Drug shortages create ethical quandaries for doctors

By Matt Kuhrt

Public awareness about drug shortages has stemmed from the agonizing ethical decisions such shortfalls have forced doctors to make, according to an article in The New York Times.

In an interview with PBS NewsHour, Sheri Fink, M.D., author of the Times article, links the difficulty of solving the shortage to the variety of its causes, including economic and regulatory pressures. In the case of a drug requiring specialized manufacturing processes, for example, an issue with a single production facility can have profound consequences in the supply chain.

Responses to pharmaceutical shortages have varied throughout the industry, with some health systems taking a more proactive approach than others. Likewise, drug manufacturers themselves take differing approaches, with some rationing their supply on a first-come, first-served basis and others coordinating with physicians to determine the best way to distribute their limited supply, according to the article.

More often than not, the bottom line for physicians has been a series of difficult ethical choices involving not only who should get treatment, but which patients even get told about the shortages, according to Peter Adamson, M.D., leader of the Children's Oncology Group. "We've been forced into what we think is a highly unethical corner," he said.

As difficult as it may be to provide such information to patients, Fink cites studies that show they would prefer to know what's going on. Adamson's group also advises that doctors establish guidelines for distributing drugs in short supply and make allocation decisions publicly.

Finally, public pressure may be necessary for a more comprehensive response than what Nicole Lurie, M.D., the federal health official in charge of emergency preparedness and response, described to the NYT as a variety of entities "doing their best to patch together their own guidelines, if they're doing anything at all."

To learn more:
- read the New York Times article
- check out the interview on PBS NewsHour

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