Even If You Escape Ordinary Hospital Dangers, You Might Get Worse Because Your Medicines Are In Short Supply


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Reports of increasing shortages of medicines, particularly of painkillers, antibiotics, and cancer drugs. Apparently the situation is so bad that the FDA has authorized, on a temporary basis, the import of certain drugs from Europe. This does seem a bit odd when we have been told that the FDA normally has to protect us from foreign drug sources because only U.S. made pharmaceuticals are safe!

Last year 211 drugs were in short supply, tripling the amount in this category in 2006. These are drugs for everything from cancer to cardiac arrest.  Vital antibiotics and antivirals such as amikacin and acyclovir are in short supply, leading to patients dying from the organisms that are sensitive only to these drugs. Even anesthetic drugs like propofol are getting hard to find. Interestingly enough, the higher costing versions of generic drugs seem to be more easily available. A cynic might conclude this is because pharmaceutical companies are dropping the cheaper generics because they cannot make as much money from them as they can from newer brand name drugs, even if these are no better than the generic version.

The problem is getting worse. According to an Associated Press report, “The number listed in short supply has tripled over the past five years, to a record 211 medications last year. While some of those have been resolved, another 89 drug shortages have occurred in the first three months of this year.”

The American Society of Health System Pharmacists publishes an updated list of Current Drug Shortage Bulletins . Some of the drugs listed might surprise you. For example, Ciprofloxacin, the anthrax drug, is on the list. Many medicines on the list are injectable like Azithromycin another antibiotic,  or Fentanyl, often combined with Versed in so-called “waking anesthesia” used in procedures such as colonoscopies. The list is extensive—check it out.

Beware Medications Prescribed in Hospitals

Estimates of prescribing or medication errors among inpatients in US hospitals cluster around the level of 1 to 2 percent. This level is roughly comparable to the 1.5 percent identified in a UK study (National Health Service) of 36,200 medication orders. Of these errors, 0.4 percent were potentially serious. The numbers seem small but in the total population, hundreds of thousands of patients face potential serious problems.

Fifty-four percent involved the choice of dosage used. There is no reason to think that the United States hospitals have any better record. In 2008, the MEDMARX database, which contains the largest available information on prescribing errors in the United States, identified 1,470 drugs involved in look-alike and/or sound-alike errors. Another report from the U.S. Pharmacopeia noted in 2003 that “more than one-third of hospital medication errors that reach the patient involved seniors.” The MedMarx database in 2002 contained a detailed analysis of 192,477 medication errors reported by 482 hospitals and health care facilities out of 530,000 medication errors. The database was expected to approach one million by the end of the third quarter of 2004. Later reports are available for purchase.

A wide range of reasons or excuses given for medication errors include:

  • Similar patient names
  • Distractions
  • Temporary staff
  • Fatigue
  • Shift change
  • Language barrier
  • Poor lighting
  • Computer network down

Among the most common drugs involved in prescribing errors are:

  • Insulin
  • Vancomycin
  • Herparin
  • Warfarin
  • Acetaminophen
  • Lorazepam
  • Aspirin
  • Ibuprofen
  • Simvastatin
  • Fentanyl

Multiple studies confirm the problem of medication errors. One such report titled “The Epidemiology of Prescribing Errors,” published in Archives of Internal Medicine, 2004; 164:785-792, looked at a 700-bed academic medical center in Chicago Illinois. In one week, there were a total of 1,111 prescribing errors, most of which occurred on admission. “Of these, 30.8% were rated clinically significant and were most frequently related to anti-infective medication orders, incorrect dose and medication knowledge deficiency.”

Viewing these statistics in the light of the serious numbers of deaths from adverse drug effects should make it clear to anyone entering a hospital the importance of being proactive in questioning and verifying prescriptions as well as every other procedure planned. This may not make you the most popular patient, but if may save your life. If the patient is not able to do this, then a designated caretaker should be involved. Sometimes even having the primary care doctor on hand or easily reachable by telephone will lessen the chances of prescribing errors.

Radiation Dangers in Hospitals: An Update

Creative Commons License, Aidan Jones

The March 9, 2011 post to this blog, March 3, 2011m “Don’t Worry; This Is Less Radiation than an Airplane Flight,”discussed some typical and at times over-enthusiastic uses of diagnostic ionizing radiation during hospital stays.

A recent study published in the Archives of Internal Medicine, Apr 25, 2011. [Epub ahead of print], titled “Incidence, Correlates, and Chest Radiographic Yield of New Lung Cancer Diagnosis in 3398 Patients with Pneumonia,” reported on the use of X-Rays to check for lung cancer in patients with pneumonia in Edmonton, Canada.

The study involved patients between 2000 and 2002 with a five-year follow-up. Fifty-nine percent were 50 years or older, 52 percent male, and 17 percent smokers. Half had been admitted to a hospital. According to the results, at 90 days, 36 patients (1.1%) had new lung cancer; at 1 year, 57 patients (1.7%); and over 5 years, 79 patients (2.3%)” were diagnosed with lung cancer. The conclusion from the study claimed that “The incidence of new lung cancer after pneumonia is low: approximately 1% within 90 days and 2% over 5 years. The authors concluded that “routine chest radiographs after pneumonia for detecting lung cancer are not warranted, although our study suggests that patients 50 years or older should be targeted for radiographic follow-up.”

If you spend any appreciable time at all as a hospital in-patient, particularly if confined to bed and mostly lying down, the chances of developing pneumonia either in-hospital or shortly after release increase. Because of this, hospitals, in the interests of protecting their patients, often routinely order chest X-Rays. Even though a chest X-Ray is only about 10 millirems,* given the low level of actual lung cancers found, particularly for those young than 50, you might consider discussing the wisdom of more radiation with your doctor.

The March 9 post included a link to a radiation dosage chart. Here is another helpful calculator: X-Ray Risk Calculator.

*The U.S. Nuclear Regulatory Commission recommends that beyond background radiation, the average person should limit their additional exposure to less than one millisievert (100 millirems) a year. The standard for workers involved in radioactive-related fields is up to 5,000 millirems per year.