Buddy, Can You Spare a Cup of Barium?

Because I only work part time in radiology I don’t stay up to date with all the current events in the field. Imagine my surprise when I learned about the worldwide shortage of barium. This is no doubt old news to you but it came as a shock to me. I thought we would run out of radiologists before we ran out of barium, but, apparently, that is not the case.

According to news reports, there is also an impending shortage of airline pilots. Could there possibly be a connection between the shortage of airline pilots and barium? Reportedly, barium is in short supply because of manufacturing delays due, in part, to increased mine safety in China resulting in decreased production.

The pilot shortage is due to increasing experience requirements, mandatory retirements, pay cuts and increased job stress. Sound familiar? Both of these seemingly unrelated occurrences have one thing in common: government regulation.

Some government regulation is necessary and inevitable, but in recent years government regulations seem to have run amok. When there is actual talk about regulating the CO2 in our breath and rainwater runoff, the inmates are running the asylum and are charging admission.

I am a firm believer in the primacy of Murphy’s Law. If there is a second law that is at work in the universe, it is the law of unintended consequences. The myriad government regulations have unintended consequences, not the least of which is interference with the free market. Basic economic theory suggests that the price of something is related to its supply and vice versa. When something is in short supply, the price goes up. When something is plentiful, the price goes down.

Medicine is not a free market as illustrated by the increasing demand and declining payments in most specialties. Physicians of my era remember with wistful nostalgia what they used to get paid for cataract surgery, coronary bypass, or an MRI. We still deliver the best health care in the world and some of the brightest, most caring individuals are providing that care.

Ultimately though, money talks and the best and brightest will follow the money. That is human nature. Who will our future physicians and airline pilots be if society values significantly more a software engineer, investment banker, or entrepreneur with many fewer years of training? Whether you are a patient or a passenger, you want the best possible person at the controls.

It is possible that the Chinese concern for their miners is a major contributing factor to the worldwide shortage of barium. But what about the FDA’s lengthy A-to-Z list of current drug shortages?

I believe markets work. When markets are allowed to work, price reflects reality and things in short supply are priced higher and supplies or innovations respond accordingly. You get what you pay for, or at least you should. Creating a regulation that the best and brightest become doctors and airline pilots, or barium and other drugs will be readily available, won’t make it so.