay, so tell me why was methotrexate so much harder to find consistently? Well, injectable metatrexate is a generic sterile injectable, which is pretty much exactly what it sounds like, generic injections. The FDA studied 163 drugs that went into shortage between 2013 and 2017. generic sterile injectables made up about half of that sample.

I spoke to Marta Woshenka, a senior fellow at the Brookings Institution Center on Health Policy in Washington, D.C. The consequences of a production disruption for a brand are so much greater because they're losing a lot of profits. When a generic manufacturer has a disruption in production, their margins are so small, it doesn't have nearly as much of a consequence. An injectable form of metatrexate has been in. in shortage since early last year, but one expert told me that this specific form is kind of a chronically short drug. In addition to what's going on now, she said some form of metatrexate injection has also been in shortage from roughly 2004 to 2008, 2010 to 2015, and 2016 to 2021. Okay, so let me do some math. That means methotrexate has been in shortage for like 16 of the last

20 years? Yeah, just about. And before we get a lot, into why exactly, I think it would be helpful to paint a little picture of how our generic drugs get to us. Basically, pharmaceutical companies like Pfizer or Intas either make or purchase their base ingredients from other manufacturers. These raw materials are called active pharmaceutical ingredients. This API supply chain and much of the drug manufacturing supply chain is spread out across the world. These active ingredients get mixed with water and other buffers and they're tested for stability and sterility. And this is a good place to point out that making these injectable generic drugs is no walk in the park.

Compared to oral pill forms, it's an intense process. There's chemically and equipment-y stuff going on. I mean, these things get injected right into your bloodstream. So there is very little room for error, and rightfully so. The final form, like say a vial of methotrexate, then moves through wholesalers and distributors, and then eventually someone like Sarah gets their medication or doesn't from a pharmacy or a hospital. So where exactly in this process were things going so wrong for injectables like methotrexate? Well, it's kind of a tough thing to pin down exactly, but for an interesting reason,

I spoke to Aaron Fox. She's the Associate Chief Pharmacy Officer at University of Utah Health. We know a lot more about other things that we buy than our medications. The medications are probably the most opaque thing that we spend billions, dollars on in this country. Even when you buy a package of lettuce, a lot of times it'll even list the farm where it was grown. With a medication, you really can have no idea which company made it where it was made. Where a manufacturer gets its active ingredients, where a final drug is made, and what exactly might be going wrong are kind of mysterious. A lot of the information is often protected as proprietary. Manufacturers are required by statute to tell the FDA if there's going to be a

shortage six months in advance or as soon as they know after that. But even once they tell the FDA, the agency might choose to work with them behind the scenes to resolve the shortage before making that information public. I mean, the FDA's goal is understandably to avoid a shortage situation. That makes good sense, of course. Indy, did you find anyone who could tell you why and how these shortages actually happen? Yes. I talked to Val Jensen, the associate director for drug shortages at the FDA. She's an expert on what's required of manufacturers when it comes to shortages and what isn't required.

The requirement is really that the company needs to report when there's a manufacturing interruption that could lead to a disruption in supply. So that's really their only requirement. They're also supposed to let us know what they expect to be the duration of the supply interruption. Val told me that manufacturers report the broad reasons behind a shortage to the FDA. through email or a form that allows them to kind of check boxes and say things like requirements related to manufacturing or demand increase. But the granular specifics behind those reasons, you know, if it's a contaminated supply line or what have you, aren't always shared publicly.

And it's also important to remember here that the FDA can't just tell a manufacturer to make more of something in a shortage situation. Okay. Then so what's the reason being given for this metatrexate shortage. So injectable metatrexate is made by several different companies, including Accord Health Care, Inc. As of this month, it looks like they do have some supply available, according to the FDA shortage database, but the original reason listed for the shortage was requirements related to good manufacturing practices. Some of the other manufacturers of injectable metatrexate are listed as having it in shortage because of delays in shipping or demand increase. Now, Accord is a subsidiary of Intos, which is a big global pharmaceutical manufacturer.

It's tough to say where geographically exactly they or any company really is making injectable metatrexate, but the FDA issued at least two warning letters to Intas last summer and last fall, in which the agency summarized a series of violations at facilities in India, missing data, destroyed records in trash bags, employees altering the time that an operation was performed, just kind of a serious hot mess. From their side, we heard from a rep with accord who said since those inspections, they've, quote, implemented a broad range of remediation efforts, unquote. They say they've been looking closely at quality and culture and working with the FDA to release important product. But zooming out, an FDA analysis of 163 drugs that went into shortage between 2013 and 2017 found that manufacturing or quality problems were the reason behind about 60% of those supply disruptions.

Why exactly are so many things going wrong? I mean, you'd think we'd have found a way to guarantee quality in our drug manufacturing process, right? Totally. It's a million dollar question, but I'll let Marta from Brookings summarize it. A lot of the shortages that we currently see, especially around generic sterile injectable drugs, are, in a sense, a self-inflicted wound because we are allowing the market forces to work in a way that, that unfortunately undermines the reliability of the system. Okay, so what exactly does she mean by market forces? Well, like we said earlier, generic drugs are supposed to be pretty much exchangeable for each other. And the way Marta describes it, it basically boils down to one factor. So when a hospital is buying a generic drug, really the only thing that will matter to them is the price.

So health systems want low prices. And there are what you can think of as these sort of middlemen entities that negotiate these low prices on their behalf, working between manufacturers, insurers, wholesalers, and the final purchaser. Which leads to, as one expert put it, purchaser sometimes paying less for a vial of a drug than a cup of coffee. And that sounds like a good thing that, you know, drugs are cheap, but that also means there's intense low price competition. And that also might mean manufacturers are looking to cut costs. This downward pressure in generic drug pricing was described to me as the race to the bottom. Which sounds like kind of bad news for these complex drugs. Yeah, exactly. I mean, generic sterile injectables like methotrexate are not easy to make.

Okay, so even though someone like Sarah, who we met earlier, is scrambling for this basic medication, because this drug doesn't make much money for companies, there's not much incentive to make it or even to keep up the infrastructure to make it. Yeah, pretty much. And that combination, of low margins plus an intense manufacturing process also means that one manufacturer can really dominate the market. Like setting up a factory and getting in the game is not an easy task. So when a supply line goes down, it can rock the whole system. And we've seen that outside of manufacturing issues too, you know, with natural disasters, like that Pfizer plant that got hit by a tornado last year or the plant in Puerto Rico that was damaged by Hurricane Maria. And because there's not a lot of

like public-facing transparency around these very complex supply chains and who actually dominates them, it's hard for the average person to know just how rocked they might get. We have to take a break, and coming up next, we'll look at how even basic antibiotics got tangled up in this drug shortage problem. This is Science Friday. I'm John Dankosky. Today on the program, we're taking an in-depth look at the problem of drug shortages in the U.S. and what policies might be needed to solve this problem with journalists Indykara and Eli Kahan. Now, we've been talking about how very important generic drugs like methotrexate are in short supply

because of a complex global production chain and minimal incentives for drug makers to increase that supply. What this means is there are a record-breaking 323 drugs that are hard to get right now, and this list includes some of the most widely used drugs, antibiotics. So you looked at this, Indy, how on earth did antibiotics run out? It's a very good question. We focused on penicillin for this story. And the reasons that we can't get penicillin are a bit different than the reasons we can't get methotrexate. Okay, I'm listening.

So this shortage is hitting a specific form of penicillin called bicillin L.A. Bicillin is also an injectable. I learned that people in the military have to get it during basic training. And it hurts. A rep with Pfizer told me that. it's nicknamed the peanut butter shot because it's so thick and goofy. I know. It's also an old drug.

I mean, penicillin was hugely important in World War II. But unlike methotrexate, there is one main manufacturer of bisillin, L.A. that I could find. And that's Pfizer. Oh, I know those guys. They're the ones that made by COVID shot. Yeah. It seems like the problem here might be that there's just one manufacturer being in charge of this important supply, right?

Yeah, you're totally right. Of all the drug categories, antibiotic manufacturing is notoriously intense. So even though bicillin is old and presumably loads of folks could produce it and produce it well, the incentives to get in the game just aren't really there. So it's Pfizer and Pfizer alone. That sounds, I don't know, not ideal. Not ideal. But here's the really interesting thing. Bicillin is listed as being in shortage because of demand increase for the drug.

But see, when I think about demand increases for drugs, I'm thinking about things I see ads for of drugs like OZempe. Yeah, right. I did too before I started reporting on this story. What I've learned, though, is that there's a qualitative difference between, you know, drugs like OZempic and others like Bicillin. Ozepic is a brand name drug, meaning it's hugely profitable. And thanks to that profitability, it comes with the playbook. Discover the Ozempic TriZone. Oh, Ombic.

I got the power of three. You know, like expensive marketing campaigns, commercials, catchy jingles, the whole ask your doctor about OZempic schick. Yeah, and I haven't exactly been seeing splashy ads for bicillin on the television. So where exactly is this boom in demand for an 80-year-old antibiotic coming from? Well, part of it is in response to how shortages are impacting other drugs. In fact, this whole thing kind of kicked off with the triple-demic. Remember that germy wave of COVID, flu, and RSV? Well, the combo of so many people ending up at the doctor's office, paired with some similar manufacturing challenges as we laid out earlier, exacerbated a shortage in another antibiotic, a moxacininin that often gets prescribed to kids for all kinds of respiratory issues.

So in response to that, by Cillin, L.A. started getting prescribed to treat things it would have been used for, like, say, strep throat. So these antibiotic shortages are connected? Yes. It's sort of like when a sprinter injures their left left. and then changes the way they run to favor the injured leg and then injures their right leg because their new running technique is faulty. And that's not just an antibiotic thing, by the way. This happens with other drugs. Okay, but I'm guessing it would take a lot of strep throat to create an entire shortage, right?

A lot. But this is not just about strep. It's also about, of all things, syphilis. Syphilis? Huh. So as in the sexually transmitted infection? That syphilis. Yeah. infection rates have skyrocketed and bicillin LA is the first line treatment for it.

That is especially true in pregnant people with syphilis, for whom other antibiotics can have extremely dangerous side effects. Bicillin L.A. is their only safe treatment and it's particularly critical right now. Between 2012 and 2022, the number of babies born in the U.S. with syphilis went up from about 300 to almost 4,000. Wait, so hold it. The shortages are actually impacting our ability to get our arms around the syphilis problem? Yeah, that's exactly right. You know, you pair what's going on with a dwindling supply of bicillin, and it's bad news. Pfizer confirmed that in early 2023, there was a roughly 70% increase in demand for bicillin, L.A., compared to historical rates. That's really bad. Yeah, and to make things even worse, the infection is disproportionately impacting the most vulnerable.

communities. CDC data found that babies born to black, Hispanic, and native mothers were up to eight times more likely to have newborn syphilis in 2021 than those born to white mothers. As one doctor put it when I was reporting on this, it demonstrates how we let the same communities down over and over again. And what's horrible about this is that syphilis is pretty much entirely treatable if it's identified and managed early enough. It's a hugely complicated issue of health equity that's then made even worse by a drug shortage. Okay, so this might be a silly question, but penicillin is such an old drug, Indy, and even amoxicillin feels so basic. Why can't we just make more of it? It's not a silly question at all, and it was one of my core questions, too. I asked Marta, the health policy

expert and someone with Pfizer, and they both explained that manufacturing antibiotics is, I mean, you can probably guess what I'm going to say next. It's complicated, right? You guys. It's got it. Marta even said that in certain cases, the antibiotic needs to be made in a totally separate warehouse or room than other drugs to keep it safe from contamination. It's an industrially intensive process, and so escalating production is no easy to ask and can take a serious amount of time. Yeah, that makes sense. So how have hospitals been responding to these shortages? Yeah, well, the FDA temporarily approved the import of a form of penicillin called extensalin, which is marketed by a French company. and Pfizer says they've dramatically ramped up their bicillin production. I've done some reporting on congenital syphilis in Illinois, which is where I live, and it's worth noting that some of the clinicians and public health officials I spoke to

actually hadn't had a terrible time locating bicillin, which brings me to another important point on shortages, which is that different health systems based on things like resources, staff, and who they purchase their drugs from can have vastly different responses to drug shortages. Okay, well, as bad as that is, I know that the, there's one more drug you guys took a deep dive into in India. I'd like to bring back your colleague, Eli Kahan. So Eli, you're a doctor and you have a story that's really hitting some of your colleagues pretty hard. Yeah, John. And as heartbreaking as the stories we heard related to

methotrexate and penicillin were, this is the one that really did us in because it's about kids and specifically kids with cancer. Maybe you've heard this ad. What if cancer wasn't a part of me? What if my only tests were at? school. What if my body wasn't a battlefield? What if I could have my old life back? What if I could just go home? The drug that many of these kids need is called vintblasting. It's a form of chemotherapy used for children diagnosed with Hodgkin's lymphoma, which is the most common cancer in kids aged 15 through 19 years. Ever since it became the standard of care for treatment of Hodgkins, outcomes have improved immensely.

But it, too, has been short since September. To get a better sense of how bad they've been lasting shortages have been, we spoke with a bunch of pediatric oncologists. You know, those people who treat kids with cancer. It's an impossible job. But they say amid the shortages, it's a job that's only gotten harder. Here's Dr. Michael Link, a pediatric oncologist at Stanford University. Generally, we tell them it's a miss, but it'll get back to normal,

and your kid will be cured, hopefully at the end of it. That's the light at the end of the tunnel. But here, on top of all of this is, my God, I don't even know if my kid can get the drug that is needed to cure them. I spent months around these doctors, John. They're unflappable. You cannot phase them. These kids on the oncology service, they're so sick

or even worse, they're pretty healthy on the outside, at least. And then chemo. You start chemo and these kids, innocent toddlers, earnest, preteens, sassy teenagers, they become shells of themselves. I've always been struck by how poise these doctors are. And how couldn't you be? You're delivering life-altering news day and day out. You're the person injecting the chemo into an eight-year-old spine that makes their hair fall out. It's all to say, day after day, these doctors are having the hardest conversations you can imagine. Day after day, they do it with the most unfathomable professionalism and grace.

It was only when we started talking about the shortages that we saw them lose their cool, because honestly, they're frustrated. These drugs are the backbones of proven and life-saving regimens, not only for kids with cancer, mind you, but for adults as well. But driving this point home is we don't have an alternative. That's Dr. Yoram Nguru, a pediatric oncologist at the Children's Hospital at Sinai in Baltimore. The shortages, they are omnipresent. They smolder along.

Now, like we've had, another times, it's a five-alarm fire. They never go away. From 2009 to 2019, nine of the 11 drugs used to treat a form of childhood cancer called acute lymphoblastic leukemia or in and out of shortage. So smoldering along is right. I'm talking with reporters Eli Kahan and Indy Kara about this drug shortage problem in the U.S. So, Indy, you've been down this rabbit hole now for months. Are some people working to solve this mess?

Yes. The good news is that there's actually been, I think, quite a bit of recent movement and attention on this front. So one of the big solutions I've heard brought up is advancing manufacturing. Like, is there a way to update some of these manufacturing lines? Marta Woshenka, the policy expert from the Brookings Institution we heard from earlier, made a really important point on this front. There is no free launch. The reason why we have this problem is because nobody's really willing to spend the money on resilience for our supply chains. She emphasized that advancing manufacturing is not just going to magically happen for free. Someone is going to have to pay for it.

In a 2023 paper, Marta and her co-author Richard G. Frank proposed the possibility of entities like the U.S. Department of Health and Human Services, aka HHS, offering loans to manufacturers to advance infrastructure. They proposed about $2 billion, which isn't that much in the grand scheme of things. In that vein in November, the Biden administration gave a green light to HHS to examine the supply chain and invest $35 million into domestic manufacturing of key starting ingredients for injectables. We also talked about how companies don't make a ton of money off of making generic drugs. So I see how getting money for these advancements would be kind of tough. Are there any ways to raise these margins at all?

Yeah, it would be a big task, but it's sort of a deep root solution that Marta has done a lot of research into. In her testimony for the Senate Finance Committee, she described how the Centers for Medicare and Medicaid services, which reimburse hospitals for drugs, could encourage purchasers to place more weight on reliability over just price when they're buying drugs. And that responsibility wouldn't just rest with hospitals, but also middle players in the supply chain, who, who negotiate drug prices and tend to have quite a bit of information about what is going on with manufacturers. The Senate Finance Committee released bipartisan draft legislation earlier this year focused on specifically addressing how these middlemen might also be involved in shortages. Lawmakers suggested some changes to current contracting practices, like having minimum three-year contracts with manufacturers of high-shortage drugs, basically just ways to make

sure that price negotiation is going fairly and not driving shortages. Sort of lightening some of that pressure for that race to the bottom we talked about. Precisely. HHS also released a big white paper in April, highlighting some of the steps they've taken or think would be important since the administration's big announcement last year. They established a new supply chain and shortage coordinator job and described a way to score manufacturers based on how reliable they are. They could then use those scores to incentivize, or penalize hospitals based on where they're getting their drugs from. And like we just talked about, the hospitals would rely on the sort of middle entities to help them assess that reliability. But in order for anyone to get a true sense, they need information about the supply chain. And to do that, I'm going to guess we need to unlock some of those trade secrets we talked about earlier. To score reliability, we need to know where materials and ingredients are coming from. That's a big key to rearranging our incentive system. Now, XVI's. Experts I spoke to did make the important point that just having information out there doesn't mean it's going to be used responsibly or be useful.

It could incite panic buying and hoarding. And just knowing that someone is less reliable than someone else without actually acting on it is kind of meh. So there needs to be intention with that transparency. Precisely. Some potential legislative proposals brought up in the HHS report include requiring that manufacturers disclose all their suppliers to the FDA and share how reliant they are on those supplies. liars so the agency can jump in more quickly on quality problems. What's happening outside of government to try to solve this problem? Yeah, so another organization to note is Civica RX.

They're a non-profit pharmaceutical company that was specifically designed to try and prevent drug shortages. And you might have heard of Mark Cuban's company, Cost Plus Drugs, which is trying to make sure everyone has access to affordable medicines. Angels for Change is also a great organization that advocates for supply chain resiliency and also directly for patients impacted by drug shortages. It was actually started after the founder's daughter couldn't get the cancer drugs she needed. So there's policy solutions and outside solutions.

But as Dr. Unguru and countless other experts put it, this thing will just kind of keep smoldering along until we take some big swings. Okay, coming back to where we started, how is Sarah the patient you spoke with earlier reflecting on some solutions and her experience, now the things have settled down for her a bit. Sarah seemed happy to have the worst of it behind her, but couldn't help but think about everyone who might not. You know, I think about people who didn't have the time like I did to make those calls.

Maybe they had two jobs, kids. Like, what do they do to shop around and try to find this? I am on top of my treatment plan, and I just feel horrible for the people who cannot. spend that time shopping for a very inexpensive drug. Eli and India, I'd like to thank you so much for your reporting on this. Thank you for having us. Thanks so much, Sean.

Eli Kahan is a journalist and physician in Boston. Indy Kara is a freelance journalist based in Chicago. If you'd like to learn more about how drug shortages happen in the U.S., you can go to ScienceFriday.com slash drug shortage. There are a lot of people who help to make the show happen, including Sandy Roberts George Harper Annie Niro

Jason Rosenberg Coming up on tomorrow's episode We'll round up the week's science news Our very own Charles Bergquist will be here So I know we're going to be going to space Hope you can join us I'm John Dankoski I'm John Dankoski