FOSCARNET, potassium phosphate, kanamycin sulphate—for healthy people, these names are a meaningless garble. For the sick, the list is a nightmare. In 2004 America had a shortage of 58 drugs. Last year it had 211 and this year 198 so far. As the problem has spread, so too has a sense of panic, with patients lacking essential medicines, doctors fretting over alternatives and hospitals navigating a “grey market” for drugs. On September 26th the Food and Drug Administration (FDA) will hold a hearing with the hope of answering urgent questions: why the world's biggest pharmaceutical market is failing its customers, and what might be done about it.

The shortage affects a variety of treatments, but most are generic, injected drugs. Some can be replaced by other medicines, often inferior in quality and more expensive. Others have few substitutes. Hospitals are desperate, for example, to have electrolytes that keep premature babies alive, explains Erin Fox, who tracks drug shortages at the University of Utah. Oncologists are anxious for cytarabine, a leukaemia drug. “That's the type of cancer that doesn't have time to wait,” says Michael Link, president of the American Society of Clinical Oncology.

The causes of the shortage remain tangled, but a few factors are probably to blame. First, manufacturing problems are increasingly common, as firms trim costs and import cheap ingredients of variable quality. Some companies say the FDA has become stricter, too. Second, generic drugmakers have merged, so a given drug is often made by just one or two companies. When one firm shuts a factory, the other cannot fill the void quickly. Third, these drugs may have a basic problem of pricing. After a drug loses its patent protection, its price plunges as generic drugmakers fight for market share. Even if demand rises, a drug's price remains low thanks to the distorting rules of Medicare Part B, which pays for many injected drugs. Squeezed by slim margins, a firm may simply discontinue a drug. Dysfunction ensues. Grey-market vendors, health-care's scalpers, hoard drugs and then sell them for many times their usual cost.

It remains unclear what might be done. Legislation in Congress would require firms to tell the FDA at least six months before they stopped making a drug. But this might just inspire wholesalers to stockpile medicine, says Dr Link. Politicians could liberalise pricing under Part B, but this is unlikely—if anything they may extend controls to other types of drugs. Congress could also give more cash and authority to the FDA, which now has just four staff working feverishly to ease the shortages. But Republicans would resist.

For now, the FDA and firms are scrounging for solutions. Eight times in the past two years the agency has allowed the import of drugs unapproved in America but used safely elsewhere. Some drugs with minor quality problems, meanwhile, are being shipped to pharmacies with warning letters. In such cases, the patient will at least receive the drug he needs. Others should be so lucky.