Critical Condition

How a botched acquisition by Pfizer helped turn America’s chronic drug shortage into a full-blown crisis.

- Erika Fry

THIS FEBRUARY Ruth Landau, an obstetric anaesthesiologist at Columbia University Medical Center in New York City, was making rounds when she got a disturbing call from one of the hospital’s pharmacists. The centre was due to run out of bupivacaine, a local anaesthetic used in virtually every baby delivery. Fast-acting and predictable, the numbing agent has long been the drug of choice for supporting childbirth, administered as an epidural for women in labour or as a spinal anaesthetic for those having a caesarean section. Prepared in a dextrose solution, the syruplike injection is especially critical in emergency deliveries.

“When the baby or mom is not doing well, every minute counts,” says Landau. “There really is no alternative that provides the same safety, reliability, and comfort that we all have using it.” If the hospital staff continued to use the drug at its usual rate, it would blow through the remaining supply in three weeks. The drug’s manufacturer, Pfizer, estimated the next delivery of the product would come in June.

A 20-year veteran of her field, Landau had seen a variety of drug shortages come and go during her career, but nothing of this magnitude, and never with such little warning: “Suddenly, we’re being told this one drug—the one we’ve been using for decades, that we know best how to give, how fast it kicks in, we can do it with our eyes shut—suddenly, we’re being told we won’t have that drug.” Within days, anaesthesiologists at hospitals across North America were conferring about the same problem over social media; many were throwing out short-term fixes that were risky in their own right—putting delivering mothers under general anaesthesia, for example. Landau thought the field had moved past such practices decades ago.