Drug supplies

If this review of a book about the supply of generic drugs to the US is to be believed, we are making almost as big a mess of the supply of legal drugs as we are of the supply of illegal drugs.

On the one hand we have the huge pharmaceutical industry in the US which invents lots of chemical and lots of drugs. But they are very pricey. So there is lots of pressure to get the price down, and the way that has been chosen is to allow the manufacture of generics, that is to say copies of drugs, once their patents have expired, say between ten and twenty years after their invention.

As it turns out, the Indians and the Chinese are really good at manufacturing cheap generics and cheap precursors to generics, with one result that they now have more than three quarters of the US market for prescription drugs. Another result is that the US industry has lost a huge amount of capacity. It is, for example, no longer able to manufacture penicillin at scale.

The catch is that manufacturing standards in Indian and Chinese pharmaceutical factories are not what one might wish for. A problem addressed by a sort of international factory inspectorate operated by the US Food and Drug Administration (see reference 4). At least it would be addressed if there were enough qualified inspectors and if the FDA was able to stand up to the various parties fighting for a slice of the action. On this evidence, neither condition is presently being met. On the other hand, lots of drugs are much cheaper - if rather dirtier - than they might otherwise be.

The answer seems to be that all the countries in the drug manufacturing business need to build effective regulatory regimes and that all these countries need to work together and to trust each other. Otherwise, we just have to wait until the populations of India and China are rich enough to insist on decent drugs for themselves, never mind foreigners.

And in the meantime, we are as exposed over drugs as we used to be over oil.

Reference 1: The scandal of our drug supply - Daniel J. Kevles - NYRB, July 23rd 2020.

Reference 2: Bottle of lies: The inside story of the generic drug boom - Katherine Eban - 2019.

Reference 3: https://energycommerce.house.gov/committee-activity/hearings/hearing-on-safeguarding-pharmaceutical-supply-chains-in-a-global-economy. It looks as if a lot a relevant material is to be found here - although I have not gone further than finding it so far. Reference 12 from reference 1.

Reference 4: https://www.fda.gov/.