National shortages force hospitals to routinely ration drugs, but the decisions about who gets the drugs have led to "contradictory conclusions, murky ethical reasoning and medically questionable practices," the New York Times reported.
According to the paper, formal committees that include medical ethicists and patient representatives made the decisions, but in others doctors, pharmacists and drug company executives are responsible for rationing. More than 150 drugs and therapeutics are currently listed as in short supply, according to the newspaper.
Decisions on who gets scarce drugs hinge on factors including a patient's age, weight and whether they're participating in clinical trials, the Times reported. Holding back drugs has been shown to cause patients more pain or nausea, to force doctors to perform surgery, and result in medication errors, disease progression and death, according to the article.
Shortages can result from production or safety problems with manufacturers as well as regulatory issues. Hospitals play a role too, with major medical centers more likely to have needed drugs, and how well they find and hoard drugs, according to the paper.
In response to the ethical issues arising from drug shortages, the cancer research organization Children's Oncology Group (CGO) developed a framework for handling drug shortages that threaten children with cancer. The framework was published Jan. 29 by JNCI: Journal of the National Cancer Institute.
"This is a problem almost exclusively impacting children in the United States and not other developed countries," CGO Chairman Peter Adamson, M.D., said in an announcement. "The problem should be preventable, but will require the government to take additional steps to address the fundamental causes of these shortages."
FierceHealthcare previously reported that drug shortages in emergency departments have increased more than fourfold since 2008, with more than half of the shortages involving life-saving drugs.
The Government Accountability Office (GAO) had warned in 2014 that providers might need to "ration care or rely on less effective drugs" because of drug shortages. GAO said the Food and Drug Administration needed to improve its control over drug-shortage data and conduct regular analyses to proactively identify drug-shortage risk factors.