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Did You Know The United States Could Have A Prescription Drug Shortage!

 

Stanley Feld M.D.,FACP,MACE

China is determined to present a favorable impression to the world during the Olympic Games. Beijing is extremely polluted. It is desperately trying to decrease the pollution in the city and its surroundings. The pollution could affect the athlete’s performance and health. Many countries have expressed concern.

In order to clean up the air quality for the Olympic Games athletes, Beijing has taken extreme measures shunting down many large commercial plant operations in its vicinity. Many chemical plants in and around Beijing produce ingredients for both generic and brand named drugs. These plants are dirty plants producing significant pollution. The closing of these chemical plants before and after the Olympics will result, at least, in large increases in drug prices globally and, at most ,in life threatening shortages of vital medications throughout the world.

“The expedience of reducing particulate pollution has prompted officials to temporarily shut down chemical production in and around Beijing prior to the Olympics. This crackdown is likely to include pharmaceutical production.”

The Chinese government has been trying to relocate polluting industries and power generating plants away from its large cities. Cleaner plants have already been built in less populated areas. However, the production of particulate matter (microscopic particles toxic to lung tissue) is still twice the admissible level recommended by the World Health Organization. Pollution from particulate matter produces both acute and chronic pulmonary disease. Chinese government officials have temporarily shut down chemical production for two months prior to the Olympics and one month post Olympic Games to decrease particulate matter in the air.

This crackdown affects pharmaceutical production. China is the largest producer in the world of bulk pharmaceuticals known as active pharmaceutical ingredients (API)

“China is the largest producer of bulk pharmaceutical chemicals, also known as active pharmaceutical ingredients (APIs), which are made into drugs that supply the world. With India it supplies 40% of the API used in U.S. pharmaceutical production, an amount predicted to increase to 80% by 2020. China provides at least 20% of the APIs used in making Indian generic drugs, as well as about 75% of the intermediate products Indian firms require to synthesize the final products they sell.”

These APIs are used for the production of both brand named and generic drugs. The U.S. press has not discussed the source of production of U.S. brand named drugs.

“For the next two months Western and Indian companies will find it difficult to import most chemical substances including bulk drugs and intermediates from China. This could prove costly to patients and especially costly for the Indian generics industry, because their companies are so reliant on Chinese inputs.”
The price of APIs has increased at least 50% over the past six months.”

This is putting pressure on the pharmaceutical industry’s profit. The increase in price for APIs has been blamed on the increase in the price of oil as well as the decrease in China’s production. This is certainly going to be reflected in the increase in drug prices shortly at all levels.

“Given that many of China’s bulk API manufacturers operate around Beijing product prices will still increase drastically over the next few weeks as supply is constricted from Beijing alone.”

I predict we are going to see the impact of China’s decreased production on the United States drug supply in the next few weeks. I suspect we are going to see life threatening shortages.

One must wonder about this perverse effect of “globalization” on our ability to deliver appropriate medical care if it results in significant shortages of vital medication.

The other perverse effect of globalization is the inability or lack of desire on the part of multinational companies operating throughout China in joint ventures with the Chinese government to protect the environment of the country to the detriment of its citizens in order to product “cheap” medication for the United States and the rest of the world.

“It is impossible to calculate how many lives will be lost because drug prices are rising,”

It is easy to feel that the wheels are coming off the global economy as indiscretions are being tolerated by government. As these indiscretions are revealed one has to wonder if the present direction of globalization is a good idea.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

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An EMR Comment From A Fellow Physician

Stanley Feld M.D.,FACP,MACE

 

The follow comment is from a good friend and steady reader of Repairing The Healthcare System. It does not matter what policy wonks think. This is a sincere reaction from an excellent physician.

“Hi Stan 

I have thought a lot about EMR from my days in academia to my days in private practice. Based on my hands on experience with computerizing labs I realized that computers work best for essentially mindless, repetitive tasks or tasks that are the same each time, like accumulating, holding, reporting and filing data. It can also deal with machine control, bar code tasks, etc. Any higher order functions (like thinking) is still not workable. That is what makes computerization of cognitive processes so difficult and is probably at the root of why EMR is not practiced more widely. Add to that the punitive action by insurance and gov’t. use or potential use of the data makes EMR a non starter.

If basic patient data (demographics), clinical findings (take your shirt off ma’m or sir), history and treatment could be hooked up with a large data base to guide the physician to make her/him more effective, efficient and better paid, than  it will fly.”

Your grouchy buddy,

B

On Aug 4, 2008

There is no doubt that perception equal reality. It is a barrier that must be overcome. I believe it can be overcome with a universal EMR paid for by the click that will be able to be used by physicians and patients for educational purposes and not for data collection to be used against patients and physicians through the use of inaccurate data making judgments about quality care delivered. Quality care has not been defined accurately at this point in time. Quality care is related to clinical outcomes and monetary outcomes not whether a particular test was done on time. It depends on the participation of both patients and physicians. It does not depend on insurance company and government judgements.

 

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.

  • Patty

    Keep up the good work.

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Most Doctors Aren’t Using Electronic Medical Records: Part 3

 

Stanley Feld M.D.,FACP,MACE

 

The New York Times article presents me with an opportunity to discuss the issue of the adoption of EMR in physician terms. Media reporting tries to be neutral and informative. It usually produces nothing but confusion.

“The report published in the NEJM also found that electronic health records were used by 51 percent of larger practices, with 50 or more doctors.”

The EMR adoption rate by large physician groups of physicians is still low. 49% of large practices still do not have an EMR.

“Indeed, electronic health records are pervasive in the largest integrated medical groups like Kaiser Permanente, the Mayo Clinic, the Cleveland Clinic, University of Pittsburgh Medical Center and others. These integrated groups not only have deep pockets. By combining doctors, clinics, hospitals and often some insurance they can also capture the financial savings from electronic health records.”

A year ago Kaiser Permanente had was embroiled in a scandal concerning its 3 billion dollar investment in information technology system which includes an EMR.

“ In the e-mail, Justen Deal, a project supervisor who has worked for the company for two years, detailed his frustration with Kaiser’s electronic health record system, which he considers inefficient and unreliable.” “Deal was placed on administrative leave.”

We have little information about the effectiveness of Kaiser’s EMR presently yet it is presented as a successful system in the New York Times article.

The promise of an EMR must be realized in the next few years. Only innovative thinking will precipitate the necessary paradigm shift toward EMRs rapid adoption. It must be done quickly before it is too late.

Using an EMR can provide finger tip information to physicians about patients they treat. If set up correctly it can speed up data entry on patients and be a guide to complete data entry for particular diseases. It can serve to improve the quality of clinical decision making by interconnecting to clinical practice guidelines. It can be used to avoid medication errors with the use of e-prescription and can point out potential drug interactions. It can be used as a guide for patient education to prevent the complications of chronic diseases. It can increase productivity of physicians by electronic delivery of laboratory findings. It must be formatted as a physician extender and not a physician substitute.

After a sometime steep learning curve physicians are satisfied with the electronic medical record. The NEJM study was a little exuberant with its statistic reporting that over 80% of the physicians were happy they had an EMR when the EMR was fully functional (3.2%). Not all EMRs in large clinics are fully functional.

The study found that a paltry 4 percent of the doctors had a “fully functional” electronic records system that would allow them to view laboratory data, order prescriptions and help them make clinical decisions, while another 13 percent had more basic systems.

Within a large clinic the electronic medical record should be totally transparent to the physicians across clinical and business functions. Patients can log in and get their records and laboratory results, physicians interpretations and radiological findings immediately and have a PMR (Personal Medical Record). The EMR could also improve communications with other physicians.

Dr. Peter Masucci, a pediatrician with his own office in Everett, Mass., embraced electronic health records to “try to get our practice into the 21st century.”

He could not afford conventional software, and chose a Web-based service from Athenahealth, a company supplying online financial and electronic health record services to doctors’ offices.

There are not many physicians in the United States that would trust their records to be outsourced at this point in time. However with the proper protections web based online electronic medical records could work.

“Dr. Masucci was already using Athenahealth’s outsourced financial service, and less than two years ago adopted the online medical record.”

Today, Dr. Masucci is an enthusiast, talking about the wealth of patient information, drug interaction warnings and guidelines for care, all in the Web-based records.

“Do I see more patients because of this technology? Probably no,” Dr. Masucci said. “But I am doing a better job with the patients I am seeing. It almost forces you to be a better doctor.”

This is a reason we need a ideal and universal EMR. However, the ideal EMR must have the ability to be used as an educational tool for patients and physicians. EMRs should be standardized and then customized by physicians to mimic physicians practice patterns. They should make medical care more efficient and less costly. Dr. Masucci is simply a testimonial stating that he has gotten rid of his paper record. However it might not be increasing his problem solving ability or his ability to transfer information or treat chronic diseases using evidence based medicine. The problem with most EMRs is they do not provide full functionality needed to solve the many problems in the healthcare system.

The opinions expressed in the blog “Repairing The Healthcare System” are, mine and mine alone.