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Worldwide Shortage of Barium
New submitter redhat_redneck writes "The U.S. and Canada has been experiencing a shortage of barium sulfate, which is used as contrast for upper and lower GI studies. It has reached the point where doctors are being asked not to order these exams except in emergencies, and some exams are being cancelled. Here's the letter that's been put out by the manufacturer. The longer this drags on, the more serious this issue becomes, eventually impacting patients and healthcare providers in both cost and quality of care. Some sources point to a dramatic drop in Chinese production. In their defense, it seems China is changing safety regulations. Medical use only make a fraction of the uses of barium sulfate, but it's going to be disproportionately affected by this shortage. We can't go back to our old contrast Thorotrast; it causes cancer. Does anyone know of alternatives to barium?"
1. Use Thorotrast.
2. People get cancer and die.
3. Then you Barium...
The icky-factor aside, Barium is an element does not vanish and can certainly be sterilized to any degree desired. So, why do they apparently not recycle the stuff?
Most ACs are not even worth the keystrokes to insult them. Be generically insulted by this and ignored otherwise.
Gastrografin and Ultravist. No reason to defer these examinations.
Of course Slashdot readers are supposed to get it.
Contrast is what it says. It's there to make whatever you want investigate stand out from the rest observe it. For instance to make blood vessels easier to see. (Now I don't know whatever this is x-ray, MR, ultra-sound or whatever.) My english isn't good enough to know what GI is (gut-ingestion?) but I guess it's the stuff from the throat to the ass.
The last time (Last Month, 19th) I got my B12 Injection I was told there is a Nationwide shortage of B12 used for Injections also. It was confirmed when I tried to refill my prescription at some local Pharmacy's. Thankfully I still have some left in my Vial, but those of you that don't and need this, you can be prescribed a Pill that will do the job, though not as good, until production picks up if it hasn't already.
what GI is (gut-ingestion?) but I guess it's the stuff from the throat to the ass.
Gastrointestinal, your guess is correct: mouth-esophagus-stomach-intestines-anus. It's basically one continuous external surface inside the body.
GI stands for Gastro-Intestinal, as in the eponymous tract. You are not as much of a smartass as you think you are.
Barium Sulfate is also HUGELY important in oil well drilling mud.
http://en.wikipedia.org/wiki/Drilling_fluid#Composition_of_drilling_mud
China putting a crimp on drilling mud could have some interesting effects, I'm sure. What makes little sense is the complaining about a shortage in hospitals, where a dose is less then an ounce, when oil drillers are pumping the stuff into the ground by the ton...daily...all over the world. Unless of course somebody wants us to get excited about China stepping on the hose without us finding out where the real shortage is.
I wonder who that might be. I also wonder who submitted this story.
Gastro-Intestinal aka the bit between the mouth and the anus. This stuff shows up (contrasts) on x-rays. Upper studies involve drinking it. Lower studies involve insertion from the other end. In other words, it's used for testing gut disorders and if you aren't swallowing it, you can shove it up your arse.
Is there any other place to get Barium besides China?
They're called rare earth metals not so much because they're rare, since they're a bit all over the place, but because they're not concentrated enough to mine efficiently. This makes it highly polluting to extract them.
The US a couple more countries used to extract them, until China came along with no pollution standards, and priced everyone out of the market. Trouble is, you can't "just restart" such a mine. It's a decade long process to do so -- and it's in progress insofar as I've been following, because China decided to keep these strategic minerals for itself so as to keep high tech manufacturing at home.
Barium is a rare earth metal.
Not exactly, Barium is an alkaline earth metal, related to Magnesium and Calcium. Interestingly though, the U.S. are one of the largest producers of Barium, accounting for about 8% of the world wide barium output. It's mainly mined as barit, or heavy spar.
Doesn't anyone recycle this crap?
Layman's explanation: Contrast agent is something that shows up as a bright color on your scan. There are many different kinds of contrast used for many different purposes, too many to list here. Barium contrast is swallowed and shows up as bright white on regular X-rays and CT scans (CTs are a multitude of X-rays taken by a computerized scanner which is then turned into a quasi-3D representation.) The reason somebody would use barium is to look at the shape of the esophagus (food pipe), stomach, intestines, and rectum to see if there are any parts that are too wide, too narrow/pinched off, the wrong shape, if there is a blockage, etc.
Not so layman's explanation of the tests mentioned:
- Barium swallow: Barium is swallowed and a real-time series of X-rays (fluoroscopy) of the throat (pharynx) is done to see if the barium is swallowed properly. The resulting video shows where the barium goes. This is ordered if the doctor suspects the person may be having problems swallowing (aspiration or refluxing.)
- Esophogram: Barium is swallowed and fluoroscopy of the esophagus is performed to see if there are any abnormalities of the size/shape/anatomy of the esophagus. This is also ordered if somebody has trouble swallowing and the doctor suspects some problem like a stricture, widening of the esophagus (achalasia), abnormal anatomy of the esophagus (such as a diverticulum, malignancy, etc.)
- UGI = Upper gastrointestinal study. This fluoroscopy stufy follows the barium from being swallowed until it goes into the stomach. It shows all of the same things as the esophagram along with the size/shape/anatomy of the stomach as well. Ordered for the same reasons as the esophagram as well as if you suspect some anatomic problem with the stomach (e.g. stomach stapling/bypass not working correctly, etc.)
- Small bowel follow through: Barium is swallowed and then a series of individual X-rays taken at certain time intervals to track the progress of the barium through the stomach and small intestine. This is done to investigate things like the stomach emptying too slowly and obstructions in the small intestine.
- Barium enema: Barium is given via enema into the rectum to look at the anatomy of the rectum. This can investigate anatomic abnormalities of the rectum such as masses and fistulas (a hole from the rectum to somewhere else, this is abnormal.) This can also be used to both diagnose and treat intusussception (a disease of infants where part of the large intestine telescopes into itself.)
Just "gittin-r-done," day after day.
Gastrografin is already being used as a viable alternative to barium in radiological studies as contrast for imaging the Gastro-Intestinal (GI) tract, especially in patients where bowel perforation may be imminent (barium spills into the abdominal cavity as a result, causing barium peritonitis; while rare, it is an incredibly deadly complication), in conditions such as intestinal obstruction, for example. See: http://en.wikipedia.org/wiki/Diatrizoic_acid Given that I am but a medical student, this is fairly well known in the medical world. Which makes this an odd question to ask...
Ouch! Complete chemistry fail!
Barium is certainly NOT a rare earth. It is an alkaline earth metal. Look at the periodic table for christ's sake.
And the sad thing is this got modded up. Doesn't anybody know their high school chemistry anymore?
*weep*
Was being brief and assumed the implications were obvious...... guess not
1. Just because a few geeks are certain re-use is ok and might be willing to do it, the general public would not be
2. Even if you are a geek, there's no guarantee some minimum-wage flunky at a re-processing company (or some unionized hospital worker who is mad and in the middle of some "labor action") is gonna do a perfect job and the stuff YOU end up drinking will be properly re-processed. A bit like drinking re-cycled urine .... fine if you are a geek and the processing is being done by the rocket scientists at NASA for the space station, but are you still willing if it's being done by the guy who's only other career option included saying "want fries with that?"
3. A good lawyer will easily convince a typical jury (possibly with members who are anti-science lefties who reject nuclear stuff) that there was some bad thing in the re-processing process (probably done by evil "big hospital" or "big pharma") i.e. it's just another level of "doubt" ....
Think some more and you can imagine many other reasons that each just make the business case a little bit harder to close. No single cut might kill the patient (in this case: re-use of Barium), but lots of little cuts and he bleeds-out
You assume, naively, that the hospital does the recycling and just makes up fresh suspensions. Of course, if any recycling was done it would be to recover the pure BaSO4, which would be the domain of a chemical supplier; who then supplies the material to a pharma company, who then makes the thing you drink, who sells it to the hospital.
Recovering the material from shit is no different to recovering it from the ore it originally came from in the ground. Medical-purity BaSO4 is likely to be a further cut above the lab-grade stuff you can buy from any number of common chemical suppliers - purifying it is trivial - they do it all the time to make the stuff in the first place. What we're discussing here is the economic viability of recovering it from sewage waste. The source is ultimately unimportant. If it ends up in a drug it has to come from a very specific, well monitored source. There's no chance some "flunky" is going to affect the dose of contrast agent you drink. (Oh, and nice, unnecessary jab at union workers and "lefties" there - given your level of discourse and opinion of union labour I'll try and keep my words to fewer than four syllables so you can follow along).
It seems you live in a world full of conspiracies and hidden enemies in the shadows at every turn trying to get one over on you. You might want to just relax a bit. You can log in too; the government is not tracking your slashdot account.
There is no shortage. The problem is the price is increasing. But most likely the reimbursement rate by Medicare hasn't gone up to keep pace so they can't fill the orders for the price Medicare is covering. Most of this GI stuff is for seniors anyway. This is most likely a political move to get people scared so they can get the lobbyists to jack up the reimbursement rate.
I love Jesus, except for his foreign policy.
It's basically one continuous external surface inside the body.
You make us sound like living, breathing Klein Bottles...
People seem to think that China is some sort of charity. If people want to talk of global monopolization, then you should consider things like farm subsidies. Cheap rare earth materials may have enabled China to grow its production industry at the expense of certain rich countries in the past (and I'd say that current changes actually represent a *restoration* of the natural order of things) but present agricultural subsidies are basically killing people in poor countries *right now*. I'd be all in favour of a fair, balanced and international system of setting regulations, pricing, and subsidies, but moaning only when it turns against you is just simple whining.
It's basically one continuous external surface inside the body.
You make us sound like living, breathing Klein Bottles...
Not a Klein bottle... We're basically just a living, breathing donut.
E pluribus unum
Maybe if you were born without a nose.
The issue with US-mined barite/barium sulfate is that is lacks the high purity required to meet pharmaceutical specifications. US barite tends to be lower grade (having higher impurities) and is more suited as an industrial filler or weighting agent in drilling mud.
We're basically just a living, breathing, seriously deformed donut.
FTFY.
(At any rate, that reminds me to get some exercise today...)
Well if your goal is to look more like a donut... eating more donuts is actually a way to achieve that.
I'm a good cook. I'm a fantastic eater. - Steven Brust
You poor bastard. My experience was just a single barium milkshake, preceded by a pill-cup full of flavorless pop rocks to inflate my stomach. Considering the after-effects of just one (I foolishly thought I could go to work that afternoon), I can only imagine the effects of multiple barium milkshakes.
For those who've yet to experience this miracle of modern medicine: when asked what flavor you want added, choose a flavor you won't care if you never taste again, for you'll probably never want to taste it again... Coworker several jobs back can no longer drink strawberry milkshakes for this reason.
"The urge to save humanity is almost always a false front for the urge to rule." --H.L. Mencken
I guess that means "No enema for you!" :-)
"Flyin' in just a sweet place,
Never been known to fail..."
The word is torus. We are basically homeomorphic to a torus. So are sheep -- apply a mapping such that the interior and exterior of the torus are exchanged, and the result is called a haggis.
Charity - far from it, more like milking us for what we're worth and hell bent on taking over the world. See "Chinese century"
It really depends upon when the cost of barium becomes greater than the cost of keeping you in some sort of minimal care/cost sh*t-wait facility. Note that no such facility exists today, but if relative costs change...
I'm also under the impression that antibiotics leave the body in urine and feces. How much antibiotic resistance is because of misuse, and how much is because of uncontrolled introduction into the environment through our wastes? Such a facility mentioned above might also be worthwhile for our antibiotics-of-last-resort, for instance.
The living have better things to do than to continue hating the dead.
It's more invasive, more expensive, and requires general anesthetic.
No. It can and usually is done under twilight sedation.
I can see that would work; watching the Twilight movies would put anyone to sleep.
Donte Alistair Anderson Roberts - hi son!
Karma: Chameleon
You wouldn't be welcome on such a site, given your attitude to questions - which, after all, are a prerequisite to learning.
First, medicine is a science, thus the expression "most scientific and medical terms" is redundant. Second, no one understands most scientific terms. "Science" refers to the entire body of human knowledge, which not only is far too vast for any one person to know most of, but also grows faster than you can learn it - even if your learning capacity was unlimited, the bandwidth of your senses is simply not enough.
Finally, "nerd" doesn't necessarily refer to someone interested in either science in general or medicine in specific. People who are enthusiastic about programming, or matemathics, or 19th century French poetry could all be called nerds without necessarily knowing what "GI" refers to in a medical context - assuming it actually refers to just one thing and isn't reused anywhere. On the other hand, "LEO" is usually used with sufficient context to conclude that we are talking about some kind of satellite orbit or at the very least a space trajectory.
Perhaps you wouldn't have such issues with jocks if you changed your attitude a little? Because I can certainly see why a jock - or, really, anyone - might not like you.
They don't like you because you're an arrogant twat, just in case you didn't get that already.
Forget magic. Any technology distinguishable from divine power is insufficiently advanced.
Typical impurities in US barium sulfate (Nevada mines) are silica and strontium sulfate. Silica can be somewhat removed via froth flotation using standard commercially known techniques. The Sr is bound up in the Ba-Sr-SO4 lattice and very difficult to remove. Were they not bound together in the crystalline structure you could likely use an alkaline leach with sodium hydroxide (I saw a patent from the 1930s or 1940s that discussed this very approach), but when they are bound together you do not get selective leaching. Also, because they are bound together gravimetric separation (SrSO4 = ~3.8 SG IIRC, BaSO4 = ~4.45 SG) doesn't work.
Sr and Ba are very similar chemically, but to meet the USP requirement of 97.5% min BaSO4 you have to be able to get the purity up (or start with a high purity ore). The USP assay test differentiates between the two because of the difference in solubility as chromates - the Sr chromate is much more soluble but you have to convert everything to chromates to get the Sr to drop out, then you'd have to convert the Ba chromate back to BaSO4 and not leave any chromate in there, as it is very toxic. At that point you are no longer dealing with natural purified barium sulfate but are instead making a precipitated barium sulfate, in which case you could just start with pretty much any barium compound and fully react it with sulfuric acid. The problem here is that any soluble barium left behind is very toxic (for a real life example of what could go wrong see http://en.wikipedia.org/wiki/Celobar_incident).
By the time you do all of the processing above the cost is nowhere near what could be achieved with natural, high-purity barium sulfate ore that undergoes a simple acid leach.
With the production of Barite at 8,000,000 metric tons per year (http://www.indexmundi.com/en/commodities/minerals/barite/barite_t7.html) the real shortage is caused by the fixed price medicare pays for a procedure involving a barium swallow.
"Twilight sedation" is when you are given a drug to make you sedated but not actually to the point of unconsciousness as with general anesthesia. The big advantages of it is that you do not need an anesthesiologist around or quite the same level of monitoring, plus patients tend to come out of it quicker. Usually it is done with midazolam (Versed) which as a useful side effect generally makes people forget the procedure. Sometimes fentanyl is used as well, it also is a pain medication. Kids tend to get ketamine, adults less so because adults can be very agitated (dysphoric) when they come out of ketamine.
Just "gittin-r-done," day after day.
A five-hole donut (assuming your anatomy is normal - including intact eardrums).
Mouth-to-anus gastrointestinal tract, two nostrils (into throat), two ducts from corners of eyes (into nasal passages).
Bantam Dominique roosters crow a four-note song. Once you've heard it as "Happy BIRTHday" you can't NOT hear it that way
Iodine is used in the illegal manufacture of Methamphetamine. As a resule, Iodine has recently been reclassified as a List I chemical under federal law. Those handling or selling iodine and its compounds must now go through a bunch of bureaucratic red tape with the DEA.
I found this out right after the Fukushima disaster (when I tried to find some potassium iodide supplement {or other potable iodine compound, such as water purification tablets or tincture of iodine} to take to bump my iodine level before the fallout arrived). Guess what: None to be found. Not just because it had been sold out by those who responded faster. But because most retailers (including large drug store chains and sporting goods stores) had stopped carrying it, rather than deal with the drug warriors.
I suspect that, even if some iodine compound is suitable for a gastrointestinal contrast medium, the drug industry has not been interested in developing it and seeking approval, at least until now. While barium was in cheap supply why should they spend money developing a replacement whose distribution would involve expensive federal red tape?
Bantam Dominique roosters crow a four-note song. Once you've heard it as "Happy BIRTHday" you can't NOT hear it that way