China Rx: Exposing the Risks of America's Dependence on China for Medicine

China Rx: Exposing the Risks of America's Dependence on China for Medicine

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Millions of Americans are taking prescription drugs made in China and don't know it--and pharmaceutical companies are not eager to tell them. This is a disturbing, well-researched wake-up call for improving the current system of drug supply and manufacturing.Several decades ago, penicillin, vitamin C, and many other prescription and over-the-counter products were manufactured in the United States. But with the rise of globalization, antibiotics, antidepressants, birth control pills, blood pressure medicines, cancer drugs, among many others are made in China and sold in the United States. China's biggest impact on the US drug supply is making essential ingredients for thousands of medicines found in American homes and used in hospital intensive care units and operating rooms. The authors convincingly argue that there are at least two major problems with this scenario. First, it is inherently risky for the United States to become dependent on any one country as a source for vital medicines, especially given the uncertainties of geopolitics. For example, if an altercation in the South China Sea causes military personnel to be wounded, doctors may rely upon medicines with essential ingredients made by the adversary. Second, lapses in safety standards and quality control in Chinese manufacturing are a risk. Citing the concerns of FDA officials and insiders within the pharmaceutical industry, the authors document incidents of illness and death caused by contaminated medications that prompted reform. This probing book examines the implications of our reliance on China on the quality and availability of vital medicines.

Product Details

ISBN-13: 9781633883826
Publisher: Prometheus Books
Publication date: 04/17/2018
Sold by: Barnes & Noble
Format: NOOK Book
Pages: 304
Sales rank: 156,796
File size: 908 KB

About the Author

Rosemary Gibson has been credited with creating national movements for safer, more humane health care. Her first book, Wall of Silence, with co-author Janardan Prasad Singh, put a human face on medical mistakes, launching a national campaign to improve the safety of America's health care. Gibson worked with Bill Moyers on the PBS documentary On Our Own Terms. She is a recipient of the Lifetime Achievement Award from the American Academy of Hospice and Palliative Medicine and is also the founding editor of a narrative series in the Journal of the American Medical Association (JAMA) Internal Medicine. She is senior advisor at the Hastings Center and the 2014 winner of the highest honor from the American Medical Writers Association. She is also the author, with Janardan P. Singh, of three other books on health care.
     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, 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.

Rosemary Gibson
Janardan Prasad Singh

Table of Contents

Preface 9

Acknowledgments 13

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

Notes 235

Index 293

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China Rx: Exposing the Risks of America's Dependence on China for Medicine 5 out of 5 based on 0 ratings. 1 reviews.
Anonymous 12 days ago
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.