Prescription drug shortages: data and mechanisms

“I should have gotten cancer last month,” she told me. That was the first thought from my patient after she’d heard the news: her ovarian cancer would remain untreated for weeks, due to a critical shortage of the chemotherapy agent doxorubicin. Like her, several thousand patients have been affected by critical shortages of chemotherapy agents like doxorubicin (Doxil) and methotrexate—common medicines that are essential backbones of cancer chemotherapy. But hundreds of other people have also been affected by critical shortages of pills around the country—limiting the supply of critical ICU medications like intravenous versed, or tuberculosis drugs like isoniazid. Why are these shortages happening, and what can be done about them?

Could social impact bonds restore public health budgets?

Occupational health in the electronic age: disease in the new sweatshop

When we say our products are made “in China”, what we really should say it that they’re made in Shenzhen–a city in Guangdong Province, just north of Hong Kong. Shenzhen is one of China’s “special economic zones” (SEZs)–754 square miles of industrial space in which foreign corporations are permitted unique rules and regulations, permitting them to run high-throughput factories that currently use 3.3 million people to make products for the Western consumer market. This is where Xboxes and cell phones come from, produced by Chinese contractors like Foxconn (which makes the new iPhone). There is an unusually high rate of suicide in Shenzhen, and in Foxconn factories in particular; behind these suicides are a broader set of public health issues among electronic workers–from those who make the new gadgets, to those who dismantle them after we throw them away.

The Robin Hood Tax: from food speculation to regulating the banks

With the recent attention garnered by the “Occupy Wall Street” movement, even the slow world of epidemiology has started to pay attention to the idea that the behavior of banks may be a significant factor in human health. Banks have critically affected the availability and pricing of food, and precipitated the mortgage-backed security crisis and subsequent economic recession that has resulted in significant joblessness and associated loss of health insurance. One idea that’s caught on internationally is the idea of discouraging risky transactions made by the banks–the kind of transactions that precipitated the global economic recession–and also raise money for “the 99%” who have been harmed by the actions of bankers. In this week’s post, we analyze the workings of such a “Robin Hood Tax“, and analyze what implications such a tax might have for public health.

How to estimate the economic cost of a risk factor or disease

We commonly see cost-effectiveness analyses in medical journals or government reports, which provide some sense of how much a new test or procedure might cost, divided by the number of lives saved by the intervention (or some metric related to morbidity or mortality, like “quality-adjusted” years of life saved). But increasing we’re also seeing estimates in the popular press and medical literature of how much a given risk factor—tobacco smoking, junk food, air pollution—or its related diseases—cancer, diabetes, etc—costs a country or state or the world economy in pure dollar terms. What does it mean when we say that “the cost of smoking in California is $15.8 billion a year” or “the cost of diabetes in theUS is more than $174 billion a year”? Where do these estimates come from, how are they calculated, and—most importantly of all—should we believe them?

Are we effectively controlling tobacco? A look at the industry’s data

If BMW made a car that was sold to one billion people worldwide, and had a fatal mechanical flaw–it locked passengers into their seatbelts and suddenly accelerated uncontrollably, crashing and killing half of its owners–surely the car would be pulled immediately off the road with great scandal, and probably tarnish the company’s reputation for decades. But today, tobacco is sold to about one billion people worldwide and kills almost half of them; it requires about five to seven attempts on average to quit smoking because of addictive materials in tobacco products; and while sales have diminished in the United States, they are accelerating and even being sponsored by governments in some low- and middle-income countries, where 80% of smokers live. In 2003, the World Health Organization signed the first global health treaty, the Framework Convention on Tobacco Control (FCTC), legally binding 174 signing countries to minimum standards that govern the production, sale, distribution, advertisement, and taxation of tobacco. In this week’s post, we look at data from the tobacco industry itself to understand how well efforts like the FCTC are working, and to determine where greater efforts in tobacco control may be needed in the future.

Health effects of financial crisis: omens of a Greek tragedy

Greece has been affected more by the financial turmoil beginning in 2007 than any other European country. Fifteen years of consecutive growth in the Greek economy have reversed. In adults, unemployment has risen from 6.6% in May, 2008, to 16.6% in May, 2011 (youth unemployment rose from 18.6% to 40.1%), as debt grew between 2007 and 2010 from 105.4% to 142.8% of gross domestic product (GDP; €239.4 billion to €328.6 billion) compared with the average change in the EU-15 (the 15 countries that were EU members before May 1, 2004) from 66.2% to 85.1% of GDP in this same period (€6.0 trillion to €7.8 trillion). Greece’s options were limited, since its Government ruled out leaving the Euro, precluding them from one of the most common solutions in such circumstances: devaluation. To finance its debts, Greece had to borrow €110 billion from the International Monetary Fund and Eurozone partners, under strict conditions that included drastic curtailing of government spending. Whereas other countries in Europe (eg, France, Germany) now show signs of economic recovery, the crisis continues to evolve in Greece; industrial production fell by 8% in 2010. Richard Horton has asked whether anyone is looking at the effect of the economic crisis on health and health care in Greece, in light of the adverse health effects of previous recessions. Here, we describe changes in health and health care in Greece on the basis of our analysis of data from the EU Statistics on Income and Living Conditions, which provide comparable cross-sectional and longitudinal information on social and economic characteristics and living conditions throughout the EU.

Conflicts of interest in public health: a guide to online investigations

In years past, the tobacco industry created front groups to write journal articles contesting the relationship between smoking and cancer, and to fight cigarette regulation as a matter of consumer rights. Some of the groups’ organizers have since shifted their business model to other industries. For example, the American Enterprise Institute’s Roger Bate, who created a front organization called “Africa Fighting Malaria” to defend industry practices in the continent around pharmaceuticals and chemicals, has written widely-cited editorials in prominent newspapers like The Wall Street Journal. More recently, the processed food industry created “Americans Against Food Taxes”, a group that’s generated a number of news articles and–through the American Legislative Exchange Council (ALEC)–drafted model food policy bills pre-written by the industry and introduced into Congress by elected representatives. How do we know if and when such forces are influencing our public health news and laws? In this post, we look at some of the online resources available to find the origins of public health news and legislation, and explore networks of influence and conflict.

Is the foreclosure crisis making people sick?

The housing crisis that precipitated our ongoing recession began with the foreclosure of 15% of US mortgages. There remains substantial disagreement, however, about whether and how public health departments should specifically address health problems experienced by the people who lost their homes in this crisis. While poor housing quality and homelessness have been statistically correlated to illness for many years, some argue that the correlation merely represents the influence of other factors that are common among people with housing insecurity: indebtedness and inability to pay for medical services, unemployment and associated insurance loss, food insecurity, mental illness, substance abuse, or family instability resulting in poor healthcare seeking or inadequate medical adherence.

As a result, it’s not obvious whether having health departments improve housing availability or quality will necessarily improve health conditions among the groups who face foreclosure. If better housing is really directly linked to better health outcomes, then health departments should expect a return on their investment in housing programs for this group. But if the statistical finding is merely secondary to other factors like indebtedness, then the money might be better spent elsewhere, for example in debt repayment programs, or in preventing the type of predatory banking practices that lead to the foreclosures. In this post, we try to answer the question: is the foreclosure crisis making people sick? And if so, what interventions have been shown to work, if any?

Shifts in humanitarian aid: a look at post-recession data

A few agencies have recently published their concerns that the “double dip” recession will negatively affect humanitarian aid, even as the worst famine in decades continues to hit East Africa. Have aid levels really been affected by the recession? If so, which countries are likely to feel the most impact? What factors are shaping aid decisions? In this post, we look at the latest data from the OECD’s Development Assistance Committee (DAC), the definitive source for international humanitarian aid data, and discuss the changes in aid that have transpired since the start of the 2007 recession.