by Leah Ramsay

Work-arounds due to shortages of crucial and life-saving drugs have become the new normal in American medicine, forcing healthcare providers to make wrenching decisions with no formal guidance, according to a Special Report in The New York Times.

“At medical institutions across the country, choices about who gets drugs have often been made in ad hoc ways that have resulted in contradictory conclusions, murky ethical reasoning and medically questionable practices,” Sheri Fink writes in the article.

After seeing the effect of chemotherapy shortages on pediatric cancer patients, and his oncologist colleagues, Berman Institute faculty member Yoram Unguru, MD, MA, MS, decided to take action. Working with the Children’s Oncology Group, he convened a working group of bioethicists, pharmacists, policymakers and cancer specialists to address the problem in 2013, and has continued the work ever since.

“The reasons for drug shortages are complex, but we must not lose sight of the fact that without access to these life-saving drugs, children and adults with cancer will almost certainly die,” Dr. Unguru says.  “It is untenable for this situation to continue any longer.  We have a clear moral obligation to act to address this critical issue.”

Now, Dr. Unguru and colleagues have issued concrete guidance for the ethical allocation of chemotherapy and other supportive care drugs for children with cancer, in a commentary published by the Journal of the National Cancer Institute.

“In the absence of a much-needed national advisory statement on how best to allocate scarce drugs, and until policymakers and stakeholders can prevent future shortages, the guidance articulated here supports reasoned decision-making in the face of an actual drug shortage and aims to minimize bias as might occur when individual clinicians or institutions are forced to make difficult, and at times tragic, rationing decisions for children with cancer,” the commentary states.

“When faced with having to decide which of two children with cancer receives a life-saving treatment, physicians and administrators should not feel that they are alone without a roadmap,” says Dr. Unguru. “Allocation of scare resources, especially those that could save a life, is difficult and complex, but it is unethical to leave these challenges unaddressed. We hope this framework will be helpful and serve as a catalyst for further substantive action.”

For more information on these issues, tune in to The Diane Rehm Show on Monday, February 1 at 11:00 AM to hear Dr. Unguru and Ms. Fink discuss the problem of drug shortages and the ethical ramifications.

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Leah Ramsay is the staff Science Writer at the Johns Hopkins Berman Institute of Bioethics

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