One element of Mylan's outreach efforts is to advise patients to double up on EpiPens—information that is parroted by doctors, parents and school nurses who repeatedly fear that "something could go wrong with your first attempt at giving the shot."
Michael Pistiner, a pediatric allergist at Harvard Vanguard Medical Associates, told NBC News, "As the father of a child with a food allergy, it is challenging [to afford an EpiPen] even for me…. Let's pretend I used one on my kid last week. I have to buy a double pack to replace it. Why do I now need three sticks?"
Though a small number of patients do require a second dose, it would appear the device is mainly sold in packs of two due to imperfect product design: A recent study conducted by the American Academy of Allergy, Asthma & Immunology that compared the EpiPen to a competing product, the Anapen, concluded that the EpiPen is the most difficult type of auto-injector to use.
The study showed that even after one year of training on the product, 14 percent of parents still accidentally stuck the needle in their own thumb instead of in their child's leg, as compared to zero percent of parents using the Anapen (which is not available in the United States).