When it comes to government policies regarding health policy, we ve seen pretty much every type: Meaningless, but mostly harmless, anti-science, money driven, and ill-conceived and harmful.
Some of these (the full list would shut down the Internet) include the Hatch DSHEA act of 1994, which allowed untested drugs to be sold under the guise of food supplements, state laws that permit vaccine exemptions based on religious and personal beliefs, and the routine banning or restricting of chemicals that are harmless, only to have them replaced by another chemical that has been much less studied.
Arguably, the worst of them all was the decision by the FDA in 2005 to ban CFC propelled albuterol (the drug in asthma inhalers) by 2008. This ridiculously silly rule is the epitome of what happens when bad policies are put into place.
The US Clean Air Act was first introduced in 1963, and has since been amended and modified several times. It is clear that it has done a very good job in reducing air pollution:
In the late 1980s, other gases called chlorofluorocarbons (CFCs) became increasingly important. CFCs are known to destroy a part of the ozone layer, which, among other things, limits the amount of UV radiation that passes through the atmosphere. During this time, phasing out CFCs became a major focus of the EPA and other environmental agencies worldwide.
Before this time, CFCs were used primarily in air conditioners, refrigerators, and spray cans. A gradual phaseout of the gases worldwide has been ongoing. By the late 1980s the United States had effectively banned, or planned to phase out these gases for routine use. But not without consequences.
ACSH S Dr. Josh Bloom comments, Not content to ban virtually all use of CFCs, some genius decided that 99.9 percent wasn t good enough. So, somehow it became a good idea to get rid of the remaining 0.1 percent, which came from asthma inhalers.
The result was a meaningless environmental regulation that put an added burden on people with asthma (25 million in the US), and the companies that made the inhalers while having absolutely no benefit in reducing air pollution. Brilliant.
The results were predictable, and this is discussed in three pieces in the May 11th online JAMA Internal Medicine.
Dr. Bloom discussed just this in 2011, noting that the only inhaler that was available OTC, Primatene Mist (Wyeth) was being discontinued because the company did not want to reformulate it. Now there are no OTC inhalers available. You must get a prescription for all of them.
Companies did reformulate their albuterol inhalers, but at a cost. (The propellants used now are chloroalkanes.) Since 2011, the price for an albuterol inhaler has roughly doubled, and insurance coverage is sometimes unclear.
In the first of the three JAMA articles, lead author Anupam B. Jena, MD, PhD of the Department of Medicine at Massachusetts General Hospital in Boston concluded: The Federal ban of CFC inhalers led to large relative increases in out-of-pocket albuterol costs among privately insured individuals with asthma and modest declines in utilization. The policy s impact on individuals without insurance, who faced greater cost increases, is unknown.
The following opinion piece by Rita F. Redberg, MD, MSc of the Department of Medicine at UCSF discussed the price increases and insurance problems. Dr. Redberg discussed her surprise when she went to the pharmacy to pick up an inhaler for her daughter and found that the price, which was normally $10 or $20, but was now $59.
Another opinion piece by Dr. Redberg and Joseph S. Ross, MD discussed the steep out of pocket cost for asthma patients: With the ban, generically manufactured chlorofluorocarbon inhalers were discontinued, leaving only branded hydrofluoroalkane inhalers available for use, even though the main pharmacological ingredient in both types of inhalers (albuterol) had been available in various generic formulations since the 1990s.
Dr. Bloom concludes, Wonderful. Let s get rid of the remaining 0.1 percent of of the CFCs in the US a ludicrous act that will not affect air quality one way or the other and force companies that have been selling an essential product to waste their time doing reformulation research, so that asthmatics many of whom are poor have to fork out significantly more money for the same product. Government at its best.
