Health Column: My medications are coming from where? |

Health Column: My medications are coming from where?

Phil Mohler, M.D.
Free Press Health Columnist

The recent escalation in prices of not only brand-name drugs, but generics as well, spurred me to re-explore the origins of the global production of medications.

A Reuters report last year pointed out that 80 percent of the raw active ingredients of prescription drugs consumed in the U.S. originate in foreign countries, mostly from China and India. The Chinese Chamber of Commerce indicates that the export of these active ingredients is worth $22 billion annually.

In 2004, the Bristol Myers plant in Syracuse, New York, closed. This was the last facility in the U.S. to produce antibiotics. Most of the active ingredients in the antibiotics that we consume are now produced in China. No antibiotics are currently produced in nationally.

The web of relationships among U.S. pharmaceutical companies and their Chinese counterparts is complex and difficult to dissect. The Chinese equivalent of the FDA, China’s State Food and Drug Administration (SFDA), claims careful supervision of the country’s drug manufacturing process. Outside observers, however, indicate that the SFDA’s oversight of Chinese-produced active ingredients is sketchy and inconsistent. Although the U.S. FDA has tripled its number of inspectors in China, there are continued reports of refusal to allow inspections and provide data.

If China decided to quit exporting active ingredients, within three months the pharmacy shelves in America and most of the industrialized world would be empty.

Be aware that:

China is the source of most of the corticosteroid medications that Americans consume.

There is no aspirin produced in U.S. Aspirin is now manufactured in Thailand, Brazil, Spain and China.

Most of the Vitamin C consumed in the USA is produced in China.

Finally, it is almost impossible to track the source of the active ingredients of drugs versus the site where the medication is actually put into pill form versus from where medication is shipped. I examined the pill bottles of four different generic antibiotics that our practice buys to give to patients. I found the following: one is marked Evansville, Indiana; another is marked Gainesville, Florida; still others are marked Ammon, Jordan, Hyderabad, India. We know the active ingredients are not made in America. I have no clue what those locations mean.


This story is worrisome. The unknowns involve both generic and brand-name drugs.

In my opinion, depending on the Chinese for our source of antibiotics and steroids is nonsensical. The U.S. government has stockpiled the antiviral, Tamiflu, that has been shown not to work very well against influenza, along with doxycycline and ciprofloxacin for a bio-terrorism anthrax attack. There are some antibiotics in the mass-casualty depots spread around the country, but the quantity and type of these antibiotics for everyday use is questionable.

This treatise is not a call to stop taking your medications, but it is a reminder to query your physician at each visit: “Do I really need this medicine? What would happen if I stopped the medication?”

Free Press health columnist Dr. Mohler has practiced family medicine in Grand Junction for 39 years. He has a particular interest in pharmaceutical education. Phil works part-time for Rocky Mountain Health Plans. Email him at

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