A critical drug that serves as the backbone of treatment for most childhood cancers, including leukemias, lymphomas and brain tumors, has become increasingly scarce, and doctors are warning that they may soon be forced to consider rationing doses.Could there, I wondered, have been recent blight of the periwinkle plant (Vinca), whose toxic alkaloids are used for the drug's manufacture?
Persistent shortages of certain drugs and medical supplies have plagued the United States for years, but physicians say the loss of this medication, vincristine, is uniquely problematic, as there is no appropriate substitute.
No. The only blight in play is on the moral compass of Big Pharma, whose ultimate aim is not to cure diseases, but to bloat their stock prices, enrich their investors and reward their CEOs, both with outrageous salaries and golden parachutes when they retire.
Of course, the Times puts it a bit more delicately than that, only noting that Trump's Food and Drug Administration tersely announced that Teva, the drug's manufacturer, had made a "business decision" last July to stop manufacturing vincristine. The only remaining manufacturer is Pfizer, which is experiencing some vague "manufacturing troubles" of its own and can't keep up with demand.
There are shortages not only of vincristine, but also of about 200 other drugs, including standard antibiotics and injectable vaccines, including the one for rabies. The generic vincristine is the gold standard of treatment for pediatric cancers, including for lymphoblastomic leukemia (which currently has an 85 percent cure rate) along with lymphomas and brain and kidney tumors.
The oncologists interviewed for the Times article describe themselves as terrified at the looming "nightmare situation" of rationing medication, reducing dosages, or even facing a "Sophie's Choice" of which children will be treated and which children will simply be allowed to die.
This situation is not new. In a 2013 survey run by the New England Journal of Medicine, 83 percent of oncologists reported they had been unable to prescribe their first-choice chemotherapy drugs because of shortages, and either had to prescribe less effective alternatives or delay treatment.
What the Times doesn't report about Teva, the Israel-based multinational generic drug company that so abruptly stopped manufacturing Vincristine, is that it is also one of the six major firms now facing billions of dollars in liabilities because of its very lucrative and possibly criminal involvement in the manufacture of opioids for worldwide distribution.
Although Teva refused to comment to the Times about so heartlessly leaving kids with cancer in the lurch, you wouldn't know from its glossy glitzy website that it even had a problem. It brags to potential investors that its idea of helping patients is practically unique among other providers of life-saving medicines. (Because it stresses the money-saving over the life-saving aspects?) While it also correctly points to having left its "unique footprint" on world markets, what it modestly omits is that this footprint is literally crushing the life and the hope out of thousands of young cancer patients and their families:
As the world’s leading provider of generic pharmaceuticals, Teva’s medicines help patients and consumers in a way that few other companies can.Teva produces 120 billion tablets and capsules a year in 70 pharmaceutical and API facilities around the world. Teva has a leadership position (top 3) in 25 markets globally. The scale and breadth of our generics portfolio has an unprecedented impact on global healthcare. Teva’s exceptional integration of generics and specialty R&D enables us to generate a robust pipeline of high-value medicines, with an emphasis on complex and branded generics. Our R&D capabilities have expanded beyond tablets, capsules, liquids, ointments and creams to a broad range of effective dosage forms and delivery systems.Teva has a unique understanding of - and footprint in - world markets, where our generic medicines are tailored to the needs of local patients, physicians and consumers. We also have an unparalleled ability to partner in commercializing generic products. Building on a remarkable track record of achievement, Teva continues to pursue a rich future in generics as we focus on patient needs, improving compliance, convenience, efficacy and safety, and providing affordable generic products to patients and society worldwide.
The worst-case scenario for drug companies may not be the cost of lawsuits. In August, Morgan Stanley analysts argued that the opioid settlements could present an opportunity for e-commerce giant Amazon.com Inc to steamroll its way into the market as it's done in other areas. "If distributors face increased regulation as a byproduct of any settlement, the cost of doing business would go up, making it easier for a fourth competitor such as Amazon to enter the marketplace, " wrote analyst Ricky Goldwasser.
So I hope that when the Democratic candidates are asked to dish on one another's scandals at tonight's "debate," Bernie Sanders will pipe up and again point to the real scandal of how our greedy, for-profit, market-based health care delivery systems are literally killing the same people who they merely pretend to help.
We have a choice: Medicare For All, or the prospect of having Alexa administer your child's chemo at the sweltering Amazon Fulfillment Center nearest you.