The U.S. Medicine Chest: Implications of Increased Reliance on China

Rosemary Gibson

doi:10.7326/M18-2552

Ideas and Opinions |18 December 2018

The U.S. Medicine Chest: Implications of Increased Reliance on China

Rosemary Gibson, MSc

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Public concern about the safety of medicines has been heightened with the recent recall of more than half of all valsartan products on the market in the United States and other blood pressure medicines. In the case of valsartan, the U.S. Food and Drug Administration (FDA) identified a probable cancer-causing chemical in the active pharmaceutical ingredient, which was made in China. Changes in the manufacturing process seem to have resulted in the presence of N-nitrosodimethylamine, which may be harmful at very low levels (1).

The recall shines a spotlight on the increased reliance of the United States on China to supply generic drugs, active pharmaceutical ingredients—the components that give a drug its therapeutic value—and the chemical building blocks and raw materials to make them. The case of antibiotics illustrates this dependence. The last penicillin fermentation plant in the United States closed in 2004 (2). China had invested heavily in building large-scale penicillin fermentation capacity. Its domestic companies began to sell products on the global market at below-market prices. Producers in the United States, Europe, and India went out of business because they could not compete. A dramatic price increase ensued (3). This experience suggests that when the United States loses control over the supply of its medicines, it can also lose control over prices.

The example of doxycycline highlights the ramifications of U.S. dependence during a public health and national security event. After the anthrax attacks in 2001, the U.S. government purchased vast...

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2018 American College of Physicians

Ideas and Opinions |18 December 2018

The U.S. Medicine Chest: Implications of Increased Reliance on China

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Ideas and Opinions |18 December 2018

The U.S. Medicine Chest: Implications of Increased Reliance on China

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