Excerpt. © Reprinted by permission. All rights reserved.
Preface
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.
Rosemary Gibson
Janardan Prasad Singh
