The politics of disaster relief...
 

You won't read about this in the paper, but I heard this story first hand from a friend who is involved at the very high levels.

As you may know, the disease that spreads after a Tsunami will likely claim more lives that the initial disaster. Infectious diseases, primarily due to gram- bacteria will cause widespread suffering and death. These bacteria are very effectively neutralized using a group of antibiotics called quinolones. Getting the proper antibiotics to the disaster scene quickly is of critical importance.

A large U.S. pharmaceutical company was contacted regarding the crisis and amazingly reported that they had 300,000 doses of quinolones that were less than a year past the expiration date and they could have them on a plane headed to Southeast Asia within 24 hours. No charge.

The U.S. State department was contacted in order to provide emergency clearance for the export. After a lengthy delay, the State Department respectfully declined the pharaceutical companies offer. The reason? The negative public opinion that might be generated if the U.S. were to send expired medications to disaster victims would be too great.

Hard to imagine, but as I said this comes from a high placed source.:(

I could see it now. Some third-world countryman dies after the injection (not even a grade-A dose could have saved him) and the US gets sued for giving expired doses.

"Papa woulda lived with a real dose" says the little kid with big eyes on the lawfirm commercial, boasting its number and "Call if you recieved a U.S. vaccine" (in another language of course).

Yes, I would rather have an expired dose than none, but there are always wolves amongst the sheep.


Baaaaaaaaaaaa

The expiration dates are nearly meaningless. In fact, the contingency plans for an American infectious epidemic call for immediate distribution of the same stores of outdated drugs. I personally use expired meds all the time with no concern. At worst, an antibiotic 5 years past expiration may be very slightly less potent.

Amazing that the U.S. could let thousands die in order to avoid international embarrassment.

We sure know how to put things in perspective, don't we? As an aside, it might have been that contingency plan that is actually preventing distribution.

Powerful, disturbing images. I hope we can find a way to get medicines over there in adequate supply before the tragedy worsens.

Moses

You're saying that the expiration dates are virtually meaningless. Is this unnecessary conservatism in estimating the drugs' efficiency not where the real problem lies?

LeRoux

Moses, I don't agree. Sure the medicine MAY be OK but what if it isn't, you'd be giving false hope to people who could otherwise be taking "fresh" medicine. The state department is correct on this one, knowingly giving expired medicine to the victims is the wrong thing to do. Besides if there are 300,000 doses of expired medicine how many doses of fresh medicine can we spare? My company manufactures OTC transdermal patches and yes we are conservative with our expiration dates, we do all sorts of aging studies on these patches and then add a margin of safety into our expiration date. In our case we aren't talking life and death, just inconvience. I want the people of the affected region to get the very best care our nation can send them.

Here is the problem. The safety and efficacy of antibiotics long past the expiration date is well established. The very short shelf life of most meds is due to limited aging studies. Much of the third world uses expired meds exclusively because of cost. This must be absolutely clear: The safety and effictiveness of one-year expired antibiotics are not questioned by any experts.

Time is the critical element. By the time 300,000 new doses of quinolones can be produced, thousands more will die.

With all due respect to the potency or lack thereof of expired medicines, given the circumstances surrounding the bad publicity Bush, his administration and the U.S. government has received in its perceived ineptitude toward the disaster, I think the State Department is merely playing it safe. I don't think it's a matter of whether or not they want to help the victims as much as it is the notion that the U.S. will be allowing expired drugs to go to the victims in light of the P.R. problems it already has experienced.

I understand the argument from a medical viewpoint - yes, the drugs are probably okay. But "expired" drugs and "U.S." in wake of the tsunami/earthquake could be one more (P.R.) disaster.

Ok in that case I can agree, if in fact they already use expired meds. However this should be pointed out not only to those recieving the meds but also to the media beforehand. The case has to be made prior otherwise undoubtedly there would be criticism especially if someone were to die. Also if in fact we don't have stores of fresh antibiotics and this is the best hope that should also be noted beforehand. One has to wonder though what the US government currently requires to have in inventory in the event of a breakout in the US be it terrorism or otherwise because if the people of the US are put into perceivced danger there will also be criticism. My fear was simply the world's perception of the US "passing off" old drugs to a third world country as well as the efficacy of said drugs. I just don't want to provide ineffective drugs to a people who are already struggling, if we know they are effective then they should be shipped.

My friend who is the source of this story is one of the worlds leading Infectious Disease experts. He is heartbroken over this. He and his academic colleagues from Harvard, the Centers for Disease Control and the National Institute for Health have offered to write a position paper testifying to the safety and effectiveness of these drugs. Sadly, this is about the politics of international public relations and nothing more.

As I recall, a few years ago, it seems to me that there was some outrage by the press both here and overseas when it was discovered that we were selling expired drugs in Africa, although I'm not really sure if they were expired or if we're giving them away for free. It seems like no matter what we do, we lose.

Moses - I concur wholeheartedly that this is a bureaucratic abomination.

On the bright side, I'm going to show this thread to my girlfriend who constantly rides my a$$ about the cabinet full of "expired" meds that I keep and access as needed. I made the point you made (and I'm no doc, so it didn't carry any weight): "so what if it's older, at worst it's just less potent ... so I'll take two [smirk]" That set her off. :D

I still keep an eye on her when she's in one of her "Stalinesque purge" cleaning modes to make sure none of my drugs wind up in the garbage. Constant vigilance is the price I pay for my stocked medicine cabinet.

JP

More to the point of the thread, here's an interesting piece about the international politics of the relief effort ...

Most Pelicans will know already what I have to say about this, so I'll just submit it w/o further comment. :D

JP

EDIT -- mmmmmMMMMMMRRRGGG!!!!! I can't resist ... here's a Mark Steyn piece as well... Technically, they're not my comments.

Man, don't double dose! Keep in mind that some things like sunscreen lose effectiveness rapidly over time. Most antibiotics are more stable if stored properly. I would never recommend that anyone make a habit of using expired meds, I'm just saying that in this specific case, it's safe, reasonable and effective.

Do as I say, not as I do? Typical Doctor! :D Tell me you're not an overweight, two-pack-a-day heart surgeon!

I don't double up routinely, but I'm larger than your average bear and I find w/ most drugs it takes more to have an effect than if you were writing the scrip for a 90 lb woman.

JP

So what meds are actually unstable over time? Which are really unsafe to take after the expiration date?

The chain smoking heart surgeon phenomenon is one of the most fascinating and disturbing things I see. No, I don't smoke.


The battery of lawyers that may read this prompt me to recommend that no one EVER take expired meds under any circumstances.

Disclaimer;
(If you are reading this and think you are having a medical emergency, or if you have ever had a medical emergency, or if you have any close relatives who have ever had a medical emergency or if you have ever taken or plan to take a prescription medication at any time, please dial 911 immediately after consulting with legal counsel and go to the nearest emergency medical facility. The opinions expressed here are not my own and I recommend you disregard all medical advice offered in this forum)

Quote from here: http://www.health.harvard.edu/fhg/updates/update1103a.shtml

"Most of what is known about drug expiration dates comes from a study conducted by the Food and Drug Administration at the request of the military. With a large and expensive stockpile of drugs, the military faced tossing out and replacing its drugs every few years. What they found from the study is 90% of more than 100 drugs, both prescription and over-the-counter, were perfectly good to use even 15 years after the expiration date. "


DO NOT take Tetracycline after the expiry date, that's a dangerous one, IIRC.

JCM