The fungal meningitis outbreak that is caused by injectable steroids contaminated by a fungus may be the tip of the iceberg. The New England Compounding Center (NECC) today recalled all of its products, including injectable drugs, solutions, creams, and pills; any pharmaceutical that had its dosage and/or delivery mechanism reformulated at NECC. Is this the end of it? No, it turns out the FDA has been denied regulatory power over compounding pharmacies, of which there are thousands. Only a few hundred have been accredited.

Check this list for medications recalled by the New England Compounding Center; make sure something you’ve taken in the last 6 months is not on the list.

Why is this relevant to Geohealth? In earlier blog posts we’ve talked about using hypothesis-driven approaches to exploring space-time pattern in human health outcomes. This is the framework that is most powerful when using tools such as SpaceStat; enumerate the explanatory hypotheses that might explain pattern (e.g. a cluster), and then systematically test each hypothesis. As hypotheses are tested and rejected, the remaining hypotheses are those that plausibly might explain the observed pattern.

But how often do we include medications contaminated with foreign agents — fungus, bacteria, or otherwise — in our set of explanatory hypotheses? Until now, rarely, if ever. What we are learning from the New England Compounding Center is that contaminated medications largely explain the observed outbreak of fungal meningitis. It seems likely this is not the end of the story, since compounding pharmacies are not regulated by the Food and Drug Administration. Exploring space-time patterns in health outcomes? Don’t exclude the possibility that they can be attributed, in whole or in part, to contaminated medications.