Drugs are treated as commodoties where one heparin is exactly the same as the other heparin. Baxter probably made pennies on the vials of heparin it sold, which forces them to seek the cheapest ingredient supplier. Wholesalers seek to buy the cheapest drugs possible, and then sell the cheapest drugs to the pharmacy so they don’t lose their contract to another wholesaler. The pharmacist dispenses whatever generic the wholesaler sold them.

The whole system forces the patient to accept the product offered to them at the pharmacy - whereas with other products, like a TV or a car, you might look at the name of the manufacturer to assess the quality of a product the ultimate user of drugs is not afforded that luxury. To a wholesaler an authorized generic or a generic made by a more “reputable” manufacturer commands no higher value in their eyes - and the wholesaler ultimately control which drugs reach the pharmacy.

I’m not saying it should be any different. The cost efficiencies and savings to society are enormous; I have no idea if the cost of the problems like this even approaches a fraction of the total cost savings. Plus, even if it was different, it doesn’t mean that a counterfeit ingredient would always get caught.

I’m just pointing out another one of those delightful nuances of healthcare - where a product user has very little choice in which product (s)he uses.

In a Macro sense not sure we could make substantial headway to fix China, particularly in government /regulatory behaviors (not our problem!), and a complete API boycott could possibly create undesired backlash without accomplishing aims. There does need to be constant pressure to insist in a Global economy for implementation of ICH/ISO standards rather than “Chinese GMP” which must be driven by Sponsors and US/FDA. In a Micro sense Sponsors have to closely work with/audit Suppliers/Contractors/Sub-contractors to build and maintain trusting relationships. Chinese companies I have dealt with have had strong willingness to adopt higher standards required unfortunately they do often lack guidance and good examples so is a long and twisty path for both sides (I have also been spoiled to have Chinese Nationals as co-workers/collaborators who knew language and culture in order to cut through to real substanitive issues).

Funny I can’t really understand some of the dichotomies that exist either such as you mention although another is that R&D activities can be comparatively bloated and inefficient (vs other industries) then end up that manufacturing getting stuck with operating overly narrowly (although here too not so much pressure as other industries) so forced to seek cheapest sources. (Note I am not advocating cuts in R&D but do think could do better with what we do have since big part of costs in successful drugs is to cover failures).

Not sure would call it economic fraud as perhaps tracks to significant number of people in charge not understanding science and drug development IMO so all they see are calculations being straightforward where those saved pennies (and likely dollars differential) add up very fast and the quality and/or risk factors which are hard to quantify do get obscured. I also don’t see any tolerance in investors or customers to earn less or pay more to cover these intangibles since focus is on prices and not costs.

However, there is no question that some societies have higher levels of certain types of criminality than others. The reasons are complex and debatable (as is the potential for ’solutions’), but the statistics are facts and are not easily disputed.

Most people familar with the situation would agree that ‘economic fraud’ is especially prevalant in China. We might not always agree on the reasons why, but the facts speak for themselves, and these facts are available to anyone with any role in outsourcing drug APIs.

So, the real question is: do ‘we’ try to ‘fix’ China, or do we leave China to ‘fix’ itself in its own time, and simply buy our critical APIs only where the data demonstrates that it is safe to do so–Even if it costs a bit more?

Considering that the largest expense in most drugs tends to be things like R&D, in large part due to safety concerns, in my opinion it makes NO SENSE WHAT-SO-EVER to spend millions of $$$ to eliminate an additional xx% risk of SAEs (where xx typically tends to be very low). And yet turn around and save pennies importing APIs from a region where the risk of fraud is almost certainly higher than xx.

Frankly, the people who make decisions like this are guilty of economic fraud as well…

Hopefully, if this turns out to be intentional wrong doing they will catch and prosecute the criminal. Considering China executed the head of their FDA equivalent last year for corruption, and politically China will want to look super-tough on this issue, I expect the penalty will be severe.