Pharmacy mistakes, importation, and how Amazon could save lives just by improving packaging and delivery

I’ve always thought that the distribution of medicines in the US was archaic. Who can forget the pharmacist mistake of packaging the wrong medicine that without the intervention of a youthful George Bailey in “It’s a Wonderful Life” would have led to the death of a child? Yet 70 years later medicines are distributed in largely the same way.

I was reminded of this problem when a friend of mine was given the wrong medicine for his condition. It was spotted by his wife, so no harm was done, but it was one of thousands of mistakes that occur every year at US pharmacies. According to one study, 11% of the mistakes led to death or serious harm.

“Most mistakes are simply the result of human error,” according to Ken Baker, a Phoenix pharmacist and lawyer who analyzes and designs pharmacy quality improvement systems.

“By and large, most mistakes are just through inadvertence. . . . Often two or more drugs will have similar-sounding names, or a technician simply grabs the next drug on the shelf from the one he or she intended to take.”

But an FDA Drug Safety Guidance from April 2016 highlights packaging as being a critical problem.

 
Safety considerations for product design to minimize medication errors guidance for industry

“Thoughtful use of unit-of-use container closures (e.g., blister packaging, calendar packaging, sachets, and pouches) that can be dispensed intact to patients may help to reduce medication errors. Such packaging may minimize certain medication dispensing errors that can occur when repackaging from a bulk container into patient-specific containers.”

A recent meta-analysis of various studies found that the error rate was 2.2% (516 errors out of 23,455 prescriptions). How many of these errors could be reduced by better packaging is not known, but it’s surely quite high.

My criticism of individual pill distribution is not with the pharmacist. All humans make mistakes, but the US approach treats the patient as largely passive in the whole process. With professional packaging and branding (of generics as well as innovator products), patients are more likely to see if the medicine is not what they were told it should be by the prescribing physician. Not all patients are lucky enough to have an attentive partner like my friend. Blister packs also reduce the chances for the pharmacist providing the wrong amount of medicine, makes it harder for illegal operators to substitute bogus products, and no doubt reduces other risks, such as contamination.

Amazon has disrupted numerous businesses over the past decade and it was recently announced that it is getting licenses for pharmacy distribution in numerous states. One of the ways that Amazon could lower the problems with distribution is by adopting better packaging. Using blister packs inside well-identified card or paper boxes, as recommended by FDA, makes the most sense.

Most OECD countries distribute medicines by blister pack, and indeed it is an upside of buying your medicine from overseas pharmacies. We often hear that there are risks involved in such purchases, and I’ve documented these risks many times, a few real and many imagined. But if you happen to go to a busy pharmacy with an inattentive or overworked pharmacist, you run a different and potentially fatal risk.

Amazon has the clout to change the way medicines are distributed in the US and they could save hundreds and maybe thousands of lives every year as a result.

Roger Bate is an economist who researches international health policy, with a particular focus on tropical disease and substandard and counterfeit medicines. He also writes on general development policy in Asia and Africa. He writes regularly for AEI’s Health Policy Outlook.

Πηγή: American Enterprise Institute