State epidemiologist Dr. David Blythe and Dr. Lucy Wilson, chief of Maryland's infection prevention and outbreak response program, helped write the article, which ran first in the online edition of the journal.

In a phone interview, Sharfstein said ideally the FDA would set regulations for these pharmacies and the states would play a supportive enforcement role.

"States have a very important role to play," he said, "but we think there should be a clear national framework for compounding."

Those in the compounding industry have said most facilities are responsible and have standards in place to prevent the contamination of drugs.

Compounding pharmacies serve an important role in providing drugs that are needed but aren't readily available, said David Ball, a spokesman for the International Academy of Compounding Pharmacists.

Ball said compounding pharmacies provide oncology medications for cancer patients who have no other options, because the drugs they need are not commercially available. Other times, the facilities make an allergen-free form of a drug for a patient who cannot take a commercially manufactured drug because it may cause an adverse reaction, he said.

"It is important for the public to know that what is alleged to have happened at NECC is dramatically different than what happens in compounding pharmacies across the U.S. every day," Ball said. "These patients have nowhere else to turn."

He added: "Any steps that can be taken to keep patients safe can and must be taken. Any disruption to patient care, though, is not an acceptable result."

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