Recently, Reader’s Digest ran a story on how many prescription drugs are simply not available despite demand. This is partly due to generics undercutting profits, but even the generic drug companies find no profit, but I digress… I’m just wondering, if you’re in the hospital, does your doctor HAVE to tell you that the drug of choice for your condition is not available, so a substitute drug is being used, often of lower quality and/or higher risk of side effects. My brother-in-law is being treated for leukemia, of which there may be many kinds, but the commonly prescribed drug is not working for him and giving him atypical side effects. After reading that article, I just wonder if he’s been given a close substitute. Would we even know?
Just wondering what the SD knowns about this. Is your doctor sworn to be honest to the patient (under the hypocratic oath, for one)?
He is in the hospital? Ask to look at the medical records. Often there are multiple doctors ordering stuff, and nobody bothers telling the patient anything. Good to have a family member involved. M
In my experience, either the patient or his/her advocate should check all hospital-provided drugs carefully. I’ve unfortunately been hospitalized several times and have experienced hospital employees trying to administer (1) meds that conflict with each other (2) meds that are plain out wrong, (3) generics that don’t work, (4) meds that were not necessary.
For example, I asked for an antacid, a simple Tums or similar item. They wanted me to take Prevacid, which is something else entirely. In another instance, the pain meds were not working and my doctor said he was going to prescribe something else. The nurse wanted me to take BOTH the original drug PLUS the new one. Later, at home, I looked up both drugs and found that they should never be given at the same time. (Sorry, I don’t remember now exactly what they were.)
Some (not all) nurses have the “don’t ask questions, just take what I give you” attitude and that really irks me. After my most recent hospitalization, I nearly went postal on the doctors for their poor communication about drugs. And this was in a very highly rated hospital.
Doctors, nurses, and pharmacists are not gods. They are not allowed to force you to accept any specific treatment that you don’t want, assuming you are a rational adult. They can, and do, make mistakes just like any other human being.
Can you check the label? They will absolutely NOT put the wrong name on the label unless they want to lose their butts. That won’t tell you which company made the drug if it’s a generic, but it will tell you whether he’s getting calcium carbonate or lansoprazole (to use **MLS’s **example.)
If it’s a pill or a capsule, head on over to drugs.com. You can use their pill identifierto find out who manufactured it.
In regards to the OP’s question about hospitalized BIL.
When in the hospital you will USUALLY be given generics of most common medicines. In a few cases where a generic may have different effects, (rarer than people seem to believe) he can specify the brand name. This is not really the problem with drugs not being available .
The problem is common drugs not being available AT ALL. Normal Saline , the most common thing in any hospital, was in short supply for months. When a hospital runs out of a drug they don’t tell you " Sorry, ordinarily we would give you morphine for your pain , but we’re out." They give you the next best thing. (Morphine is not a great example, lots of things similar to it.) But your Dr. is under no obligation to tell you about that. He should know if the hospital is out of a medicine he usually prescribes. He will just give you an alternative drug.
I guess the question for the OP is - if there was a drug shortage and your brother-in-law was getting some second-rate treatment because the first-rate isn’t being produced… what would you do with that knowledge?
I would first contact the manufacturer to see if I could obtain it some other way than the local/hospital pharmacy. The answer would probably be no, but you never know what sort of programs they’re running. Sometimes they do keep a stash aside for urgent need, and the squeaky wheel gets the good stuff.
I’d consider a social media or local media campaign to raise awareness of the issue; sometimes the really loudly squeaky wheel gets the good stuff.
I would find out if paying out of pocket might get me the drug, when the insurance company might have stricken it from their list due to cost during the shortage.
I would look for clinical trials being done with the first-rate treatment and see if I could get in one, if the difference between first-rate and second-rate was great.
I would try to find out if the shortage was worldwide or nationwide or just local, and consider moving to where I needed to be to get the best treatment.
I think the OP raises an excellent point, if it’s a little lost there: doctors are free to withhold information because *they *decide that it doesn’t matter or because they don’t know a way around the problem. I think that’s rather bullshit, actually. Whether or not to work harder to try to get something should be my decision, not my doctor’s.
You would not be able to procure the drug direct from the manufacturer. Trust me, I am in drug manufacturing.
The pharmaceutical manufacturing business is a mess right now. It will sort iteslf out, but it will take time. There have been a lot of compliance isses causing manufacturing facilities to go down, some big companies have got out of the business. Much of the infrastructure is old, and the FDA is cracking down, but the capital investment for a pharmaceutical manufacturing facility is staggering.
The profits are in the on-patent drugs. Margins on generics are razor thin, and so if I own a line I can make much more money on the on-patent, so I decide not to make the generic. The margins on the generic won’t support building a line. All this is either driven or exacerbated by the closure of lines as I noted above. The best way to make money on a line is to maximize its utilization (naturally). But with costs going up, the impact of idle lines is greater. That has driven more and more companies to outsource the manufacturing, where the CMO (contract manufacturing organizations) can realize higher utilization rates. But that means much less slack in the system.
Finally, I would never hesitate to take a generic. Generics must prove themselves identical to the name brand. It is conceivable that a generic would fail to match the original, but it would require a really bizarre set of circumstances, such as the efficacy of the active being impacted by an excipient (non-drug component like binders and flavorings). The studies required to get a drug to market are exhaustive, and look for all manner of odd things. Plus, modern analytical techniques are pretty amazing.
For a really interesting overview of all this, google what happened a couple of years ago when Ben Venue Labs (BIG CMO) went down.
It seems to be a world wide problem "Royal Pharmaceutical Society spokesman Neal Patel has told PharmaTimes World News that the government must take action to ensure that patients can access the medicines they need when they need them, after worrying findings of a report indicate that the medicines supply chain is not working and patients are being put at risk."http://www.pharmatimes.com/article/13-12-03/UK_drug_shortages_harming_patients_in_75_of_cases.aspx
On the subject of generics - GPs are told to prescribe medication by its generic name, and hospitals will always source drugs as cheaply as they can.
My mother’s experiences taught me that it is always a good plan to write down what you are told by the hospital doctor. Many times she was able to contradict the nurses when they were about to administer the wrong medication, or when they failed to offer it at all.
I had exactly the same experience when the ward sister, on her evening round, did not give me the powerful antibiotic that was prescribed. This happened three times on different days and I discovered that it was because it was not a drug that they normally used in that ward. Why that meant they didn’t get it for me, I never found out.
I beg to differ. It’s unlikely, but it’s not impossible. I was able to get IM Vit B that way for a patient. I’ve also been able to get things compounded after making a dozen phone calls.
The point is that one shouldn’t take no easily. You may have to take no eventually, but if your doctor or pharmacist doesn’t let you know that there’s a no being said, you have absolutely no chance of getting the preferred treatment. If they at least let you know, there’s a slim chance you (or your nurse) can do something about it.
Saline, as in perfectly ordinary NaCl(aq)? We made this in middle school. Certainly a pharmacist could be trusted to mix up a batch at the desired concentration - or have pharmacists really been reduced to counting pills all day?
There is no functional difference between a generic and a brand name.
There is such a thing as a given pharmaceutical available elsewhere not being on a given hospital’s formulary. This could be for cost-containment or other reasons.
Practices vary by hospital for how to handle it if a clinician orders a drug not on formulary. Occasionally the policy might be to substitute the similar drug which is on formulary automatically; sometimes notification of the clinician is required by policy. Sometimes the ordering system will let the clinician know that a substitution will be made.
Those sorts of substitutions (an antibiotic for a similar one, or similar antacids) are not made for areas where a critical clinical difference exists, such as chemotherapeutic protocols. As a rule of thumb, hospital decisions like this are made by a Pharmacy and Therapeutic Committee in conjunction with hospital clinicians, and the policies are made available openly.
I cannot imagine any clinician “hiding” formulary substitutions from a patient for any reason. For trivial substitutions, it’s equally unlikely for a clinician to feel like she has to actively address them, since they are trivial. For any “drug of choice” that’s not available, I’d expect every clinician to discuss that with a patient, along with the reasons. The Hippocratic Oath really doesn’t have anything to do with anything, except tradition, but it would be an ordinary standard of care to do so, and there is no reason not to do so.
If a generic is not available because it’s not being manufactured, then it’s not available. There isn’t a secret way to get it (unless you find it from someone else’s leftover stock), and I would not trust any source that said they were getting it. You can’t just compound legitimate drugs in your basement.
Unless you are talking about taking medical grade, already-manufactured hypertonic saline and adding it to a medical grade, already-manufactured IV solution such that the final concentration is what was ordered, there is no such thing as a pharmacist “mixing up a batch at the desired concentration.”
Pharmacists do a great deal more than count pills–especially in hospitals where they frequently are involved in direct patient care–but they don’t have a little manufacturing facility where they can make medical grade pharmaceuticals (including “perfectly ordinary NaCl”) de novo from table salt, or something. In general, anything that is “compounded” is done so from medical-grade components already meeting very strict standards. You can’t even use leeches unless they are medical grade leeches.
I can make saline on my stove. And I have, in a pinch, for wound cleansing when there wasn’t any other option. Doesn’t mean it’s going to be sterile enough that I want to put it in my veins.
Endotoxin. Basically bits of dead bacteria. And this scratches the surface. You can kill potentially harmful bacteria by boiling the water, but even dead they can be a problem. The best way to eliminate endotoxin is to prevent microbial contamination in the first place. As an added precaution endotoxin can be deactivated by long dwell times at high, dry temperatures (say 250C for 30-60 minutes), but if your plastic IV bag can’t handle those temperatures that won’t work.
Every input material, every material with contact with every input material, every process step, everything has to be clean in a way that most people really can’t imagine. The floor in a parenteral (injectible) drug manufacturing facility is probably cleaner than most operating tables.
The precautions required to make safe injectible drugs literally fills books. Just because the recipe (i.e., saline) is simple, doesn’t mean that making it safely is simple.
I wouldn’t hesitate to take a generic and I also wouldn’t hesitate to insist on the name brand when the generic obviously isn’t cutting it. We’ve had threads on generics that don’t match the effectiveness of the name brand. It isn’t usual, but it happens. Sometimes it only happens for a few people. Other times it happens enough that doctors watch for it.
In my case I got what amounts to a series of blinded tests because the pills look exactly alike. It was mobic, for arthritis pain. The name brand worked fairly well. The generic, which became available after I had been taking it for awhile, was as effective as aspirin or tylenol. The pharmacy not only made the switch without telling me, they kept occassionally reverting to generic without warning even after I had arranged for the prescription with the name brand - no substitutions.
By about the third day of taking the generics, the pain would be constant and it would take two or three days of taking the name brand to damp it back down. Since the pain was breaking through when I thought I was taking the name brand, I’m pretty sure it wasn’t in my head.
I’ve had a knee replacement since then and don’t have to take anything for pain. And I take generic pills for other things. But if I was still taking mobic, I’d be double-checking the label every time I picked it up and refusing acceptance of the generic.
Jinx, I hope things turn out well for your brother-in-law. Does he have a physician who is overseeing his treatment, in addition to the staff physicians dropping in? That would make it easier to discuss whether or not it was time to try Plan B, no matter what Plan A was.
