The end of the intrahepatic pump?

I was amazed to learn today from a friend at the Cholangiocarcinoma Foundation that the sole manufacturer of the intrahepatic pump, also known as the “Codman pump” – which I have in my abdomen, and through which I’ve received chemotherapy since it was surgically implanted in August 2016 – plans to stop production. But this is in fact the case, as the New York Times reports.

Dr. Nancy Kemeny, a Memorial Sloan Kettering doctor who was “a pioneer in using the pump,” is quoted as saying: “I don’t know what we’re going to do …. We have enough for another month or so.” The Times reports that “[a]t least 10 operations to implant the pump at Sloan Kettering have been postponed” already, and apparently similar things are taking place at other medical centers.

The manufacturer in question is Cerenovus, which is owned by Johnson & Johnson. It “told doctors in a letter dated April 4 that it had decided to stop production effective April 1 ‘because of significant and multiple raw material supply constraints within the manufacturing process.’” That explanation is interesting for what it does not say: it doesn’t assert that in fact the supply constraints made production of the pumps impossible, nor does it say that these constraints even made production unprofitable. They evidently sell for $7000 - $11000 each, which you would think would cover quite a few supply constraints.

Perhaps Cerenovus could have said more, but the letter certainly permits the impression that the company just can’t be bothered with the burdens of producing this minor item on its product line. Apparently there are only about 300 of these pumps sold each year in the US (although medical interest in them is said to be growing just as they’re ceasing to be available), and somewhat more than 1000 people have received them in total.

1000 people isn’t that many – unless you happen to be one of them. I am. Though the pump is used for people with a number of different cancers, I react to this company’s decision as someone with a rare cancer, a cancer for which the pump is a valuable treatment that is now to be discontinued for reasons, at least according to what the company has said so far, not of necessity but of something less. (Fortunately for me, the pumps don’t have to be returned; the people who won’t have access to treatment are the ones who would receive them in the future. Maybe not so fortunately for me, Teresa tells me that the kits used to load and unload the pump every two weeks are also made by this same company. Will they decide to stop making these too?)

It’s also notable that Cerenovus only sent notice to doctors on April 4, telling them that its decision had already taken effect on April 1. There’s also no suggestion in the article that there was any prior discussion with doctors before the decision was made. This is not a company trying to proceed in a consultative manner.

Can anything be done? The Food and Drug Administration says that it doesn’t have the power “to compel manufacturers to sell a specific product,” and that’s not surprising in a society that respects private property as much as ours does. There may be substitute products from other companies, though whether they are as good as the Codman pump I do not know. 

But even though Cerenovus and Johnson & Johnson may be immune from legal requirements, they certainly aren’t immune from popular pressure. So I hope you will visit their websites, their facebook pages, and your representatives in Congress and express in every way you can how disturbed you are by this position. And if you feel like telling Johnson & Johnson that you’ll be boycotting their other products, such as Band-aids, Benadryl, Tylenol and Motrin, until they change their mind about producing the Codman pump, well, that would be really good too.