The Compounding Pharmacy Mess – an opinion piece by Louis B. Cady, MD
(Dr. Cady has written an insightful response to the frenzy surrounding compounding pharmacies, brought on by the recent fungal meningitis crisis. The cutting-edge and personalized work we do with patients depends upon the ability to customize medications that only our compounding pharmacy partners – exemplary pharmacies by any standard – can deliver. Feel free to contact us if you have questions about your medications, and we will be happy to assure you that we only work with the best compounding pharmacies with the highest integrity.)
The Compounding Pharmacy Mess – an opinion piece by Louis B. Cady, MD
As I have watched the newscasters’ recent bloviations on the mess of the New England Compounding Center (the compounding pharmacy that “compounded” – indeed, manufactured – the contaminated steroid drug that has apparently been directly and proximately linked to the outbreak of fungal meningitis and so much heartache, misery, and death to so many people), I have been reminded of the similar media shenanigans that went on with Propofol and the Michael Jackson murder trial of his cardiologist, Dr. Conrad Murray. At that time, newscasters and vapid pundits were all atwitter about the supposedly “dangerous” drug Propofol and were wondering aloud whether or not it should be banned.
I can speak to that. I have had it administered to me on at least three different occasions when I had surgeries. It is GOOD STUFF. It makes the so called “emergence” from the anesthetized state smooth and unproblematic. It also knocks you out cleanly and precisely. It is a good drug. The fact that a physician went “off the reservation” in terms of not using good common sense, not observing good medical judgment, and not proceeding with ethics and motivation intact does not obviate the fact that there was nothing wrong with the drug in question in the first place.
Now we have another similar situation. All the newscasters are vapidly singing the same tune and asking the same questions: “Do we need more regulations on compounding pharmacies?” “Why aren’t they regulated better?” “Whose job is it to regulate compounding pharmacies?” “How can we be sure that nothing similar will happen with OTHER compounding pharmacies?”
The answer, to my friends in the media that are asking these essentially idiotic questions, is that you cannot be absolutely sure to 100% perfection on this earthly plane that mistakes will not happen at a compounding pharmacy, any more than you can be sure that there won’t be some fringe doctor that will take hundreds of thousands of dollars to willingly participate in the drug abuse and addiction of a celebrity that had the money to pay you and buy off your ethics.
What is needed, however, is NOT more regulations. There are already plenty of them. Compounding pharmacies are not supposed to prepare compounded prescriptions in advance. That is called “manufacturing.” You have to be a drug company to do that. This pharmacy apparently was engaged in manufacturing. There are laws against it. Let’s use them.
There is also the legal system and the plaintiff’s bar. This pharmacy had already had violations in the past, and had apparently not put into place safeguards to avoid further problems. They deserve to be sued, bankrupted and have their pharmacy wiped out and their owners and investors fortunes with them. And that is probably what will happen. What other compounding pharmacies will see is the abject catastrophe that will befall them if they are not running a squeaky clean enterprise. This will probably contribute mightily in our free-market capitalistic system to reign in the type of slipshod practices that must have been occurring the pharmacy in question.
What will not be helpful is a willy-nilly hysterical call to reign in legitimate, excellent, proficient compounding pharmacies. TRUE compounding is the compounding of a limited supply of medication to fill the needs for physicians’ prescriptions for their patients. At Cady Wellness Institute we have wonderful relationships with several compounding pharmacies, including Medquest Pharmacy in Salt Lake City, Utah, Bellevue Pharmacy in St. Louis, MO, Rice’s Pharmacy in Beaver Dam Kentucky, and more locally Paul’s and Hook’s Apothecary here in the Evansville area. There is also Danhauer’s Pharmacy in Owensboro that we use for our patients. All of these compounding pharmacists have had specific training in producing the compounded medicines that we use for hormonal balancing of our patients. That includes estrogen, progesterone, testosterone and thyroid preparations. The people I have dealt with are professionals, they take their job seriously, and they don’t put out defective compounds. They also abide by appropriate regulations and do NOT “manufacture” compounded medications in advance of a defined need.
They also provide medications that are NOT commercially available, including mixed and balanced estrogen cremes, and progesterone transdermal cremes as well as these hormones in dissolve-under-the-tongue troches. For some of my male patients who are on testosterone, the difference in price is about $400 per month for “Big Pharma” testosterone preparations or about 40 – 60 dollars a month for transdermal compounded testosterone – a difference in price of one order of magnitude.
Compounding pharmacies provide an excellent service. They are of indispensable use and importance to physicians who practice integrative, functional medicine and who want to use bio-identical hormones rather than the kind that were associated with breast cancer in the Women’s Health Initiative Study (Provera). They provide bio-identical estrogen rather than “conjugated horse estrogens” which is double talk for “estrogen derived from pregnant mare horse pee which is put in a pill called Premarin.” Would you rather have the real stuff or would you like the horse pee kind-of-similar-to-human estrogen variety? Well then, ladies (and gentlemen), you need compounding pharmacies.
Let’s all simmer down, look at the facts, watch what happens to New England Compounding Center, and not get our collective underwear in a wad. We do not need more regulations. We do not need more constraint of what is available to our patients and what is supported in the peer reviewed literature.
What we need – in compounding pharmacies and indeed all walks of life – is honest, ethical, caring human beings that are devoted to their professions and their conscience. And that will beat all the regulations in the world.
Louis B. Cady, MD – Newburgh, IN
October 15, 2012
