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Baking Soda Shortage Has Hospitals Frantic, Delaying Treatments and Surgeries (arstechnica.com)
An anonymous reader quotes a report from Ars Technica: Amid a national shortage of a critical medicine, US hospitals are hoarding vials, delaying surgeries, and turning away patients, The New York Times reports. The medicine in short supply: solutions of sodium bicarbonate -- aka, baking soda. The simple drug is used in all sorts of treatments, from chemotherapies to those for organ failure. It can help correct the pH of blood and ease the pain of stitches. It is used in open-heart surgery, can help reverse poisonings, and is kept on emergency crash carts. But, however basic and life-saving, the drug has been in short supply since around February. The country's two suppliers, Pfizer and Amphastar, ran low following an issue with one of Pfizer's suppliers -- the issue was undisclosed due to confidentiality agreements. Amphastar's supplies took a hit with a spike in demand from desperate Pfizer customers. Both companies told the NYT that they don't know when exactly supplies will be restored. They speculate that it will be no earlier than June or August. With the shortage of sodium bicarbonate, hospitals are postponing surgeries and chemotherapy treatments. A hospital in Mobile, Alabama, for example, postponed seven open-heart surgeries and sent one critically ill patient to another hospital due to the shortage.
Is this shortage happening in countries with "socialized medicine", or just in free market America?
My local Office Depot has some "Commercial Grade" Baking Soda available, made by some other supplier named "Arm & Hammer". It's in stock, and $1.39 for a pound of it.
I think the summary neglected to mention this is "Pharmaceutical Grade" baking soda. Which would need approval from the FDA to be used as medicine.
One of our competitors trademarked the term "hypothesis". From now on, we will call them "boneheaded ideas".
And will Office Depot certify that it is safe for medical use and is free of contaminates? I mean who do we sue when people start dying, Office Depot, the hospital or you for suggesting it?
“Common sense is not so common.” — Voltaire
I think the summary neglected to mention this is "Pharmaceutical Grade" baking soda. Which would need approval from the FDA to be used as medicine.
Other than handling and packaging requirements any idea what exactly makes sodium bicarbonate "pharmaceutical" vs "commercial" besides millions of dollars and years of approval processes?
It does seem a little silly though, that it's fine we eat it. Hell, some people brush their teeth with it. But "Oh no, don't use the substitute in an emergency!".
"The solution must be pure and sterile because it is injected into the bloodstream."
From deep inside the New York Times article.
This is what happens when you manage your supply chain to maximize profit.
I'm sure US hospitals are hoarding these vials in preparation to ship them to some miserable 3rd-world country with an incredibly underdeveloped healthcare system, but the article misses to tell us which country that is... right?
Arm & Hammer has been a trusted name for 150 years. I'll take my chances.
I wouldn't trust commercial grade, but the FDA could save a ton of lives by allowing hospitals to buy food-grade and sanitize it and create their own solutions. The FDA and malpractice insurers would rather go after hospitals for trying to save lives than to recognize what's best for everyone.
Purity.
Your hair look like poop, Bob! - Wanker.
Hmmm ?
1. Purity. Guaranteed absolutely free of anything that could be dangerous if injected.
2. Sterility. No microbes. Hermetic seal container made free of life at the factory.
3. A paper trail saying where it was made, when, and who shipped it where, for use in identifying any contamination that does occur.
4. Someone who can be sued if all the above fails.
Looking at some of the things it's used for, the risk seems to be worth it in some cases.
if the option is nothing or commercial grade, wouldnt commercial grade be the better option???
have you seen my sig? there are many others like it but none that are the same
Brushing your teeth and injecting it (or equivalent like adding it to dialysis to augment a kidney's natural excretion) is wildly different usage. Think about it a bit more.
Often wrong but never in doubt.
I am Jack9.
Everyone knows me.
He has been known to do this.
Sepsis ain't no fun.
“Common sense is not so common.” — Voltaire
Liability for the hospital?
love is just extroverted narcissism
The option is delaying surgeries and running less effective dialysis. It's not a great long term option, but it is a viable short term option. (obviously with risk and consequences)
“Common sense is not so common.” — Voltaire
One of the major global producers of medical grade baking soda went bankrupt a few years ago, the Australian company Penrice. It wasn't able to compete against the US soda ash cartel, which dumped soda ash into the Australian market.
Soda ash, or sodium carbonate, is mostly used to manufacture glass. The US has large naturally-occurring deposits of it, whereas other parts of the world produce it via the Solvay process, which involves heating limestone with salt.
Penrice was spun out of ICI Australia, which has subsequently became known as Orica, Ixom and Dulux Group
There is :
- ensuring everything is done in a sterile environment
- ensuring its purity
- testing of batches
- tracing and tracking the whole process
- precise weighing and packaging
- ensuring everything is in tamper proof packaging
- auditing of the whole process
All the equipment used in the manufacture, testing, packaging and the people involved are also traced and certified, with everything going back to calibrated National Standards and tested annually (or more). The temperature, humidity, raw materials, etc etc etc etc etc are all tracked right through the whole system in triplicate.
This is not a "throw a teaspoon full in" and it will be all OK.
Ingesting something (and we all swallow a low of bugs, insects, dirt, etc every year) is totally different to having it injected into the blood stream,
And the role of a pharmacists as a chemist is long gone.mixing and compounding substances to be used by humans topically and injected. Only a billion dollar company is willing to take the risk of marking up a common compound and selling at thousands of dollars per oz in the 1st world. Pharmasists are now the ones who are listed on the liability policy and monitor the pill dispensing machine.
FDA approval and the guarantee that it is pure. Hospitals pay for that stuff even though there is no reason that an average lab couldn't produce similar qualities, the brand name of the product would probably have to go through FDA approval which can take years.
Custom electronics and digital signage for your business: www.evcircuits.com
Other than handling and packaging requirements any idea what exactly makes sodium bicarbonate "pharmaceutical" vs "commercial" besides millions of dollars and years of approval processes?
Purity as well as the certification process. Same difference between Certified Unix(TM) and Unix. If it doesn't matter to you that the certification was met, you can use commercial grade (like as a cleaner). If it matters to you that all necessary protocols were followed including ones on contamination, then you need to get the pharmaceutical grade.
Well, there's spam egg sausage and spam, that's not got much spam in it.
well, go shoot up some toothpaste and tell me how well that works out.
---
Is this the MPAA? Is this the RIAA? Is this the DMCA? I thought it was the USA!
You say "purity and packaging" as if it's no big deal. It's a very big deal for something you're going to inject into someone's bloodstream. Take some common fungal spores which might not even count as contamination in food, inject them into patients and you could be facing horrific medical consequences on a massive scale.
Post may contain irony: discontinue use if experiencing mood swings, nausea or elevated blood pressure.
It's used as a solution to clean wounds and mixed with injectable anesthetics to make them less painful. Considering how much sh*t people inject on a regular basis, including bathtub caulking* and >a href=http://content.usatoday.com/communities/ondeadline/post/2010/03/6-women-hospitalized-for-butt-enhancement-injections-with-bathtub-caulking/1#.WSNi3uvyvDA>industrial silicon oil, I doubt that there'd be enough of an impurity to make a difference considering the very small quantities used.
* Warning: gross picture (but still on of the less gross ones)
"Transparent" is a shit show that trades on every stereotype going. A man in drag is NOT a transsexual.
Let's restate "purity" in terms that someone at your level will understand. It has less shit in it that shouldn't be there. Kind of important when you're using it in medical procedures, not so important in industrial procedures.
It's a perfectly simple concept to understand so I'm not sure why you're having so much trouble. If the stuff available from Wacko's Online Emporium was as pure as what's required for medical procedures, there wouldn't be A FUCKING SHORTAGE.
That's fine right up until you realize the arm and hammer baking soda was stored in the same warehouse as raw uncured pork bellies and now has trace amounts of botchulism in the baking soda, and now you're injecting it in to people's blood streams.
moox. for a new generation.
Do you know a Mike Rowsoft by chance?
Table-ized A.I.
The solvay process doesn't have the impurities that the mined sodium bicarb has. The ammonium bicarbonate is removed from the resulting precipitate by heating it; all the other products of the reaction except the solid sodium bicarbonate are gases. As long as the raw ingredients (dry ice, brine, and ammonia solution in water) are not contaminated, what you'll get won't be either.
"Transparent" is a shit show that trades on every stereotype going. A man in drag is NOT a transsexual.
There are remarkably few bacteria that can survive in such a basic environment (8.3 pH), and I don't think they would survive in the much less basic environment inside the human body. Contamination with heavy metals (e.g. aluminum oxide) would be a more plausible concern.
Check out my sci-fi/humor trilogy at PatriotsBooks.
Amusing or terrible parenting? Obviously intentional.
Sure, but the ones that can survive, most likely you really absolutely do not want in your more neutral ph bloodstream
moox. for a new generation.
The whole problem that neither the free market or the socialized system completely solves is the basic reality is that people don't want to work and shucks, no one really wants to compete, either.
Competition is a lot of work and the simplest way to make money is to try and be in a business that can avoid it. The easiest way to do that is to churn out intellectual property and rely on the regulated monopoly to attract investment in that property. In systems where there is no intellectual property, then, the next best way to avoid competition is through scale. In fact, big companies make use of both today - they invest capital enough to differentiate themselves, and then they sit on it as long as they can. If a company wins completely in the marketplace, the smartest move is to raise prices. If you have a nimbler competitor, he or she might just instead simply sell out, because, again, most people don't want to work.
In socialized systems, there's never a part where you get to get rich and sell out, and then not work, so the easiest way to avoid work is to simply do as little as one can get away with. Since everyone is doing as little as one can get away with, smart people with no opportunity for advancement figure out exactly what is just enough to move them ahead commensurate to what the risk is, and social stagnation ensues. But pretty much, the end game of either a free market sector that is mature versus one that is run by the government, is a bunch of people sitting on top of a monopoly sufficient to last their lives, they hope, so they can get paid and not have to work all that much.
This is my sig.
The commercial stuff is cut with baby laxative.
You are welcome on my lawn.
I use a ton of baking soda to adjust my swimming pool PH. Looks like I'm fine. Such a relief.
That's fine right up until you realize the arm and hammer baking soda was stored in the same warehouse as raw uncured pork bellies
If you get outta town to where you're breathing dirt kicked up by off-road vehicles, you're probably breathing botulism spores. But they don't produce a viable culture unless they are in the right conditions. Now, ask yourself, can botulism grow in baking soda? And even if it can, can it get through a plastic bag?
"You're right," Fisheye says. "I should have set it on 'whip' or 'chop.'"
See, without the great and wise FDA's policies of looking out for the people by allowing the concentration of critical supplies and medicines into the hands of 2 such wise and benevolent entities we'd not be in a position where decisions made entirely for profit could affect the lives of the general public. As much as I hate to see people suffer, I almost wish there would be deaths as a result of this and that forced some legal light onto the situation. Critical basics that are free from patent should required to be multiply sourced to ensure a steady interruption free supply chain, not concentrated into one or two 'most' profitable and controllable streams.
errr....umm...*whooosh* *whoosh* Is this thing on ?
Sure, but the ones that can survive, most likely you really absolutely do not want in your more neutral ph bloodstream
Is it most likely, or really and absolutely? Or just bullshit? Because if it can even survive 8.3, it's not likely to be comfortable at 6.5.
"You're right," Fisheye says. "I should have set it on 'whip' or 'chop.'"
Purity.
Not exactly. Both food grade and pharma grade sodium bicarbonate are greater than 99% "pure". Many industrial producers make both food and pharma grade sodium bicarbonate, some of them on the same line and processed to the same purity level...
The difference is that Pharma grade sodium bicarbonate is specifically tested to assure very small levels of certain specific impurities** mostly to minimize potential issues with inconvenient formation of various precipitates and other complications in equipment (e.g., hemodialysis), or your body.
All that product testing/certification isn't cheap and is completely unnecessary if you are simply eating it. For example, if 0.05% of the impurity was NaCl or MgCl, that would *bad* in your blood, but if you ate the typical amount of bicarbonate, you wouldn't even notice that impurity.
**USP has specific tests for impurities such as Chloride (0.015%), Sulfur (0.015%), Aluminium (2ug/g), Arsenic (2ppm), Calcium (0.01%), Magnesium (0.004%), Copper (1ppm). Iron (5ppm), Ammonia (20ppm), Organics (0.01%), etc...
I think we can all agree that the pharmaceutical grade is what hospitals should use. However, if they cannot get it then the potential risks of using a non-pharmaceutical grade product should be compared against not having the treatment which uses it.
For example, if it is used to treat poisoning and the patient will probably die without baking soda it might be worth the risk of commercial grade baking soda. Similarly, open heart surgery sounds pretty serious and might be something which is potentially very risky to delay so the risks of using a less-pure baking soda may be less than the risk of not doing the procedure which requires it.
Why not? /s
General Relativity: Space-time tells matter where to go; Matter tells space-time what shape to be.
And malpractice insurance.
It's not FDA approval of the initial product so much as FDA approval of the ongoing use of the product. A drug maker's FDA interaction does not end when the drug gets approved for use. Pfizer cannot just take industrial grade sodium bicarbonate and sell that instead because it will fail to pass the inspections and audits. Even if the owners are evil there are going to be some employees saying "boss, there's something wrong with this batch, it's clumping up and has impurities, we should toss it out before someone gets hurt".
I would suggest going to another country, but apparently it's illegal to import medicine (for Americans).
They're not out of sodium bicarbonate, they just have shortgages. So they will use the supplies on the most important cases, if your surgery can be delayed then they'll delay it as needed.
The ordinary Walmart product is pure enough for human consumption, as a tooth powder and stomach remedy. My example is chemical reagent purity.
I once worked in the analytical laboratory at J.T. Baker as an analytical chemist. I personally tested NaHCO3 among many other chemicals to USP, FCC, and ACS standards. We had a warehouse with plenty of barrels of these kinds of commodities. Also, I seem to recall that the ordinary box of Arm&Hammer on the supermarket shelf is actually very high quality material, almost pure enough to use for creating primary standard grade sodium carbonate by baking out some water and CO2 at a specific temp.
Note that the costs to certify to USP grade are little different than for the other grades. It is important to understand that many chemicals which come into a chemical plant never require any further purification. In such cases, a portion is split off to be packaged as ACS, another portion goes in the USP bottles, etc. The remainder can be sold off as "Technical" grade if there isn't enough room to store it. If there is room, it might be preferable to store the raw material that meets the higher specs. rather than sell it all off as tech. grade, because the next load that comes in might not meet the requirements for certs. and thus would need to go through a purification process.
What's sad about this story is that because of the regulatory/liability state, it is impossible to engage in simple acts of innovation ("winging it") that could solve problems such as this "shortage." E.g.:
Find a chemical company with some barrels of bicarb. that has been tested to one of the specs., or USP if possible. If they don't have the USP, then have them test the ACS or FCC to the USP std., which would probably pass if it already met one of the other stds.
Then just procure the damn stuff!
If additional sterilization is needed, have the truck routed to an accessible sterilization service. Ie., a facility with a gamma ray sterilization unit, where the material could simply be put on a belt and sent through the rays.
Hospitals should have the capability to filter small lots of solution to further remove any particulates if necessary.
But no, we'd rather incur large risks of an actual death to a patient to stave off some tiny risk.
What a pathetic thing we have become.
If they're using it in open heart surgery it needs to be handled and packaged in contamination free environments.
Pfizer and Amphastar are probably tied into global supply chains for this, i doubt that there's a magical world of abundant pharmaceutical-grade baking soda just over the border.
About the only os that has hardware still in production that is unix certified is mac os so it's meaningless anymore.
Because the FDA doesn't care about the purity of the manufacturer's product all that much.
Oversimplified, but here's kind of how it works.
In general, as far as the FDA is concerned, it is all about the manufacturing process.
The FDA does not look at whether one manufacturers version is as pure as the other; the testing of new manufacturers of a drug isn't about purity, it is about determining equivalent biological activity.
The reason is that two pills containing the exact same chemical and purity can have different biological activity depending on pill hardness, the coating that allows the pill to get past the stomach, and the pill and coatings resistance to humidity or temperature changes, and, of course, contaminants.
And speaking realistically, the complex chemicals you take may have exactly the same amount of the active chemical, but there will always be contaminants, and the contaminants vary according to the process and equipment used. Those contaminants may affect the shelf life and a 6month old pill from a French company may have greater biological activity than one from a German plant even though they both acted the same when new.
That's the sort of thing that happens and that costs boatloads of money to discover in testing. That's why it's all about the process, not the pill.
The FDA generally does not do assays and testing (boatloads of money), the manufacturer does that. The FDA requires detailed logs of the manufacturing process and equipment. The FDA monitors the process by inspecting the logs and doing on-site inspections, and it's an ongoing process because many, if not most, drug manufacturers have been caught cheating.
The manufacturer cannot deviate from the process as was initially approved without the FDA's approval, nor can anyone else just say "it's exactly the same" and sell the product. And the FDA does't say "oh well, it's probably OK" for simple drugs. One law to rule them all.
hospitals could allocate the pharmacy grade stuff for the open heart and use the industrial/food graded stuff for things like the bandage itching. Have the patient sign off on it. And as an incentive, charge the patient the buck it costs for the food grade product if they are willing to use it instead of the 100 they'd charge for the pharma grade.But oh, common sense, not in medicine. This is why an aspirin costs 10 bucks a pill at a hospital.
"delaying surgeries" .. plural forms of a word does not mean all possible instances. I clearly did not say "every surgery must be delayed" and I don't see how I could have even implied that.
“Common sense is not so common.” — Voltaire
There were many posters implying that because surgeries were delayed that we should use off the shelf cooking or industrial sodium bicarbonate. After seeing several of those I assumed yours was falling into that category.
You mean besides mainframes which is still being used by big banks?
Well, there's spam egg sausage and spam, that's not got much spam in it.
Would contamination be restricted to microbes that can survive in a basic environment even if the baking soda is dry? I thought antimicrobials generally had to be solution/liquid/gas to be effective.
And that's not even getting into spores which can't thrive in a basic environment, but wouldn't be killed either.
A cat can't teach a dog to bark.
It's an injectable, not an oral consumable. So, chemically, it's no big deal, but it has to be produced in an FDA-licensed factory to guarantee sterility. Go ahead and try to repeal that, and you'll have thousands of people telling you that drug companies want to sell arsenic-laden rat dung as medicine, and the only thing holding them back is the FDA, so why do you want to kill children? It's not entirely wrong, but it's way overblown, and nobody can measure how many people die because the FDA didn't approve a drug that might have helped them, or (as in this case) because treatment was delayed due to shortages.
No, he bought the company after the name was already established.
Apparently he bought that share to make people shut up about his name. Though he was named after a different Arm & Hammer according to this source.
Highly optimised systems get increasingly fragile. A highly optimised market for drugs will falter on the slightest off-the-regular imbalance. Same goes for IT services. Imagine everything running on and with Google in 3 decades. And Google then having some kind of hickup that puts the entire society of humanity to a grinding halt for a few days. Or weeks.
A Utopia would have to be built taking this systemic problem into account. But then again, this might not be the best example. As we all know, the US medical system is about as far away from Utopia as it gets.
We suffer more in our imagination than in reality. - Seneca
If you've no other option, sure. It wouldn't be the first time doctors have improvised treatment in a disaster situation using whatever comes to hand. But such practices should be avoided where at all possible, and it's not that desperate yet.
I would suggest going to another country, but apparently it's illegal to import medicine (for Americans).
The top producers and consumers of sodium bicarbonate are China and the USA. Europe is the next largest and they consume nearly all of their own production.
I'm not so sure that many would want to follow your suggestion of importing pharma grade sodium bicarbonate from China...
An this, ladies and gentlemen, is why Libertarians should be locked in an asylum on sight.
No, it has to be a liberal conspiracy of Big Pharma/Teh Evil Government/Alien Lizard Overlords.
To have a right to do a thing is not at all the same as to be right in doing it
if the option is nothing or commercial grade, wouldnt commercial grade be the better option???
| know slashdotters love binary choices, but it's just possible that there is a slightly more nuanced risk assessment going on, and that delaying an operation rather than risking infection is the better clinical decision.
To have a right to do a thing is not at all the same as to be right in doing it
This is the smoking gun, people. The fact that the situation is constrained by secret agreements between players shows that no free market existed.
The "free market" is a myth, and it has always been a myth. Without some independent mechanism to enforce honest behavior any market will become a criminal extortion enterprise. That is why there are laws against raising prices in emergencies. Otherwise bottled water and cans of food would go up by double digit amounts in case of a hurricane, tornado or earthquake, and people might even die as a result.
Of course these days it doesn't take a catastrophe for greedy corporations to charge obscene prices. Epi-Pen, Valeant Pharmaceuticals, and Turing Pharmaceuticals have all engaged in extortion pricing after acquiring existing drugs. This is life threatening and gouges the taxpayer as well.
The history of food and drug regulation in the US is the history of mass poisoning as a result of ignorance, greed and lack of regulation. All the comments about the "ebil gobment" blocking noble free enterprise are right wing masturbatory fantasies.
The biggest issue we face is regulatory capture where special interests take over the government agencies that are supposed to keep them in check. Examples are the revolving door between the FDA and the pharmaceutical industry or the end of Net Neutrality at the hands of the telecommunication cartel.
It's not about the government squashing the free market, it's about corrupt powerful monopolies using the government to enforce their dictatorial control over the economy.
Why is Snark Required?
Is this how he wants to make America great again? Or is that the outcome of his health care legislation: we offer everything, but you won't get any of it.
My local Office Depot has some "Commercial Grade" Baking Soda available
Personally, I only smoke crack that’s been rocked-up with pharmaceutical grade baking soda, but I get that not everyone is a connoisseur.
-- sudon't
Air-ride Equipped
Unless of course they already are, and they're the undisclosed supplier having unspecified problems.
I have a bottle of that very same stuff in my lab right now, same grade, from the same supplier. Notice the the terms "Reagent Grade" and "Assay Percent Range 99%"? Those mean that, in reality, it's not exactly high quality.
What's the other 1%? Well, on the side of the bottle is listed a "certificate of analysis" that includes, among other things, lead, copper, sulfur, and chloride ions along with their approximate concentrations. Still want that in your body? Well, for what I use it for (creating buffer solutions) I don't care if those are present, but if I need the ACS/analytical/pharmaceutical grades, those are going to cost significantly more (they start at around $60 for the same quantity rather than $8 for that bottle of low purity stuff you linked to).
It's not FDA approval of the initial product so much as FDA approval of the ongoing use of the product.
Your comment started strong, but then...
The problem is the intricate web of approved manufacturers, raw material suppliers, processing/manufacturing equipment makers, etc etc was not implemented with sufficient redundancy along the chain because it gives the government more opportunities to seek graft and votes from those wishing to enter the market and from those already entrenched who wish to cripple possible competition and stay politically/regulatorily-competitive among themselves, as well as political control using the power of approval/denial and an artificially-limited market. If you're a big pharmaceutical or medical device maker you're going to donate to whatever campaigns, pay whatever K-Street lobbyists, and donate big money to whichever charity organization/think-tank front for whichever power-broker they need to buy to stay in business and turn a profit. Include a revolving-door to "friendly" regulators, lawmakers, etc in government who cash in on a "consultancy" job with those they formerly held power over after leaving government as another major reason much of the government regulatory landscape is a nonsensical spaghetti-mess that is the current US pharma and medical device/technology fields.
Strat
Progressivism (aka US 'Liberalism'): Ideas so good they need a police/surveillance-state to enforce.
Read it again - the few contaminants are easily removed. Most of them go away on their own, since they're gases, not solids, and the only one that isn't is removed by heating and it too becomes a gas. For the quantities needed, it's more than good enough.
"Transparent" is a shit show that trades on every stereotype going. A man in drag is NOT a transsexual.
Doofensmirtz Evil Incorporated just announced a plan to use a giant baking soda volcano to take over the ENTIRE Tri-State area! Their stock is up 5 points after the announcement.
I'm trying to teach myself to set people on fire with my mind... Is it hot in here?
The ordinary Walmart product is pure enough for human consumption, as a tooth powder and stomach remedy. My example is chemical reagent purity.
Yes, but is it pure enough to be injected via an IV? Lots of stuff enters through your mouth, how much of that would kill you if injected? Chemical reagent purity doesn't necessarily meet the same standards as injectable purity.
The cesspool just got a check and balance.
But muh free markets!
I'm a good cook. I'm a fantastic eater. - Steven Brust
The ordinary walmart product isn't being directly mixed with the content of your bloodstream.
There are a number of barriers between the digestive tract and your internal liquid systems.
Is there a big overlap between antivax and libertarians? Or, maybe, people that promote antivax, but themselves have all their shots.
I'm a good cook. I'm a fantastic eater. - Steven Brust
I call bullshit on the whole "pharmaceutical grade bicarb is so spesh-ul" argument. If you're in medicine in the UK, guess where you can order this grade, and at what price?
https://www.amazon.co.uk/Sodiu...
Note the big red caution that no supplier will ship this product to the US. Since the bloodstreams of British [patients are going to be the same as US patients, the reason for this is that US pharma is setting us up for another Daraprim.
If they get away with this one, we might as well fill our bathtubs for when pharma engineers a shortage of water.
Since hospitals quit having formulating pharmacies and went to outsourcing for common stock items like sterile saline, sterile bicarbonate solution, and sterile distilled water; they have been at the mercy of third party suppliers. Such common items are really a low profit item for suppliers that they don't stockpile such.
The trend to outsource instead of having employees and equipment to do things in house has been working its way into industry since the 1970s. And a hospital is very much an industrial installation when you get down to daily operation.
NRRPT/RCT
> Because postponing chemotherapy and open-heart surgery is so safe, amirite?
It's safer than operating like you're on a 19th century battlefield.
This isn't software where you can slap something together with zero discipline of any kind and "patch it later".
A Pirate and a Puritan look the same on a balance sheet.
Either that or prison.
Doctors have found that when they get rid of medical malpractice that they still have to worry about going to prison for gross negligence. Apparently that doesn't just magically go away because you've managed to avoid one aspect of personal responsibility.
A Pirate and a Puritan look the same on a balance sheet.
Mainframes and Unix are entirely two separate and competing entities. They have their own operating systems.
If a mainframe is running a Unix "VM", it's probably Linux.
A Pirate and a Puritan look the same on a balance sheet.
By definition, reagent grade must be absolutely pure. You can't get more pure than reagent grade, you can only label it differently and charge more for it, which is what pharmaceutical grade really means.
APK quotes people (including myself) without context and should not be trusted. Just thought you should know.
for something this critical. That's the part that shouldn't be left to the free market. We do the same with our food supply through subsidies. When stuff matters we don't leave it to the free market. If we did we'd still have dust bowls and food shortages.
Hi! I make Firefox Plug-ins. Check 'em out @ https://addons.mozilla.org/en-US/firefox/addon/youtube-mp3-podcaster/
I suspect that may be the answer. Lots of chemicals sold by international companies specializing in chemicals (e.g., Fisher, Baker) have switched their raw suppliers from Western sources to China. As we all know, you have to ride herd constantly on Chinese suppliers because they will take any shortcut they can to save money.
It wouldn't surprise me if the latest batches failed QC testing here in the States even after supposedly passing QA at their source. Even more fun, if FDA inspectors found problems anywhere in the supply chain it may take a while to remedy. With only two end product suppliers problems at one can cause a shortage very fast.
Hospira (a Pfizer company), which is the one that has the shortage, has had a recent history with quality control issue (problems with cardboard particulates in injectable vancomycin).
FWIW, in an email, a spokesman said the shortage is due to issues with a third-party supplier but not the API supplier. (API means active pharmaceutical ingredient), so it isn't likely to be the actual soda ash / bicarbonate supplier that is the issue per se, but perhaps some other company that supplies testing materials, or perhaps some packaging supplier. As I mentioned the USA is one of the largest suppliers of sodium bicarbonate, it seems unlikely that there is a simply sourcing problem with the basic ingredient and not something fixed by going to China.
Except that in this case, sodium bicarbonate is not a big profit center for Pfizer. I don't think they're sending out lobbyists to keep others from getting into this market.
Incorrect. There are numerous standards. Reagent grade is never 100% pure. Some standards have thresholds for toxins or sterility that are not specified in reagent grade specifications.
Man, you really need that seminar!
Nowhere did I say that ALL mainframes use Unix. However, if there are mainframes, there's a chance it is using Unix still. You of all people should know that mainframes ran Unix or VMS originally.
Well, there's spam egg sausage and spam, that's not got much spam in it.
Interesting. Any good references for this information?
Someone with mod points, please mod my earlier comment down so it doesn't spread misinformation.
APK quotes people (including myself) without context and should not be trusted. Just thought you should know.
Backed up by paperwork. Plus, the paperwork can be traced back to reference samples from that batch from the packaging plant, and those reference samples will be available when people are investigating your operation in 50 years from now.
Birds are not dinosaur descendants;birds are dinosaurs, for all useful meanings of "birds", "are" and "dinosaurs"
we subsidize the growing of unprofitable crops to ensure diversity. We subsidize specific behavior too (like crop rotation). Our food supply is heavily controlled by our government and largely for the better.
Hi! I make Firefox Plug-ins. Check 'em out @ https://addons.mozilla.org/en-US/firefox/addon/youtube-mp3-podcaster/
Except that in this case, sodium bicarbonate is not a big profit center for Pfizer. I don't think they're sending out lobbyists to keep others from getting into this market.
Pharmaceutical companies don't typically enter the market depending on a single product to keep them afloat.
Bicarbonate of soda would be only one minor side-product for a competitor as well as the other, major, cash products they would need to offer to be competitive, same as the established players. Keeping competitors out of the market for medical-grade bicarbonate of soda is simply a part of the collateral damage caused by collusion between the pharma industry and government to suppress new competition.
Government isn't the solution, government is the problem. "The nine most terrifying words in the English language are; 'I'm from the government and I'm here to help.'" --- Ronald Reagan
Strat
Progressivism (aka US 'Liberalism'): Ideas so good they need a police/surveillance-state to enforce.
I'm too lazy to find any LOL. My gf works in biochem/pharma and talks about the standards. For say an injectible solution it would need to be sterile (with a specific testable definition of sterile) and would have a constellation of acceptable levels of various metals and other molecules. They test everything and have to keep records on batches. Lots of stuff doesn't pass. ACS grade might specify 99% pure but you could have something be 1% MRSA or methylmercury and still meet that standard.
Man, you really need that seminar!
Huh, I always thought reagent stock had to be exceptionally pure to avoid side reactions. Really interesting to learn that this is not the case.
There's probably a reason I didn't get into chemistry in any real capacity.
APK quotes people (including myself) without context and should not be trusted. Just thought you should know.
It's funny, biochemistry is really different from standard chemistry. They don't understand why or how a lot of things work, which is why a lot of these things have standardized manufacturing methods and testing. You wouldn't think that 2 compounds that appear to be identical but made with different processes would work differently but they very much do. Tiny variations in the inevitable impurities can make the difference between something causing a nasty reaction when injected and everything being fine. Another big variable is shelf life. Some processes give product that is quite stable, others give product that is very perishable.
Man, you really need that seminar!
Piss off, Alexander.
APK quotes people (including myself) without context and should not be trusted. Just thought you should know.