7 ms·
This issue is a conundrum. Most drugs don't fall off a cliff of efficacy when they reach their expiration date. There are drugs such as tetracyclines that shou
by slr555 9y ago
This issue is a conundrum. Most drugs don't fall off a cliff of efficacy when they reach their expiration date.
There are drugs such as tetracyclines that should never be used past their expiration dates because they degrade into toxic compounds. Certain classes of drugs such as anti-arrhythmics or drugs like warfarin are dosing critical to the point where I would not want them if they were out of date.
I worked in pharmaceuticals in a medically underserved community for a couple of years. At that time when drug samples expired, sales representatives had to return them to their companies for destruction. One doctor in the area made sure that all the drug reps knew he would accept short dated (but not outdated, which would have been against policy for reps) samples for a free clinic he ran. Everyone I knew participated when they had short dated samples. While reps could not distribute outdated samples, doctors had much more latitude in how they dealt with them. It was one of those rare and wonderful situations that was good for patients, created good will for reps and was all completely within regulations.
I should say this was some years ago and regulations may have changed since then.
- agumonkey 9y agoI wonder if a single rule 'no consumption past date' is a safeguard to insure simple behavior from population. If people started to think some drugs can and some cant they might indulge into trying random stuff.
- dekhn 9y agoyes, that's a big part of it. It's a simple rule that's easy to follow, which can often be better in terms of health overall.
- agumonkey 9y agoYeah unless we put something better in place, maybe a dedicated QR code website to quickly verify if that box is 1, 2, 10, toxic
- dgfgfdagasdfgfa 9y agoIt seems like you could use that same space for the QR code to just specify its toxicity.
- dekhn 9y agoBut there are too many details in how the drug could fail depending on its individual storage.
- zentiggr 9y agoA big chunk of this article's message is that those considerations seem to not have anywhere near as much of an effect as currently assumed. (EpiPens viable 50 months past their marked date) I would push two prongs: reinforce that expiration dates are serious, and at the same time test and extend any/all dates to the actual behavior of each drug. turn a one year into 5, 10, 20? Hell yes. Pretty obvious that big chunks of the health care system are rigged for profit, not efficiency or usefulness.
- dekhn 9y agoI don't completely agree with the article's message. I think people who deal with statistical quantities of product and do extensive quality control testing probably have some wisdom about what's really safe. The article refers to a paper (which I've skimmed) that leaves a bunch of unanswered important questions.
- hrktb 9y ago
- blacksmith_tb 9y agoI agree keeping the message simple is important, but isn't the implication of the article that the FDA's requirements need more nuance? Some medicines could have expiration dates of 10 years, others should be kept to 2?
- agumonkey 9y agoYeah unless we put something better in place, maybe a dedicated QR code website to quickly verify if that box is 1, 2, 10, toxic
- pessimizer 9y agoIf people know that many expiration dates are untrue, wouldn't that make them more likely to experiment and accidentally take expired drugs that actually lose effectiveness or become toxic out-of-date? Expiration dates that are explicit and trustworthy would make people less likely to try random stuff, not more. I don't think you make people less likely to experiment by making experimentation successful most of the time.
- gist 9y agoThe other issue (as mentioned in the article) is environment. For example I keep some drugs in a backpack that I regularly leave in a hot car. The drugs that were in the Pharmacy probably had near ideal conditions and didn't even move. Giving end users and consumers an algorithm to follow with regard to disposal simply would stand little chance of working in a practical sense. One size fits all is the way to go.
- deleted 9y ago[deleted]
- ballenf 9y agoThe article states with absolute certainty that no patient has ever been harmed by an expired drug. Not doubting your point about tetracycline, but how much would a patient need to ingest to be harmed? Then there's the argument that the reason no one's been harmed is because the policy is working. Harm due to unavailability of drugs or higher costs are much harder to track, of course. Yet another case of a balance being hard to reach due to the visibility of costs on one side versus the difficulty of measuring on the other. So easy for the general public to see the cost of strictly enforcing overly conservative expiration dates as close to zero. /offtopic: these issues are the achilles heals of democracies. Not that there's a better system.
- epistasis 9y agoSee this comment for some contrary opinions on harm with citations in the literature: https://news.ycombinator.com/item?id=14797616 https://news.ycombinator.com/item?id=14797616 Personally, I take all quotations like the ones in the article with a huge grain of salt. There's often enough of a communication barrier that even good reporters can misunderstand an answer, or for the researcher to be answering a different question than the reporter asks. And there's also the possibility that the researcher just had a failure of memory.
- deelowe 9y agoI thought antibiotics lose their efficacy part there due date
- bluehazed 9y agoSome even become toxic, like tetracyclines!
- sliverstorm 9y agoI have to think they must, considering they need to be refrigerated. (Or at least the ones I've used did)
- skinnymuch 9y agoOther drugs lose efficacy at different times too, of course. But most still won't do you any harm (except for not helping the issue you're seeking to remedy), which was the OP's point, right? Or am I misunderstanding things.
- mjevans 9y agoA 'mishandling indicator' for field dispensary seems like a good idea. I think that a better approach to 'expiration dates' should be that highly controlled dispensaries (pharmacies) track lot and production dates. A given medication should have a standard expiration date based on /observed/ potency and reserving a safety factor (which should be known and recorded). Drugs before the typical expiration date would have very infrequent random samples tested for effectiveness. If there is economic or technical incentive, medications nearing the expiration date would be tested and based on the results a new expiration date and testing schedule for the remaining units set.
- t0mbstone 9y agoWouldn't the real solution here be to put real expiration dates on things that can harm you, and real expiration dates on things that haven't actually expired? Like a "dangerous to use after 01/01/2019" label on things that actually are dangerous. Other items could have labels like, "Safe for use until 01/01/2025 - Effectiveness may be degraded after 09/05/2019"
- techthroway443 9y agoSeems simple enough, just extend the expiration dates on the meds that don't turn toxic and that still work. The issue here though is that it's not in the drug manufacturers interest to have super long dates. Putting labels that expire sooner means they can push higher volume.
- Kalium 9y agoThere's also the not-irrelevant issue that testing is slow and potentially other than free. How do you find out when a drug expires? You have a bunch of it sit around and test it periodically, right? I assume that would be done after bringing a drug to market, otherwise drugs could easily be delayed 10+ years if they're shelf-stable.
- yomly 9y agoI would expect the chemistry to be characterised well enough to the point where you shouldn't need clinical tests to know it's degredation profile...
- EpicEng 9y agoI don't know about that. There are variables beyond theoretical chemistry, like the packaging, the manufacturing process, etc. I'm not anywhere near knowledgeable on pharma, but I worked on an FDA regulated medical device. If we made a claim, we had to test it. Knowing that e.g. every component in the machine was rated safe between temperatures X and Y did not mean that we didn't have to perform real environmental testing.
- kiahjw 9y agosirum.org (YC W15) helps redistribute surplus drugs that are often short-dated. Our online platform allows orgs to register, upload their surplus, and we connect them to charitable clinics and pharmacies. Check us out!