There is another side to the Drug pricing problem.
I recently read a report about Drug Shortages, especially for several Cancer treatment drugs.
One was because a supplier was shut down for quality problems and the others didn't have the capacity to pick up the load. Hoarding by Hospitals is another factor in this problem.
The other side of the pricing problem is that some Drug Companies make a Business Decision to discontinue producing drugs that are Not Profitable. The FDA has NO authority to compell drug companies to manufacture any specific product.
'Interesting' times ahead!
'AL'
Al, this is a big issue all by itself. In the cardiac-relevant field, we've got an ongoing "supply crisis" in the supply of one radioactive drug that's recently become very popular for diagnostic tests of cardiac function. The radioisotope that's distributed is called Molybdenum-99, and as it decays in the container it's distributed in (which they call a "generator" or a "cow"), it produces Technetium-99m, which is "milked" off by hospital staff and used for the tests. Tc-99m is very handy because it's a pure and substantial gamma-radiation source, and it decays away completely quite quickly. (Yes, the "m" is part of the name of Tc-99m, and it's important!)
One ancient government-owned reactor in Chalk River, Ontario, was producing around half of the WORLD'S supply of Mo-99 when it shut down several years ago for extended repairs lasting several years. The rest of the world's supply comes from several smaller-but-similar old reactors, which had their own problems and couldn't ramp up to fill the gap. I think it was the second-largest (in Netherlands?) that was shut down most of the last year or two, and may still be down.
A plan to build TWO brand-new isotope-production reactors ("MAPLE") in Canada to replace our ancient ("NRU") reactor ended in tears because of a series of major errors in reactor physics, design, and safety analysis, finally leading to the cancellation of the project after it was many years late and many 100s of millions of dollars over budget, with no clear end in sight. (Some people still think the project was about to succeed and should be restarted, but it's always with MY money and not just THEIRS. . .)
A number of analysts in the US have noticed that US nuclear-medicine tests are vulnerable to disruption in radio-isotope supply from a few non-US reactors (and old and unreliable ones, too), AND that most of those reactors need shipments of atom-bomb-usable High-Enriched Uranium (HEU) to operate, and the shipments come from the US, in general violation of US policy to stop spreading bomb-grade materials around the world. So there's a move to build new facilities (reactors and/or accelerators) in the US to make Mo-99.
Mo-99/Tc-99m is very handy, but I believe it largely captured the developing marketplace for nuclear-medicine isotopes because its pricing is crazy cheap. The competing drugs are sold by Big Pharma (which is determined to MAKE MONEY on drugs, for their shareholders), and virtually all competing radio-isotopes are made at hospitals in accelerators which have to be built and operated with REAL money. In contrast, the reactors making the Mo-99/Tc-99m were built in the 50s and 60s with tax money, often as part of a nuclear-weapons program (Canada was making Plutonium for the US back then), and nobody remembers or cares what they cost, or how much the isotopes would cost if they came from a brand-new reactor. So organizations like Atomic Energy of Canada Limited (AECL) just set out to create and capture a "world-class" market and become famous for something other than building power reactors late and over-budget. And they succeeded. Money was basically no object, because they already had the reactor(s), and the rest could be financed with grants from taxpayers. So they sold the isotopes for a tiny fraction of their full cost, and created a large dependency. (I've heard that some dope peddlers actually give out free samples.)
The whole system is limping along now, rationing isotope supplies and using accelerator-made substitutes. And when this generation of old reactors finally gives up the ghost and (especially if) the Mo-99/Tc-99m business is taken over by somebody who cares about money and wants to make some, the system may adapt in different ways, to restrict Mo-99/Tc-99m to a smaller role in nuclear medicine.
I don't know if anybody here has been told that they SHOULD have a nuclear heart scan but it had to wait until Mo-99/Tc-99m was available. But it's definitely happened in many places in the world (including Canada and the US), and I don't think it's over yet.
BTW, in addition to being expensive and unsustainable at today's prices, the Mo-99/Tc-99m business is also very messy, leaving wastes behind that are highly radioactive and even fissionable. Chalk River still has a few tanks that have to be constantly stirred mechanically and warmed-and-agitated with injected steam, to make sure that the HEU in the tank doesn't precipitate out and create a critical mass(!).
