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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.
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Purity.
Your hair look like poop, Bob! - Wanker.
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.
He has been known to do this.
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,
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.
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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.
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.
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.
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Critical systems should have redundancy built in.
That isn't the same thing as inefficiency.
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.
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 ?
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.
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.
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.
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
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?
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.
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.
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.
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