At least five people dead and 35 sickened with fungal meningitis that has been linked to steroid shots for back pain. These incidents involved medicines that had been custom-mixed at compounding pharmacies which supply hospitals, clinics and doctors. The risks from these products have long been known but are being amplified now by a national shortage of many drugs that has forced doctors to seek custom-made alternatives to the usual first-choice treatments. The steroid suspected in the current outbreak has been in short supply. "Because of the incredible number of drugs that are out of stock or back-ordered, compounding pharmacies are working with local hospitals, clinics and physicians to fill that gap," said David Miller, executive vice president of the International Academy of Compounding Pharmacists, a trade organization.