The recent study by Kluckow and his colleagues points out another serious issue in neonatology: drug shortages. In recent times we have had poor or no supplies of dramatically important drugs, including for example indomethacin, phenobarbitone and more recently caffeine. We also had a shortage of betamethasone, another life-saving drug, given to mothers threatening preterm labour.
These are drugs that save lives, (and brain cells) and we should not tolerate a situation where cheap generic drugs are difficult or impossible to source for our patients. This occurs largely because they are cheap and generic, so there are very limited profits to be made. When statins are potentially given to a billion people and Lipitor alone has made 120 billion dollars in sales, how can we convince a company to continue to make a drug which is administered to a very small population of very small people, who consequently don’t pay very much for the tiny quantities that they use?
I think the answer is a government drug production agency, who can control and manufacture the drugs that we need, according to proven benefit, rather than profit margins. I can’t see another way to assure the continued availability of essential drugs, unless we as a collective decide to make it a priority.
Neonatal Research 
To understand the root cause of the generic drug shortages, see our 9/3/13 New York Times op-ed, “How a Cabal Keeps Generics Scarce”: http://www.nytimes.com/2013/09/03/opinion/how-a-cabal-keeps-generics-scarce.html. Then sign, post and circulate our Change.org petition: http://chn.ge/1cH8ZPT.
Congress created this travesty, and it’s up to Congress (and/or federal and state antitrust authorities) to fix it. Getting the government into the business of manufacturing generic drugs is definitely NOT the answer.
Phil Zweig MBA
Executive Director
PhysiciansAgainstDrugShortages (PADS)
I am not sure that your analysis is correct. Drug shortages have been occurring around the world, not just in the USA, so to blame Congress seems unlikely to be be right. The idea that the free-market is the answer seems to me to be a very US style answer, it was deregulation of the banks and the return to the free-market that led to the collapse of the world economy, only those countries who had maintained strong, restrictive bank regulations avoided any bank failures (like Canada) similarly regulating drug manufacturing for the public good is something that we as a society could easily do. We can, and should nationalize some drug manufacturers, and ensure a supply of essential drugs. We cannot rely on the profit seeking behavior of manufacturers to provide us with what we need for the most vulnerable of our patients.
You clearly do not understand how the U. S. hospital supply chain works—or more precisely, doesn’t work, and how the shortages in the U. S. have created shortages of generics in Canada and elsewhere around the world. Unfortunately, I don’t have time to educate you. Read the NYT op-ed, then visit http://www.physiciansagainstdrugshortages.com, which will redirect you temporarily to http://www.puncturemovie.com. As for banking, my work as a banking reporter in the early 1980s gave rise to the “Too Big to Fail” doctrine, so I’m well acquainted with the ongoing failure of U. S. regulation in that industry as well.