[ RadSafe ] Isotope shortage affects patients

Brennan, Mike (DOH) Mike.Brennan at DOH.WA.GOV
Thu Dec 6 12:07:21 CST 2007


Actually, it has more to do with "capitalism" and "free market" than it does with socialized medicine.  

First, there is not and never really can be a free market in some things, because the barriers of entry are too high compared to the expected return on investment, based on the highest possible price that could be paid by the customer.  If you need something like a nuclear reactor to produce the product, with a capital outlay on the order of billions and operating costs of hundreds of millions per year, and potential return of tens of millions per year, you won't get anyone to build a production facility (this of course can all change when technology and/or economic conditions change).  The best you can hope for is to piggy back on a reactor built for and doing something else.

A lot of research reactors used to make isotopes for university hospitals, but most of those reactors are gone, now.  A commercial reactor has to be designed and built with this capacity, and almost no groups making the financial decisions will choose to increase initial cost and complexity of design in exchange for what they view as a chump change income stream that they don't understand.  The non-trivial possibility that a new technology will come along and make their system obsolete and their investment vanish has to be considered.  Breaking into the market against an established supplier is risky, especially if under normal circumstances that supplier can completely meet the needs of the market.  And, if I am being cynical, the knowledge that they and their families can afford to go where necessary to get treated factors in, too.  

On top of that, one of the goals in a capitalist model is to get as large a market share as possible, so as to exercise as much control on price as possible.  Under the right conditions this becomes a positive feedback system, with one player completely controlling the market.  I wouldn't be surprised if a look into the past would find that the current supplier helped some of the other suppliers out of the market by accepting lower profits until the competition folded.

As for the scree against the Canadian, and presumably all "socialist" health systems: All effective health programs rest on four cornerstones that not only are but must be collectively owned and paid for: clean water, good sanitation, vaccination, and emergency services.  Let any of these work on an unregulated free market model and the health, productivity, and longevity of the people in your society (including those who can afford to pay) decreases.  One can make an argument that if other big-ticket medical hardware and services were collectively paid for further increases could be had.

There is much to be said in favor of a healthy private sector in health care.  I LOVE that we get professional athletes to pay for perfecting knee reconstruction and movie stars to pay for research into reconstructive surgery, and then we all get the rewards.  But never loose sight of the underlying assumptions of Free Market theory, and that one of them is that at a market driven price some people will not be able to afford what is for sale.  In a health care system not being able to afford something often means death or incapacitation, and even worse (from an economic POV) loss of productivity.  This may well be sub-optimal for society at large, to say nothing of the individual in question.

I apologize for the length of this, but Capitalism/Free Market econo-mysticism is a hot button issue for me. 

-----Original Message-----
From: radsafe-bounces at radlab.nl [mailto:radsafe-bounces at radlab.nl] On Behalf Of Brunkow, Ward
Sent: Thursday, December 06, 2007 5:47 AM
To: joseroze at netvision.net.il; radsafe at radlab.nl
Subject: RE: [ RadSafe ] Isotope shortage affects patients

This is predictable. It goes with the Canadian health system. It appears that Chalk River is one of the few places producing Tc99m up there. I requested Tc99 the last time I had cardiac analysis from my Dr.  as I work in a nuclear facility and didn't' want to be radioactive for 3 weeks walking in the place. I threw my Dr. for a loop, he thought I was an oncologist or something, but it was  not hard to get. It appears the Canadian govt. has compromised the medical radionuclide production process just as they have the socialized health care system. But Tec is a very short T1/2 and any interruptions in a place like CR would definitely stop the availability of it. They just need many other facilities that can produce it, like we do in the U.S.   If there is a demand, as in any free market or private system, why not be producing plenty of it...but again their govt. is running their health care system...there you go. 


-----Original Message-----
From: radsafe-bounces at radlab.nl [mailto:radsafe-bounces at radlab.nl] On Behalf Of joseroze at netvision.net.il
Sent: Thursday, December 06, 2007 5:38 AM
To: radsafe at radlab.nl
Subject: [ RadSafe ] Isotope shortage affects patients

Dear colleagues,
I am in Montreal for two weeks, and I found today the following press news.
Probably colleague from Canada could comment

Jose Julio Rozental
joseroze at netvision.net.il

Latest from Gazette topic 3


THE GAZETTE, MONTREAL,  THURSDAY, DECEMBER 6 2007, page 7A Isotope shortage affects patients Delays in diagnostic medical imaging tests. MUHC reduced to treating only most urgent cases DERFEL AARON, The Gazette
Published: 4 hours ago
Hundreds of cardiac, cancer and kidney patients in Montreal - and thousands more across North America - face delays in diagnostic tests because of a shortage of radioisotopes used in medical imaging.
The problem has been traced to the Chalk River, Ont., nuclear reactor, which produces most of the world's supply of isotopes for medical applications. The facility, run by Atomic Energy of Canada Ltd., was shut for repairs two weeks ago, but the work is expected to take another 10 days to complete, straining the limited supply of isotopes even more.
At the McGill University Health Centre, an average of 80 patients a day are injected with the isotope Technetium-99m for medical imaging. The isotope is not used for treatment.
The MUHC is being rationed a small supply from its distributor, Bristol-Myers Squibb, that is good enough for about a dozen patients a day.
Patients with urgent and semi-urgent cases are getting the diagnostic tests on time, said Robert Lisbona, chief of nuclear medicine at the MUHC.
"We want to make sure patients don't panic," Lisbona said. "One way or the other, we'll look after them."
The isotope is injected into a patient as a tracer to detect abnormalities in organ function. The images are captured by what's known as a gamma camera.
Medical imaging involving X-rays, CT scans, MRI scans and PET scans are not affected, Lisbona emphasized.
"We monitor many patients every three months who are not deemed urgent," he said. "So if they wait another two weeks, it won't make a difference.
"But those patients who need a test done because we think they will have to undergo, say, chemotherapy, they get the tests done right away."
The isotope shortage has not affected any patients at the Centre hospitalier de l'université de Montréal. That's because the CHUM gets its isotopes from two suppliers.
"We're still managing well," said Nathalie Forque, the CHUM's communications officer. "Other hospitals have just one supplier."
The Chalk River reactor produces the isotopes, which are quickly delivered to a facility in Ottawa for processing. Within hours, the product is flown to pharmaceutical companies around the world for final processing and packaging.
Since the isotopes have a short half-life (the time it takes to be reduced to half its strength), the pharmaceutical-grade Technetium-99m must be used within three days of receipt at a hospital.
"This is the first time this has happened in 35 years," Lisbona said.
"Unfortunately, it takes a crisis to realize we need to find an alternative supply of the isotopes."
aderfel at thegazette.canwest.com

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