Providing Data to Drive Policy-Making
Doctors, medical professionals and students are uniquely positioned to make major contributions to the field of policy making. I think the medical community often feels isolated from policy because it seems abstract. It is something done by politicians, lawyers and policy wonks on Capitol Hill. While this is true, we often underestimate our ability to contribute to the conversation. Physicians and other health care professionals have the distinct ability to recognize and study system-wide problems, as well as devise creative strategies and solutions to address issues of concern to patient care.
I have personally found value in pursuing research that can highlight breakdowns in our healthcare system and potentially drive policy change. I became interested in drug shortages while I was a Health Policy Fellow for a congressman on Capitol Hill. I read binders full of different papers—mostly economic ones—which all postulated different theories behind the shortages. My job was to read through the papers and propose a position for the congressman. However, through my reading, I realized there was one major element missing. There was not enough information on the actual impact on patient care. Big policy changes are often hard to make in Washington unless you can give evidence that the problem is significant enough to cause harm to our citizens. In theory, a drug shortage could not possibly be good for a patient, but there was limited published data on the actual health impact.
I became curious and started to think about possible research ideas that would help bring more national attention to the issue. I contacted two senior physicians with significant accomplishments in health policy and clinical research. They were willing to mentor me, and off we went! I located a partner university who had the data available that we wanted to analyze. We now had both the data and the human resources necessary to produce several papers. Together, our team wrote a series of three peer-reviewed papers that were published in respected journals that described shortages in the fields of emergency medicine, toxicology, and infectious disease.
One of these papers, on which I was first author, looked at drug shortages specifically in the emergency medicine setting. We wanted to see how common drug shortages are in the emergency department, and how the shortages affect people with life-threatening conditions. We also wanted to examine whether or not drugs on shortages had viable alternatives for the treatment of emergently ill patients. Our study was the first of its kind to directly analyze data to estimate the proportion and specific types of medications that have been in shortage in emergency care for 14 years, from 2001 to 2014. We found that drug shortages for medications impacting emergency care have risen dramatically—by more than 400%—since 2008. Nearly half of the drugs in shortage were drugs used for high-acuity or life-threatening conditions, and for a minority of products (32 drugs over 13 years), there was no substitute available. A wide range of medications used both in emergency departments and in pre-hospital settings, such as antidotes, heparin, and nitroglycerin, have been affected by national drug shortages. The most common categories of emergency medicine drugs found on shortage during the study period were infectious disease, analgesia, and toxicology. Not having enough commonly used medications to treat life-threatening conditions such as respiratory distress, cardiac dysrhythmias, and overdoses can reduce the ability of emergency department providers to deliver quality care because in many cases substitutes are considerably less effective, and physicians are not as familiar with their use. Toxicology shortages are of particular concern since there are often no substitutes available, and not having treatment poses serious risks to patients.
While our research did not devise a system-wide plan to stop shortages, we were able to contribute to the evidence of shortages in a meaningful way, and our articles were featured on TV and in major news outlets such as the Boston Globe and the Washington Post. Physicians need to be creative and take initiative to provide policy makers with compelling data in order to make informed decisions. Hopefully our papers will provide policy makers and government officials the evidence they need in order to make this an issue of national importance given the potential impacts on patients.