Unbeknown to patients, drug shortages, rationing practices common in hospitals

Shortages of drugs — including anesthetics, painkillers, antibiotics and cancer treatments — have become increasingly common in the U.S. Although some shortages create a stir in the media, patients are less frequently aware they are not being administered a certain drug as a result of rationing, according to The New York Times.

The American Society of Health System Pharmacists says there are inadequate supplies of more than 150 drugs and therapeutics, according to the report. Reasons for drug shortages include manufacturing problems, new federal safety rules or drugmakers ceasing production of low-profit products.

In turn, hospitals must decide which patients get certain drugs and which don't, raising ethical red flags and resulting in medically questionable practices, according to the report.

Here are five things to know about drug shortages and rationing in hospitals.

1. To decide which patients will get rationed drugs, some institutions have created formal committees that include ethicists and patient representatives, while in others, individual physicians, pharmacists or drug company executives make the decision, according to the report.

2. Other criteria are used to decide which patients will receive drugs. For instance, researchers have found obese patients required nearly three times the amount of an antibiotic before surgery than average-size patients, but they were given only a standard dose at the Cleveland Clinic during a shortage. Age is another deciding factor at some hospitals. A Cleveland Clinic pharmacist said children were not favored over adults during a chemotherapy shortage, but at other hospitals, they are because of their potentially longer lifespan, or because they may require a smaller dose, according to the report.

3. Studies have found an association between alternative treatments during a shortage of a preferred treatment and higher rates of medication errors, side effects, disease progression and even death, according to the report.

4. Physicians and hospitals typically do not inform patients about shortages and rationing practices to prevent them from worrying or becoming angry. Ivan Hsia, MD, an anesthesiologist in Ontario, Canada, said many physicians follow a "paternalistic model," telling NYT, "I'll inform them when I think it's unsafe enough to inform them."

5. Dr. Hsia and his colleagues surveyed hundreds of patients at the Mayo Clinics in Arizona and Florida and other patients in Canada about their preferences when it comes to being informed on drug shortages and rationing. The majority of patients wanted to know about a drug shortage that could affect their care during an elective surgery, and many said they would delay the surgery.

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