Almost five years ago, due to an introduction by a mutual acquaintance, Rosemary Gibson walked into my office for a visit. Prior to our meeting, thanks largely to the internet, I crammed to learn as much as I could about her. Rosemary, I quickly learned, had co-authored four highly-trusted books about healthcare, and I was halfway through her first book, “Wall of Silence,” when we first met. Her research prowess and writing style had me immediately hooked. In a blog that followed our meeting, I called her a healthcare ‘Rock Star.’

China Rx

Five years later, in a recent op-ed piece for the Des Moines Register, Rosemary and I co-wrote an article about a subject that was not on our radar five years before – China’s growing influence on becoming the “pharmacy of the world.” Through Rosemary’s tenacious appetite to reveal important subject matter that affects Americans, she spent a few years researching, and subsequently writing the book, “China Rx: Exposing the Risks of America’s Dependence on China for Medicine.”

This book is full of examples about how and why China was able to cajole the manufacturing of key active ingredients for many of our medicines away from the U.S. and other friendly countries. This is a critical problem today because, as former government and industry officials have shared with Rosemary, “…if China shut the door on exporting many of these necessary therapeutic ingredients to the U.S., within months, pharmacy shelves in the U.S. would be empty and hospitals would cease to function.” Even India, a top country that manufactures generic drugs, is dependent on China for the active ingredients and raw materials in many of the medicines it makes, not only for its own people, but also for exports.

To borrow a term from the ‘Apollo 13’ movie, “Houston, we have a problem.” No wait, we have a BIG problem!

The China Problem

According to China Rx, a major event occurred in the year 2000 that triggered the U.S. to rely more on China for the supply of medications. Congress and the White House agreed to grant China access to the U.S. market, and also permitted China to join the World Trade Organization. Shortly after, China developed the penicillin and Vitamin C ‘cartels,’ by basically replacing American manufacturers by dumping low-cost product in our country. As a result, American manufacturers could no longer compete against China’s government-financed manufacturers. China’s monopolizing behavior is also commonly seen in many other manufacturing products found in other industries.

In 2004, Baxter Healthcare switched suppliers for Heparin, an important blood thinner agent. The new supplier, now China-based, began controlling this market. A contaminated ingredient was found in Baxter’s Heparin product – “a deliberate contamination for economic-motivated reasons.” From this, 250 deaths in the U.S. resulted from this contamination.

Having a high concentration of our medicine coming from just one country, no matter the country, can become a major strategic health and security risk to our population. To function, the U.S. (and any other country) relies on having appropriately manufactured medicine of high-quality with safe ingredients, reasonably-priced, and readily available. In fact, by ceding the manufacturing of medicine elsewhere, any country could become victims of a new warfare that has never been waged in the past – the weaponization of medicine.

In addition to the on-going trade ‘war’ with China, tensions in the South China Sea continues as an international hot spot. During any of these disputes, China could strategically reduce (or cut-off) the exportation of medicine that we depend for our livelihood, including our health and safety.

How Dependent Are We on China for Medicine?

China Rx does a splendid job of explaining how reliant Americans (and other countries) are on China as it relates to our key medicines. In fact, due to poor quality, the Food and Drug Administration (FDA) banned 29 different medicine products being imported from China. However, because the U.S. is so dependent on these medicines, the FDA had to exempt 14 of those products from its own ban. Some of these products included antibiotics, ingredients for antibiotics and ingredients for chemotherapies. This happened because the FDA was concerned about drug shortages in the U.S.

Below is an excellent video from C-Span in which Rosemary Gibson discusses many issues and implications about relying on China to be the sole supplier of many of our medications.  Additionally, two former international trade officials corroborate the findings of China Rx, giving this discussion a troubling, yet powerful vibe about our current reliance on China for our medicine.

A stunning finding from Rosemary’s book is that even when American companies have their own plants in China, they frequently do not meet the quality and safety standards that we would all come to expect. China products can be initially cheap because they hope to capture the market and drive their American competitors out. This can be done because the Chinese assume no liability for what they make – a ‘buyer beware’ mentality.  The problem is that most Americans have no idea that the medications they use come from a relatively unregulated country. One hidden price of cheap drugs is the lack of consumer protections. However, once American competitors are no longer competing, the prices can be (and are) arbitrarily increased with no particular reason – other than greed – and control.

A Few Recommendations

For the future, China Rx provides three recommendations to the China problem:

1. The U.S. must change its mindset about our medicines. Medicine should not be viewed as a ‘cheap’ commodity. Currently, it is. We must view medicine like we do our food and energy resources, such as oil – it should become a strategic asset.
2. We must have a tracking and forecasting system available of noting where drugs are manufactured and how much supply is available at any one time.
3. The U.S. must maintain manufacturing capabilities at home. Provide incentives to U.S. manufacturers to keep their plants in our country. We are the ONLY industrialized country in the world that does not have an industrial policy.

The medicine we depend on must be affordable, manufactured safely with trusted third-party oversight, and always be in supply for our country. Rosemary Gibson is on to something very important – indeed, crucial.

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