Family physician, Dr. George Miller, long in practice in southwestern Ontario and a former President of the Ontario College of Family Physicians, writes in response to our CMAJ article with an excellent question that embodies a suggestion! We agree.
Dr Miller writes:
The CMAJ mentions that this has been a problem since 2010 but it has been present for long before that. Around 2006, the pharmacy in our building started issuing a list of common drugs that could no longer be obtained, and as you have already noted, the list consisted exclusively of cheap, proven medications for which the patent had run out. They were all generic. By the early 200s it was impossible to prescribe as simple an antibiotic as penicillin G or V, despite the fact that it was still effective in simple strep infections and cost pennies. I remember over 14 commonly-used medications being on one list including antiemetics, cheap antibiotics, and some of my epileptic patients had to visit numerous pharmacies to find medication that had kept them stable for years.
Even then we were were being told by the drug companies that the problem was “complex”, but I don’t think it is at all. It all boils down to what is most profitable to produce.
I think the solution is for our government to found a crown corporation to produce the common, proven cheap medications that the drug companies are unwilling or unable to provide. This would be on a non-profit basis. The benefits would be many. If doctors were able to prescribe proven and cheap medication for common conditions rather than blockbuster drugs, the cost to Provincial drug plans would decrease. Also the corporation would be able to export cheap, proven medication to third world countries in desperate need. I well remember a colleague of mine arriving in Africa as part of doctors without borders to find one bottle of tetracycline in the clinic for a population of over 2,000. Although such a crown corporation would make no profit, it would provide jobs for many people and could become an international Canadian industry.
Congratulations on your article in the CMAJ. I hope that you are able to effect change.
George B Miller
Family Physician & LTC (retired)