Drug Shortages have a solution but nobody will do it

Drug shortages can’t be solved by using ‘the system’; only by hacking that system.

A hack, as defined by Sean Parker, the creator of Napster and Facebook pioneer “is ‘a clever work-around or a clever way of leveraging an existing system to do something you didn’t think it was going to be able to do’ ” [@FortuneMagazine]

In recent weeks, I made some presentations to various organizations about the notion of a Company of Tomorrow, Today and there I postulated that in the past decade and a half the world has changed so much, there has been so much innovation in Science, in Technology and in the way we communicate that the structures and systems that underpinned our economy and our society for most of the past century can no longer cope with the speed of change and indeed the paradigm shift we’ve been witnessing.

And one of the symptoms of this gap of inadequacy is the emergence of new approaches to solve problems that bypass the old ways. Examples of this are everywhere: how citizens improvised solutions in Katrina, Haiti and Nepal; what Apple did to the music industry; Uber and the Taxi system; Amazon with Retail; indeed Sean Parker’s new project to cure cancer by hacking the old research system; and so on. The inadequacy of old institutions cannot be more evident than when we look at the global Financial industry and the mess it caused in 2008; or how long the economic recovery is taking.

But the best example I can think of, here, closer to home, is the powerlessness of the Generic Pharma industry to resolve the shortage of medication in the market. It’s been going on since 2009 and although some inroads have been made and the rate of growth of the number of drugs in shortages has slowed down, the number of drugs still in shortage is staggering.

I worked in this industry, I ran supply chains and I know only too well the causes of drug shortages and from experience, I can tell you that there are enough resources to maintain a steady supply of drugs to the market. But the system can’t handle the challenge. I think by now nobody is going to argue with me on this one with any measure of credibility – not after 7 years of this. (At the time I’m writing this post, there are 806 drugs (dosage forms) listed in Canada’s Drugshortages web site. These are not all the shortages, though, only the ones for drugs that meet the criteria whereby shortages have to be reported.)

One of the characteristics of Companies of Tomorrow, certainly the leaders of that class, is that they disrupt current systems by going around the incumbent structures and creating new ones. This question occurred to me, then: what would a Company of Tomorrow do with this problem of drug shortages? If we could answer this question, we could help save lives or, at the very least, save life styles (the most important benefit of medication, in critical care therapies, is the recovery of quality of life).

So, let’s give it a go.

All you need is an iPhone

3 years ago I wrote an article on this very theme; I didn’t get any calls, only an email from somebody at Health Canada who basically listed everything the government was doing to solve the problem – clearly, not enough. But since 2013 technology has evolved immensely and so today we have options that are way simpler than what I suggested then.

imageA year ago Apple introduced a brilliant platform called Research Kit and then, this year, a derivative called Care Kit. What these platforms have in common is that patients can use iPhone Apps to share data about their health conditions with Doctors and, presumably, Pharmacists. I thought we’d start here.

What’s really important to keep in mind is that both of the above Kits are open source, meaning you get the platform for free; and that you use it through Apps on an iPhone or an iPad.

What could we do with this platform? Well, firstly, this platform, which is used in very large research studies and in the care of many patients, can be used, among other things, for patients to share their prescriptions with Pharmacists; and for the latter to offer services to their patients, such as advice and reminders of the need for medication renewal.

But this platform offers something else of great value: it tells us where demand is, in a very simple, direct way, without the need for corporate IT systems.

Bring in Social Media

Now, let’s add social networking to the platform. Why? Well, firstly, because it will make it easier for patients and pharmacists to communicate with each other. But, if many pharmacists use the same platform, then Pharmacists could talk to each other as well. But what for?

We’re talking about shortages, right?, so Pharmacists could do two things:

  • They could post the drugs that they’re experiencing shortages of;
  • They could help each other – you’re short of this, I’m short of that, let’s trade…

One of the problems with shortages is that, for a variety of reasons, it’s very difficult for Distributors to keep stock in the exact regions where shortages are occurring. The same exact drug isn’t shortening everywhere at the same time and knowing where these ‘holes’ are is not a science.

It is, therefore, likely, that Pharmacists can help each other by trading surpluses with deficits and thus eliminate some of those shortages.

Now, let’s give this App whereby Pharmacists help patients and help each other, a name: let’s call it SOS Shortages.

Filling ‘holes’ called drug shortages

A drug shortage is, basically, a ‘hole’ in supply of a pharmaceutical product, at some location in the country. What is difficult for Pharmaceutical Suppliers is to know exactly where the ‘holes’ are because, by and large, they don’t deal directly with Pharmacists. Ok, then, let’s connect them.

The database of this App called SOS Shortages contains information on drugs in shortage and where those shortages occur; possibly, it also contains information on demand – how many patients need the drug, how many of them are in critical care, etc. By opening a controlled window into this data to Suppliers (by barring access to confidential information and providing only quantitative data), the latter will have visibility of those ‘holes’ in supply. One Supplier will see shortages caused by another Supplier; shortages can be filled by existing inventory or Suppliers can expedite supply of drugs out of stock; in extreme cases, Suppliers can work with Health Canada to bring in drugs from sources not yet approved. These mechanisms already exist but the information is not so easy to get.

So far, we’ve done all this using an iPhone and an iPad – notice that?

Let’s bring in Analytics

Drug Shortages can be anticipated! In the above, I proposed a mechanism to detect shortages; but you can actually anticipate them. In an article in the MIT Sloan Management Review, Yossi Sheffi presents 9 ways in which disruptions in the supply chain can be detected – it can be done!

Drug Shortages have a few very common causes and we can keep an eye for them. For instance, shortages occur quite commonly when a raw material supplier gets disqualified by Health Canada or the FDA and Pharmaceutical companies are barred from using that raw material until problems are fixed. Such an event may affect many products from many manufacturers. Another common cause is the acquisition of one manufacturer by another,  followed by the shutdown of Plants and the movement of products from one Plant to another.

Because the most common causes are well known, we can determine, through Analytics, events and behaviour that are predictive factors of those causes – the causes of the causes, as it were. For instance, as Sheffi explains, by ‘listening’ in on the Internet and accessing available financial data about raw marterial suppliers, we can detect that a supplier is exhibiting symptoms that will lead to shortcuts in quality which will later lead to disqualitification. Monitoring weather systems and earthquake warnings can help us anticipate a natural disaster that will disrupt production in a region of the Globe. By monitoring chatter on the Internet, through Twitter and Facebook or company emails, we may detect hints that a regulatory body in Europe has audited a supplier and the results are not so good, an indicator of a possible disqualification.

By using Analytics technology and establishing correlations between predictive symptoms and causes of shortages, we can anticipate the latter and prepare for them.

Analytics used to be the ‘secret potion’ of data scientists but it’s no longer the case. There are tools like Datameer and Tableau that are accessible to everyone with a basic understanding of data and data mining. We  may also resort to a company like IBM who has a fantastic  platform for iOS Apps with Analytics features built in.

This capacity to anticipate shortages is there for Pharmacists to exploit and for Generic manufacturers to exploit. And it can easily be plugged into our (fictitious) SOS Shortages App.


In Summary

In summary, then:

  • By using the Care Kit platform from Apple, we can set up an iOS App environment where Pharmacists interact with patients; and where patients post their health information and indeed their prescription data. We could call this environment SOS Shortages.
  • By adding social media to the platform (something that can be done through commonly available commercial software) Pharmacists can collaborate with each other on shortages.
  • By accessing non-private data in this App, Manufacturers can obtain invaluable information about patient demand and in particular about ‘holes’ in supply with a great deal of precision and thereby shift supply to where it is needed.
  • Adding Analytics to the platform, it is possible to receive warning signals about upcoming shortages in medication. This can be accomplished through services from IBM, CGI, Microsoft and others.


So… Why will nobody do it? Because what I just described above by-passes a number of well established relationships between key players in the industry, relationships that nobody dares to break – that’s why. We by-pass the system and those that rule the system don’t like being by-passed.

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