drug shortages that has afflicted anesthesiologists.
So far this year we've faced an ongoing scarcity of propofol, especially after Teva pulled out of the market following the bone-headed $500 million jury verdict against the company in Las Vegas. We've been discouraged from using TIVA if gas will do. We are also facing a shortage of morphine. If we order morphine for our patients, the pharmacy will kindly substitute a dilaudid equivalent dose. Last year there was a deficit of protamine. They were only stocked in the vascular and heart rooms unless requested from pharmacy.
Why do these problems keep recurring in anesthesia? I suspect it is because we anesthesiologists seem determined to undermine our own self interests by using the cheapest drug available. The aforementioned drugs are all generics, costing just pennies per dose. There really is little incentive for drug companies to stay in that sort of market. As Teva demonstrated, one adverse event can devastate the cost structure of generic drugs and cause these companies to withdraw their products.
You certainly don't see other specialists racing to be the most cost efficient provider. Pharmaceutical companies spend billions every year trying to persuade internists to prescribe their latest treatments for hypertension and hyperlipidemia with great success. Orthopedic surgeons are feted by the hardware manufacturers to use their newest implants. General surgeons frequently demand to use the latest and most expensive laparoscopic equipment. They never seem to run short of those in the OR.
Newer drugs like Precedex and Lusedra are just subjects I read about in anesthesia journals. Our pharmacy refuses to stock them because of the price. We don't have patients coming into preop to demand that we give them fospropofol for their anesthesia. Anesthesiologists, in their attempts to appease the hospital administration, try to keep costs low by using generic drugs whenever possible. But this discourages drug companies from conducting research on the latest anesthetics. There aren't twenty pharmas in competition to develop an alternative to succinylcholine the way there are for the next ACE inhibitors.
So maybe we can do ourselves a favor and start administering the newest drugs on the market instead of one that have been generic for a decade or two, or four. This will show the drug companies our commitment to make sure their drug research pays off and we can finally stop having these regular drug shortages. And maybe we'll get a few free dinners and golf games along the way.