Really important medicines. This has been going on 20 years. Andave had hundreds hundreds. One of the medicines and shortage right now is a really important blood thinner that hospitals use every single day. There was an article in a local newspaper about a boston physician saying i do not know if we can do cardiac surgery two weeks from now if we do not have this product. We are walking on a very thin line. We have had shortages of chemotherapy to treat cancer in children and adults. We have had shortages and right now, there is a shortage of a really important antibiotic to treat a lifethreatening infection. These are life and death medicine. Sometimes, we cannot get them, and we are rationing. In therationing medicine United States of america. Really remarkable. Host is this hyperbole or is is a real, existing problem . In washington, we hear a lot of talk from a lot of Different Industries saying that scott is falling here, the sky is falling their there. Is is a real problem where peoples lives are endangered danger because these drugs are not available . Guest this is the real deal. I do not take money from industry. I have no conflict of interest that i was talking with a physician working to try to get medicines for children with Rare Diseases. These are not the new, innovative drugs needed. These are the old, mainstay medicines. Many, many children are dying from Rare Diseases because we do not have basic medicine. Host how did we get here . Guest that is a long story and we will get to that. 12 years ago, there were hundreds of americans who died from dialysis, others in the hospital, because there was a shortage of this blood thinner, heparin. That happened because there was a shortage, and we were getting it from china, and china did not want to spend the money, so they put in a fake substitute for the real ingredient, and it turned out to be lethal. Shortages are real. People are dying. And people suffer. If you cannot get the right antibiotics and doctors have to come up with a substitute, you get a secondbest antibiotic. That can cause a whole lot of problems. This is real. We just do not count the number of people who are harmed, because it is so hard to do that, but this is a very serious problem that affects all of us. It is not democrat or republican. It does not discriminate in any way. Host how did we get here . Guest we got here because we have stopped making, in the United States of america, many of the medicines that are vital. Many of your viewers have probably taken an antibiotic lets take penicillin. We used to have penicillin plants all over this country. Rees to have other antibiotic plants all over this country we used to have other antibiotic plants all over this country. Now we have virtually nothing. If we cannot make the medicine and are relying on other countries this is how we lost penicillin. In the early 2000s, china dumped penicillin product on the u. S. And global market. They made it at a really cheap price. What happened was u. S. Producers couldnt compete, so that drove out all of the u. S. Producers and producers around the world. And then they raised the price. If we cannot make something, and if we are dependent on another country that is applying the whole world it is like oil. Can you imagine if lee and the world depended on china for 80 of our oil . What would that look like . That would be a problem. You would have a problem with supply and a problem with quality. That is how we got into this situation. And that chemotherapy drug you know why that was in shortage and had to be rationed . The food and Drug Administration went into the plant and found very serious problems. There were medicines that did not have will potency. They do not have the real active ingredient, which is devastating if you are a cancer patient. Some of those medicines have particles and other things in them that should not have had them, so they had to ban all those products coming from that plant. But because the fda was so concerned about a shortage, he later said he will allow some of it in. This is the situation we are here in 21st century american medicine. It is really concerning. Host you brought up the fda. I wanted to read this quote from your book. Its no in china rx, ones job in the federal government to know who controls our drug supply. Are you literally saying that there is no one responsible for the drug supply of the United States of america . Guest if there is someone who was responsible, we would not have shortages. What the fda does, and they do a good job of this they track what medicines are in shortage. They have a website you can go on and see what audits are in shortage right now. Reported, and doctors and pharmacists have to scramble and ration, and people can be adversely affected. That is our system now. We do not have anyone in charge of assuring that we have a full supply of medicine whenever we need it, every person, every day , in this country. That is what needs to change. And it really is a manufacturing issue. If we cannot make things anymore, if our plans have shut down, i went on and looked, before the show come out all the drugs on shortage on the e. A. List, and itfda turns out there are u. S. And western manufacturers stopping production of generic drugs. It says that discontinuing production. Why is that . Because they cannot compete with a lower cost of china, which is ramping up its production of generic drugs. Ourt now, about 9 of generic drugs are coming from china. That happened in just 10 years. Where are we going to be . And they are ramping up quickly. So where are we going to be 10 years, 15 years from now . There will be 25 , eventually up to 80 of suppliers of our generic drugs. Think of what could happen with that. Host since you brought up generic drugs, you are just talking about drugs used in surgeries. We are talking about every day, overthecounter drugs and prescription drugs, given to americans by their doctors. So we are not just talking about drugs used for surgery, we are talking maintenance drugs as well. Guest that is right. Lets take Blood Pressure medicine. I am sure a lot of your viewers will get calls about Blood Pressure medicine recalled. There was a hearing in summer at the u. S. China Economic Security review commission, and one of the commissioners, who is retired military, as a commissioner, he took a few minutes during the hearing to talk about his experience with his Blood Pressure medicine. He said i have three recalled Blood Pressure medicines. The ingredient came from china. And it had rocket fuel in it. And if i am getting medicines like this, then active duty military must be getting it. So millions of americans were affected by this. That is not something you get in a hospital. Supply the hospitals may Blood Pressure medicine, but you go to the drugstore and pick up the Blood Pressure medicine, they will say we do not have that one, you will have to call your doctor and get a new prescription. This has created havoc for doctors. They do not know what to prescribe with so many shortages, prices have gone up. It is a really difficult situation for so many americans. Host we will open up regional lines. That means if you are in the eastern or central time zone, we want to hear from you at 202 7488000. If you are in the mountain and pacific time zones, your line is 202 7488001. And we will open up a special line this morning we want to hear from medical professionals. Are you seeing this shortage in your hospital, in your pharmacy, in your Doctors Office . We want to hear from you. This is something you are seeing . Medical professionals, call in at 202 7488002. And remember, you can always text us at 202 7488003. We are always reading on social media, on twitter, cspanwj, and on facebook, facebook. Com cspan. Lets take our first caller, hanover,m pennsylvania. Good morning. Caller how are you doing . The greed that is involved with all of these Companies Moving out. You cannot get anything but generics now. I am diabetic, taking all kinds of stuff all my life. Youlet me tell you this are right. You do not know exactly where this comes from or that comes from, yet they have an idea. The administration. I will not mention names we get stuff from canada, we get stuff from here that is no good. What is the difference . It is all about the greed. That is why i am on generics. I cannot afford to get lipitor. It is all about the greed. Thank you, for you looking into it. It disturbed me, what you are saying. I understand you 100 . God bless you all. Guest thank you for the call. The caller mentioned about you do not know where it is coming from. There was, about 10 years ago, a bill introduced to have country of origin legislation that would require manufacturers as where a product comes from, where medicine comes from, and that was killed immediately. Nurses,umers, doctors, pharmacists, we should know where our medicines are being made. We have to do that quickly. China is ramping up production, taking a whole lot of our generic market as western generic any factories are collapsing. We have to do that quickly, or we will be in a situation where china is the predominant producer of our generic drugs. Host does our dependence on china on these medicines, is already causing some of the shortages . Guest absolutely. If we cannot make antibiotics anymore, if we stop making ingredients for chemotherapy, if we are dependent on a single country once again, if we had all of the worlds oil, all the country in the world had to go to china to get there oil supply or wheat or corn we do not do that. But that is where our medicine supply has migrated. China controls about 80 of the ingredients to make generic medicine. Think about that. They make the raw materials, the chemicals, and then they turn that into what makes medicine medicine. It has been a very deliberate strategy, i really smart strategy, crafted over many years. Shortage problem is we need to bring some of this manufacturing back home, so we are not dependent on a single country and have to stand in line. Orthere is a Global Pandemic a Natural Disaster in china, we will be lining up to get medicines, and china any country would keep those medicines to themselves. They will not send them patients and hospitals here. It is a serious problem. Host is it that the United States cannot make these medicines or that we will not . Shut down a lot of manufacturing plants. With that goes the talent and skill and knowledge to know how to make them. The next 10ment, in years, where we need to capture that talent to make sure we do not lose it. Here is some good news about what is happening to address shortages. There is a consortium of about 1000 hospitals, mayo clinic and others, that have been really concerned about these shortages. So they have set up a new organization, and they are doing something really smart, like anybody would do in any other market. They are looking for new suppliers and trustworthy countries and giving them longterm contracts, paying a fair price, not a race to the bottom price. And, within one year of start up, they were able to supply their member hospitals with a really important antibiotic. One of these last resort on the life or death reticence. And the finished drug is made in a plant in ohio, and the active ingredient is coming from europe. There are are 13 other drugs in line, and more to come next year, so shortages are solvable. We do not have shortages of anything in this country why is it we have shortages of medicine . It is remarkable. But we are seeing hospitals turn it around. We just have to grow this exponentially. We have to do it quickly to have some of that manufacturing back here in the u. S. Host how is this not a National Security issue . I assume our military needs all of these medicines that the civilian population does. I assume they are getting the same medicines everyone else gets. How is this not a National Security issue . Or is it . Guest it is a huge National Security issue. Think of what you could do with medicines in a geopolitical context. If you control the supply of penicillin, if you are the dominant use of antibiotics, you can withhold those. You can contaminate them. You can make them look like medicine and have nothing in them. If you want to destabilize a country and demoralize a population really quickly, all you have to do is withhold medicine. Like at least someone at the fda agrees with you. Janet wilcox as head of the fda center for drug evaluation and research. Heres what she said lack of reliable supply of critical medicines creates a significant risk to National Security, not just for our military but for all of our citizens. That is just what you were just talking about, right . That is right. You do not have to hack the electric grid or fire a missile to take a country down. And our military think of the young men and women in the South China Sea on the aircraft carriers. They are looking out on an adversary and they are dependent on that adversary for basic medicines, the ingredients to make them. It is remarkable. But i am delighted, on a positive note, with china rx and the hearings on capitol hill, that word has gotten out, and people are now seeing this as a tremendous National Security risk that we have to tend to quickly. Host back to our phone lines, lets talk jim, who comes from cheyenne, wyoming. Caller earlier, it was stated no one in the government is responsible for our drug supply. I am wondering who is responsible here. Is there anybody in the house or senate really making a concerted effort to correct this . Or does china have such a powerful lobby that it is somehow depressing any political activity to correct the issue . Thank you. Guest the first thing that is taking place is that there is National Security reviews going on in the federal government to understand where we are vulnerable. At aent hearing recent hearing in a subcommittee, this topic came up. On fda provided answers where we were vulnerable. That is the first recommendation in china rx we have to know where we are vulnerable. Ive been surprised, briefings ive done in many different sectors, that people are not aware of it. But that is changing. Then we need a plan to escalate this, and how do we use our procurement dollars, our taxpayer money, to support manufacturing to come back to the United States for various medicines . Our military, the department of the v. A. , taxpayers are spending millions of dollars a year, and some of that is going to china we need to bring that money back home so we can support our workers and communities here and have the security of medicine supply when we need it, every person, every time. Robert,ts talk to calling from california. You are a medical professional. Tell us what you are seeing. Issue goingad this on for years now where we have essential medications, something had to give to people having seizures and other conditions, and it just disappears off the market we have our pharmacies scrambling to find places for it. I am not big into regulation, but capitalism is failing, and you have Companies Stop making andntial medications opioids flood the market somebody needs to step in and find out what these Drug Companies priorities are. Guest the caller is right. There is a drug to treat tuberculosis that has been in short supply, and it has been in short supply many times this is the situation we are in. Foreed incentives manufacturers to come back home. You know what the root cause is . Manufacturers are going out of business because we are viewing generic drugs as cheap commodities, like buying cheap tshirts. If you and i go to the Shopping Mall next weekend and look for the cheapest possible tshirt, we will find an save . 10 on it. On adibly, this is, largescale, how our drugs are being purchased a are looking for cheap. Peoplewant to find keep, will find a. Businesses are going out of business because they want a quality product. That is what we have shortages. Because there are so few producers left. We need to bring that manufacturing back home, support those companies that want to do it right, pay them a fair price, and shortages will disappear. Host i want to read a bit from an editorial you wrote earlier this year about this over the past 30 years, a lot of drug and you factoring has been offshore. 90 ofnerics comprising the medicines americans consume, there is not a growing reliance on china for essential drugs. The u. S. No longer makes penicillin, for example, with the last u. S. Penicillin plant closing in 2004. Now, the u. S. Has virtually no capacity to make generic antibiotics used treat ear infections, strep throat, pneumonia, urinary tract infections, sexually chessmen it diseases, lyme disease, and other illnesses. And when the u. S. Government needed to buy 20 million doses of the antibiotic doxycycline after the 2001 anthrax attacks, it turned to a european supply that sourced ingredients from china. This seems to be a huge problem. Guest it is anna normas problem. Problem. Is an enormous we need to fix it quickly. It is remarkable how our dependency is accelerating. China has a plan, and industrial policy. It has an industrial policy. They said their aim is to become the pharmacy to the world. They are on track to do exactly that. A plan and we need to do it quickly. Has the tradeect battles between the United States and china during this administration have on the drug supply . Has it had any . Has china threatened the drug supply because of these trade battles . Or has this been a completely separate issue that has nothing to do with their trade talks between the administration and china . Guest for the most part, there were no tariffs placed on medicine coming into the United States from china. But here is how trade policy and our medicine supply came together in 2000, we opened up free trade with china, which meant china could sell products year to the United States without tariffs they once had, so they were cheaper here. Within four years, here is what has happened to our medicine. Within four years of opening free trade with china, that is when our last penicillin plant closed, when our last aspen plant closed, aspirin plant closed, our last vitamin c plant closed. That is when this blood thinner, necessary and surgeries called heparin, that is when companies started buying it from china. So trade policy has a profound impact. We did not protect our homeland when it came to medicine in regards to trade. We got to really do a reset on that, to ensure we have the medicines we need in our country, for national and health security. Host lets go back to the phones. Lets talk to david, calling from texas. Good morning. Caller good morning. Terrific topic. Your guest brought up an absolutely critical issue. On, describing how this happened or how it happened specifically with the pharmaceutical industry, when , perhaps,into the wto because this is such a hot issue in life and death and easy to see, i hope it becomes part of conversation having to do with china in general. They are getting into the wto has led to this sort of scenario and other places, not just medicine hey look at the situation with rare earth metals. They control the world market on that as well, i am pretty sure. I believe they control assets and minds in this country, because they dump things in the for control assets and mines in this country, because they dump rings in the will market, run everybody out of the markets, raise the rates and the price, then they control everything. They do this over and over and have done this 20 years. It is not a mystery. You mentioned lobbying a moment ago. This is one of the big reasons trump got elected. Foreign lobbying lobbying by Foreign Countries should be illegal. U. S. Lobbying. It is part of the first amendment, or at least it is interpreted that way. But you can ban foreign lobbying. Home prices in d. C. Were probably become more affordable. Lookave to really take a when you have a Vice President s son taking a trip on air force two and coming back with a billiondollar deal. This is not a democrat or republican thing. This is the way the world has worked, for hundreds of years. We are supposedly not a country with corruption problems like other countries in the world. What youre are talking about, this issue youre discussing, this lifeanddeath scenario our politicians have allowed it to happen. It is happening in plain sight, the way 70,000 manufacturing plants disappeared and all sorts of Different Industries. Donald trump, with his policies, is willing to fight the chinese. At some point, we will get real deals made, deals that include being made to enforce the theft of intellectual property and everything else. This will go on until china is in charge of everything. Guest the caller makes a good point, that there is a playbook here. That china has used. Here is how we lost our manufacturing of vitamin c. There has been an Ongoing Court case, went to the supreme court. A handful of Chinese Companies came in and, once again, dumped really cheap ingredients to make a sore back acid, in our a sore back ascorbic acid. Dad drove out all the producers in the United States and around the world. There were a handful of companies that challenged this, saying this is antitrust, against our laws. So in a federal court in brooklyn, a jury saw this for what it was. There was unequivocal evidence. There was no dispute that the Chinese Companies fixed prices and controlled supply of widening c to the United States. C to the United States. There was a settlement that the Chinese Companies had to pay. That was not the end of it. The Chinese Companies appealed in federal court. Here was their argument and the Chinese Government actually came in to u. S. Federal court on a put in a brief, and said we required our companies, as a matter of chinese law, to fix ofices and control the supply ascorbic acid and vitamin c to the United States. We required our companies to do that, control supply. And the federal Appeals Court ruled in favor of the Chinese Companies. Them toe cannot expect abide by their law and u. S. Law at the same time. Internationalt of comedy comity, neighborliness, we will overturn the jury conviction in brooklyn. Across administrations of both political parties, the department of justice sat on the sidelines. There was no one defending the American People and american businesses, to protect our ability to make a really important vitamin. This is emblematic of chinas playbook. And a year and half ago, the department of justice did play way in, and this case was appealed to the supreme court, and there was a unanimous decision written by Justice Ginsburg that said that the Appeals Court probably put too much weight on the Chinese Governments assertion that it was a matter of chinese law. It has been more than a year since that decision, and the case is still pending in the Appeals Court in manhattan. This is the playbook here they do it with vitamin c, they can do it with anything. They can control the price and the supply of medicine and everything else. This is where we are headed. Host we have been hearing about the problem this entire segment. What is the solution . What should be done . What should the government doing right now . What can be done immediately to stop these shortages . What can be done to stop this in the future . About we do not hear shortages of anything in the United States. Why is that . Because markets fix it. So this consortium of more than 1000 hospitals, they are looking for suppliers. That willy Companies Make a high quality product, you pay them a fair price, give them a lot of business, you have a longterm contract, so they have the incentive to invest in good manufacturing facilities and even backup. That is how you solve shortages. Look for different suppliers. I was contacted by a group of people that want to sell this blood thinner i keep talking about, heparin, that hospitals need to do surgery. Without it, surgery programs will shut down. For some reason, they cannot get anyone to buy their product. And it is coming from the u. S. Congress needs to investigate why products are in shortage, new suppliers coming in cannot get their product to market. The market can fix it, but we have to allow the market to fix it, and we have to view this as a National Security priority. You know what has happened with our generic drugs they have been viewed as cheap commodity. I remember going into the grocery store, and there was a time we could get free antibiotics remember that . 4 supply was free, you paid for it. We cannot view our medicines as commodities. As a country, we want them to be fairly priced we need to view them as a strategic asset, like we do oil, like we do food. These drug shortages are predictable. If you have a soul supplier in a country 10,000 miles away, for the whole world, of course there is going to be a shortage. It is just the way life is. Suppliers, andew they are concentrated in a certain region, and if they have a history of problems in their plants, guess what . There is going to be shortages. We predict hurricanes in this country. You cannot do anything about hurricanes. We predict hurricanes, prepare we do not have any addiction system for shortages. We do not have a plan to prevent them. An effective have response to get in there and deal with them right away. Host lets see if we can get to couple more calls and before we wrap up the show. Lets talk mary, calling from washington, d. C. Good morning. Caller good morning. I would love to have available the label made in usa or made in canada, or made someplace respectable. I do not want to be taking my standard prescription from a country where who knows they also manufacture fentanyl. The same for pharmacy. Why can we not just have a made in soandso product . Guest the call is bringing up a really important point p there was a survey done 10 years ago that 95 of americans do not trust medicines from china. Out, one ofrx came the responses i would get from a lot of people was i would remember when thousands and thousands of dogs and cats died because of pet Food Poisoning from china. Trust is everything. If we have rocket fuel in our Blood Pressure medicines, it is a real problem. We need to fix it and fix it fast. Part of the solution is bring some of that manufacturing back home. What congress can do, congress can provide incentives to bring some of that manufacturing back home. There are good people who want to fix this problem. We have to unleash that talent and motivation to fix it and to serve the American Public and countries around the world. We are not the only ones in this situation. There was a dutch public this. Sion documentary on this is a global issue. We can bring back that manufacturing, and that will revitalize communities and ring jobs back. Host is there anything you can do as a consumer, when you hear a medicine you need, whether it is a main list drug or a drug any or surgery in short supply is there anything you can do . Guest that is a tough one. That is a tough one. Because if hospital cannot get it and your pharmacy cannot get it, how are you going to get it . And you do not want to go on the internet. You do not want to do that. Lets try diane in georgia. Good morning. Caller good morning. How are you . Host i am fine. Go ahead. Caller first of all, i really appreciate this commentary. My qualm is with generic drugs. I was diagnosed with high Blood Pressure. Instead of the doctor discussing things with me about preventive care, i immediately was put on something called diovan. They switched me from that to something else. Fast forward 15 years later, about three years ago, i was put called lisinopril. It was a generic, which i did not research the doctors tell us things, we do not research it, we just go for it and do what the doctor says, because we have an expectation that they are in the know. About two days in, all of my respiratory systems shut down. My son rushed me to an er. By the time i got there, they went past triage, because everything my lips were swollen, my eyes were swollen, couldnt breathe. I ended up four days in the hospital in an induced coma. They literally thought i was not going to make it. Now i am at a place in my life where i am looking for preventive maintenance for myself. We do not always have to go to these different drugs because we are told this does not work. We feel like a guinea pig. We are sitting ducks, unless we do the research on our own. Guest that is a very unfortunate situation the caller talked about. That is terrifying. Here is another good thing there is a new Startup Company in connecticut, an online pharmacy, and they do something unique. They test every medicine before they sell it. And they test three batches. Of every medicine. Lisinopril,y tested and there was significant variation in the amount of the active ingredient in these products. One of the Manufacturers Product had Different Levels of the 94 ,e ingredient, some at summit 93 , others same company of over 105 . Test oure to begin to generic drugs, every batch. This is the recommendation i made when i testified to the house energy and commerce subcommittee. We are in a situation where we have to test every medicine before it is sold. Smith introduced the indicating emergency drug shortages act, which would include requiring prescription Drug Companies to share causes of shortages and the expected duration. Require them to develop contingency plans. It would give the fda authority to prioritize review of new drug applications and are the hhs and the department of soul deferment of Homeland Security to conduct Risk Assessment of National Security threats when it comes to drugs. Is this the type of thing congress should be doing . Guest those are some good steps. The reporting to the government on your contingency plans, reporting when there may be shortages of the ingredient in your medicine i do not know if government reporting is going to solve the problem. Here is what members of congress to do first, they need have accurate information. They should ask why is that chemotherapy drug in shortage . They need to get the real deal. Not that we are having trouble with our suppliers. If the product was banned by the fda because it had huge issues of integrity of their product, members of congress should know that. There was a plant in china that exploded, and it exploded because the workers were not handling the chemicals right here that triggered a global shortage of an antibiotic to treat a lifethreatening infection called sepsis. Members of congress should know that. We have a shortage of heparin, this blood thinner i keep going back to. Of the rawuch material to make heparin from china. Beinge pig publishing is decimated by a disease, so there is not the raw material last time we had a shortage, hundreds of americans died they had members of Congress First need to ask or accurate information, the full story, for down the rabbit hole, on why we have these shortages. The second thing that needs to be done is lets get rid of the red tape. Make it much easier for the department of defense, our military, and the v. A. To find alternative suppliers, trustworthy customers companies, who want to make quality netizens for our military at a fair price and sign longterm contracts for that, so our military and veterans do not have to go without. And that support that manufacturing to come back home, revitalize communities, and bring jobs back. Host lets see if we can get one more quick call, maybe two. Calling from caller i just have a comment. This state of medicine is the state of everything in our country, the state of health care, education in the schools. We have a feeble congress, a criminal president , a bad environment. Ofically, i am just so tired iss room is falling, rome falling, and i am glad two thirds of my life is over. Thank you for letting me speak. Host suzanne from vancouver, washington. Caller my question is are they making our flu vaccine also . Because this is ridiculous. Everything is coming from china. We know this. Congress knows this. Yet their portfolio for financial gain is wrapped up in chinas stock. Can we make you guys get off your stick, and the fda should be we always thought the fda was looking out for the people, but the fda is probably, you know, some corporate conglomerate, and they took away all the testing and all the areas that should be doing what we thought we were doing. We as a people need to stand up and demand that congress, all of our political guest share sure. Congress passed legislation to enable manufacturing of flu vaccines here in the United States. My understanding is that they are made here. Host we would like to thank rosemary gibson, author of china rx exposing the risks of americas dependence on china for medicine for this illuminating. Cspans washington journal Jeffrey Rosen will join us to talk about the impeachment process and the constitution. ,lso with us, Robert Costa National political reporter for the Washington Post will preview the week ahead in impeachment inquiry and campaign 2020. Be sure to watch washington journal, live at 7 00 eastern monday morning. Join the discussion. Ahead of this weeks impeachment inquiry hearing, the collins ander jeffries appeared on fox news sunday. About who should be called to testify. Will republicans on the Committee Call for subpoena witnesses to testify. Who are you going to ask . The first person and that needs to testify is adam schiff. Adam schiff has been the author of many things, a lot of them found to be false over the last couple years. He has compared himself in the past to a special counsel. If we go back to clinton, ken starr presented a report. He testified under oath and took questions, including from the white house my first witness is adam schiff