Attention-driven choice: FDA vs. Compounding pharmacies

In October of 2012, the Food and Drug Administration announced a nationwide recall of sterile products Mortar and Pestlecompounded by the New England Compounding Pharmacy after several deaths resulted from contamination.[1]  In less than one year following this announcement, another 10 compounding pharmacies conducted voluntary recalls of products.[2]  As the bright light of the FDA shined on the practice of compounding, state boards of pharmacies began to crack down on any pharmacy with sterile compounding capabilities.  Pharmacies passing previous board inspections were now in fear of receiving fines or other penalties from the same exact state employed inspector for continuing once accepted practices.  Individuals temporarily caught in social-dilemma structure are more likely to invest resources to change the structure than individuals simply facing an unequal distribution of outcomes.[3]  Many pharmacists engaging in pharmaceutical compounding below USP standards were not motivated to change for the common good but were quick to change when their practice faced public and regulatory scrutiny.

[1] FDA. New England Compounding Center issues voluntary nationwide recall of all products. October 12, 2012. Available at:, accessed February 26, 2014.

[2] Woodcock J. Examining drug compounding. Presented to the Congressional Subcommittee on Health. May 23, 2013. Available at:, accessed February 26, 2014.

[3] Ostrom E. A behavioral approach to the rational choice theory of collective action: Presidential address, American Political Science Association, 1997. American Political Science Review. March 1998. 92:1-22.

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Joey Mattingly, PharmD, MBA is an assistant professor at the University of Maryland School of Pharmacy located in Baltimore, Maryland. Joey has managed retail and long-term care pharmacy operations in Kentucky, Illinois and Indiana. Leading Over The Counter is a blog of Joey's views and opinions on the topics of pharmacy leadership and management and do not represent the University of Maryland, Baltimore. Joey can be followed on Twitter @joeymattingly.

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