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      China Rx: Exposing the Risks of America’s Dependence on China for Medicine by      Rosemary Gibson and Janardan Prasad Singh, Prometheus Books, US $25.00, Pp 304, April 2018, ISBN 978-1633883819

If you take a prescription drug, over-the-counter medicines, or vitamins, it is more likely than not made in China or its key ingredients have come from China. China 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. In China Rx, Rosemary Gibson and Janardan Prasad Singh argue that we trust blindly and unquestionably the purity of the medicines we take. A poorly made athletic shoe is not a matter of life and death. But a poorly made drug could be the difference between life and death for those who take it. They argue that there is no room for error with medicines and they better be available when we need them.

Rosemary Gibson and Janardan Prasad Singh tell us that China is the dominant global supplier of the essential ingredients to make penicillin. The United States does not make penicillin anymore. The last penicillin fermentation plant phased out production in 2004. European and Indian plants have also shuttered. 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, Gibson and Prasad Singh argue that countries will queue up and compete for available supplies. They say that countries without strong safety rules are more at risk of buying contaminated and ineffective medicines. Despite the national security risk American dependence on China represents, US pharmaceutical companies have advocated for making it easier for the Department of Veteran Affairs to buy drugs made in China because they are the cheapest. 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.

The authors trace the history of how the United States became dependent on China and the risks involved in this relationship. The authors also offer solutions to ensure self-sufficiency. They include, briefly,

1 — Consider medicines a strategic asset, not a commodity to be bought at the lowest price

2 — Track and forecast vulnerabilities in the supply of America’s medicines

3 — Prioritize a list of medicines for which a supply interruption poses a danger to public health

4 — Investigate Chinese drug cartels to find out if they cause drug shortages in the United States

5 — Provide incentives to bring drug manufacturing home

6 — Ensure the US military does not depend on China for essential medicines

7 — Strengthen, don’t weaken government oversight of drug manufacturers

8 — Don’t cede US regulatory oversight of drug manufacturing to China

9 — Increase FDA testing of medicines

10 — Luck is not a strategy: identify problem products rapidly

China Rx is an eye-opening, mind-boggling story of America’s dependence on China for essential and life-saving drugs. Rosemary Gibson and Janardan Prasad Singh convincingly show that it is not a good policy to blindly trust and rely on our adversary for the supply of medicines and/or essential raw material for medicines. They also show that the United States and other Western countries do not have a viable plan in case China chokes the supply of medicines and/or essential raw material for medicines. China Rx is a well-researched and -argued book. It is a must-read for everyone interested in pharmaceutical industry and international trade of pharmaceutical raw material.

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