I Can't Believe I'm Writing About IV Fluid Again

There’s another critical shortage of salt and water in a bag. Hurricane Helene is only the surface-level cause; it’s really about America refusing to learn the lessons of monopoly fragility.

by David Dayen October 11, 2024

When I was writing my book Monopolized, I talked to a guy who went viral for a 2017 tweet about how his cancer patient wife had to be given her chemotherapy drugs manually. “My wife’s nurse had to stand for 30 mins & administer a drug slowly through a syringe because there are almost no IV bags in the continental U.S. anymore. See, they were all manufactured in a Puerto Rican factory which still isn’t fixed. Meanwhile that stupid swollen prick golfs.” (We can assume that last bit was referring to Donald Trump.)

It was a visceral response to an emotional moment. And it wasn’t the whole story.

In fact, intravenous saline solution had been on the Food and Drug Administration’s official shortage list for four years before Hurricane Maria slammed into Puerto Rico, knocking out the two Baxter International factories that produced the bags. The reason why was complex, but it came down to this: Over time, we built an insane system for generic, low-margin, vital medications and supplies, and it introduced unnecessary fragility into what should be a perfectly simple supply chain.

The pandemic brought home a greater lesson about the dangers of centralizing markets and production within single companies and at single geographic locations. The indelible image of medical professionals fighting COVID while wearing trash bags for protection infuriated policymakers. Years of internal deliberation ensued, about the need to diversify sources of supply, to remove hidden risk, to dismantle systems built up by globalization and just-in-time logistics that everyone could recognize as looming time bombs.
https://prospect.org/health/2024-10-11-cant-believe-im-writing-about-iv-fluid-again/