{"id":45951,"date":"2019-10-25T16:31:20","date_gmt":"2019-10-25T15:31:20","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmj\/?p=45951"},"modified":"2019-11-01T17:31:25","modified_gmt":"2019-11-01T16:31:25","slug":"jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmj\/2019\/10\/25\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\/","title":{"rendered":"Jeffrey Aronson: When I Use a Word . . . Drug shortages\u2014harms and errors"},"content":{"rendered":"<p><span style=\"font-weight: 400\"><a href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/10\/18\/jeffrey-aronson-when-i-use-a-word-explaining-drug-shortages\/\"><span style=\"font-weight: 400\">Last week<\/span><\/a><span style=\"font-weight: 400\">, I reported my analysis of over 800 reports of drug shortages, published since the <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/29012691\"><span style=\"font-weight: 400\">first report<\/span><\/a><span style=\"font-weight: 400\"> of shortages of quinine and mepacrine in India in 1942.<\/span><\/span><\/p>\n<p><span style=\"font-weight: 400\">In surveying the literature, I was struck by how infrequently clinical harms attributed to drug shortages had been reported until relatively recently. In illustration of this, consider three papers, published by the American Society of Health-System Pharmacists.<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">The first, \u201cASHP Guidelines on Managing Drug Product Shortages\u201d (2001), discussed the causes of shortages under 11 headings and actions that might be taken under 13 headings.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">The second, \u201cASHP Guidelines on Managing Drug Product Shortages in Hospitals and Health Systems\u201d (2009), introduced only minor changes and added a diagram detailing processes for decision-making in the management of shortages.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">In the third, \u201cASHP Guidelines on Managing Drug Product Shortages\u201d (2018), there were more major headline changes, and this time a completely new section, titled \u201cPatient safety\u201d, with references from 2010 onwards.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">I have now reviewed again the papers that I originally found in my search for drug shortages, this time looking for harms, and again relying on the titles and MeSH terms listed in PubMed. Although I restricted my survey to papers published since the year 2000, the total corpus included 761 papers out of the original 811 published since 1942, with additional references from the papers I found, emphasizing again that this is a relatively recent problem.<\/span><\/p>\n<p><span style=\"font-weight: 400\">As well as frustration and anxieties, drug shortages can cause four types of clinical harm:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">failure to treat conditions properly, with delays and suboptimal treatment or none;<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">withdrawal effects (e.g. during shortage of <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/20618239\"><span style=\"font-weight: 400\">heroin<\/span><\/a><span style=\"font-weight: 400\">);<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">adverse effects of substitute medications;<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">medication errors, particularly when the substitutes are unfamiliar.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">In addition, <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24156647\"><span style=\"font-weight: 400\">extra monitoring<\/span><\/a><span style=\"font-weight: 400\"> and <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/24644117\"><span style=\"font-weight: 400\">referrals<\/span><\/a><span style=\"font-weight: 400\"> to other facilities may be required, <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/23515514\"><span style=\"font-weight: 400\">clinical trials<\/span><\/a><span style=\"font-weight: 400\"> may be disrupted because of reduced recruitment, and <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/26284924\"><span style=\"font-weight: 400\">drug expenditure<\/span><\/a><span style=\"font-weight: 400\"> may increase.<\/span><\/p>\n<p><span style=\"font-weight: 400\">In some cases authors have reported observing few if any harms as a result of shortages. However, harms do occur, as the examples in Table 1 show.<\/span><\/p>\n<p><b>Table 1.<\/b><span style=\"font-weight: 400\"> A summary of 66 unwanted outcomes selectively <\/span><a href=\"https:\/\/www.ismp.org\/resources\/special-issue-drug-shortages-national-survey-reveals-high-level-frustration-low-level\"><span style=\"font-weight: 400\">reported<\/span><\/a><span style=\"font-weight: 400\"> from a database of over 1000 cases reported to the Institute for Safe Medication Practices in 2010<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"aligncenter size-full wp-image-45952\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/10\/aronson_shortages_harms.jpg\" alt=\"\" width=\"614\" height=\"715\" srcset=\"https:\/\/blogs.bmj.com\/bmj\/files\/2019\/10\/aronson_shortages_harms.jpg 614w, https:\/\/blogs.bmj.com\/bmj\/files\/2019\/10\/aronson_shortages_harms-258x300.jpg 258w\" sizes=\"auto, (max-width: 614px) 100vw, 614px\" \/><\/p>\n<p><span style=\"font-weight: 400\">How often do we discover that treatments we thought would be effective are not, or may even be harmful? 1007 patients, who were given antivenom after being bitten by snakes, underwent a double-blind, randomized, placebo-controlled <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/21572992\"><span style=\"font-weight: 400\">trial<\/span><\/a><span style=\"font-weight: 400\"> of subcutaneous adrenaline, intravenous promethazine, and intravenous hydrocortisone, each alone and in all possible combinations, in the hope of preventing adverse reactions to the antivenom; 752 (75%) had acute reactions to the antivenom (9% mild, 48% moderate, and 43% severe); adrenaline significantly reduced severe reactions to antivenom by 43% (95% CI = 25, 67) at 1 h and by 38% (95% CI = 26, 49) up to 48 h after antivenom administration; hydrocortisone and promethazine did not, but adding hydrocortisone negated the benefit of adrenaline.<\/span><\/p>\n<p><span style=\"font-weight: 400\">So it may be no surprise that drug shortages may in some cases prove beneficial, when ineffective or harmful treatments are withheld. For example, during a shortage of noradrenaline 214 patients with severe sepsis or septic shock were either given noradrenaline (n=106) or not (n=108). A <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28804796\"><span style=\"font-weight: 400\">retrospective analysis<\/span><\/a><span style=\"font-weight: 400\"> showed that there was no difference in ICU length of stay after controlling for differences in intensity of the illness (APACHE II score), age, weight, and sex; however, those who were <\/span><i><span style=\"font-weight: 400\">not<\/span><\/i><span style=\"font-weight: 400\"> given noradrenaline were more likely to survive (OR = 5.9; 95% CI = 3.1, 11). But perhaps the difference was accounted for by the higher serum lactate concentrations in the treated group, which were not controlled for. In another <\/span><a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pubmed\/28322415\"><span style=\"font-weight: 400\">study<\/span><\/a><span style=\"font-weight: 400\"> of septic shock noradrenaline shortage was associated with increased mortality.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">Publication bias takes two forms. In the better known form, studies of interventions that show no benefit are not published. In the less well known form, studies that show harms are not published either. Together, these two forms of publication bias lead to overestimation of benefits and underestimation of harms. I suspect that both forms of bias have affected studies of drug shortages, perhaps tilting the balance in the opposite direction.<\/span><\/p>\n<p><a href=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"alignleft wp-image-32935\" src=\"https:\/\/blogs.bmj.com\/bmj\/files\/2014\/12\/jeffrey_aronson.jpg\" alt=\"\" width=\"116\" height=\"143\" \/><\/a><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"font-weight: 400\"><em><strong>Jeffrey Aronson<\/strong>\u00a0is a clinical pharmacologist, working in the Centre for Evidence Based Medicine in Oxford&#8217;s Nuffield Department of Primary Care Health Sciences. He is also president emeritus of the British Pharmacological Society.<\/em><\/span><\/p>\n<p><strong>Competing interests:<\/strong> None declared.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Last week, I reported my analysis of over 800 reports of drug shortages, published since the first report of shortages of quinine and mepacrine in India in 1942. In surveying [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/10\/25\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\/\">More&#8230;<\/a><\/p>\n","protected":false},"author":1,"featured_media":38359,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5762],"tags":[],"class_list":["post-45951","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-jeff-aronsons-words"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Jeffrey Aronson: When I Use a Word . . . Drug shortages\u2014harms and errors - The BMJ<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/bmj\/2019\/10\/25\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Jeffrey Aronson: When I Use a Word . . . Drug shortages\u2014harms and errors - The BMJ\" \/>\n<meta property=\"og:description\" content=\"Last week, I reported my analysis of over 800 reports of drug shortages, published since the first report of shortages of quinine and mepacrine in India in 1942. In surveying [...]More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/bmj\/2019\/10\/25\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\/\" \/>\n<meta property=\"og:site_name\" content=\"The BMJ\" \/>\n<meta property=\"article:publisher\" content=\"https:\/\/www.facebook.com\/bmjdotcom\/\" \/>\n<meta property=\"article:published_time\" content=\"2019-10-25T15:31:20+00:00\" \/>\n<meta property=\"article:modified_time\" content=\"2019-11-01T16:31:25+00:00\" \/>\n<meta property=\"og:image\" content=\"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/02\/Jeffrey-Aronson.jpg\" \/>\n\t<meta property=\"og:image:width\" content=\"540\" \/>\n\t<meta property=\"og:image:height\" content=\"350\" \/>\n\t<meta property=\"og:image:type\" content=\"image\/jpeg\" \/>\n<meta name=\"author\" content=\"BMJ\" \/>\n<meta name=\"twitter:card\" content=\"summary_large_image\" \/>\n<meta name=\"twitter:creator\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:site\" content=\"@bmj_latest\" \/>\n<meta name=\"twitter:label1\" content=\"Written by\" \/>\n\t<meta name=\"twitter:data1\" content=\"BMJ\" \/>\n\t<meta name=\"twitter:label2\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data2\" content=\"3 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"Article\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2019\\\/10\\\/25\\\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\\\/#article\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2019\\\/10\\\/25\\\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\\\/\"},\"author\":{\"name\":\"BMJ\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\"},\"headline\":\"Jeffrey Aronson: When I Use a Word . . . Drug shortages\u2014harms and errors\",\"datePublished\":\"2019-10-25T15:31:20+00:00\",\"dateModified\":\"2019-11-01T16:31:25+00:00\",\"mainEntityOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2019\\\/10\\\/25\\\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\\\/\"},\"wordCount\":692,\"commentCount\":0,\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2019\\\/10\\\/25\\\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2017\\\/02\\\/Jeffrey-Aronson.jpg\",\"articleSection\":[\"Jeff Aronson's Words\"],\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"CommentAction\",\"name\":\"Comment\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2019\\\/10\\\/25\\\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\\\/#respond\"]}]},{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2019\\\/10\\\/25\\\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2019\\\/10\\\/25\\\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\\\/\",\"name\":\"Jeffrey Aronson: When I Use a Word . . . Drug shortages\u2014harms and errors - The BMJ\",\"isPartOf\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\"},\"primaryImageOfPage\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2019\\\/10\\\/25\\\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\\\/#primaryimage\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2019\\\/10\\\/25\\\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\\\/#primaryimage\"},\"thumbnailUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2017\\\/02\\\/Jeffrey-Aronson.jpg\",\"datePublished\":\"2019-10-25T15:31:20+00:00\",\"dateModified\":\"2019-11-01T16:31:25+00:00\",\"breadcrumb\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2019\\\/10\\\/25\\\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\\\/#breadcrumb\"},\"inLanguage\":\"en-US\",\"potentialAction\":[{\"@type\":\"ReadAction\",\"target\":[\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2019\\\/10\\\/25\\\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\\\/\"]}]},{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2019\\\/10\\\/25\\\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\\\/#primaryimage\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2017\\\/02\\\/Jeffrey-Aronson.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2017\\\/02\\\/Jeffrey-Aronson.jpg\",\"width\":540,\"height\":350},{\"@type\":\"BreadcrumbList\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/2019\\\/10\\\/25\\\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\\\/#breadcrumb\",\"itemListElement\":[{\"@type\":\"ListItem\",\"position\":1,\"name\":\"Home\",\"item\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\"},{\"@type\":\"ListItem\",\"position\":2,\"name\":\"Jeffrey Aronson: When I Use a Word . . . Drug shortages\u2014harms and errors\"}]},{\"@type\":\"WebSite\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#website\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\",\"name\":\"The BMJ\",\"description\":\"Helping doctors make better decisions.\",\"publisher\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\"},\"potentialAction\":[{\"@type\":\"SearchAction\",\"target\":{\"@type\":\"EntryPoint\",\"urlTemplate\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/?s={search_term_string}\"},\"query-input\":{\"@type\":\"PropertyValueSpecification\",\"valueRequired\":true,\"valueName\":\"search_term_string\"}}],\"inLanguage\":\"en-US\"},{\"@type\":\"Organization\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#organization\",\"name\":\"The BMJ\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/\",\"logo\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/logo\\\/image\\\/\",\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2018\\\/05\\\/The-BMJ-logo.jpg\",\"contentUrl\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/files\\\/2018\\\/05\\\/The-BMJ-logo.jpg\",\"width\":852,\"height\":568,\"caption\":\"The BMJ\"},\"image\":{\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/logo\\\/image\\\/\"},\"sameAs\":[\"https:\\\/\\\/www.facebook.com\\\/bmjdotcom\\\/\",\"https:\\\/\\\/x.com\\\/bmj_latest\"]},{\"@type\":\"Person\",\"@id\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/#\\\/schema\\\/person\\\/ba3da426ed20e8f1d933ca367d8216fe\",\"name\":\"BMJ\",\"image\":{\"@type\":\"ImageObject\",\"inLanguage\":\"en-US\",\"@id\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"url\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"contentUrl\":\"https:\\\/\\\/secure.gravatar.com\\\/avatar\\\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g\",\"caption\":\"BMJ\"},\"sameAs\":[\"https:\\\/\\\/blogs.bmj.com\\\/\"],\"url\":\"https:\\\/\\\/blogs.bmj.com\\\/bmj\\\/author\\\/admin\\\/\"}]}<\/script>\n<!-- \/ Yoast SEO plugin. -->","yoast_head_json":{"title":"Jeffrey Aronson: When I Use a Word . . . Drug shortages\u2014harms and errors - The BMJ","robots":{"index":"index","follow":"follow","max-snippet":"max-snippet:-1","max-image-preview":"max-image-preview:large","max-video-preview":"max-video-preview:-1"},"canonical":"https:\/\/blogs.bmj.com\/bmj\/2019\/10\/25\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\/","og_locale":"en_US","og_type":"article","og_title":"Jeffrey Aronson: When I Use a Word . . . Drug shortages\u2014harms and errors - The BMJ","og_description":"Last week, I reported my analysis of over 800 reports of drug shortages, published since the first report of shortages of quinine and mepacrine in India in 1942. In surveying [...]More...","og_url":"https:\/\/blogs.bmj.com\/bmj\/2019\/10\/25\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\/","og_site_name":"The BMJ","article_publisher":"https:\/\/www.facebook.com\/bmjdotcom\/","article_published_time":"2019-10-25T15:31:20+00:00","article_modified_time":"2019-11-01T16:31:25+00:00","og_image":[{"width":540,"height":350,"url":"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/02\/Jeffrey-Aronson.jpg","type":"image\/jpeg"}],"author":"BMJ","twitter_card":"summary_large_image","twitter_creator":"@bmj_latest","twitter_site":"@bmj_latest","twitter_misc":{"Written by":"BMJ","Est. reading time":"3 minutes"},"schema":{"@context":"https:\/\/schema.org","@graph":[{"@type":"Article","@id":"https:\/\/blogs.bmj.com\/bmj\/2019\/10\/25\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\/#article","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2019\/10\/25\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\/"},"author":{"name":"BMJ","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe"},"headline":"Jeffrey Aronson: When I Use a Word . . . Drug shortages\u2014harms and errors","datePublished":"2019-10-25T15:31:20+00:00","dateModified":"2019-11-01T16:31:25+00:00","mainEntityOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2019\/10\/25\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\/"},"wordCount":692,"commentCount":0,"publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2019\/10\/25\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/02\/Jeffrey-Aronson.jpg","articleSection":["Jeff Aronson's Words"],"inLanguage":"en-US","potentialAction":[{"@type":"CommentAction","name":"Comment","target":["https:\/\/blogs.bmj.com\/bmj\/2019\/10\/25\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\/#respond"]}]},{"@type":"WebPage","@id":"https:\/\/blogs.bmj.com\/bmj\/2019\/10\/25\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\/","url":"https:\/\/blogs.bmj.com\/bmj\/2019\/10\/25\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\/","name":"Jeffrey Aronson: When I Use a Word . . . Drug shortages\u2014harms and errors - The BMJ","isPartOf":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#website"},"primaryImageOfPage":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2019\/10\/25\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\/#primaryimage"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2019\/10\/25\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\/#primaryimage"},"thumbnailUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/02\/Jeffrey-Aronson.jpg","datePublished":"2019-10-25T15:31:20+00:00","dateModified":"2019-11-01T16:31:25+00:00","breadcrumb":{"@id":"https:\/\/blogs.bmj.com\/bmj\/2019\/10\/25\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\/#breadcrumb"},"inLanguage":"en-US","potentialAction":[{"@type":"ReadAction","target":["https:\/\/blogs.bmj.com\/bmj\/2019\/10\/25\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\/"]}]},{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/2019\/10\/25\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\/#primaryimage","url":"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/02\/Jeffrey-Aronson.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2017\/02\/Jeffrey-Aronson.jpg","width":540,"height":350},{"@type":"BreadcrumbList","@id":"https:\/\/blogs.bmj.com\/bmj\/2019\/10\/25\/jeffrey-aronson-when-i-use-a-word-drug-shortages-harms-and-errors\/#breadcrumb","itemListElement":[{"@type":"ListItem","position":1,"name":"Home","item":"https:\/\/blogs.bmj.com\/bmj\/"},{"@type":"ListItem","position":2,"name":"Jeffrey Aronson: When I Use a Word . . . Drug shortages\u2014harms and errors"}]},{"@type":"WebSite","@id":"https:\/\/blogs.bmj.com\/bmj\/#website","url":"https:\/\/blogs.bmj.com\/bmj\/","name":"The BMJ","description":"Helping doctors make better decisions.","publisher":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#organization"},"potentialAction":[{"@type":"SearchAction","target":{"@type":"EntryPoint","urlTemplate":"https:\/\/blogs.bmj.com\/bmj\/?s={search_term_string}"},"query-input":{"@type":"PropertyValueSpecification","valueRequired":true,"valueName":"search_term_string"}}],"inLanguage":"en-US"},{"@type":"Organization","@id":"https:\/\/blogs.bmj.com\/bmj\/#organization","name":"The BMJ","url":"https:\/\/blogs.bmj.com\/bmj\/","logo":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/logo\/image\/","url":"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/05\/The-BMJ-logo.jpg","contentUrl":"https:\/\/blogs.bmj.com\/bmj\/files\/2018\/05\/The-BMJ-logo.jpg","width":852,"height":568,"caption":"The BMJ"},"image":{"@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/logo\/image\/"},"sameAs":["https:\/\/www.facebook.com\/bmjdotcom\/","https:\/\/x.com\/bmj_latest"]},{"@type":"Person","@id":"https:\/\/blogs.bmj.com\/bmj\/#\/schema\/person\/ba3da426ed20e8f1d933ca367d8216fe","name":"BMJ","image":{"@type":"ImageObject","inLanguage":"en-US","@id":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","url":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","contentUrl":"https:\/\/secure.gravatar.com\/avatar\/b4d8f39281bcae118348a1c027347b8e53b82d42520e774a8b50dd9a6ac6c01d?s=96&d=mm&r=g","caption":"BMJ"},"sameAs":["https:\/\/blogs.bmj.com\/"],"url":"https:\/\/blogs.bmj.com\/bmj\/author\/admin\/"}]}},"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/45951","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/comments?post=45951"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/posts\/45951\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media\/38359"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/media?parent=45951"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/categories?post=45951"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmj\/wp-json\/wp\/v2\/tags?post=45951"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}