Feeling fine, looking good.

Went through my annual physical on Tuesday, and all seems well. Blood work will be done next week to reveal what’s going on under the skin.

I went through the TURBT procedure for bladder cancer in late June. Next steps are the BCG wash. My urologist first said it would start in July, maybe August.

I mentioned this to my PCP on Tuesday. She was surprised. “Oh, they’re doing them? There was a nationwide shortage.”

Oh.

Forward to today. The BCG wash won’t start until the end of October.

The reason: a nationwide shortage of BCG. The United States has one source, a Merck facility. They’re trying to increase production but that won’t be successful — if it happens — until the end of 2026.

This is only a US issue:

The BCG shortage in the United States has been primarily due to a reliance on a single manufacturer, Merck, which produces the TICE strain of BCG. This dependency became critical after Sanofi Pasteur ceased production of the Connaught strain in 2012, leaving Merck as the sole supplier for the U.S. and many other countries . In contrast, other countries have access to multiple BCG strains produced by various manufacturers . In the U.S., the stringent FDA approval process has limited the availability of foreign-produced BCG strains, contributing to the prolonged shortage.

I’m simultaneously happy that the BCG wash is available and I have the means to have the procedure and frustrated by this continuing trend in the US. We become dependent on one source, and live and die by it.

It’s not just BCG; an article I read the other day recounted the US shortage of 155mm howitzer shells:

Manufacturing woes hamper US 155-mm ammo production

Businesses love to consolidate, buying up competitors, merging to ‘improve production’. Rarely works. Instead, we find ourselves more and more with just one location, putting all our trust and faith in them.

We often won’t modernize infrastructure until it reaches the brink of failure.

And in the US, we tend to wait to earnestly fix things until a crisis is clear. Witness what’s going on with Lake Meade and the growing water shortage. Even there, instead of actively addressing the problem, the Trump administration is paying to reduce consumption.

Something to think about as news and entertainment companies continue to merge.