My wife gets regular infusions and had to ration for months; the local hospital canceled elective surgeries as well.
For those downvoting me, here's the American Medical Association:
https://www.ama-assn.org/delivering-care/public-health/fixin...
> The Biden administration has invoked the Defense Production Act “to help speed up recovery efforts and get that North Cove plant back up and running,” Garcia noted. Hospitals, meanwhile, are turning to alternative options such as hydration tablets and sports drinks while prioritizing IV fluids for the higher-acuity and higher-risk patients.
> The FDA, meanwhile, has “released new guidance that eases up on rules regarding the compounding of IV solutions,” she added. “That's to make it easier for hospitals and other facilities to do this during the shortage period.”
NBC https://www.nbcnews.com/health/health-news/long-helene-iv-fl...:
> So, why are these essential fluids — a lifeline for hospitals — so hard to come by?
> As is often the case with drug shortages, it comes down to money, and IV fluids don’t bring in much of it for manufacturers, said Erin Fox, senior pharmacy director at the University of Utah Health.
> “These are life-saving products, but at the same time these are absolutely treated as kind of commodities,” Fox said.
> The high barrier to entry — including the time and cost required to meet the regulatory requirements for setting up a manufacturing facility — along with the pressure to keep prices low, means drugmakers aren’t really motivated to jump into the market, Fox said.
NPR: https://www.npr.org/sections/shots-health-news/2024/10/11/nx...
> On Wednesday, the Food and Drug Administration announced it has authorized 19 IV products for temporary importation from Canada, China, Ireland and the U.K.
having worked in the space... you are at the level of knowledge of "you don't know what you don't know." it's regulated for good reason. WFI is ultra pure water and costs quite a bit of money to make and is one of the main ingredients in a lot of pharmaceuticals.
IV fluids aren't difficult to produce, but it IS difficult to produce PACKAGED IV fluids consistently, every time, in such a way that they don't make people sick.
Because that is difficult and important, there are tests and certifications. In turn the tests and certifications are difficult - and yes at this point there is extra cost, and that extra cost becomes a moat, which drives up price.
Unfortunately, the moat is both consumer protection and rent seeking business advantage. That is, part of the excess cost beyond the base ingredients goes to protecting consumers, however a lot of the excess cost comes from the fact that not everyone is willing to undergo all of the paperwork and process that consumers and insurance have asked the government to require.
You are not completely wrong, just mostly wrong.
"Pure government regulation" is so rare as to be non-existent in most people's daily life. "Government regulation" is someone's moat. Sometimes it's a consumer group, sometimes it's special interest, sometimes it's a business. Very rarely it is for the government's own sake.
I’ve worked in parenteral pharmaceutical manufacturing (IV drugs) and making sterile products at scale is actually quite hard to do.
It is true the ingredients are basic. Where the challenge comes in is running a manufacturing line where all products that come out the other end are guaranteed to be 100% sterile.
And actually calling them “sterile” isn’t true, they need to be “pyrogen-free” or "aseptic". Pyrogens are basically “fever causing” materials like fragments of bacterial cell walls.
You can’t just mix up the ingredients and then sterilize it (heat or radiation). There may not be any viable infectious agents (bacteria or viruses) but it will contain fragments like LPS (lipopolysaccharides) which will make patients very sick.
And the finished product is a fantastic growth medium for bacteria since it doesn't typically contain any preservatives to prevent bacterial growth.
So the process requires a number of steps to remove all pyrogens (micro pore filtration) on a large manufacturing plant which is quite challenging when you’re dealing with ten thousand liter process vessels then filling millions of IV bags. Every vessel, line, filter, connection and package in the plant is a potential source of contamination. You also need extensive testing throughout the process to ensure nothing goes wrong.
It’s one of the reason why there are often shortages of generic IV drugs. It’s expensive to set up and requires expertise to maintain the process. If problems happen, production lines can be shutdown for months while the issue is fixed. As a result a lot of manufacturers just exit the market when prices drop because the profit margin gets eaten up every time an issue arises.
You can read the FDA's guidance document and the cGMP guidance to get a sense as to the complexity.
It is very much known that you can arbitrage medical costs, drug costs by going to Canada and Mexico. It is very much also very simple to research, search and find vendors or manufacturers located outside different geographic areas.
Therefore, your "qualifications" rebuttal becomes nil, this is basic adult literacy.
Call it economics/subsitution research, call it being informed, or just googling.
It is very much not ignorance but a very valid question to a very valid concern - most market restrictions are not because of "safety" (unfortunately, but it does become a boogey man) or "non-availability" (there is supply, but it isn't allowed.) but because it benefits some one/some company financially.
We had similar situation in communist czechoslovakia. There was a plan to manufacture female hygiene products, in a single factory for entire country. This factory burned down on second year of five year plan. So for some time our ladies were forced to use toilet paper. We still managed to make IV fluids though!
My guess US planning is a bit similar. Too special to import medical supplies from neighbours or from Europe.
https://www.reuters.com/business/healthcare-pharmaceuticals/...
Losing 60% of production in a country of 350M people is hard to make up from elsewhere, though.
The US is unlikely to be unique in this sort of thing. Everyone depends on Taiwan for chips, for example.
It looks like the problem is a for-profit health system. I want IV fluids, injected directly into the bloodstream of very sick people, to be very carefully regulated.
China produces ~80% of the world's magnesium. Cobalt comes mostly from Congo.
In the 40-50% range, there is Kazakhstan with uranium and Australia with lithium.
You can explore more here: https://worldpopulationreview.com/search?query=production&fi...
And of course, phosphate reserves are only a small portion (0.02%) of the world's estimated phosphate resources.
Moreover, they are famously the limiting element in Isaac Asimov's thought-experiment of converting the earth's crust into biomass.
Platinum group metals, phosphorus, manganese, cobalt etc all pretty Africa heavy usually one or two countries
At $4-$7 per Kg in the US, the cost per Coke can would be in the order of 0.025 cents (guesstimate).
This is interesting considering that 80% of the supply comes from Sudan.
It is a nearly universal ingredient in processed foods and professional kitchens. I wonder how the economics work to push the price down.
EDIT: Apparently naturally abundant Acacia trees produce it with barely any oversight and it is easy to harvest in large quantities compared to how much volume is needed in end-products. I suppose if Sudan tried to squeeze their monopoly other suppliers would easily come up in other regions. The reason for the monopoly must simply be a combination of a favorable environment and the fact that they are willing to do it very cheaply because unfortunately they don’t have many other options to sustain themselves.
There are a lot of goods like this, where the market has consolidated around the cheapest supplier for convenience but if that supplier disappeared the next-cheapest one would be fine at 10% more. It looks like a catastrophic chokepoint on the economy but it's really not a big deal.
Maybe it’s not only the economic strategies that push the price down?
Maybe they will make a movie about it: Lord of Gum <WIP>
https://www.cnn.com/2023/04/20/africa/wagner-sudan-russia-li...
"The Russian mercenary group Wagner has been supplying Sudan’s Rapid Support Forces with missiles to aid their fight against the country’s army, Sudanese and regional diplomatic sources have told CNN."
Nomads and colonisers mostly. Interesting keywords/phrases to look into might include janjaweed, Muammar Ghadaffi, Omar al-Bashir, genocide in Darfur, United Arab Emirates, anglo-egyptian forces.
There are also tangential events worth looking into, like the 1998 attack on the Al-Shifa factory.
https://www.ide.go.jp/English/Data/Africa_file/Company/sudan...
Seems weird world population and consumption increased by... a lot sinc ethe 60s but Sudans production halfedand still accounts for 80% of world demand? I guess there's substitutes, or some uses deprecated.
Sudan has had a military dictatorship from 1989-2019 (led by Omar al-Bashir).
In 2017, both President Obama and President Trump lifted sanctions on Sudan, after al-Bashir reneged on a promise to step down just two years earlier.
In 2018/2019, price hikes resulted in massive protests and a subsequent revolution against al-Bashir. This finally resolved in 2019, when a joint military-civilian political agreement, constitution, and council were formed. At that point, lots of aid was needed in order to rebuild and stabilize the country, but as usual, actually getting that money was difficult. The bulk of it came from Saudi Arabia and the UAE.
In 2021, there were two more coups.
In 2023, a new civil war broke out between the military dictatorship and a paramilitary branch of it. That war is still persisting. War crimes are rampant, mass-murder and genocide persist, almost the entire country cannot afford food. The main backer of the paramilitary group preventing the conflict from ending is the UAE.
"From 1954 onward Guatemala was ruled by a series of US-backed military dictators, leading to the Guatemalan Civil War which lasted until 1996. Approximately 200,000 civilians were killed in the war, and numerous human rights violations committed, including massacres of civilian populations, rape, aerial bombardment, and forced disappearances"
there are other gums, too. And now that i know about the collection of gum arabic i'll avoid it in processed stuff, too. I already boycott nestle, and i can do without coca-cola, too.
Outside the US, there are Coca-cola products that do though like some Schweppes and Fanta sodas.
I don't have any problem not buying products for reasons like this. No problem whatsoever. So if a company wants me to buy its product, they can use another ingredient that doesn't involve smuggling it out of a conflict zone.
Hell, I don't know anything about Sudan, but if you told me the CIA installed Omar al-Bashir to ensure the continued cheap supply of Gum Arabic, I wouldn't necessarily believe you, but I wouldn't call you a liar either.
Well he immediately suggested to "install a new dictator" in the adjacent comment. [1] I figure dictators are OK as long as the spice keeps flowing.
2) use foreign policy maneuvers to pressure UAE to end its support for the paramilitary group
3) provide aid of our own which strengthens our position and gives us more options to end the paramilitary group's reign
4) install a new dictator. it's not a good option, but if the previous options don't work, I think the citizens of Sudan would admit it's better than genocide and starvation at this point.
Remember back in "Trump 1.0", when he stopped us from being involved in foreign affairs "because America First", and there were warnings that a lack of American presence would create a power vacuum that our enemies would fill? This is that outcome.
If we had been the ones providing aid instead of the Saudis and the UAE, this whole recent catastrophe might have been avoided. An important lesson for the current administration as they continue to end foreign aid to gain cheap political points.
And granted, I know a whole lot of people go "so what?" to genocide and starvation, but also Coke & M&Ms are now more expensive, so maybe that'll matter to them.
It's gum arabic.
> Sudan produces around 80 per cent of the world’s gum arabic, a natural substance harvested from acacia trees that’s used widely to mix, stabilise and thicken ingredients in mass-market products including L’Oreal lipsticks and Nestle pet food.
"Gum arabic, a vital ingredient used in everything...."
The identity of this secret isn't what makes this article worth reading.
And also probably because the article is featured on general audience site rather than a scientific or culinary journal.
I get that people hate clickbait headlines but this is hardly misleading, impossibly vague nor exaggerated.
In short, that’s not an improvement.
This is a classic case of the HN crowd not understanding that different audiences are interested in different details.
And it's two words, you could make other cuts if you want.
However, at this point, you arguing a matter of taste.
I don't think Coca-Cola or M&Ms are relevant to the article itself. Gum arabic isn't that uncommon. I mean, this is a largely software developer focused crowd and a lot of people here were like "Ah, gum arabic".
i was more interested in what the ingredient was. the fact its being smuggled (a) doesn’t surprise me and (b) isn’t something im particularly interested in learning about.
so, in this case, it wasn’t worth opening the article for me. i learned what i wanted to learn during my normal comment scan that i usually do with titles like this (outside my wheel house).
I don't read all the news in the world, I don't even read all the news on HN. Having that extra bit of info helps me decide whether to read the article.