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The Myth of Drug Expiration Dates

propublica.org

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Re: The Myth of Drug Expiration Dates

#111

Post by jeremynixon »

jessriedel wrote: post #45

This article has some shoddy logic. For the vast majority of drugs, the actual marginal manufacturing price per pill is essentially zero. That means that when the expired pills are thrown away and new pills are manufactured, there is no true economic loss. Rather, all that potentially happens is a transfer between the consumer and the manufacturer. If pill prices were set by some external force, this could at least b…

Pfizer behaves very differently with an increase in marginal revenue than a patient (who is passed the cost from the distributor) would behave with a similar decrease in health care costs.

Anticipating pill expiration and what will be excess supply is a difficult predictive modeling problem. At a practical level, it's difficult for pill expiration date to make it into the price, especially when the purchasers of the pill are different people than those who throw out the pill years down the line.

Re: The Myth of Drug Expiration Dates

#112

Post by L_Rahman »

Overtonwindow wrote: post #27

Another facet to this is "Medication Adherence" which is defined generally as taking medication properly, but which the drug industry defines as taking all of your medication, and getting a refill for more. Speaking only as a lobbyist who has (regrettably) worked for a Pharmacy Benefit Manager in the past, there is tremendous amount of money and thought being put into how to get patients to take all of their medicati…

Along with some other people in the healthcare industry (process person at a large provider, product person at a large EHR), I'm trying to make a map of the "systems truth" of healthcare in America.

We'd love to talk to you (in confidence!) about how the PBM part of the world works. Please reach out to me if you'd be interested - contact information is in my HN bio.

Re: The Myth of Drug Expiration Dates

#113

Post by dragonwriter »

harshreality wrote: post #4

> The findings surprised both researchers: A dozen of the 14 compounds were still as potent as they were when they were manufactured, some at almost 100 percent of their labeled concentrations. What kind of reporting is this? Anything less than 100% is not "as potent as when manufactured", and the sentence implies some of those dozen weren't close to 100%. > The idea that drugs expire on specified dates goes back at…

> Anything less than 100% is not "as potent as when manufactured",

Since the % is of labelled strength, it might still be “as potent as when manufactured” if the drug was at less than labelled strength when manufactured, though that, too, would be a serious issue.

Re: The Myth of Drug Expiration Dates

#114

Post by StavrosK »

Greed wrote: post #34
harshreality wrote: post #4

> The findings surprised both researchers: A dozen of the 14 compounds were still as potent as they were when they were manufactured, some at almost 100 percent of their labeled concentrations. What kind of reporting is this? Anything less than 100% is not "as potent as when manufactured", and the sentence implies some of those dozen weren't close to 100%. > The idea that drugs expire on specified dates goes back at…

I work for a company that has some periphery exposure to FDA-regulation, and as a result we have to do a lot of very similar scientific calculations to satisfy their archival records. A big part of why most medicines still expire (at least for medicines available over the counter) much earlier than they should is that a majority of the testing is done to determine the expiration date at a controlled temperature, pres…

I don't understand your comment. You say they test at a controlled pressure, whereas conditions in the typical medicine cabinet vary wildly, and then say that that's why the drugs expire much earlier than they should.

Do you mean that varying conditions make medicines last longer? You can't mean that medicines would last much longer if stored in perfect conditions, because that's not expiring "earlier than they should", it's expiring exactly on time for the poor conditions they are kept in.

Can you clarify?

Re: The Myth of Drug Expiration Dates

#115

Post by refurb »

Reason077 wrote: post #42

"Berkowitz picks up a box of sodium bicarbonate, which is crucial for heart surgery and to treat certain overdoses. It’s being rationed because there’s so little available." Huh? US hospitals have a shortage of Baking Soda ?

It's an injectable product. That's not easy to manufacture at all and has high capital costs. You need to make sure it's sterile and remove any pyrogens. Manufacturing injectables requires a much more strict adherence to quality than oral products.

Re: The Myth of Drug Expiration Dates

#116

Post by dragonwriter »

collyw wrote: post #100
Greed wrote: post #34

Earlier quoted context omitted.

I work for a company that has some periphery exposure to FDA-regulation, and as a result we have to do a lot of very similar scientific calculations to satisfy their archival records. A big part of why most medicines still expire (at least for medicines available over the counter) much earlier than they should is that a majority of the testing is done to determine the expiration date at a controlled temperature, pres…

Most medicines are sold in blister packs these days. Won't that prevent a fair bit of the environmental stress from affecting them?

> Most medicines are sold in blister packs these days. Won't that prevent a fair bit of the environmental stress from affecting them?

Well, it keeps out humidity, and might prevent air-exposure effects. It won't prevent heat effects and some other environmental effects.

Also, quite a lot are sold in bottles of pills or other non-blister-pack forms.

Re: The Myth of Drug Expiration Dates

#117

Post by rectangletangle »

valuearb wrote: post #104
rectangletangle wrote: post #83

Degraded tetracycline has been documented to be dangerous in those who are suffering from renal failure. There's also the possibility that a person may be suffering from a new undiagnosed condition, which hadn't yet onset when they were initially prescribed the drug. In this case you could think of it less as an expiration for the drug, and more of a suggestion to seek additional medical guidance on continuing after…

3 cases in 50 years? That's all you've got?

I would be more concerned about the second point. A patient developing additional complications isn't unheard of.

Re: The Myth of Drug Expiration Dates

#118

Post by mandevil »

valuearb wrote: post #103
doctoring wrote: post #55

Earlier quoted context omitted.

Oh yes... it's a pain in the ass. Recently in the news, too [1]. There weren't many days where the hospitals I've worked at weren't short on something . (And these are like, big name academic medical centers in big U.S. cities.) I've run into a shortage of normal saline before. Yes... salt water. Sometimes hospitals will even stockpile basic supplies to keep from running into shortages... which only makes the whole s…

Remove patent protection for any drugs that are in shortage.

Do you honestly think that baking soda is in shortage because of patent restrictions? The US drug system is messed up, but not that messed up.

They are in shortage because it takes a long time (six-ish months) to certify a factory as producing something safe for consumption[1], and in the normal course of things, there is very little point in setting up a second line to produce medical grade sodium bicarb- no company is going to show a profit from it. So you get one place producing the national supply, just large enough to handle the normal demand. Then they have a problem (in this case, Pfizer was unable to source the glass ampules) and now there is no production.

[1]: And with good reason. Producing mass quantities of sterile, consistent, things with the correct amount of material is hard.

Source: wife is a pharmacist tasked with doing her hospitals contingency plans on bicarb.

Re: The Myth of Drug Expiration Dates

#119

Post by refurb »

maxerickson wrote: post #108

What's going on with our healthcare system that pharmaceutical grade baking soda is being rationed? W T F.

It's the generic drug business. Competition is purely though price. That squeezes margins significantly, even for more capital intensive product like injectables. If you're a manufacturer who has a sudden quality control issue, it often makes more sense to just shut down production than try and fix it and lose a ton of money.

Re: The Myth of Drug Expiration Dates

#120

Post by maxerickson »

doctoring wrote: post #55
Reason077 wrote: post #42

"Berkowitz picks up a box of sodium bicarbonate, which is crucial for heart surgery and to treat certain overdoses. It’s being rationed because there’s so little available." Huh? US hospitals have a shortage of Baking Soda ?

Oh yes... it's a pain in the ass. Recently in the news, too [1]. There weren't many days where the hospitals I've worked at weren't short on something . (And these are like, big name academic medical centers in big U.S. cities.) I've run into a shortage of normal saline before. Yes... salt water. Sometimes hospitals will even stockpile basic supplies to keep from running into shortages... which only makes the whole s…

Your second link says including $546 for six liters of saline that cost the hospital $5.16.

That doesn't sound like the cost of the saline is much of a problem. It sounds like hospital billing is the problem.

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