Diluted Chemotherapy Medicine Is Killing Canadian Cancer Patients

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A few weeks ago, the news broke that a number of cancer patients in Canada had been on the receiving end of faulty chemotherapy medications. The saline bags used to administer the drugs were overfilled, diluting the medication anywhere from 3 to 20 percent. These bags were administered to 1,176 patients in Ontario and New Brunswick. When the story broke, it seemed as though the controversy was relatively minor. Of course, no cancer patient wants to hear that their medications have been compromised by an avoidable human error, but public officials and oncologists alike assured the public that the possible effects of this mistake were minimal.

Health Minister Deb Matthews reassured the Windsor Star that "Oncologists tell me the likelihood of this having a serious impact on the health of patients is slight." While trying to find more information on the matter, I attained an email to the Windsor Star in which Dr. Ken Schneider, Chief of Oncology at the Windsor Regional Hospital (one of the five hospitals affected by the scandal) matched Matthews sentiment, stating that "Based on input from my medical oncology colleagues and the scientific evidence available, there is a low statistical probability of a decreased effectiveness or worse outcome than what would be expected."

On Friday, the impact of the scandal increased when the London Health Sciences Centre reported that 137 of the patients treated with the diluted chemo cocktails have since died. While this is indeed a staggering number (over 10 percent of the reported 1205 patients treated with the faulty bags), a representative from the Health Centre reminded the Toronto Star that "The death numbers … need to be taken in a broader context in terms of the types of patients that were there." In other words, many people being treated with chemotherapy would likely have died even if their medications had not been compromised, but Dr. David Stewart, an oncologist from the Ottawa Hospital, did tell the Star that underdosing of medication has been associated with lower life expectancies in cancer patients.

Regardless of the effects of the mistake, more of which may come to light in the coming days, this scandal has also revealed a shocking lack of government oversight in the manufacture of medications within Ontario. Researchers from the University Health Network in Toronto told CBC News two months ago that a number of improvements should be made to mitigate the effects of human error in chemotherapy treatment. One of the solutions they provided was that hospitals should have "a second person check that the volume and concentration of chemotherapy is correct when drugs aren't available in a ready-to-use liquid form."

But the defective medications were not the fault of any of the hospitals researched by the University Health Network team. Rather, they were produced by a Marchese Hospital Solutions in Missisauga, Ontario, a private pharmaceutical supplier that was not regulated by any federal or provincial authority (at least, not until Friday.) Marita Zaffiro, the president of Marchese Hospital Solutions, has refused or ignored every media request for an interview (including one from VICE Canada) since the scandal came to light. On the Marchese Health Care website, however, she released a statement that deflects blame towards the hospitals, stating that "[Marchese Hospital Solutions] is confident that we have met all of the contractual requirements including both volume and concentrations for these solutions." It is unclear how this statement could be true considering four separate hospitals had the same problem and all the diluted medications came from the same source.

The legal "grey area" that allowed Marchese Hospital Solutions to go unregulated occurred because hospitals were permitted to outsource certain responsibilities, like the mixing of chemotherapy drugs to for-profit companies. The Ontario College of Pharmacists, a provincial agency, regulates pharmacies in Ontario, and Health Canada, a federal agency, regulates drug manufacturers. Marchese Hospital Solutions was not considered a pharmacy or a drug manufacturer. This affair and Zaffiro's continued silence toward it are reflective of the problems that occur when public health care responsibilities are contracted out to private companies.

At this point, the deflection of responsibilities has occurred from three sides. The federal and provincial governments both refused to take responsibility for not regulating something as important as the manufacturing of chemotherapy drugs (despite the existence of a step-by-step Health Canada guide on differentiating drug manufacturers from pharmacies). The manufacturers themselves have deflected the blame on to the hospitals, who, given the known facts, are probably not at fault. What can be determined from this case is that when governments and private companies point fingers and assign blame like this, the only real losers are the patients themselves—1,176 of whom have been affected by avoidable human error.

Follow Alan on Twitter: @alanjonesxxxv

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