Maybe you heard the same program I heard yesterday morning on National Public Radio about a recent series of articles that appeared in the Kansas City Star. Under the title, "Rx for Disaster," two veteran KC Star journalists concluded a six-month investigation with a wide ranging report on the dangers and drawbacks of drug compounding. Unfortunately, NPR completely ignored the many benefits of drug compounding. Which is certainly in keeping with the tone of the Star articles, which are little more than a thinly veiled attack.
On one hand, I can forgive the Star reporters for their lack of balance. In August, 2001, a compounding pharmacist in Kansas City was arrested for diluting a chemotherapy mixture, severely compromising the potency of as many as 150 intravenous doses. The pharmacist, Robert R. Courtney, was apparently motivated to endanger the lives of dozens of cancer patients with the opportunity to reap a personal profit of over half a million dollars.
As a community, Kansas City was justifiably outraged. And as someone who cares deeply about the state of healthcare, I am outraged, too.
But that doesn't give NPR license to paint compounding pharmacists as stubborn, uncooperative rebels who simply refuse to use approved drugs. Compounding pharmacy exists as a practice to provide much needed solutions for patients with unique medication requirements. And the NPR report completely failed to acknowledge that critical function.
Imagine that you had a child with a history of life-threatening allergic reactions. Your child develops a raging infection, which requires treatment with a specific class of antibiotic. The problem is, that antibiotic contains yellow dye #5 - a substance that you know would induce a severe reaction in your child. What would you do?
Or, say you suffer from an extremely rare condition that is controlled by a specific prescription drug. But the patent expires, and the pharmaceutical company decides that there isn't enough demand for the drug to justify the expense of a patent renewal and continued production. You need the medicine to manage your symptoms - but now the drug will no longer be available. What options do you have? Both of these situations present formidable obstacles. But in both cases a solution can be found through a compounding pharmacy.
Compounding pharmacists don't just count out and measure mass-produced drugs as most pharmacists do. Compounders work with your doctor to create a medicine that best fits your specific needs. Ingredients, dosage, concentration, delivery method, flavoring - all of these variables are within the control of the prescribing physician and compounder. For example, a compounding pharmacist can combine two medications into one pill, or formulate some medications into lotions, eye drops, lip balms, nebulizer solutions, or suppositories. They give you options where otherwise you would have none.
Despite the slanted focus of the NPR story, compounding is not just a matter of convenience or preference. In many cases, compounding comes to the rescue in life-threatening situations. For instance, many critically ill patients in hospice care rely on compounded medications because they are unable to swallow pills.
And don't believe anyone who describes a compounding pharmacist as just any old Joe playing mad scientist with controlled substances. We're talking about licensed, educated pharmacists - professionals with years of training. They cannot dispense any medications, compounded or otherwise, without a doctor's prescription. In fact, doctors are the ones who usually initiate the compounding order, asking the pharmacists to formulate the medication according to precise specifications.
Also, all of the ingredients used by compounders are approved drugs listed in the U.S. Pharmacopoeia National Formulary (USP/NF), an encyclopedia of each drug approved by the U.S. Pharmaceutical Convention. So for those of you that are reassured by regulation, you can be sure that there's plenty of it here already (and I mean plenty).
The portrayal of compounding pharmacists as loose cannons running amok is unfair. The reporters of the Kansas City Star have been diligent in running down the details of mistakes and abuses that have occurred among a handful of compounders nationwide. And without question, it's hurtful and sometimes tragic when mistakes are made in any healthcare field. But this is not a situation that's unique to compound pharmacy. Every year, thousands of patients are harmed (sometimes fatally) by health providers who make mistakes using standard prescription drugs.
Our hearts go out to the Kansas City cancer patients who, while fighting for their lives, discovered that the pure greed of a single individual made their fight just that much harder. There's no excuse in the world for that. But there's also no reason to set off on a witch hunt, branding all compounding pharmacists as negligent and dangerous.
To Your Good Health,
Jenny Thompson
Health Sciences Institute |
