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The Myth of Drug Expiration Dates

propublica.org

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Re: The Myth of Drug Expiration Dates

#121

Post by philipkglass »

civilitty wrote: post #64
sevenfive wrote: post #50

Earlier quoted context omitted.

> There are a few compounds (like fentanyl or LSD) where the dosages are so small and the compound so potent that 10-25% makes a difference but for the majority, precision isn't that critical. Wrong. Therapeutic ratio, not dosage.

Wrong. LSD and fentanyl have polar opposite therapeutic indexes - the therapeutic index is specific to toxicity whereas I'm talking about clinical outcomes in general. There are drugs that have threshold doses below which there is essentially no effect on the patient but aren't toxic until 10-1000x that threshold dose. Fentanyl just happens to have an effective threshold dosage that is dangerously close to its LD50.

LSD has an exceptionally wide therapeutic index, but fentanyl's therapeutic index of 270 is pretty good as prescribed drugs go. That's a far wider TI than over the counter painkillers like ibuprofen. Warfarin, a common narrow-therapeutic-index drug, has a TI of ~2.

Re: The Myth of Drug Expiration Dates

#122

Post by rcdmd »

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 ?

Yes, and it's even more bizarre when you realize what we need it for-- critically ill patients who are so acidotic that drugs like epinephrine (adrenaline) don't work. Bicarb reverses that acidosis, it doesn't cure it, but it does make it so your epi and other drugs have a chance to work. The main alternative is sodium acetate, which depresses heart function, causes low blood pressure and reduces respiratory drive.

Re: The Myth of Drug Expiration Dates

#123

Post by jessriedel »

breischl wrote: post #86
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…

>This article has some shoddy logic... all that potentially happens is a transfer between the consumer and the manufacturer. The point of the article is that this is an expensive mess for everyone except the manufacturer, which means approximately everyone. As a consumer, having the manufacturer "transfer" money from your pocket into their own sucks. Seems like the article's logic is actually pretty decent. Also, eve…

> As a consumer, having the manufacturer "transfer" money from your pocket into their own sucks. Seems like the article's logic is actually pretty decent.

As I addressed in my second paragraph, it is not actually a transfer unless you introduce new assumptions into the standard model of a monopoly. Please describe them.

> There are real costs in time, money, and resources for creating the packaging, transporting drugs, stocking/shelving them, unstocking them, sending them to a disposal location, and then disposing of them.

These are, in almost all cases, trivial compared to the development cost of the drug. You can group them under the marginal cost of the pill.

> Basically, outside of theoretical econ-land, wasting perfectly good things is wasteful.

Much worse than theoretical econ-land is non-quantitative land where all "waste" is bad and cost-benefit analyses are never done, not even at the order of magnitude level.

Please, by all means, construct a more accurate model. But just criticizing the imperfections of a model, which always exist, and then making non-quantitative value judgements is how we get recycling programs that cost 10 times the value of the material they recover.

Re: The Myth of Drug Expiration Dates

#124

Post by jessriedel »

valuearb wrote: post #93
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…

Your logic would be fine if manufacturers were required to replace expired pills with new ones. But they aren't, so early expiry dates impose enormous economic costs on consumers of drugs, while manufacturers get the massive benefits of selling drugs twice to same consumer.

This is addressed in my second paragraph.

Re: The Myth of Drug Expiration Dates

#125

Post by jessriedel »

learn_more wrote: post #80
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…

The cost model is like a time limited software license. If there is some new trick to extend the license, the drug companies would likely just charge more up front.

Exactly. The price is set by the willingness to pay (the demand curve), which accounts for the fraction of purchased pills that will actually be consumed.

Re: The Myth of Drug Expiration Dates

#126

Post by dragonwriter »

maxerickson wrote: post #120
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…

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.

It sounds like the labor and other costs of tracking, delivering, etc. the saline, rather than the material costs of the solution itself, are the issue.

Re: The Myth of Drug Expiration Dates

#127

Post by rhblake »

dragonwriter wrote: post #78
rhblake wrote: post #36

Earlier quoted context omitted.

Depends on the country. In Sweden it's illegal to have certain drugs in your system. E.g. if THC is found in your blood you can be convicted for a minor drug offense. We're sadly pretty extreme with regards to drugs though.

Is it illegal to have THC in your system or is having THC in your system admissible as rebuttable evidence of possession/use of illegal drugs? Either would support the outcome you describe, but they are meaningfully different. E.g., with alcohol, the “in the blood is illegal” rule would criminalize auto-brewery syndrome occuring in those legally denied alcohol (e.g., due to age), while the “in the blood is admissible…

It's the latter: (intentional) use of (illegal) drugs is illegal, and having THC in your blood is proof enough to convict you (even if you've consumed it in a different country where it's actually legal; there's precedent). Typically you'd just get a fine though, if you admit guilt and don't go to court. See § 1 here for the exact law: http://www.notisum.se/rnp/sls/lag/19680064.htm

Re: The Myth of Drug Expiration Dates

#128

Post by pstch »

derefr wrote: post #84
gumby wrote: post #77

(former pharmaceutical developer here). This article makes it sound like there's a big conspiracy, which there isn't. A very few drugs (like erythromycin) become toxic so should be discarded. Some drugs become less efficacious over time, but nobody really knows the shape of the curve as they are simply tested to see if they have the same efficacy on day E as they did on day 0. Well of course all drugs will become wor…

> Last week purchased some vacuum-packed lamb that had a manufacturer label with an expiration date a month away, but was prominently labeled to expire this week. Are you sure this was an expiration dates, and not a "sell by" or "best before" date? A sell-by date is the date at which the grocery store will voluntarily throw out the product—not because it has gone bad, but rather because its unprepared appearance/text…

> (Why don't they talk this up for PR? Because the fact that this is "expired" food would have to come up, and the public will never bother to read and understand what I just wrote above.)

The deals for grocery chains are usually made with tax deductions as an incentive, as there are logistical costs associated with it, and they still dump/grind a very large volume of perishables every day. Talking this up for PR could be detrimental to grocery chains, as theirs clients might not appreciate the "inefficiency" of their distribution chain, as they are the ones paying for the donated/dumped perishables.

Re: The Myth of Drug Expiration Dates

#129

Post by maxerickson »

dragonwriter wrote: post #126
maxerickson wrote: post #120

Earlier quoted context omitted.

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.

It sounds like the labor and other costs of tracking, delivering, etc. the saline, rather than the material costs of the solution itself, are the issue.

Sure, if you think $100 a bag is reasonable for that, then that would be a reasonable explanation.

Re: The Myth of Drug Expiration Dates

#130

Post by maxerickson »

refurb wrote: post #119
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.

It seems that when it comes to business consolidation, what is good for the goose is not good for the gander (apparently there are 2 suppliers left in the US).
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