The Healthcare Supply Chain

We often think about healthcare as a service provided by medical specialists to patients. However, high quality healthcare is the result of efforts by individuals in many different industries including medical device firms, pharmaceutical firms, and insurance firms. In this way, healthcare can be thought of as a river or supply chain with the products of pharmaceutical and technology firms facilitating high quality care by providers. While we don’t typically pay much attention to the workings of these non-care focused companies, sudden industry shocks have downstream effects on patient care and health outcomes. 

This issue has become most apparent in cancer treatment, particularly chemotherapy. In a recent Public Health on Call episode (by the Johns Hopkins Bloomberg School of Public Health) titled “The Far-Reaching Impacts of Drug Shortages Affecting Cancer Treatments,” oncologist Dr. Fader and policy researcher Dr. Socal discuss chemotherapy drug shortages in the US as well as the downstream effects of these shortages on patients. (1)

Drs. Fader and Socal discussed how roughly 90% of US hospitals are affected by ongoing drug shortages. They also discussed some alternatives healthcare staff may turn to when thinking about prescribing or providing a drug that is in shortage: some physicians may adjust drug doses or extend intervals (prescribing one instead of two doses a week) and others may use a similar drug that may present more side-effects. While they emphasize that these decisions are made to have a negligible impact on patients, they have put additional strain on providers.

Statistics show that 40% of patients participating in a national survey experienced chemotherapy delays for acute lymphoblastic leukemia and non-Hodgkin lymphoma (both types of cancers) treatment. (2) Furthermore, 45% of cancer patients experienced a delay in treatment with 38% experiencing delays of over a month, significantly impacting their outcome. (3)

Somewhat surprisingly, it appears that most often the drugs in shortage are generics, or non-patent protected drugs that may be produced widely in a competitive market. Dr. Socal found that because these generic drugs may be produced cheaply, competition between firms drives the price down even further, resulting in producer firms postponing renovations of existing machinery. However, because these generic chemotherapy drugs have proven effective over longer periods of time, Dr. Fader emphasizes that most physicians use these drugs as a pharmaceutical backbone, and thus these drugs are essential to treating most patients. While the FDA is currently working with pharmaceutical producers and distributors to speed up the review and delivery process, the truth is there exists no single long-term solution to drug shortages in the US. 

I think about the use of novel technology and AI in patient care as a provider supplement not a replacement. I believe that healthcare providers may use AI to gain additional information about a patients’ condition or about treatments to use; however, I do not think they are a physician substitute for patients. I also believe that novel technologies should be rigorously tested before use in the medical field where they may play a role in the health outcomes of patients.

That said, a recent MIT Technology Review article reveals some of the breakthroughs AI has had in the medical field, making the treatment process more efficient and eliminating waste. (4) Titled “AI is dreaming up drugs that no one has ever seen. Now we’ve got to see if they work,” the article focuses on the use of AI as a diagnostic and therapeutic tool. 

The article focuses on the UK company Exscientia which has recently been featured on 2023’s TIME AI Top 100 Companies List. (5) The company has developed a matchmaking technology to provide individuals with the personalized cancer treatment they need; honing in on one patient, the firm extracts a single cancerous tissue sample before exposing that sample to over 100 different drug combinations. Using AI and machine learning technology, researchers observe the impact of each treatment at the cellular level before determining the best treatment for the patient’s specific type of cancer. In this way, Exscientia is transforming the patient and provider experience by limiting the amount of chemotherapy patients are forced to receive until they reach cancer remission. The firm is also cutting pharmaceutical costs associated with research and development by using AI to predict how drug molecules will work in the body.

Research has shown that the use of AI drastically reduces the costs associated with cancer treatment while also reducing the amount of time patients must wait until achieving remission. (6)

With a focus on novel drug development and personalized medicine, it seems unlikely that Exscientia may be a long-term solution for chemotherapy drug shortages. However, by using AI to hasten the drug development process by identifying new treatments for existing diseases and disease variants, and by innovating new treatments for previously untreated diseases, Exscientia may be part of the solution in alleviating our current dependence on a few generic “backbone” chemotherapy drugs. 

A National Comprehensive Cancer Network survey identified that commonly prescribed chemotherapy drugs carboplatin and cisplatin are most in shortage; these drugs are used to treat many different types of cancers and have few current substitutes. (7) However, 86% of surveyed cancer centers lacked adequate reserves of carboplatin. Machine learning and AI have the potential to expand existing treatments by providing healthcare workers with the agency to choose the treatment that will provide the patient with the best outcome and minimizing the waste associated with providing rounds of treatment in the hopes that a solution will develop over time. 

While Exscientia and other technology-based pharmaceutical firms innovate new drugs and minimize pharmaceutical waste in patient care, a supply issue remains: what do healthcare providers do when a drug they need to treat a patient is in shortage? 

How is a single drug made? What are the steps in the manufacturing and distribution process? (8) Where and how rigorous are the quality assurance checkpoints? If each firm in the manufacturing process demands a cut of the final profit, how much money does each firm get and what is the actual price of each drug?

Many Federal agencies play a role in the pharmaceutical supply chain: the Food and Drug Administration (FDA) is one of the main organizations that regulates pharmaceutical markets and ensures quality of drugs on the market. By developing policy to maintain the health of pharmaceutical markets and establishing safeguards to protect pharmaceutical suppliers without damaging the patient care process, policymakers and medical leaders may establish a more secure “healthcare supply chain”, ensuring that patients receive the care that they need. Ultimately, healthcare is a system AND a process; providing quality healthcare means not only serving the patient in the best way possible but also ensuring that the tools and supplies needed for quality care are available for the tasks at hand.