Antidote: Compounding Pharmacies

Marc Siegel, MD
Marc Siegel, MD

Fungi are everywhere, but one place they are not supposed to be is inside our medications. So it is very concerning that we are in the midst of a fungal meningitis outbreak emanating from the New England Compounding Center in Massachusetts.

There are over 7,500 compounding pharmacies in the US, and most do good work, taking medicines produced by a manufacturer and packaging it for public consumption, often at a reduced cost. In this case, NECC contaminated a steroid injection with two fungi, and over 14,000 patients who got back injections are at risk of infection. At the time of this writing, close to 300 have developed meningitis (an infection of the lining of the brain); 23 have died.

As always in a health scare, fear is spreading faster than the illness, although this kind of meningitis is not contagious and you can only get it by being exposed to the contaminated product.

Though FDA issued warnings to NECC in 2004, the agency is not always directly involved with overseeing sterilization at the level of the compounding pharmacy, leaving this type of oversight to state health departments. Since the meningitis outbreak began, lawmakers have been calling for stricter laws and federal oversight of these “middlemen” pharmacies.

Many patients receive shots for back pain unnecessarily. Though the fear of meningitis is far greater than the actual risk in part because of media hype and hysteria, nevertheless, the meningitis scare can lead to a healthy discussion about whether a patient really needs a shot for back pain or not.

Marc Siegel, MD, is an internist and professor of medicine at New York University and the author of False Alarm: The Truth About the Epidemic of Fear
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