what's the deal with the HRT and contraceptive implant shortage?just reading about it in the Graun and apparently "nobody knows why it is happening". How can this be>?! Surely with all the clever Lean thinkers in the industry it must be possible to identify the problem?
0
5
No idea why but shortages of various medications are surprisingly common, constantly getting alerts about trying to avoid prescribing something or other (the implication being that normally I don’t bother and just prescribe the first thing that comes to mind)
0
0
I know about pharmaceutical supply chains, what would you like to know?
0
1
in this article it says the UK is uniquely affected in this instance, despite UK government restrictions on exporting the in-demand products
just wondered if they had been moving around manufacturing sites or something
0
1
A little while ago there was a shortage of Tazocin - bit concerning as this is one of the most effective antibiotics we have
0
2
my op pls phil! why is this hrt thing happening and why is it only the UK?
0
1
did patients actually have to go without, phil??
0
2
*chimp!
0
1
I just carried on as normal
0
3
It isn't just the UK.
https://www.janssen.com/uk/hormone-replacement-therapy-hrt-shortages-uk
0
3
I am confsed cos that link suggests it is the UK!
0
1
is there a secret reason they are not telling us?
0
1
has qatar bought up all the hrt?
0
3
The UK (sensibly) approved three main products on the market. The one made by Theramex ran into a problem with production (glue on their patches, manufactured in China) and the other two manufacturers can't keep up with the demand which the main supplier disappearing has caused.
0
2
You are confused Clergs because the Independent and Grauniad are DESPERATE for there to be medicine shortages because of Brexit. Which there aren't, and won't be.
0
5
why is it sensible to only approve three? and why don't they just immediately approve an emergency fourth?
0
2
oh the thing I was reading didn't actually mention Brexit (although I did wonder if there was a practical realignment taking place in preparation for that)
0
2
The approval of medicines and their production is a very complicated process. Even if there were a fourth supplier they would have to go through the approval process for access in the UK, and why would they bother when they would only have a short period to sell and then when the other three got themselves sorted again they would be down to zero?
0
3
oh the thing I was reading didn't actually mention Brexit
Oh they are subtle aren't they!
0
1
so, isn't this a reason why it is NOT sensible to only have three suppliers? shouldn't it be a free for all (assuming you meet the threshold)?
0
1
Three major suppliers for a product is a lot. For some products there is absolutely no substitutability and patent protection, so there is only one. If the manufacturer fooks up supply in those circumstances, patients can die.
0
1
so, isn't this a reason why it is NOT sensible to only have three suppliers? shouldn't it be a free for all (assuming you meet the threshold)?
Even if there were more than 3 manufacturers, allowing unlimited approved products on the market might result in one or all of them saying it's not worth bothering with
0
1
WEAREALL GOINGTODIE OF BREXIT!!
0
2
interesting
so, competition kind of has to be tempered to make it sufficiently profitable for anyone to bother supplying the essential supply
I wonder if there are any other industries where a similar dynamic arises
will they stop relying on china in the future? guessing no
0
1
The issue is that a medicine costs, on average $2.7m to bring to market. The launch costs are eye-watering, and the application for marketing authorisation is torturous and expensive. If a manufacturer feels they won't recoup sufficient profit by launching in a market, they just won't. If you allow a market to be flooded with identical products which they can't differentiate in, they might not bother. This is the tightrope that national regulators face, as they are rightly screwed when supply goes awry. The issue is there is no quick fix - you can't make this stuff overnight. Setting up production takes years.
0
2
will they stop relying on china in the future? guessing no
The manufacturing and supply chain for pharma is WAAAYYYYYYYY more complex that just "China". A lot of countries demand jobs be provided in countries in return for market access, so lots of manufacturers have facilities in countries which make no logistical or practical sense, because the government (payers) have demanded it.
0
1
I assume (without knowing anything about this) that the patent has expired and the products are generic. There is no/limited profit in producing generic medicines so probably no other party wants to make them. Also, even if there was, the process of getting approval (a marketing authorisation) is onerous and takes a while as the company has to prove it can make the products to the correct spec and it's all about patient safety etc. Getting an MA can take easily over a year, sometimes two.
0
0
There was a shortage of co-amoxiclav last year as well. It’s pretty normal I think.
0
6
As any regular rof reader will already be aware, the final point in the pharma supply chain is
Tecco.
0
1
Nom nom gimme moar pills!
0
2
There is no/limited profit in producing generic medicines
This may be of news to Teva, a generic drug manufacturer whose annual profit is around $9bn.
0
2
This may be of news to Teva, a generic drug manufacturer whose annual profit is around $9bn.
Cool story, bro
0
3
So the first person on this thread to mention Brexit (with replies from Clergs and Wibbles ALL CAPS BRILLIANCE) was a right wing frother who constructed a fabulous straw man and then brutally disembowled it before our eyes.
Phil Stamp, you are a true hard man of Brexit.
0
1
tbf he did give us some good facts
(I am a bit astounded that "oh well we have no drugs now" is the upshot but I guess it is a salient reminder of the precariousness of supply chains for all essentials)
0
1
The fact that generic ibuprofen has been almost impossible to buy for months now has caused a lot less fuss than I would have expected.
I guess it's not the end of the world as you can still pay £2.50 for a box of Nurofen, but it's crazy that the generic version of such a staple drug can just vanish from the shelves.
0
1
do u know, I just assumed it was because my local boots was crap!
0
2
I have moved on to naproxen now it is the bee's
but you have to pretend it is for period pain to get it otc
0
2
Right-wing frother?
That's a surprise to me as I haven't voted for anything resembling a party right of centre for over a decade.
0
1
Careful on the Naproxen Clergs, can give you stomach ulcers if overused.
0
3
is it riskier than ibuprofen for that?
i do always take it with food (and only when very in pain) so hopefully will be ok
0
1
I had what I think was flu at the beginning of the year and I am pretty sure it helped cure me (apparently it can interfere with flu RNA?)
0
1
Yes, naproxen much riskier than ibuprofen, hence why pharmacist-sale only and different warning label. They are an NSAID
0
0
NSAIDs may cause an increased risk of serious cardiovascular thrombotic events, including myocardial infarction and stroke, which can be fatal. This risk may be increased in patients with cardiovascular disease or risk factors for cardiovascular disease. Naproxen is contraindicated in the setting of CABG surgery. NSAIDs can also cause an increased risk of serious gastrointestinal (GI) adverse events, including bleeding, ulceration, and perforation of the stomach or intestines, which can be fatal. Elderly patients and patients with a history of peptic ulcer disease and/or GI bleeding are at greater risk for serious GI events.
0
0
Clergs - I have it prescribed sometimes for back pain and you need to be taking something to protect your stomach with. I get it with omeprazole to do that.
0
2
one of the shit things about 40 coming down the line is that I am no longer going to be able to read those warnings and think "yeah but that's mostly for old people in their forties isn't it"
alas
0
0
teclis it is an ingredient in feminax ultra (or whatever it is called) you definitely don't need to take anything extra with it
0
3
Oh ok cool I’ll let my gp know, cheers.
Duh.
0
1
maybe you should, I wouldn't want to take unnecessary medication
0
0
I trust him a little more than I trust clergs in the medical side of things tbf m12.
0
0
Clergs did you stick to the limit specified in the label? If so, you're right.
https://www.drugs.com/uk/feminax-ultra-250mg-gastro-resistant-tablets-leaflet.html
If not, a proton pump inhibitor is probably a good idea to accompany, because of the gastric damage risk.
0
1
Feminax ultra is 250mg. GPs often prescribe higher doses for other kinds of inflammation and pain than period pain, hence the need for a PPI.
0
3
Also mine are a tad stronger tbf - 2x500mg
0
1
so why were you suggesting everyone who takes it needs to take other medication?
0
1
interestingly (or not) I have a genetic imperviousness to PPIs
I don't know if this makes me also more susceptible to the things they prevent
0
2
Probably does. You’re doooooomed!
(It does actually state to take the other drugs in pretty much every reference online btw I just had a gander).
0
2
then how come they are allowed to sell it in Boots on its own?
0
0
FWIW when I was on fairly large doses of Naproxen I didn’t have a PPI prescribed. Can’t remember how much they were but the co-cos I was prescribed at the same time were stronger than the ones my wife had at the same time for her c-section.
So it’s not like my GP was fvcking around with the dosing...
0
3
Maybe I just have a good gp and y’all have shite ones.
0
3
You have a risk-averse GP Teccers, who doesn't mind prescribing at extra cost to help a minority of patients. A rarity in the NHS these days.
0
3
yeah my pal got them for falling down the stairs at chrismas and she didn't get any despite also benig on duloxetine or whatever it is
0
1
Phil it's its way too late to reply but I'm doing it anyway. I take exception to your Guardian / Indie strawman that they would love to publish stories about drug shortages due to the B word.
They didn't mention the B word. Prob cos we haven't properly left yet as you know.
They will probably revel in 'i told you so' stories come 2021.
0
1
Duloxetine isn’t a risk for stomach issues clergs. I’m on 120mg of the stuff, it’s great. You should try it.
0
3
NHS had a fixed price Sterling rate to buy it. There are shortages, and because of the devaluation of Stg since the price was fixed, the manufacturers are focusing on sales to more lucrative markets.
Soz if anyone posted. CBA reading this all.
Join the discussion