“Ineffective” generic drugs burn a rare public outrage in China

The outrage of Chinese citizens over concerns raised by doctors that generic drugs used in public hospitals are increasingly ineffective, which is what leads to rare reactions from the government.

Doctors say they believe the national drug procurement system, which encourages the use of inexpensive generic drugs against original branded drugs, has led to reduced costs at the expense of people’s safety.

But officials cited by multiple state media on Sunday say the issue is one of perceptions rather than reality.

One report says that different people simply had different reactions to the drug, and claims that they were not effective “came mainly from people’s anecdotes and subjective feelings.” .

The official response rarely alleviated the public’s fear of drug reputation in public hospitals and pharmacies. This is the latest challenge for healthcare systems, already under heavy burdens due to a rapidly aging population.

The debate over common drug use began in December when authorities released a list of nearly 200 companies that have won contracts to sell medicines to Chinese state hospitals. Almost all of them were domestic manufacturers of common medicines.

This escalated in January when she shared concerns about the drug procurement system in a video interview that went viral, the director of the hospital division in Shanghai.

Zheng Minhua cited “antibiotics that cause allergies, blood pressure that does not fall, anesthetized patients who do not sleep,” and laxatives that did not remove as one of the problems he encountered in the intestines.

Dr. Zheng’s words quickly hit a chord and condensed into a social media slogan seen by millions of people last month, but much of the discussion on this topic has since been censored on Weibo. Many people are moving forward to sharing their bad experiences with substandard drugs.

“I had intestinal surgery in 2024, so I had to consume laxatives beforehand,” a Weibo user wrote. They said the drugs that were administered were “not effective at all.” He said he had to switch coffee to drink to cleanse his intestines, even after the dosage doubled.

The concerns raised about the effectiveness of generic drugs have caused distrust and made some people unwilling to use them.

People at Xiaohongshu, an app like Chinese Instagram, say that when hospital doctors prescribe a general version of antibiotics, they quickly buy “original” and “real” things online He said he went online.

“There are a lot of people who have been catching colds lately. Many of them may have bought this medicine. I’ll send a reminder to a friend right away and check the brand before I buy it.” The user warned.

Some of the most popular posts debating the procurement debate, unknown by whom, have been deleted. China’s surveillance Internet has a strong censorship culture, both by the authorities and by users themselves.

In a scathingly excluded post by popular podcast host Meng Chang, he denounced the shortage of public sector imported drugs.

The rage of the nation has also focused on the difficulty of accessing imported drugs that people believe are of better quality.

In response to an agency’s attempt to reassure people about the quality of generic drugs, one Weibo user wrote:

This was introduced in 2018 as a way to reduce state spending on medicines, and involves local governments having a bid process of about 70% of state hospitals’ annual drug requirements.

Various pharmaceutical companies then compete to offer the lowest prices for drugs to win these lucrative contracts.

This brings benefits to domestically produced generic drugs containing the same active pharmaceutical ingredients as the original patented drug, but often several times cheaper because it does not include the high cost of research and development.

China has appeared as one of the world’s largest players in the world’s generic drug market, exporting both finished products to overseas consumers and major raw materials to foreign companies. At home, thousands of generic drug makers are competing to sell their products at competitive prices in the growing domestic market.

The generic drugs covered by the Chinese procurement process are deemed and must be determined to be sufficiently similar to the branded version of the drug.

Beijing celebrates its drug procurement system for saving millions of residents over $50 billion (£400 billion) in its first five years.

However, in the procurement process, some drug manufacturers offer medicines at very low prices. One of the winning bids last December was aspirin pills, which were sold for less than a cent.

“Is there a cost for eating less than a cent?” At the time, it became a trending topic for Weibo.

“Manufacturers who win bids often set prices very low, which can cause them to struggle to produce high quality drugs with the right ingredients, leading to potentially ineffective drugs.” Stacy Zhang, an associate professor at Nyu Langone Health, told the BBC.

She added that the procurement system is “not designed to restrict access to imported branded drugs,” but it could still “impact accessibility.”

A proposal submitted to Shanghai authorities last month by 20 doctors, including Dr. Zheng, said, “In an industry where procurement prices are too low, unethical companies will cut corners to reduce costs and impact drug efficacy. There is widespread concern that it will give.

“Doctors are helpless because they have no choice and no channels to escalate feedback.”

A recent article by Hangzhou doctor Xia Zhimin has been added to the scrutiny. In it, he highlighted what he said was questionable data from a generic drug trial on the procurement list – it was identical to the data for the original drug that it was based on. Dr. Xia suggested that it could be evidence of fraud.

The National Medical Products Administration responded by saying that his findings were due to “editorial errors.” His article has since been deleted.

In addition to quality concerns, there are counterfeit medicines. It has penetrated both the generic drug market and branded drug markets around the world, and is notoriously difficult to detect. The World Health Organization describes this as a global health issue.

“The introduction of cost-effective generics is essential to increase affordability,” Kevin Lou, an associate professor at the University of South Carolina Pharmacy University, told the BBC.

He added that the procurement process requires “enhancing quality control” and “continuous improvements in drug approval and manufacturing standards.”

This controversy comes as China’s healthcare system is already under pressure.

The rapidly aging population means that the country’s total health consumption has nearly 20 times higher in the last 20 years, reaching 9 trillion yuan ($1.25 trillion, £1 trillion) in 2023.

Public health insurance funds are becoming thinner across the country. The deficit has already appeared in several states. There, local governments that were currently dependent on land sales are currently struggling with debt as the real estate crisis engulfs the Chinese economy.

At the same time, the healthcare system is experiencing a crisis of trust. Violent attacks on medical staff have been on the rise since the 2000s, supported by anger over the lack of resources and the erosion of faith in doctors.

Unlike issues that are politically sensitive and considered strongly censored by the authorities, such as the persecution of political opposition and the restraint of the Uyghurs in New Jiang, the ongoing debate over drug procurement is at least the state. At least addressed as a problem.

The National Health Bureau’s Security Bureau said in a statement on January 19 that the authorities are linked to these safety concerns “very important” and will seek feedback on drug procurement policies.

“It cannot be denied that national centralised procurement is still in its early stages. There are many pharmaceutical companies with varying production quality,” National Media Lifetimes quotes public health scholars as saying. Other experts cited in this article are calling for improved drug evaluation criteria.

As authorities try to improve the loose image of their procurement systems, all scrutiny veils a system designed to save lives. Save lives and save money.

As one Weibo user argued, savings from lower drug prices are merely a “bucket reduction” in China’s national healthcare costs. On the other hand, they write, allowing the widespread use of potentially defective drugs is similar to “drinking poison to quench thirst.”