It seems sort of shocking when we’ve seen great advances in some of the ways we give patients care, and then economic forces lead to it going away. —Michael Johns, MD
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October 2021
Here are some common reasons for discontinuation:
Otolaryngology field size. The size of the otolaryngology field, physicians say, puts products they use at more risk than those used by larger specialties, such as cardiology. “We’re a small field, otolaryngology in general,” Dr. Johns said. “And when we break out into subspecialties—all using different little tools—we get even smaller.”
Supply chain issues. Michael Crook, chief operating officer for Grace Medical, a manufacturer in Memphis, Tenn., that makes otolaryngology instruments, said that products are sometimes discontinued because a problem in the supply chain makes a part unavailable. Issues with parts can cause a product to miss revenue expectations, hitting the bottom line of the manufacturer.
Regulatory considerations. Sometimes a product can be discontinued with regulatory considerations in mind, added Crook. Earlier in 2021, Grace Medical discontinued a disposable instrument kit that had been developed after physicians requested it, believing that full sterilization of every instrument, rather than just cleaning and decontaminating after every patient, would become the new standard. That regulation was never put into place, and the demand for the disposable kits waned, Crook said.
Customer complaints. Without a thorough vetting by end users, a product can be at risk of quickly becoming discontinued if it doesn’t suit the market, said Crook. He recalled that while he was at a previous company, a ventilation tube was made using a new manufacturing process. Engineers compared them to the old ones and saw no substantial difference, so production of the new tubes went forward. The rollout didn’t go well. “One of our biggest vent tube accounts called the first time they used the new tube and said, ‘This is a change that’s completely unacceptable,’” he recalled. Company officials realized that although the engineers had taken a close look at the instrument’s geometry and lumen—everything that had to do with its essential function—they had missed important qualities.
“The texture and feel were really strange,” Crook said. “That was enough for the customer. The company didn’t take into account the surgeon’s ‘feel’ of the new product and how long they had been using the old tubes.” Going back to the original manufacturing process was unfortunately a costly process, he said.
Offering Alternatives
When things are done correctly, offering alternatives suitable to customers is a crucial part of the discontinuation process, said Crook. “You should reach out to your key users and let them know the reasons for discontinuing a product and ask them to comment with a couple of suggestions that the company might consider as an alternative,” he said. “It’s really frustrating for a surgeon to all of a sudden find out that an instrument that they’re accustomed to using, that’s important to them, has suddenly been discontinued, with no alternative. That’s when you get issues.”
Finding parts for discontinued products can be a challenge. An Aura XP laser, made by manufacturer AMS, was stopped after the rights to the product were sold to another company, said Dr. Johns. So, otolaryngologists, still with a supply of the laser itself, managed to find a supply of fibers through rental companies so that the laser could continue to be used.