One in ten hospital patients acquires a “hospital bug.”

Contact with a health care system is the fifth most common cause of death in the United States.

A common way of encountering a bug is through a needle-less catheter. Those are the kind used so commonly now, for injecting drugs into IV systems. A threaded tip is screwed into port designed for that. But if the tip brushes against anything, or even while it is exposed to ambient air, it can pick up microbes; and once they’re there, it’s hard to remove them from the threaded surface.

The rate of bloodstream infections is three times higher, using those nice, convenient needle-less systems than it is with needle-based ones. When contamination occurs, it can be a straight shot for the infectious agents, into the bloodstream.

So Thomas Shaw, an engineer, invented the retractable syringe. A study by SGS Laboratories found that this syringe prevents germ transfer almost 100 percent of the time. Contamination of IV systems by injections drops to zero or near zero. Six petals protect the tip until it is in place in the port; once the payload is injected, the top is retracted into the syringe body, never having been exposed.

Shaw’s design adds a few pennies to the cost of production. But his company has promised to match the price of the other kinds of syringe, those with needles and  those with “naked” screw tips.

Sad to say,  most IV patients have little chance of having far safer Retractable Technologies syringes used on them. The common screw-in type is what they will get, almost certainly, and maybe a few germs at no additional charge.

Years ago, the National Institutes of Health awarded Shaw $60,000 in funding to finish design details and produce 50,000 retractable syringes for clinical trials.

Doctors who invested in the factory that was to produce retractable syringes believed it was only a matter of time before those became the industry standard. The clinical trials had provided proof that the retractable syringe was much safer. Health care professionals were enthusiastic about it. So why wouldn’t it be a big seller?

Small medical suppliers or new products carried by them can’t make a dent in the market. This is because of the way hospitals must purchase their supplies. And that is because of a sleeper provision in Medicaid. It was meant to hold down the prices of medical supplies (or at least that was what the solons thought when they included the provision in the legislation—although the industry lobbyists may have known better). But actually this provision pushes prices upward and restrains competition in the marketplace; and it keeps life-saving products from being distributed.

That’s part of the reason that health care costs are growing like the thing that came from outer space, and now consume about a fifth of the gross domestic product.

A few gigantic medical supplies companies not only dominate but virtually control the market. Becton Dickinson, aka BD, has about 70 percent of the syringe market. It has been in trouble with the U.S. Justice Department for anticompetitive practices, from buying up companies and patents and killing the innovation or variety of choice they represented, to forcing hospitals to buy its syringes in order to be allowed to buy other essential, and even exclusively BD’s, supplies.

In response, medical facilities formed group purchasing organizations, or GPOs. Good for them, huh! Suppliers give price breaks for large quantity orders. Big hospitals get better deals, but with GPOs, small and medium facilities could get in on the savings by pooling their buying clout.

GPOs were not-for-profit collectives, in the beginning, back in the 1970s. But then some large hospital chains created for-profit GPOs, and invited other hospitals to join them on a paid membership basis.

In 1986 Congress, for reasons best understood by sponsors and their favorite lobbyists, passed a measure exempting GPOs from anti-kickback regulations. GPOs could collect “fees,” which we might be forgiven for thinking of as bribes or kickbacks—but hey, let’s call them, um, share-of-sale revenue. A GPO would sign with a certain maker of, say, masks, and would get a percentage of whatever the company made selling masks to members. Sweet!

Why would this be allowed? It was sold on the basis of the argument that this would shift the costs to operating GPOs to vendors.

“Fees” of more than three percent were supposed to be reported to the secretary of Health and Human Services. In practice, there is scarcely any monitoring or follow-up on reports of excess fees.

The effect has been to produce incentives for GPOs to boost margins, because that’s where their revenues come from, not member dues. Vendors can use GPOs to exploit members (health service providers.)

Since then Congress has also exempted GPOs from antitrust laws. Better and better.

This has doomed Shaw’s retractable syringe, and its life-saving effects. Try getting staff to use the Retractable Technologies product next time you or your loved one is in the hospital and on IV. Put the request in writing. Keep a copy, just in case a you or your loved one becomes a victim of a bloodstream infection.

E drymar@gmail.com. Skype lilimartini.