[e-drug] NYTimes on Cipro, Cipla, and Bayer

[Asia Russell <asia@critpath.org>]

E-drug: NYTimes on Cipro, Cipla, and Bayer
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[Odd consequences of the US biological attacks. Cross posted from
Ip-health. Thanks. Copied as fair use. HH]

New York Times

Anthrax Fears Send Demand for a Drug Far Beyond Output
By Melody Petersen and Robert Pear

As fear of anthrax continues to rise and demand for the antibiotic
Cipro skyrockets, the German company that makes the drug in the
United States has only begun to increase its production and will
probably take several months to produce the drug in the quantities
the government wants. 

But federal officials are not pressing Bayer, the maker of Cipro, to
increase production beyond the levels it currently plans, and public
health officials warned that the soaring demand threatens to leave
hospitals and drugstores without a medication that is also needed
to treat other serious infections and diseases. 

Bayer began monitoring demand for Cipro after the terror attacks on
Sept. 11 and discussing whether to increase production, a spokes-
woman said. But the company had announced no manufacturing
changes until the middle of last week, when officials at the Centers
for Disease Control and Prevention asked them to increase
production. 

Bayer, which was reaching a similar conclusion at about the same
time, now plans to reopen a German plant on Nov. 1 to increase
Cipro production by 25 percent. Over the weekend it also expanded
manufacturing at its factory in Connecticut to 24 hours a day,
seven days a week from what had been a 40-hour week. In
addition, Bayer has shifted operations in Connecticut to convert
more machines to making Cipro. 

"We're doing everything we can to ensure that we have increased
buffer stocks of Cipro," said Karen Dawes, senior vice president for
marketing and sales at Bayer's United States division. She
acknowledged that the company could not fill all the orders for
certain dosages of Cipro, but said it was not unusual for a drug to
be on back order temporarily. "The demand is changing by the
minute."

Bayer officials would not, however, say how much of the increased
supply from the German plant would go the United States, and they
refused to disclose how much Cipro they produce. Sales of the drug
in the United States exceeded $1 billion last year. 

Outside the United States, many foreign drug companies make
ciprofloxacin, the generic form of Cipro. Cipla, the Indian drug
company that has offered to make low-priced AIDS medicines, said
yesterday that it could supply large quantities of ciprofloxacin to the
United States. Dr. Yusuf K. Hamied, chairman of Cipla, said his
company had been making ciprofloxacin for more than a decade
and could quickly increase production. But Cipla and the other
companies cannot now sell the drug in the United States because it
is protected by Bayer's patent until 2003.

The health and human services secretary, Tommy G. Thompson,
said Sunday that the White House would ask Congress for an
additional $643 million for the purchase of antibiotics, including
Cipro, to have enough to cover 12 million people for 60 days. 

Government officials said they believed that the company could
now produce enough Cipro to meet that goal within a few months.
But they said they were accepting the company's assurances and
had not independently verified Bayer's production capabilities.

The escalating demand for Cipro is affecting medical decisions. 

Mount Sinai Hospital in New York, for instance, said that it told
doctors on Friday to try to use other antibiotics if they could. Other
hospitals in New York said that they were still receiving shipments
of Cipro, but less than they had ordered.

Bill Larkin, senior vice president for pharmacy services at the
Greater New York Hospital Association, said that most city
hospitals had begun trying to increase supplies of the drug after
they met with city health officials on Sept. 25. The city officials had
recommended in that meeting that hospitals have a three- day
supply of Cipro on hand to cover all patients and employees, Mr.
Larkin said.

"That created a very big demand from wholesalers," Mr. Larkin
said. 

Dr. Linda S. Tyler, who works at the University of Utah's health
system and runs a national system that keeps track of drug
shortages, said that hospitals from around the country had begun to
call her to complain about not getting all the Cipro they had
ordered. "We're watching this very closely," Dr. Tyler said. "We
don't have a lot of information from the company on what is going
on."

Cardinal Health, a national drug wholesaler, said that it had carried
out special shipping procedures to help limit hoarding of the
antibiotic. The company is now shipping Cipro to pharmacies based
on their ordering patterns before Sept. 11, said Geoffrey Fenton,
spokesman for the wholesaler, rather than on the larger amounts
many are ordering. For instance, if a pharmacy orders 100 bottles
of Cipro, he said, but had been ordering 25 before the terrorist
attacks, it will probably get a shipment somewhere in between.

Bayer has not been able to fill all of orders that Cardinal Health has
placed, Mr. Fenton said, so that some dosages are in short supply.
"Stocks are low," he said, "and some orders are going unfilled."

Demand for Cipro has increased at pharmacies around the country,
but especially in New York and Florida.

At Merck-Medco, a prescription benefit management company,
Cipro demand has shot up, said Anita Kawatra, a company
spokeswoman. Prior to Sept. 11, on a typical day the company
filled about 8,000 to 10,000 Cipro prescriptions a day. After the
attacks, the average number of prescriptions climbed by about
2,000. Last week, the number of prescriptions climbed to 12,000
to 14,000 a day. Then on Friday, when NBC announced that one of
its employees had contracted anthrax, Medco handled about
18,000 Cipro prescriptions.

Walgreens said that stores in Fort Lauderdale and Palm Beach, Fla.,
sharply increased their orders early last week. Michael Polzin, a
Walgreens spokesman, said some stores had run out for a day or
two, but the company had restocked those stores. Mr. Polzin said
demand in South Florida began to subside on Friday.

But even as fears were beginning to subside in Florida, they hit a
new peak in New York, after reports that an NBC News employee
was infected with anthrax. Rite Aid and CVS both reported an
increase in Cipro sales across their chains, with a particularly strong
spike in New York City. 

"Compared to the rest of the country, there is a significantly greater
demand," said Todd Andrews, a CVS spokesman. "The New York
metro area has paced ahead." 


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