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The Myth of Drug Expiration Dates

propublica.org

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Re: The Myth of Drug Expiration Dates

#191

Post by philipkglass »

civilitty wrote: post #182
philipkglass wrote: post #121

Earlier quoted context omitted.

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 .

Fentanyl's therapeutic index is NOT 270 except when used as an opioid supplement for surgical anesthesia cocktails, where the dosage is less a microgram per kilogram and it's balanced with several other drugs and opioid antagonists. The maximum recommended dose for fentanyl is 50 mcg/kg and that requires ventilation because it is well above the estimated LD50 of 30 mcg/kg. The recommended low dose for fentanyl on its…

I didn't know that extra context about the numbers for fentanyl. Thanks for correcting me.

I was going to post something long about LSD but it turns out I am just wrong. So thanks twice, and have my upvote.

Re: The Myth of Drug Expiration Dates

#192

Post by sliverstorm »

BrandoElFollito wrote: post #147
dragonwriter wrote: post #116

Earlier quoted context omitted.

> 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.

I live in France and cannot remember the last time I saw pills not in a blister pack. I remember vaguely having seen pills in bottles maybe 20 or 30 years ago. Again this is for France, I know that e.g. in the US one gets refills. Which by the way I find great because the waste of pills is tremendous. It would have been much better to get the specific number prescribed.

It is a waste of pills- but in many cases the marginal production cost of a pill is incredibly small. See generic asprin, many hundreds of pills for a few dollars at an ordinary grocery store. More than you need, but the packaging & marketing probably still costs more than the pills.

Over here, benadryl is the main over-the-counter drug I see in blister packs. They say it's to slow down the meth cookers.

Re: The Myth of Drug Expiration Dates

#193

Post by cwkoss »

Seems like an easy fix would be to require the manufacturers of patented drugs to replace, free of charge, any unused expired drugs.

Incentivizes the manufacturers to accurately measure expiration times and the marginal cost to them of replacement is much less than to the consumer.

Re: The Myth of Drug Expiration Dates

#194

Post by cwkoss »

mandevil wrote: post #118
valuearb wrote: post #103

Earlier quoted context omitted.

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…

> there is very little point in setting up a second line to produce medical grade sodium bicarb

Decentralization and redundancy of medical production lines would make our country safer and more robust to unforeseen events. It would certainly be a benefit. I agree, however, that it would be more expensive.

Re: The Myth of Drug Expiration Dates

#195

Post by sliverstorm »

mandevil wrote: post #118
valuearb wrote: post #103

Earlier quoted context omitted.

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…

At least in government, that sort of thing is usually handled with second-source agreements as a contingency of a supply contract. Can have the side benefit of introducing some competition. See AMD, once-second-source-supplier for Intel, Fairchild, and National Semiconductor.

Re: The Myth of Drug Expiration Dates

#196

Post by wolfgang42 »

maxerickson wrote: post #108

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

More discussion here: https://news.ycombinator.com/item?id=14798615

It seems the problem is that the suppliers' supplier had a problem supplying a component (not the bicarbonate itself, but the vial it comes in, I think) and this caused production to come to a halt while the issue was being sorted out. Presumably this particular component has been certified in some way and replacing it with an alternative requires recertification, though the news articles merely say that the companies could not divulge additional details.

Re: The Myth of Drug Expiration Dates

#197

Post by Kalium »

yomly wrote: post #179
Kalium wrote: post #161

Earlier quoted context omitted.

There's also the not-irrelevant issue that testing is slow and potentially other than free. How do you find out when a drug expires? You have a bunch of it sit around and test it periodically, right? I assume that would be done after bringing a drug to market, otherwise drugs could easily be delayed 10+ years if they're shelf-stable.

I would expect the chemistry to be characterised well enough to the point where you shouldn't need clinical tests to know it's degredation profile...

From what I read, current expiration dates are produced by the sort of actual testing I described.

Re: The Myth of Drug Expiration Dates

#198

Post by cwkoss »

verroq wrote: post #22
noonespecial wrote: post #16

The cynic in me suspects that if this gains too much traction, drug manufacturers will simply start adding self destruct compounds to all of their formulations "for our safety". In fact, some of them have track records of such "ethical" behavior, it wouldn't even surprise me if they turned them poisonous vs simply inactivating them.

The only solution is to fix the economic incentives so that drug manufacturers want to make less wasteful medicines. Same with preventing planned obsolescence. The only solution is to encourage more competition.

Require manufactures to send back fresh pills (at their own expense) if you mail them expired ones.

Re: The Myth of Drug Expiration Dates

#199

Post by jessriedel »

breischl wrote: post #137
jessriedel wrote: post #123

Earlier quoted context omitted.

> 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 drug…

>Please, by all means, construct a more accurate model. Gee, you get to just hand-wave an entire manufacturing process and supply chain into insignificance, but I need a model, huh? Fine. Let's use a generic drug (ie, not paying patent/development costs) as a proxy for how much the entire supply side costs. How about loratidine. You can get that at Walmart (stocked on the shelf, since that's mostly what the article w…

> Gee, you get to just hand-wave an entire manufacturing process and supply chain into insignificance, but I need a model, huh?

Nope, for this you just need a number! (In my comment, the "model" part referred to how monopoly pricing was done.)

> So 11 cents/pill just to run a pill through the supply chain and then dispose of it.

Good, your estimate process is a reasonable one, and I accept this number.

> $330 million/year...I dunno, seems potentially significant, at least to an order of magnitude level.

Ok, let's compare to what the article says:

> Experts estimate such squandering eats up about $765 billion a year — as much as a quarter of all the country’s health care spending.

So we see that our cocktail napkin math has been extremely useful, and that the article has overstated the size of the issue by some three orders of magnitude! (25% --> 0.01%) The many suggestions in the article that this is important on the level of the entire health care system is absolute bunk.

Thank you for engaging in this exercise with me!

Re: The Myth of Drug Expiration Dates

#200

Post by cwkoss »

dp-tyvek wrote: post #146
euyyn wrote: post #82

Earlier quoted context omitted.

I'd think there's a business opportunity in recycling the still-active chemicals in those pills.

A lot of cost of drugs comes from R&D, quality control etc. The chemical synthesis itself generally isn't that expensive. And expired pills would be a quite unpredictable precursor, which isn't very desirable in the pharma industry (or anywhere else for that matter). In other words, I doubt you could make much of a profit (if any) from purifying non-decomposed chemicals from pills.

I wonder if you could get around drug patent laws with the first-sale doctrine.
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