The Last Week Tonight host looks into the largely unregulated, and therefore potentially exploitable, industry of bespoke pharmacies in the US

John Oliver steered clear of America’s central political drama – a formal impeachment inquiry into Donald Trump – on Sunday’s Last Week Tonight in favor of a more niche, less explosive issue: compounding pharmacies. Like most of Oliver’s topics, compounding pharmacies – bespoke pharmacies which make their drugs on site, often in small batches – are a common feature of American life whose obscurity and lack of government regulation allow corruption to fester.

Compounding pharmacies do have an important role, Oliver acknowledged – the nearly 7,500 of them in the United States concoct specialty drugs for a variety of medical needs, such as a liquid medicine for someone who struggles to swallow pills, lower concentration doses than commercially available, and pina colada-flavored medicine for pet parrots.

“At this point, so far so good,” said Oliver. “But as you’ve probably guessed from the very fact that we’re talking about this story in the first place, there are some huge problems here.”

Oliver first looked at what he saw as the most glaring problem: lack of oversight compared with massive drug factories. On one level, it makes sense to regulate compounding pharmacies differently than big pharmaceutical manufacturers; you wouldn’t apply the same regulations to Coca-Cola’s mass-produced Minute Maid and Mikey’s lemonade stand on the block, said Oliver. But the regulations are so lax that Oliver called compounding pharmacies “the wild west of the drug industry, resulting in fraud and, in the worst cases, many, many people dying”.

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Oliver cited several examples: one 2013 study from the FDA found a 33% failure rate for compounding pharmacy drugs – far higher than the industry standard 2%. “To put that in perspective, compounded drugs have about the same failure rate as the Jonas Brothers.”

And the conditions where these drugs are made can be appalling. Oliver referenced one news story from several years ago, which exposed a compounding pharmacy that kept some of its products in the staff bathroom. “I’ve never been to pharmacy school,” Oliver said, “But I’m pretty sure lesson one is, ‘don’t put the pills where you poop.’”

In the worst cases, Oliver continued, the results of unregulated, unsanitary compounding pharmacies can be tragic. Oliver pointed to a widely reported outbreak of meningitis in 2012, which eventually killed 100 people and stemmed from fungus-infested medicine at a corrupt pharmacy called the New England Compounding Center.

Compounding pharmacies are supposed to make small batches of medicine for individual patients, but the company skirted rules to increase profit by creating fake patient names and shipping drugs around the country. A federal indictment of the company found that the company “made” drugs for transparently false patients, such as Big Baby Jesus, Roy Rogers, Wonder Woman, Bud Weiser, Method Man, Jack Bauer and David Schwimmer.

Another problem, Oliver continued, is that although Congress toughened regulations after the meningitis outbreak, it left “massive loopholes”, such as a voluntary regulation service for pharmacies wanting to produce larger batches.

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Only 1% of compound pharmacies registered, Oliver said, and many boldly continued as they were. For example, Oliver pointed to a news report in which the owner of a compounding pharmacy, faced with a request to recall her sterilized medicine, said simply: no. “Just no. That’s it! She responded to a request for a drug recall the way most us responded to seeing the trailer for Cats,” joked Oliver.

The most egregious example, Oliver said, is that of Guardian Pharmacy Services in Texas, which mass-produced medicine injected into people’s eyes; their batches turned out to contain formaldehyde and acetone, “two things pretty high up the list of things to keep away from your eyes”, said Oliver. “Right above jalapeno peppers and just below the trailer for Cats.”

Guardian Pharmacy Services didn’t opt in for FDA oversight, so it was overseen by the state government. The oversight failed tragically – nearly 70 people are now partially or completely blind, and it took six months from the first injections for regulators to even be notified there was a problem.

In sum, Oliver said: “Compounding pharmacists play an important role, but that is all the more reason that they should be properly regulated.” He called for three specific improvements: “More inspectors at the state level, the outsourcing facility designation should not be voluntary, and compounders should have to alert regulators whenever they fuck up.”

Until then, “bad facilities could probably really benefit from a message from some of the very real names that they’ve thrown around in their nonsense prescriptions”, Oliver said, introducing a ludicrous warning video from some of the real fake patient names: David Schwimmer, Jimmy Kimmel, Method Man, Michael Bolton (with a parrot), RuPaul, Sarah Marshall (Kristen Bell), and Jack Bauer (Kiefer Sutherland).