by Rosemary Gibson and Janardan Prasad Singh, ISBN 9781633883819, Prometheus Books, 2018.

“Without firing a missile or hacking the electric grid, China can take America down by disrupting access to essential drugs,” write the authors of this important book.

This book is a fine piece of investigative journalism that educates the reader about the genesis of China’s grip on our supply of medications. China is now the largest global supplier of the active ingredients and chemical building blocks needed to make many vitamins, and prescription and over-the-counter drugs. These include antibiotics, steroids, and cancer drugs.

Until the mid-1990s, the U.S., Europe, and Japan manufactured 90 percent of the global supply of key ingredients for the world’s medications. Now more than half of the 4,000 active ingredients needed to make a make a pharmaceutical depend on China.

Our weakness for bargains has created a monster. The authors note that hospitals and retail pharmacies have become “like the big box stores, stocked with made- in-China items.” China’s winning formula is for a company—with the help of the government—to undercut the price of drugs or components; the artificially low price forces other companies out of the market; then the company is free to manipulate the price and supply at will.

But the authors warn that “cheaper drugs required a cheaper way to make them.” A light was shined on China’s poor manufacturing practices of ingestibles in 2007 with the well-publicized dog and cat-food recall. More than 4,000 pets died from renal failure due to contamination with melamine, an industrial chemical used in plastics manufacture.

The outrage over this “economically motivated contamination” of pet food dissipated while in the next year a far less-publicized drug contamination took human lives. Although “manufactured” by an American company (Baxter Healthcare Corporation), heparin was made in China under substandard conditions and was sold to unwitting hospitals with tragic consequences. One-third of the batches of heparin from China were contaminated. The book fully explores the heparin debacle, telling how it happened and what our government has done about protecting us in the future.

From the start, the authors received robotic, scripted, unhelpful replies to the straightforward question: where was this drug made? Searching for the answer, the authors delve into the loopholes in treaties and Food and Drug Administration (FDA) regulations that have allowed shoddily manufactured drugs for human consumption to be used in the U.S. Moreover, politics was interjected. The Transparency in Drug Labeling Act was introduced in 2008 to force drug labels to disclose where the drug was produced, not merely the location of the parent company. The law went nowhere, and it appears that the power of the drug company lobbyists prevailed over safety. Did this signal to China that the U.S. could be influenced by special interests, sometimes to the detriment of its populace?

China’s latest Five-year Plan for National and Social Development includes entering (and cornering?) the market on medical devices. The centralization of global supply in China leaves the world vulnerable. Not only can they disrupt the supply chain and cause shortages but purposefully create shortages or adulterate drugs. Keep in mind, the active ingredient for ciprofloxin to treat anthrax is in China’s hands.

This meticulously researched book is disturbing, but it is required reading for anyone who takes or prescribes medications. It is a real page-turner that reads like a novel and includes real-world scenarios. The authors included a detailed index, making the information readily accessible for repeated reading.

The Chinese think ahead with their well-known “five-year plans.”This book is a wake-up call for America to start planning for our future as well.

Review by Marilyn M. Singleton, M.D., J.D., Redondo Beach, Calif.

Purchase Book at: https://amzn.to/2IygpYD