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Check This Gift Horse Carefully
By Mary Ann Malloy, MD

On January 29, President George W.  Bush announced a plan for government aid to go to religious groups providing social services.  The White House Office of Faith-Based and Community Initiatives will coordinate the program through five federal agencies.  The plan sounds great!  Worthy religious groups will have increased funding to carry out their individual programs.  The government, as a gracious benefactor, will provide money and the needy will be better served.

Wait!  Examine this proposal carefully.  Look at the track record of the gracious benefactor.  The largest social program the government has been involved in recently is Medicare.  The support received under the Medicare Program has often resulted in reduced or inadequate levels of care, monitored by a government bureaucracy with little or no practical medical expertise.  Accounts and statisticians have often controlled the medical decisions.

The Medicare Program began by simply paying a major portion of an eligible patient's medical bills for needed services.  It has evolved into determining what services the patient should have and when they should have them and what they are worth.  

Those providing the medical care are bound by voluminous government regulations that are updated and added to regularly.  These updates usually involve services being deleted or delayed and payments decreased.  Penalties for noncompliance are substantial.  Hospitals have to add large numbers of employees to facilitate and document their compliance with the government rules.  Medicare fees are often not sufficient to fund teaching programs and medical training  opportunities have to be decreased.

As the Medicare Program has grown, medical institutions have become dependent on the funding.  If they do not receive Medicare approval, their whole program can fail, not just the part actually receiving the Medicare payments.

Examine the Medicare track record carefully before embracing this new government funding for social service.  This is one gift horse that could swallow you!

Drug Shortages
By Mary Ann Malloy, MD

Vaccines, antibiotics, seizure medications.  Suddenly we're hearing about unavailable drugs in all these categories and more.  It would seem these shortages would be happening in a third world country, but they're right here in the United States.

Just last night an emergency room physician called about one of my patients.  He said, "Don't order Compazine for her because we've been out of it all week."  Compazine is a long used, effective medication for nausea that is also available in a less expensive generic form.  The drug shortages suddenly became very real to me. 

The shortage of tetanus vaccine is puzzling and disheartening.  The adult tetanus shot demand is predictable since it is basically recommended once every 10 years.  The need for it, theoretically, doesn't fluctuate.  What happened?  One drug company suddenly stopped making it for, "business reasons."  Tetanus vaccine takes 11 months to produce, so now  with another company taking up the slack, there is a delay in getting the vaccine to market.

Many factors have been blamed for the drug shortages.  Fewer companies now make the same drug, smaller hospital inventories may play a role and stricter FDA controls also are offered as an excuse.  However, one disheartening fact stands out.  The shortages almost always involve older, less profitable medications that have long since fallen from the marketing spotlight.

Drug manufacturers often spend millions on a single drug, both in direct consumer marketing and marketing to medical professionals.  Their marketing budgets can, and often do, equal their research budgets.  Direct-to-consumer marketing of a single drug can run over $100 million in a year.  So far, I am not aware of any one of these highly profitable, top-of-the-line drugs in the market spotlight running short for even a day.

Patients have a right to be able to obtain the drugs they need and depend on at all times.  One solution might be to divert part of the huge marketing budget to continue producing less profitable vital medications.  If these drug shortages continue to multiply, manufacturers may be forced to accept outside government regulations.