Nationwide Drug Shortages Hit WAY Too Close To Home: The Curious Case of Vincristine

Roughly a year ago, media outlets began covering the news of widespread chemotherapy drug shortages in the United States. At least one of driving interests in this news was the fact that these shortages are disproportionately impacting children and women. One of these drugs, vincristine (a.k.a. oncovin), is among the most frequently short-supplied chemotherapy agents, and is used prolifically in the treatment of leukemia and other blood-related cancers. You think about this and, certainly, anyone with a pulse would be moved to empathy, but probably in a quite disconnected way. You just don't realize how important a regular supply of these drugs is until, like the situation I found myself in during my third round of treatment, the pharmacist informs you that one of your life-saving drugs is not available. Of the four days I was in treatment, they had on hand enough vincristine for two days.

Of course I've explained that I'm a social statistician, so immediately my mind went to thoughts of whether the regimen would be effective with vincristine administered only half the time. Miraculously, and due in no small part to the vigilance and dedication of my healthcare team, they were able to locate enough vincristine for me to receive it the whole time. And you would think I'd be happy, but in fact, I was quite disturbed by this. It's all basic economics: if I get a drug in short supply, then someone else who also needs it is probably not going to get it. This is a cruel and utterly avoidable dilemma that oncology finds itself in, here in the United States.

Additionally, the public's understanding of this crisis is quite complicated. The Institute for Safe Medication Practices, for example, has extensively researched this issue and has found that despite the fact that shortages impact as many as 1-in-4 of all cancer patients, that most people fundamentally don't understand the reasons why drug shortages occur. A fantastic article in the New England Journal of Medicine, however, elucidated the issue quite directly: it's all about money. Vincristine, for example, is made from a simple flower, so there is no real medical reason as to why it should be in short supply. Simply put, drug companies have difficulty making the profit margins they would like off of drugs that are essentially naturally-occurring compounds; so... what they do, in effect, is stop making them from time to time so they can drive up the cost of the available supply. For all the sacrosanctness of "American exceptionalism," which by the way I largely agree with, it's just plain disgusting that we value profits over peoples' lives in something as literally life-or-death as cancer treatment.

It's difficult to say what can be done about this, especially given the enormous power of BigPharma; but change, as it were, has almost always occurred at the grassroots level. Some believe, as I think is a valid analysis, that the plain reality that people are dying so a few companies can make a buck will eventually catalyze a healthcare-centered solution to this problem. I certainly hope so, because most attempts to deal with this issue, to date, have been unsuccessful. The free market is a wonderful thing, and it has certainly driven the American economy to great riches; it also has NO place involving itself in decisions about whether or not people live. Please support organizations like Stop Drug Shortages so we can put an end to this atrocity now.

Sit Down for This One, Cuz' It Might Make Ya Faint...

I have been very, very lucky so far. Because my white cell counts have been normal, I have not required any supportive care, but just mention the words "supportive care" to an experienced cancer patient and she is likely to cringe. This is because "supportive care" is just a fancy way of saying, "you need to get Neupogen or Neulasta." No, we don't cringe because it is given in syringe form, nor because it hurts, nor because it has any particular side effects; rather, we cringe because Neupogen costs $3,000.00 PER INJECTION! It gets worse: Neulasta costs more than twice that. The decision between the two is a consideration of your particular progress and exactly how compromised your counts might be. Chemo wreaks havoc on your immune system and if your counts get too low, you might require the more costly injection, which involves a larger molecule of the main active ingredient, filgrastim, thus allowing the body to process it over a longer period of time. Either way, you're stuck up the proverbial estuary, without means of locomotion. And don't think insurance gets you off. Mine and many other plans are not exactly crazy about the cost of this, so don't be surprised if you get a bill anyway. There is hope, however. If you qualify, at least, a group known as The Safety Net Foundation offers assistance to people who are prescribed medications from the Amgen pharmaceutical company (yes, they have a bit of reputation for way overpricing their drugs). Aside from this, you just have to hope and pray that your counts stay good, and I'd recommend consuming lots of orange juice or other Vitamin C-rich products to give your immune system a hand where you can. For now, this issue remains highly controversial, and I consider myself very lucky to have avoided it so far. Nonetheless, I may have to receive this medication at some point, and I am sympathetic to those who receive it on a regular basis. Consider this: 6 round of chemo X $3,000.00/injection = $18,000 alone! By comparison, adriamycin (a common and powerful anti-cancer drug) costs between $25 and $75 per cycle. Something is majorly wrong here.

A Must-Have for the Technologically-Inclined Chemo Patient

If you are like me, and addicted to your smartphone, you understand the epic battle that occurs between the "need" to have constant access to the world of social media and the reality of a limited phone battery. Aside from this, I normally am on the road several days a week, and it is important for the mental health of my family and friends that my phone be always available. I recently discovered the ZeroLemon battery (I'm not a paid spokesperson), which I can personally attest to being able to keep a phone alive for upwards of three days on a single charge. I believe these are mostly for Samsung/Android devices, but the general sentiment here remains. If you use a smart phone, I recommend purchasing an extended battery so that while you're in the hospital you can enjoy phone access readily and without the frustration of having to find an outlet that works with your IV stand (I hate those things). It's not something you would normally think about, but trust me, it will make treatments (and your life) a lot easier, and almost all of them are very affordable at around $40 or less!

Cancer Awareness: Know Your Color