What Semi-Trailer Aerodynamics Can Teach Healthcare About Small, Recurring Losses

A Familiar Sight Sparked an Unexpected Connection

I was driving recently when I noticed the aerodynamic panels attached beneath and behind a semi-trailer.

Most people have probably seen them. Large panels—commonly called side skirts—extend beneath the trailer and reduce the amount of turbulent air moving underneath it. Other devices, sometimes called trailer tails, rear fairings, or boat tails, extend from the back to reduce the low-pressure wake created behind the trailer.

They do not change what the truck carries. They do not change its destination. They simply help the vehicle move through the air more efficiently.

That observation made me think about medication delivery.

At first, semi-trailer aerodynamics and biologic medication preparation may seem completely unrelated. One involves transporting freight across highways. The other involves preparing and delivering medications to patients.

But both demonstrate the same larger principle:

A relatively small inefficiency can become enormously consequential when it occurs repeatedly and at scale.

A Few Percentage Points Can Matter

Aerodynamic drag is easy to ignore because it is largely invisible. A truck continues moving even when air is flowing inefficiently underneath it or creating turbulence behind it.

But the engine must work harder to overcome that resistance—mile after mile, trailer after trailer, and year after year.

According to the U.S. Environmental Protection Agency’s SmartWay program, trailer side skirts can reduce airflow and turbulence beneath trailers, while rear fairings reduce drag created by the low-pressure wake behind them. EPA-verified devices and combinations are categorized according to tested fuel savings, including 1%, 4%, 5%, and 9% or greater for qualifying combinations.

A few percentage points may not sound transformative.

For one truck traveling a short distance, perhaps they are not. But for a fleet traveling millions of miles, the same percentage represents a very different level of impact.

What Does This Have to Do With Medication Delivery?

Medication loss can also be difficult to see.

A small amount remaining in a rigid bottle may appear insignificant. A brief delay while fluid flow slows or stalls may seem routine. A few bubbles entering the administration tubing may be treated as another normal interruption requiring attention from clinical staff.

Each event may appear small when viewed individually.

But biologic medications can cost thousands—or tens of thousands—of dollars per treatment. When similar losses occur across repeated infusions, multiple containers, numerous facilities, and hundreds of thousands of patients, the scale changes dramatically.

This is where I see a connection to I2F.

I2F is designed to provide a dedicated pathway for filtered replacement air to reach the headspace of a rigid medication container. By supporting pressure equalization during withdrawal or administration, the technology is intended to improve fluid flow and medication recovery while reducing problems associated with uncontrolled air movement and vacuum formation.

The physical mechanism is not the same as trailer aerodynamics. The analogy is about scale.

In both situations, fluid dynamics influence efficiency. In both situations, an apparently modest loss can be repeated thousands or millions of times. And in both situations, improving the system by a few percentage points may create far more value than the percentage initially suggests.

What Does 2% to 5% Look Like With IVIG?

Intravenous immunoglobulin provides a useful illustration because it is frequently administered in relatively large doses and can represent substantial medication value.

Consider a hypothetical 40-gram IVIG treatment billed at approximately $250 per gram:

• Total medication value: $10,000

• Value represented by 2%: $200

• Value represented by 5%: $500

At the level of one treatment, $200 to $500 no longer feels insignificant.

If that treatment were repeated monthly, the value represented by the same 2% to 5% range would be approximately:

• $2,400 to $6,000 per patient per year

This calculation does not establish that every infusion loses 2% to 5%, that all residual medication is recoverable, or that I2F would recover the full amount. It simply demonstrates how quickly a small percentage becomes meaningful when applied to an expensive therapy.

Now Consider the National Scale

A 2024 review of the U.S. immunoglobulin market, citing a 2022 Hogan Lovells roundtable report, estimated that approximately 275,000 people in the United States receive IVIG or subcutaneous immunoglobulin therapy each year.

If we apply a deliberately simplified scenario in which those patients receive the equivalent of 40 grams monthly at an illustrative billed medication value of $250 per gram, the annual medication value represented by a 2% to 5% residual range would be approximately:

• 2% scenario: $660 million annually

• 5% scenario: $1.65 billion annually

Those figures are not estimates of documented national IVIG waste. They are not projections of guaranteed savings. Patients receive different products, doses, treatment schedules, and routes of administration. Medication pricing also varies considerably among payers, providers, products, and sites of care.

The calculation answers a narrower but important question:

If a small percentage of a high-value therapy is repeatedly left unused, how large could the underlying opportunity become?

The answer is large enough that it deserves careful measurement.

IVIG Is Only One Therapeutic Category

Immunoglobulin is not the only high-value therapy supplied in rigid medication containers.

Other potential categories for future investigation include:

• Enzyme-replacement therapies

• Complement inhibitors

• Neurology biologics

• Plasma-derived products

• Other specialty infusion medications

• Certain subcutaneous biologic therapies using compatible preparation systems

Some individual treatments in these categories represent tens of thousands of dollars in medication value. In those cases, even a small amount of residual medication can represent hundreds or thousands of dollars during one administration.

That does not mean I2F is automatically compatible with every medication or container. Each product would require appropriate engineering, material, sterility, stability, usability, workflow, and regulatory evaluation.

But it does suggest that the potential importance of medication recovery should not be evaluated by percentage alone.

A 2% improvement involving an inexpensive fluid is very different from a 2% improvement involving a biologic treatment worth $30,000 or $70,000.

The percentage may be the same. The consequence is not.

What Trucking Can Teach Healthcare About Adoption

The trucking industry offers another useful lesson.

New efficiency technologies are often evaluated cautiously. Decision-makers want reliable evidence, operational compatibility, durability, ease of use, and a reasonable return on investment. Those questions are appropriate in transportation—and even more important in healthcare.

But delayed adoption also has a cost.

Every mile traveled before an effective aerodynamic improvement is implemented represents fuel that cannot be recovered later. Once that fuel has been consumed, the opportunity is gone.

Medication loss works the same way.

Medication remaining after an administration cannot benefit the patient once it has been discarded. Staff time spent correcting avoidable flow interruptions cannot be reclaimed. A dose discrepancy that has already occurred cannot be retroactively prevented.

This does not mean healthcare should adopt unvalidated technology prematurely. It means we should recognize the cost of accepting familiar inefficiencies without studying them.

The correct response is rigorous evaluation:

• Measure the loss.

• Understand its causes.

• Test potential solutions.

• Determine what can be safely recovered.

• Quantify workflow effects.

• Evaluate product and container compatibility.

• Compare the intervention’s cost with the value it creates.

That is how a reasonable observation becomes evidence—and how evidence can eventually change standard practice.

Small Improvements Are Not Always Small

The aerodynamic panels on a semi-trailer are easy to overlook. They are not the engine, the cargo, or the driver. Yet their influence accumulates across every mile the truck travels.

The same may be true of technologies surrounding medication preparation and administration.

A device does not need to change the medication itself to improve how effectively that medication is used. It does not need to recover every possible loss to create value. And it does not need to produce a dramatic percentage improvement for its impact to become significant at scale.

Sometimes innovation is not about creating more.

Sometimes it is about preserving more of what we already have.

For healthcare, that could mean more of the medication already purchased reaching its intended destination. It could mean better stewardship of limited biologic resources, more consistent dose delivery, fewer preventable workflow interruptions, and less pharmaceutical waste.

That is the larger possibility I saw while watching air move around a semi-trailer:

What appears to be a small improvement at one point in a system can become transformational when repeated across the entire system.

In trucking, the accumulation happens mile after mile.

In healthcare, it may happen infusion after infusion—and drop after drop.

Every drop matters.

Sources and Notes

• U.S. Environmental Protection Agency, SmartWay Verified Aerodynamic Devices

• U.S. Environmental Protection Agency, SmartWay Verified List of Aerodynamic Devices

• North American Council for Freight Efficiency, Trailer Aerodynamics

• U.S. Environmental Protection Agency, Heavy-Duty Trucking and the Energy Efficiency Paradox

• BioSupply Trends Quarterly, The Expanding Role of Immune Globulin Treatment

Closing disclosure: The calculations in this article are illustrative scenarios intended to demonstrate the potential scale of small, recurring medication losses. They do not establish actual national medication waste, the proportion of residual medication that is recoverable, product-specific I2F compatibility, or demonstrated economic savings from human use of I2F. Those questions require controlled testing and appropriate regulatory review.