Two people blinded in Washington, D.C., in 2005. Three dead in Virginia in 2006 and three more in Oregon the following year. Twenty-one dead polo horses in Florida in 2009. Earlier this year, 33 people in seven states with fungal eye infections.

And now, at least five people dead and 35 sickened with fungal meningitis that has been linked to steroid shots for back pain.

All these disasters involved medicines that had been custom-mixed at what are called “compounding pharmacies” – laboratories that supply hospitals, clinics and doctors to a much wider degree in the U.S. than many people realize.