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About the Author
Janardan Prasad Singh is economic advisor at the World Bank. He designs strategies to strengthen economic development, health care, global trade, and national security for countries around the world. He has served as an advisor to prime ministers of India on national security affairs. Formerly, he was a member of the Board of Contributors of the Wall Street Journal.
Read an Excerpt
If you take a prescription drug, over-the-counter medicine, or vitamin, this book is for you. It reveals a dramatic shift in where the medicines in your kitchen cabinet or desk at work are made. The mainstream media has virtually ignored this shift, and their silence has kept you in the dark.
Antibiotics, chemotherapies, antidepressants, HIV/AIDS drugs, medicines for Alzheimer’s and Parkinson’s diseases, and birth control pills made in China are now sold in the United States. People taking them don’t know it, and neither do the physicians who prescribe them.
China’s biggest footprint, though, is making the key ingredients in prescription drugs and over-the-counter products. It is the dominant world supplier of the essential ingredients needed to make thousands of medicines found in American homes and used in hospital intensive care units and operating rooms.
Why is this a problem? Because we trust blindly, unquestioningly, the purity of the medicine we take. We place medicine in our mouths, inject it, or wear patches so it seeps into our bloodstreams. Our medicine becomes a part of us. A poorly made athletic shoe is not a matter of life or death. But a poorly made drug could be the difference between life and death for those who take it. With medicine, there is no room for error. And it better be available when we need it.
Worldwide dependence on a single country for life-saving medicines is breathtaking. “Without question, if China stopped exporting ingredients, within months the world’s pharmacies would be pretty empty,” says Guy Villax, chief executive officer of Hovione™, a Portuguese pharmaceutical company. Surgeries would be canceled, cancer treatments halted, kidney dialysis rationed. Infections would spread.
China is the dominant global supplier of the essential ingredients to make penicillin. The United States doesn’t make penicillin anymore. The last penicillin fermentation plant phased out production in 2004. European and Indian plants have shuttered.
When it comes to treating anthrax, “China is the largest exporter, head and shoulders above everybody else,” of the building block to make ciprofloxacin, an anthrax antidote, says Bharat Mehta, cofounder of PharmaCompass.com, the largest open-access global pharmaceutical database.
Medicines manufactured in Canada, Europe, India, and other countries are made with active ingredients from China, and the finished drugs make their way to the United States and elsewhere.
If a global shortage occurs, countries will queue up and compete for available supplies. Countries without strong safety rules are more at risk of buying contaminated and ineffective medicines.
For an idea of how China might leverage our dependence, consider what happened in 2010 when China, the dominant global producer of rare earth metals, allegedly halted shipments to Japan. Toyota®, one of Japan’s biggest carmakers, depends on rare earth metals to make its popular hybrid cars. China reportedly didn’t end the embargo until Japan released the captain of a Chinese fishing boat that had collided with Japanese coast guard vessels in the East China Sea.
The world can do without hybrid cars for a while, but in a public health emergency there is no time to wait for medicines.
Despite the national security risk our dependence on China represents, US pharmaceutical companies have advocated for making it easier for the Department of Veterans Affairs to buy drugs made in China. Even now, if an altercation in the South China Sea causes Americans to be wounded, military doctors may have to rely on medicines with essential ingredients made by the adversary.
China Rx is the story of America’s reliance on China for essential drugs, how the country became dependent, the risks of dependence, and solutions to ensure self-sufficiency. We were inspired to write China Rx while in a Starbucks™ two blocks from the White House, reading an online story in an Indian newspaper about India’s dependence on China for essential ingredients in antibiotics. India’s national security advisor warned of the risk of a severe shortage if any tension arises between the two countries.
As we talked about whether America might also be dependent upon China, we saw a man sitting next to us popping a pill while sipping his coffee. We had seen him there before and knew he worked in the White House. We leaned over and asked him what he was taking. “An antibiotic for strep throat,” he replied. “What would you think if that pill was made in China?” we asked. He shook his head in disbelief, mumbling, “Is it safe?” We wanted to find the answer.
We wrote this book because everyone affected by outsourcing decisions should be able to find out where his or her medicines come from, and if they are made to the highest standards.
This book scratches the surface of a multibillion-dollar marketplace remarkable for its lack of transparency. We were able to piece together information from federal government documents, industry press releases, media reports, and scientific articles. Many people we interviewed are employed in the industry or government, and others are retired. Some understandably wish to remain anonymous, so we use pseudonyms for them.
We wrote China Rx in the public interest, not for any special interest. It tells a human story of the impact of globalization and de facto deregulation of the safety and security of America’s medicines. We hope the book, with its landmark investigative research, increases public awareness about where America’s medicines come from and the risks.
China Rx raises more questions than it answers. We invite policy makers, public interest organizations, and journalists to build on this foundation and delve deeper into the vast array of topics that we have only touched upon.
When we mentioned to colleagues and friends that we were writing this book, one of the most frequent questions we heard was, “Why are we buying drugs from China? Can’t we make them here?” Others responded with resignation, saying, “Well, everything else comes from there.”
Many companies say they are trying to reduce their exposure to foreign sourcing but can’t find products made in the United States. We have been heartened by a small number of industry players who want to ensure the country has a basic level of manufacturing capacity to make essential medicines. Jobs will return, communities will be revitalized, doctors and the public will have greater confidence in medicines, and the nation’s security will be strengthened.
We hope China Rx stimulates public policies and private initiatives to achieve these noble aims. It won’t be easy, but with a spirit of optimism and determination, what seems impossible is possible. And it’s the right thing to do.
Janardan Prasad Singh
Table of Contents
Part I The Difference A Country Makes
Chapter 1 "They Took My Heart Away" 17
Chapter 2 What's in Your Medicine Cabinet? 27
Chapter 3 Washington Wakes Up 41
Part II Pivot East: How It Happened
Chapter 4 "These Drugs Can Reach Anyone Including the President" 53
Chapter 5 The Vitamin C and Penicillin Cartels 69
Chapter 6 The China Trap 83
Chapter 7 The Great American Sellout 101
Chapter 8 Today's Gain, Tomorrow's Pain 117
Part III The Hidden Cost Of Cheap Drugs
Chapter 9 Are Drugs from China Safe ? 137
Chapter 10 Made in China, Sue in America? Good Luck 161
Chapter 11 The Perfect Crime 173
Chapter 12 Where Does the Secretary of Defense Procure His Medicine? 189
Chapter 13 China Bashing? Take a Look at This 205
Part IV Bring It Home
Chapter 14 A Ten-Step Plan to Bring It Home 221
Appendix: How to Find Out Where Your Medicines Are Made 231
Most Helpful Customer Reviews
Well written and researched, this book begins with an anecdotal death from a botched Chinese batch of Heparin (plus many other deaths and illnesses) and traces how this poisoning of our prescription drug supplies occurred. The author discusses failed inspection practices, sporadic dosages, and lack of sanitation. Chinese and Indian drug labs sound disgusting, but according to this book while both countries are improving slightly, only China has used its monopoly on drugs for extortion. She also shows how American labs have been shut down by the competition and how we would not be able to get through a health epidemic without China's cooperation. The takeaway is that we need to get Rx manufacturing back to the U.S and consumers need to be willing to pay more for the higher standards typical of U.S. drug supplies.