This post is not about creativity, but about the fundamentals further back in the pyramid of life–sheer survival.  I’ve got a bad case of skepticism today.

 

Doxycycline structure

What’s the inside scoop on tetracycline? It is “unavailable.”  Doxycycline, an antibiotic in the same family, which we give our dog daily for pemphigus, went from  <$20/per Rx to >$300 in the course of one month.  It’s like this all over, and it seems that the shortage startied back in August.  The prices just skyrocketed this month. Some hospitals are reporting prescriptions shooting up from $77 to over $3000. Wow!

On superficial investigation, I get dead-ends at FDA, CDC, and NIH.  Companies making these drugs say they are missing an ingredient or that it’s simple “supply-and-demand” pricing.  However, tetracycline is produced large scale by fermentation of Streptomyces.  That means it should be easy. Nubian mummies had large levels from drinking beer, it’s surmised. Something is very wrong.  This has been a cheap, easy-to-obtain antibiotic since the 50s.

We have lots of antibiotics, but tetracycline is the first line for many diseases, including Lyme’s Disease, malaria treatment and prevention, and some STDs.  It was used recently in an outbreak of “the plague” in India.  It’s the only drug that’s kept our dog’s condition stable, and it’s a part of the regimen for treating heartworm in dogs, which is now prohibitively expensive (it was always quite costly).

This shortage means that some people and pets will not get the medicine they need.  It also means that only the wealthy will be able to afford it.

I am not one to readily believe in the first conspiracy theory to come down the turnpike, but this event has red flags all over it.

I recall when I was in veterinary practice that we used a cattle wormer off-label in dogs with colon cancer with some remarkable results.  When the producer of the wormer got wind of it, the cattle wormer was pulled off market.  When it returned, our $15 per pint wormer cost $1500 a bottle.

Perhaps coincidentally, tetracycline derivatives recently have been found to have potential in fighting cancer.  Some engineered forms are particularly interesting, although they then lose their antibiotic effectiveness.  Are we seeing the cattle wormer situation again?  Doxycycline was off the shelves and has returned at much higher prices.  Are these parallels just happenstance?

There are other scenarios we could speculate on:

  • Perhaps manufacturing of some base form is done in only one location and someone seriously contaminated the equipment or product along the line.
  • Manufacturing occurs only in some small country in which a violent political overthrow has closed off access; no one has reported any such event.
  • We can always raise the specter of bioengineering, which has so much potential for good.  Some pharmaceutical company may have decided to shortcut “proper channels” in order to find a synthetic means of production that is more profitable than fermentation and introduced some bad juju.  Can you say three-headed rats?  This might cause a quiet withdrawal of the product.
  • A clandestine group is planning a bioterrorist attack of humongous global proportions and has bought up all the available supplies to make sure the most likely remedy is unavailable.
  • A crazy mega-billionaire has been watching too much “Doomsday Preppers” and has bought out all available stock at a price the pharmaceutical companies could not refuse.
  • A clerk back in the bowels of the supply chain for production of tetracyclines forgot to order a main ingredient and well, you know how back orders are.  Of course, this kind of error does not usually result in a 10- to 20-fold increase in prices.

Whatever the cause, I am leaning heavily in the direction of suspicion right now.  In one of my new favorite science fiction shows, “Continuum,” the protagonist discovers that the insurgent uprising she is quelling (she is a riot squad cop) is actually caused because  the corporate powers-that-be are withholding food rations to drive up prices, resulting in people starving.  I can imagine that it would be easy to make money on a cheap, easy-to-produce medicine if you drove prices up.  Why bother with all that expensive R&D when you’ve got a product you know works and you have a built-in market.  There I go, buying into conspiracy–except I saw it happen with the cattle wormer.  Is this so far-fetched?

If anyone knows a rational, reasonable explanation not caused by unregulated greed, please let me know.  I hate to think poorly of my fellow corporations–I mean, my fellow man.


http://www.cdc.gov/std/treatment/doxycyclineShortage.htm

http://www.cdc.gov/malaria/new_info/2013/doxycycline_shortage.html

http://www.fda.gov/Drugs/DrugSafety/DrugShortages/ucm314743.htm