Needless Drug Shortages Threaten the Lives of TB Patients

Several drugs to treat Tuberculosis have made it to the FDA’s drug shortage list. (I recommend a quick glance at the list. Big government (thankfully) at work!)

A friend/acquaintance of mine posted that the following medications are presently in short supply, or unavailable: Isoniazid, Rifampin, Ethambutol, Amikacin, Streptomycin, Tubersol and Aplisol.

Now, I’m not going to pretend to be an expert on TB, though I do know enough about the condition to know that TB is most common among the poorest and most marginalized members of society. In Malawi, I’ve seen active and advanced cases of TB. It’s an awful sight.

People who live in substandard housing in urban areas, prisoners, alcoholics and homeless people are at particular risk for infection. It’s particularly common in Africa, and a problem that seem to be getting worse, rather than better. Coinfections with HIV are common.

Japan, specifically the Airin area of Osaka, where homeless men and day laborers congregate in substandard and densely occupied housing units, is well known to have one of the highest incidence rates of TB in the developed world. Russian prisons are also famous for TB transmission, as the work of Paul Farmer has shown.

According to the FDA list, many of the drugs are in short supply due to “Demand increase for the drug.” I find the claim to be somewhat dubious. Drug companies have long been known to be sleeping at the wheel when it comes to development of new drugs for TB. Most of the drugs that are currently used were developed in the early the mid 20th century, with one very recent exception (Bedaquiline).

I find it highly unlikely that demand for the drugs went by unnoticed to drug companies. I suspect that there simply isn’t enough profit in the drugs to warrant ramping up manufacturing.

The implications are, of course, immense. If drugs to treat TB are unavailable, opportunities to transmit TB will persist. Given the nature of the populations which are at risk for the disease, we can expect a resurgence in cases. Worse yet, the longer a patient has the disease, the more likely it is that the infection will become resistant to all medications, making treatment nearly impossible.