Diabetic prepared to die for Brexit

Squiffy

Distinguished Member
Try reading my initial post again
"Technetium-99m (99mTc). This extremely useful element has a half-life of just six hours, and so is transported to hospitals and radiopharmacies in the form of ‘technetium-99m generators’. These devices contain the decaying parent element, molybdenum-99 (99Mo) which has a half-life of sixty-six hours." This is a quote and I gave the link for the source of the quote.
Google technitium 99m half life 6 hours or molybdenum-99 66 hours and see what the hits say if you want to dispute those figures.
Ok. So please explain how the 60% of the world that Europe supplies get usable doses, while we just over the channel will not be able to.

Again I suggest you re-read the comments I quoted from Dr Jeanette Dickson, Vice-President of the Faculty of Clinical Oncology at the Royal College of Radiologists to House of Commons Health Committee on this. "If you delay that at customs or through border issues, you have paid for 100 but you get 50 doses. You therefore cannot treat patients adequately…and you are incurring a massive cost for the NHS”.
And yet, the USA which is a much longer journey away from the UK doesn't produce its own supply and finds it more economic to import from Europe?

Why does 60% of the world, most of which is much further away than we are, find it economic to buy from Europe if delay is so expensive?
 

Bl4ckGryph0n

Distinguished Member
Didn't you like my little Aesops Fable for our times?

How about you providing some hard facts that there will be no impact from a no deal brexit on the supply of medical radioactive isotopes to the UK? All I'm seeing from you is it will turn out OK with absolutely nothing to back that position up.
I can't prove something that will not happen... Just take a deep breath, and look at this situation objectively. 60% goes around the world... When we will be outside the EU we'd be the nearest of those around the world. It will only a problem when people want to make it a problem. Sure, as I've said before, there will be some changes. Nothing wrong with that, deal with it and move on.
 

LM1405

Well-known Member
Didn't you like my little Aesops Fable for our times?

How about you providing some hard facts that there will be no impact from a no deal brexit on the supply of medical radioactive isotopes to the UK? All I'm seeing from you is it will turn out OK with absolutely nothing to back that position up.
How about you provide proof there will be an impact. We already have shortages and we're in the EU would you care to explain this?
 

Sonic67

Distinguished Member
Note, half life is when it is at half the radioactivity. It doesn't mean it is no longer radioactive.

Again if you put this stuff on a truck now, one contra flow now can delay your journey.

Again, if we can lay on flights to bring people back from around the world at short notice due to the collapse with Thomas Cook why couldn't we fly medicine if we had to? Aren't medicines a higher priority than stranded holiday makers?

As a final note, a few years ago, myself and others were involved on a tasking in Kazakhstan. No flights were available, no military flights and no available civvy flights. So an aircraft was chartered to make the flight. We had one large civilian aircraft to ourselves. Best flight I'd ever been on. It wasnt just having three seats to yourself it was those in front and behind you as well. Food was great too. Had three meals on the journey.
 

ashenfie

Well-known Member
European drugs companies are not going to stop selling drugs to the UK if Brexit happens. Too much money involved methinks.
I don't believe we get much Insulin from within the EU as most of it come from the US and other countries. So being outside the Eu maybe it will be cheaper if we get a good US trade deal.

As for shortages will they not going to stop supply, just the cost go up. The bigger issue for me is that all the medical staff we get from the EU will no longer want to be in the UK.
 

doug56hl

Distinguished Member
I can't prove something that will not happen...
But you should be able to produce some document to show that all steps have been taken to avert the risk of something happening. If not, frankly your statement is B/S.
What about the results of dry runs? or failure stress testing? Can't find any of them?

It can not be proved that something untoward will not happen in a no deal brexit. I am not aware of a trial of say supplying all radioisotopes by air which normally come by land for a two week period to see what practical difficulties may present themselves. There is talk of switching supply chains to the by air route just before a no deal brexit but that may be leaving it too late to iron out any problems. Some companies have said there may be delays in their delivery times.

Do a dry run, prove the systems work and then it can be said something will not happen. Until then it is just trust us, it will all be fine on the day. I have zero trust in a government which contracted a ferry company without any ferries as a contigency for supply difficulties. And wasted millions of pounds in the process.

When I was involved in disaster recovery planning for datacentres we would never say nothing unplanned/unexpected will not happen until the processes and procedures had been tested fully in the real world i.e. invoke the disaster protocols.

There are too many historical examples of government cockups to believe they will get it right first time. And unlike systems testing there will not be a roll back option available with no deal Brexit.
Just take a deep breath, and look at this situation objectively. 60% goes around the world... When we will be outside the EU we'd be the nearest of those around the world. It will only a problem when people want to make it a problem. Sure, as I've said before, there will be some changes. Nothing wrong with that, deal with it and move on.
So your advice to the radiologists and oncologists who are concerned about the possibility of having to cancel their patients treatment due to non arrival of JIT isotopes is "deal with it and move on".

Current official advice is to reduce the number of appointments for the first week following a no-deal Brexit, in order to see what the impact is likely to be. This will lengthen waiting times for patients who really do not have time to wait for their treatments. Is your advice to affected patients also to "deal with it and move on"

So there will be nothing wrong with some changes. What about changes for the worse?
Only a problem when people want to make it a problem? You come over the same way (whether intentionally or not) as the consultants I've seen who didn't know their arse from their elbow, made a deal of money and then moved on leaving the mess behind them that others then had to clean up.
 

doug56hl

Distinguished Member
I don't believe we get much Insulin from within the EU as most of it come from the US and other countries. So being outside the Eu maybe it will be cheaper if we get a good US trade deal.

As for shortages will they not going to stop supply, just the cost go up. The bigger issue for me is that all the medical staff we get from the EU will no longer want to be in the UK.
There are three main insulin manufacturers: Eli Lilly, Novo Nordisk and Sanofi. The latter two of them are EU companies. A good US trade deal will thus not reduce costs of the insulin from the two EU companies.

Novo Nordisk is the world’s largest producer of insulin. They have production sites in the US, Brazil, Denmark, France, China, Russia, Algeria and in Japan.

Lilly produces insulin in the US, Puerto Rico, France and Italy. They have packaging facilities for these products in France and China.

Sanofi has manufacturing sites in Germany, Russia, India, China and Saudi Arabia. They do manufacture some drugs in the UK, but insulin is not produced in the UK by them.
Diabetes UK responds to reports that a no-deal Brexit could disrupt UK insulin supply
 

ashenfie

Well-known Member
There are three main insulin manufacturers: Eli Lilly, Novo Nordisk and Sanofi. The latter two of them are EU companies. A good US trade deal will thus not reduce costs of the insulin from the two EU companies.

Novo Nordisk is the world’s largest producer of insulin. They have production sites in the US, Brazil, Denmark, France, China, Russia, Algeria and in Japan.

Lilly produces insulin in the US, Puerto Rico, France and Italy. They have packaging facilities for these products in France and China.

Sanofi has manufacturing sites in Germany, Russia, India, China and Saudi Arabia. They do manufacture some drugs in the UK, but insulin is not produced in the UK by them.
Diabetes UK responds to reports that a no-deal Brexit could disrupt UK insulin supply
But as you see the main locations Novo Nordisk produce as I said in US & Brazil which outside the EU and therefore outside EU tariffs
 

Bl4ckGryph0n

Distinguished Member
...snip

So there will be nothing wrong with some changes. What about changes for the worse?
Only a problem when people want to make it a problem? You come over the same way (whether intentionally or not) as the consultants I've seen who didn't know their arse from their elbow, made a deal of money and then moved on leaving the mess behind them that others then had to clean up.
LOL Well you clearly made your bed and are laying in it...Must be uncomfortable with that chip on your shoulder. All those consultants making all that money and poor old you having to clean up after them. Just have a think for a moment what you are actually saying there.

But yes, you are right from one perspective, just drawing the wrong conclusion. I have indeed seen that sadly too many times.
 

tapzilla2k

Distinguished Member
Ok. So please explain how the 60% of the world that Europe supplies get usable doses, while we just over the channel will not be able to.
Usually medical isotopes are transported overnight through the channel tunnel, if we don't have an agreement in place for those isotopes they will get held up in customs which might well push past the usefulness of some isotopes used in medicine. Some medical Isotopes come ready made and others have to be extracted from a parent nuclide in hospitals or specialist facilities.



And yet, the USA which is a much longer journey away from the UK doesn't produce its own supply and finds it more economic to import from Europe?
Because they extract Tc-99m from it's parent nuclide in hospitals, the parent nuclide has a longer half life of around 66 hours, more than enough time to transport it from Europe to the US then extract Tc-99m for medical use.

Why does 60% of the world, most of which is much further away than we are, find it economic to buy from Europe if delay is so expensive?
Because they would have to build nuclear reactors with the express aim to produce medical isotopes, which would cost billions of dollars. There are only about 5 nuclear reactors worldwide that can produce the parent nuclide of Tc-99m from what I remember. Some of which are located in Europe.
It's much cheaper to buy from countries with those nuclear reactors than to build a nuclear reactor with the express aim of making medical isotopes, again it would cost billions of dollars.

Note, half life is when it is at half the radioactivity. It doesn't mean it is no longer radioactive.
Note - Tc-99m has a half life of six hours, once it goes past that it becomes pretty much useless for medical use. It's still radioactive just of no use for nuclear medicine.

Again, if we can lay on flights to bring people back from around the world at short notice due to the collapse with Thomas Cook why couldn't we fly medicine if we had to? Aren't medicines a higher priority than stranded holiday makers?
The transport of nuclear materials is subject to heavy regulation, as you should well know. Other medicines will be easier to transport but those that have specific time limitations cannot be delayed for very long. You'd also find Big Pharma will jack the prices up on medications to make a quick profit, which might restrict access or restrain supply.

As a final note, a few years ago, myself and others were involved on a tasking in Kazakhstan. No flights were available, no military flights and no available civvy flights. So an aircraft was chartered to make the flight. We had one large civilian aircraft to ourselves. Best flight I'd ever been on. It wasnt just having three seats to yourself it was those in front and behind you as well. Food was great too. Had three meals on the journey.
There is a difference between transporting people and transporting nuclear materials. Transporting nuclear materials is heavily regulated - Regulations for the Safe Transport of Radioactive Material | IAEA

So yes the Government could charter planes (or use the RAF) to transport nuclear materials, but they would still be subject to IAEA regulations and also require the necessary licenses from the EU to transport them into the UK. That's where the delay will stem from, unless a deal is struck to cover all of the issues around nuclear materials being imported/exported to and from the EU into the UK and vice versa. Some medical isotopes have such short half life's there will be no choice but to import them from the EU.
 

Squiffy

Distinguished Member
Usually medical isotopes are transported overnight through the channel tunnel, if we don't have an agreement in place for those isotopes they will get held up in customs which might well push past the usefulness of some isotopes used in medicine. Some medical Isotopes come ready made and others have to be extracted from a parent nuclide in hospitals or specialist facilities.
And?

This applies to the 60% of the world that Europe supplies, that is a much longer distance away than the UK is.

Because they extract Tc-99m from it's parent nuclide in hospitals, the parent nuclide has a longer half life of around 66 hours, more than enough time to transport it from Europe to the US then extract Tc-99m for medical use.
And plenty of time to make the much shorter journey to the UK and then do the same extraction.

Because they would have to build nuclear reactors with the express aim to produce medical isotopes, which would cost billions of dollars. There are only about 5 nuclear reactors worldwide that can produce the parent nuclide of Tc-99m from what I remember. Some of which are located in Europe.
It's much cheaper to buy from countries with those nuclear reactors than to build a nuclear reactor with the express aim of making medical isotopes, again it would cost billions of dollars.
And yet, it's still economic for the US health system to import these things from Europe, and they still have a long enough life to be useful.

So why wouldn't we be able to do the same in the UK?

Note - Tc-99m has a half life of six hours, once it goes past that it becomes pretty much useless for medical use. It's still radioactive just of no use for nuclear medicine.
Note : the flight time to most of the USA from France is longer than that.

The transport of nuclear materials is subject to heavy regulation, as you should well know. Other medicines will be easier to transport but those that have specific time limitations cannot be delayed for very long. You'd also find Big Pharma will jack the prices up on medications to make a quick profit, which might restrict access or restrain supply.
How would they jack up prices? The supply and demand is unchanged. We are only talking about using air freight rather than road / rail to transport this.

So yes the Government could charter planes (or use the RAF) to transport nuclear materials, but they would still be subject to IAEA regulations and also require the necessary licenses from the EU to transport them into the UK. That's where the delay will stem from, unless a deal is struck to cover all of the issues around nuclear materials being imported/exported to and from the EU into the UK and vice versa. Some medical isotopes have such short half life's there will be no choice but to import them from the EU.
We already comply with the IAEA (which is not an EU agency) and will continue to do so.
 

doug56hl

Distinguished Member
But as you see the main locations Novo Nordisk produce as I said in US & Brazil which outside the EU and therefore outside EU tariffs
Checking my Novo Nordisk insulin just now I can assure you it is made in the EU. France to be precise.
Country of manufacture can be determined by the batch number on the packaging.

Care to show any info that their main manufacturing locations are the US and Brazil? The latter is shown to be their largest manufacturing location outside of the EU. Personally I'd rather my insulin came from Denmark or France than Brazil.

There aren't any EU Tarrifs.
Tariffs are imposed by the importing country not the exporting one. Many countries (US, members of the EU, Canada, Switzerland, Japan, Norway, Czech Republic, Slovakia, Macau in China) have zero percent tariffs as part of the Pharmaceutical Agreement of the WTO Uruguay Round of TRIPS

A number of WTO members, mainly upper income countries, concluded the Pharmaceutical Tariff Elimination Agreement in 1994. Under this agreement, the parties to the agreement eliminated tariffs on all finished pharmaceutical products as well as on designated active ingredients and manufacturing inputs.
http://haiweb.org/wp-content/uploads/2016/04/ACCISS-Tariff-April2016_FINAL.pdf

Whether or not the UK becomes a signatory to the Pharmaceutical Tariff Elimination Agreement after it leaves the EU, it will still be able to trade with the EU on the basis of a zero tariff for pharmaceutical products. In written evidence to the House of Lords EU External Affairs Subcommittee in February 2017, the Government confirmed that:

The Pharmaceutical Agreement is extended on a Most-Favoured Nation (MFN) basis. This means that signatories extend the tariff eliminations to all WTO members. So, all WTO members enjoy the benefits of tariff free trade to signatory countries irrespective of whether or not they themselves are members. The UK will therefore continue to benefit from the tariff eliminations of negotiating parties and in line with our technical rectification approach, the UK will continue to place zero tariffs on pharmaceutical goods covered by the Agreemen
t.
The impact of Brexit on the pharmaceutical sector - Business, Energy & Industrial Strategy - House of Commons
 

tapzilla2k

Distinguished Member
This might shed some light on the medical isotope problem -
Lorries carrying radioactive isotopes may not even be allowed to park up and wait near Calais, due to the strict anti-terror regulations governing the storage of radioactive material. At the moment, the use and transport of radioactive material is governed by the rules of Euratom – an organisation that, although formally distinct from the EU, is subject to some of its institutions, including the European Commission and the European Court of Justice – but in 2017 the UK announced its intention to leave Euratom post-Brexit.

“Leaving Euratom risks breaking a series of time-sensitive supply chains,” says John Buscombe, president of the British Nuclear Medicine Society. “If we don’t have the isotopes, the tests can’t get done, because delivery is timed for the morning of an appointment. Patients may arrive at the hospital, find we have nothing to give them, and then go home and wait for another slot. A lymphoma PET scan is timed to be just before the treatment. If you delay the scan, you affect treatment outcomes, and patients may die.”
 

doug56hl

Distinguished Member
Because they would have to build nuclear reactors with the express aim to produce medical isotopes, which would cost billions of dollars. There are only about 5 nuclear reactors worldwide that can produce the parent nuclide of Tc-99m from what I remember. Some of which are located in Europe.
It's much cheaper to buy from countries with those nuclear reactors than to build a nuclear reactor with the express aim of making medical isotopes, again it would cost billions of dollars.
Although new technolgies are being developed to manufacture with no residual nuclear waste. One I mentioned previously is expected to be producing after 2021 and could make the majority of the USA requirements from one manufacturing plant. Three US firms awarded Mo-99 production funds - World Nuclear News

Another is using an approach of enhancing the cyclotrons some hospitals have to be able to produce Tc-99m. These would supply the hospital and possibly others within a close location. Not clear if this would just be a backup facility or a main production facility.
Schematics of current production vs the concept of localised production

Picture3.png Picture9.png

There is a 2017 article which mentions a UK company licensing the ARTMS Products Inc technology
ARTMS Products and beginning Uk production in 2019 but there is nothing dated later to show this has occurred yet.
Solving the technetium medical isotope shortage
plus this press release also dated 2017
ARTMS Products Inc. partners with Alliance Medical to modernize, stabilize UK medical isotope supply chain | Alliance Medical UK

So this would appear not to be able to affect the Tc-99m supply issues around a no deal brexit on October 31st.
 

IronGiant

Moderator
All well and good, but if we are talking about the technetium generators where the pre-cursor has a half life of 66 days, even if it sat on the docks for 2 weeks you'd still have 86% of the activity you started with. Not ideal, but surely we could cope until such time as the (import) process becomes more stream lined.
 
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doug56hl

Distinguished Member
All well and good, but if we are talking about the technetium generators where the pre-cursor has a half life of 66 days, even if it sat on the docks for 2 weeks you'd still have 86% of the activity you started with. Not ideal, but surely we could cope until such time as the (import) process becomes more stream lined.
Apparently not.
NHS buys for the doses it needs. If it doesn't get full fat generators it doesn't get all the doses. And that may mean patients go without. So the alternative is to buy more doses than needed.

From the no deal brexit guidance from the British Nuclear Medicine Society, the UK Radiopharmacy Group and The Royal College of Radiologists:
If it is likely your generator will arrive later than practical for use on the day of delivery, consider ordering a higher activity generator for the first couple of weeks (one reference activity step higher) to allow for not using it on the usual first day of delivery. It may be possible to combine a higher activity generator with a request for it to be supplied the day prior to your usual delivery so in effect your usual eluted activities could be retained. A one day delay to delivery would reduce available activity by approximately 20%. This clearly needs to be funded
 

IronGiant

Moderator
That's not so good, I agree. But it doesn't make sense if the 66 days quoted is correct. Perhaps it continuously generates Tc-99m from the moment it's loaded?. Anyway, it's been a thought provoking read, thanks for bringing it to my attention :thumbsup:
 

doug56hl

Distinguished Member
That's not so good, I agree. But it doesn't make sense if the 66 days quoted is correct. Perhaps it continuously generates Tc-99m from the moment it's loaded?. Anyway, it's been a thought provoking read, thanks for bringing it to my attention :thumbsup:
It is 66 hours, not 66 days.
2 weeks = 336 hours....

Everthing you want to know (and lots more) about Mo-99/Tc-99m Background and Study Task - Medical Isotope Production without Highly Enriched Uranium - NCBI Bookshelf
including this on the supply chain timings TABLE 3.4, Typical Process Times for Mo-99 and Tc-99m Supply Chains - Medical Isotope Production without Highly Enriched Uranium - NCBI Bookshelf

Also of note is that even without the issues of a no deal brexit, delays are fairly common
A representative of the Australian Nuclear Science and Technology Organisation (ANSTO) reported to the committee that it encounters an “adverse” Mo-99 cross-border shipping event once every 3 weeks on average. Such events include shipments being laid off at airports or delayed in customs. These adverse events often occur without notice. They disrupt Mo-99 delivery schedules and may delay patient care.
 
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IronGiant

Moderator
Doh, I misread it as days, thanks. That completely changes things :thumbsup:
 

tapzilla2k

Distinguished Member
As for this question - I'm an asthmatic and no I'm not willing to die for Brexit. I don't particularly fancy slowly suffocating to the point where the lack of oxygen causes my lungs to cease working and my heart to stop. My main inhaler is made in Italy and France, while I can extend how long the inhalers last it would negatively impact my asthma control. Which is vital to avoid asthma attacks/death and hospital admissions. I was lucky earlier in the year that heavy doses of steroids and Antibiotics kept me out of hospital. All down to a particularly nasty bacterial infection.

For those who don't know what an asthma attack looks/sounds like -
 

kav

Distinguished Member
Given we are fortunate enough live in the first world, I doubt we're going to see a significant impact on the availability of medicine. Where the impact will be felt will be in our wallets. Any significant change to a process will incur costs, and there's no way the companies involved in the supply chain for medicines won't take full advantage of Brexit by passing on those costs to the UK.
 

Squiffy

Distinguished Member
Given we are fortunate enough live in the first world, I doubt we're going to see a significant impact on the availability of medicine. Where the impact will be felt will be in our wallets. Any significant change to a process will incur costs, and there's no way the companies involved in the supply chain for medicines won't take full advantage of Brexit by passing on those costs to the UK.
It's not going to affect our wallets.

If you are asthmatic, your prescription cost will remain the same.

If you are diabetic, your prescriptions will continue to be free.

I doubt that short term measures to fly some drugs in will have a significant impact on pricing.
 

weaviemx5

Distinguished Member
It's not going to affect our wallets.

If you are asthmatic, your prescription cost will remain the same.

If you are diabetic, your prescriptions will continue to be free.

I doubt that short term measures to fly some drugs in will have a significant impact on pricing.
I read it as the proverbial “our” in the fact the the UK Government costs will go up, and as a side effect “we” will feel the impact of this through lack of funds elsewhere.

The cost of chartering a plane as a one off to fly in medication is comparatively small, how about doing that every day for 6 months (according to Yelowhammer estimates for transport disruption)? Also, it’s pretty obvious that pharmaceutical vendors are likely to take advantage of the situation and increase the price.

The fact that your prescription is free is ok for you, but pretty shortsighted.
 

kav

Distinguished Member
I read it as the proverbial “our” in the fact the the UK Government costs will go up, and as a side effect “we” will feel the impact of this through lack of funds elsewhere.
Yes, this is what I meant. Lack of funds elsewhere or an increase in taxation.
 

SteakAndCake

Suspended
Given we are fortunate enough live in the first world, I doubt we're going to see a significant impact on the availability of medicine. Where the impact will be felt will be in our wallets. Any significant change to a process will incur costs, and there's no way the companies involved in the supply chain for medicines won't take full advantage of Brexit by passing on those costs to the UK.
I got my flu shot yesterday. The pharmacist who did it told us that they are already seeing medicine shortages due to stockpiling and he and his colleagues believe it is inevitable there will be medicine shortage in the event of a no deal Brexit.
 

LM1405

Well-known Member
I got my flu shot yesterday. The pharmacist who did it told us that they are already seeing medicine shortages due to stockpiling and he and his colleagues believe it is inevitable there will be medicine shortage in the event of a no deal Brexit.
Whats the reasons for shortages while we're still in the EU?
 

IronGiant

Moderator
Whats the reasons for shortages while we're still in the EU?
I think it's because some suppliers? pharmacies? have been stockpiling medicines in case there is a shortage. As manufacturers haven't ramped up production to meet the increased demand some pharmacies are going short. A bit like when the BBC mistakenly forecast a blizzard and suddenly there's no bread or milk left in the local shops.
 

Bl4ckGryph0n

Distinguished Member
They've been stockpiling such medication for a long time though.

Just as an example, was Brexit the reason in 2011?

or 2010?

or what about the distribution problems in 2000?

Just a few examples...

Are all those historic distribution and shortages also Brexit related?
 

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