Tag Archives: ‘outrageous

‘It’s outrageous’: Costly cancer drugs thrown out because of one-size-fits-all packaging

The health-care system is wasting millions of dollars by buying cancer medications that are thrown out because of the way they are packaged by drug makers — in one-size-fits-all vials that hold too much for most patients, a study found.

“It’s outrageous,” said drug policy researcher Alan Cassels, who is familiar with the study. 

“We have so many demands on our health-care dollars for drugs and doctors and hospitals and so on. So, to see this kind of waste is appalling.”

The waste costs as much as $ 102 million over a three-year period, according to the study published two years ago in the medical journal Cancer. 

“What people don’t realize is that wastage is actually a real cost that’s borne by the provinces or hospitals [and] ultimately the taxpayers,” said Dr. Matthew Cheung, a senior co-author of the study and a hematologist at Sunnybrook Health Sciences Centre in Toronto.

The drugs are administered in very specific doses based on a patient’s weight and/or height, then, because of concerns about possible infection from reusing the same vial, nurses discard the rest.


Drug policy researcher Alan Cassels says because the drug-negotiating process is so secretive, taxpayers don’t know what they’re paying for costly medications. (Ben Nelms)

Some hospitals have been trying to reduce waste by sharing vials, but can only do that with patients who need the same drug on the same day, since many of these medications have a short shelf life once opened.

The study looked at 12 high-priced injectable cancer drugs and found that the amount being wasted per vial ranged from zero to 87.5 per cent.

“We realized that drug wastage is actually a huge component of what we’re paying. And again, when we’re wasting drugs, we’re increasing costs without getting any extra benefit,” said Cheung.

In the U.K., the government told drug companies in 2016 they must produce some cancer medications in packaging that reduces waste if they wanted to be considered in the bidding process for which drugs it will purchase.

Since making the change, the U.K.’s National Health Service tells Go Public it’s saving an estimated 18 million pounds ($ 31 million Cdn) per year.


Waste is a ‘huge component’ of what Canada pays for medication according to Dr. Matthew Cheung of Sunnybrook Health Sciences Centre in Toronto. (Tina MacKenzie)

Drugmakers will ‘scream and complain’

Cassels — who is part of the Therapeutics Initiative, an independent drug analysis group based in the University of British Columbia’s Faculty of Medicine — says the same hard-nosed negotiations done in the U.K. need to happen here.

He says the group that negotiates prescription drug prices here — the Pan-Canadian Pharmaceutical Alliance (PCPA), of which all the provinces are members — needs to pressure drugmakers to produce smaller vials and give refunds for what’s not used.


Deb Hebert noticed that instead of being given to another patient, the unused portion of her cancer medication, which costs almost $ 8,000 per dose, was thrown out. (Submitted by Deb Hebert)

Cassels says he expects the drug companies will “lobby and scream and complain,” over anything that adds to the cost of production.

“But at the same time, the public agencies have a monopoly in terms of paying for these drugs and they should be able to go to the mat in terms of negotiating the best prices and negotiating refunds if necessary,” he said. 

He also says the negotiating process also needs to be less secretive. Right now, Canadians are kept in the dark about what the country is paying for these drugs and what specifically is part of the negotiating process.

“The biggest problem with drug prices is sometimes we don’t even know what the drug prices are … so we don’t really know what we’re paying for. When you think about other things that we use public money for, like building bridges or roads, those costs are known down to the penny. Whereas in the drug world, oftentimes, the drug costs are completely hidden.”

Asked if vial sizes and refunds for unused portions are part of the price negotiations, PCPA tells Go Public those talks are “confidential at the request of the manufacturer.”

The confidentiality includes pricing information, budget impact estimates, “and other sensitive information is held in confidence and is not disclosed, except in accordance with applicable law or with the consent of the parties,” the alliance said. 

The provincial agencies that comprise PCPA are, mostly, equally secretive — except for B.C., where the Provincial Health Services Authority tells Go Public it typically does ask drugmakers to offer smaller vials.

But, it points out, the vial sizes are set when the drugs are submitted to Health Canada for marketing approval — and making a change is a long process. Health Canada didn’t respond to questions about that.

‘Typical dose,’ says drugmaker

When Deb Hebert, who is battling non-Hodgkin’s lymphoma, went to get her stem cell-stimulating drug plerixafor injected by the oncology nurse last month, she realized her dose only required about three-quarters of what was in the vial.

“I asked her what was going to happen with the rest of the medication. She told me that it would be discarded,” said Hebert, who has been on sick leave since August from her job as a finance administrator at CBC in Calgary while she battles the disease for the third time.

The same thing happened with Hebert’s second dose the next day. Each injection used about 75 per cent of a vial. At $ 7,893 per vial, that works out to a waste of about $ 3,900 between the two doses.


Experts propose multiple solutions to the drug waste problem, including changing drug packaging, grouping chemotherapy patients who need the same drug, and refunding buyers for unused portions of drug. (Colin Hall/CBC)

Sanofi, the company that makes Hebert’s medication, says it sells the drug in that vial size because it’s a “typical dose for the majority of the patient population,” and, it says, to account for any spillage while the drug is being administered.

The company adds, the drug is “preservative-free and therefore does not support multi-dose usage.”


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Iran calls new U.S. sanctions ‘outrageous and idiotic’

Iran has criticized new U.S. sanctions targeting the Islamic Republic’s supreme leader and other top officials, saying Tuesday the measures spell the “permanent closure” for diplomacy between the two nations.

For his part, Iran’s president described the White House as “afflicted by mental retardation.”

President Hassan Rouhani went on to call the sanctions against Supreme Leader Ayatollah Ali Khamenei “outrageous and idiotic,” especially as the 80-year-old Shia cleric has no plans to ever travel to the United States.

Trump retorted on Twitter, saying the “ignorant and insulting” Iranian statement “only shows that they do not understand reality.”

“Any attack by Iran on anything American will be met with great and overwhelming force. In some areas, overwhelming will mean obliteration. No more John Kerry & Obama!”

From Israel, Trump’s national security adviser John Bolton said talks with the U.S. were still possible and the U.S. is leaving an “open door” for Iran to walk through.

But the comments from Tehran clearly showed its leaders think otherwise, at a time of heightened tensions between Washington and Tehran over Iran’s nuclear program and its downing of a U.S. military surveillance drone last week.

“The fruitless sanctions on Iran’s leadership and the chief of Iranian diplomacy mean the permanent closure of the road of diplomacy with the frustrated U.S. administration,” said Abbas Mousavi, a Foreign Ministry spokesperson, according to the state-run IRNA news agency.

The crisis gripping the Middle East is rooted in Trump withdrawing the U.S. a year ago from Iran’s 2015 nuclear deal and imposing crippling new sanctions on Tehran. Recently, Iran quadrupled its production of low-enriched uranium to be on pace to break one of the deal’s terms by next week while also threatening to raise enrichment closer to weapons-grade levels on July 7 — if Europe doesn’t offer a new deal.

France’s Foreign Affairs Minister Jean-Yves Le Drian warned Iran that breaking the 2015 nuclear deal is a “grave error” and the “wrong answer” to pressure from the United States.

He also called the U.S. initiative to build a global coalition to counter Iran “disturbing,” and said European diplomats are working to avoid further escalation of the tensions between the U.S. and Iran. France, Germany, the United Kingdom and other European countries are trying to save the 2015 nuclear deal

Sharp comments reminiscent of North Korean barbs

Citing unspecified Iranian threats, the U.S. has sent an aircraft carrier to the Middle East and deployed additional troops alongside the tens of thousands already there. All this has raised fears that a miscalculation or further rise in tensions could push the U.S. and Iran into an open conflict, 40 years after the Islamic Revolution.

U.S. President Donald Trump enacted the new sanctions on Monday against Khamenei and his associates.

“Iran leadership doesn’t understand the words “nice” or “compassion,” they never have. Sadly, the thing they do understand is Strength and Power,” Trump tweeted on Tuesday.

“The wonderful Iranian people are suffering, and for no reason at all. Their leadership spends all of its money on Terror, and little on anything else.”

The sanctions follow Iran’s downing last week of a U.S. surveillance drone, worth over $ 100 million US, over the Strait of Hormuz, an attack that sharply escalated the crisis in the Persian Gulf. After the downing of the drone, Trump pulled back from the brink of retaliatory military strikes but continued his pressure campaign against Iran.

U.S. officials also said they plan sanctions against Iranian Foreign Minister Mohammad Javad Zarif, something that drew Rouhani’s anger during his televised address on Tuesday.

“You sanction the foreign minister simultaneously with a request for talks,” an exasperated Rouhani said and called the sanctions “outrageous and idiotic.”

“The White House is afflicted by mental retardation and does not know what to do,” Rouhani added.


The purported wreckage of a U.S. drone that was downed by Iran last week. (Meghdad Madadi/Tasnim News Agency/Handout via Reuters)

There was no immediate reaction from Washington early on Tuesday to the remarks from Iran. The sharp comments are reminiscent of North Korea’s verbal attacks on Trump before the dramatic change in course and the start of negotiations with Washington. However, in Iran’s case, there are no signs Iranian leadership would welcome talks.

Mousavi’s statement echoed that of Iran’s UN ambassador, Majid Takht Ravanchi, who warned on Monday that the situation in the Persian Gulf is “very dangerous” and said any talks with the U.S. are impossible in the face of escalating sanctions and intimidation. Meanwhile, the U.S. envoy at the United Nations, Jonathan Cohen, said the Trump administration’s aim is to get Tehran back to negotiations.

Bolton, Pompeo holding meetings abroad

The sanctions were announced as U.S. Secretary of State Mike Pompeo held talks in the Middle East with officials in the United Arab Emirates and Saudi Arabia about building a broad, global coalition that includes Asian and European countries to counter Iran. Pompeo is likely to face a tough sell in Europe and Asia, particularly from those nations still committed to the 2015 nuclear deal.

Meanwhile, John Bolton, the U.S. national security adviser, said Trump was open to real negotiations to eliminate Iran’s nuclear weapons program and “all that Iran needs to do is walk through that open door.”

Bolton was meeting with his Russian and Israeli counterparts in a first-of-its-kind trilateral security summit in Jerusalem that was focused on Iranian involvement in conflicts across the region, particularly in neighbouring Syria.

“As we speak, American diplomatic representatives are surging across the Middle East, seeking a path to peace. In response, Iran’s silence has been deafening,” he said. “There is simply no evidence that Iran has made the strategic decision to renounce nuclear weapons and open realistic discussions to demonstrate that decision.”

However, Bolton said “all options remain on the table” if Iran exceeds the uranium enrichment limit under the 2015 deal and added it would be “a very serious mistake for Iran to ignore those limits.”

Earlier, Russian national security adviser Nikolai Patrushev rebuffed U.S. and Israeli attempts to isolate Iran and urged both countries to show “restraint” toward the Islamic Republic.

Patrushev said attempts to present Iran “as the main threat to regional security” or equate it to international terrorist groups are “not acceptable.”

“Iran is contributing a lot to fighting terrorists on the Syrian soil and stabilizing the situation there,” he added

Israeli Prime Minister Benjamin Netanyahu called for the three countries to agree on expelling foreign forces from neighbouring Syria, and said Israel will not allow Iran to establish a permanent military presence there.

Patrushev called on Israel and the U.S. to encourage a political settlement in Syria.

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