Simi Pharmacy

Getting your meds: simple and not so simple

A pharmacy is a bright, busy place.  You know SIMI PHARMACY as reliable … and always ready to go above and beyond so that you get the medication you need well in time, with no hassle.

A pharmacy is what the customer sees … the human interaction tip.  The bigger thing that the pharmacy is a part of is the pharmaceutical industry.  This is the iceberg:  huge and not visible at all, unless one takes a very deep dive.

Since the beginning of February, we have been reading a lot about danger from China. The US shot down a Chinese balloon flying over US airspace; so in retaliation, China might stop supply of active pharmaceutical ingredients (APIs). American pharmaceutical giants dominate drug production, but at least half of all the APIs come from China.  And this may understate the dependence, since there are no reliable statistics.  APIs that appear to originate elsewhere may in fact originate in China. This was true long before covid hit and its even more true now.

But if America has to worry, China has to worry more. A recent article in Scrip (a magazine focusing on the pharmaceutical industry) analysed the rising geopolitical strains that are putting the healthcare industry on alert.

It predicted that the US will probably increase pressure on China. This could mean more delays and cancellations of upcoming trips by US officials to China, including US FDA inspectors, which could cast a long shadow over any hope of improving bilateral cooperation in the health area.  But after three years of strict lockdowns, China’s economy has taken a serious hit.  China earns billions from API export and cannot easily sacrifice that income.

Remember early months of 2020?  N95 masks and other PPE were in short supply.  Since that time, shortages have hit several medicines.  As University of Michigan professor Wallace Hopp points out “Disruptions in medical product supply chains have greater implications than making people wait for a new television set. They have the potential to seriously compromise patient care.”  A life can depend on getting enough of the right medicine in time.

Since covid, several Congressmen and Senators have proposed legislation seeking to “onshore” drug manufacturing in the interests of national security.

Of course.  By golly … we’ll just make it all right here in the good ole USA.

Except, it’s not that simple.  The pharmaceutical companies don’t want any such laws.  Lower wages and costs abroad keep their manufacturing costs down.  An American worker can’t live on what is paid to a fellow doing the same job in Lianyungang.  If pharmaceutical companies were compelled to locate all processes in the USA, they would pass on the higher costs to the American consumer.  Medicine costs would skyrocket.  (Medicines in America already cost quite a lot.  But that is another story.)

Then, there’s the environmental angle:  Units manufacturing APIs or FDFs (Finished Dosage Form – in other words, the pill you take) produce waste products, many of which are highly toxic.  

Devices to neutralize or manage toxic wastes are expensive.  Why spend if you can just pump the waste into the nearest stream?  Factories in the USA cannot easily evade pollution laws.  If drugs are made somewhere else, then somewhere else has the problem.  Let’s suppose that income from pharmaceutical exports is a major contributor to the economies of a somewhere else nation.  That nation’s attitude toward pollution may be exemplary when it comes to declared policy and even legislation, but not so rigid when it comes to enforcement.  Should this concern American legislators or American drug manufacturers.  Isn’t it true that a problem doesn’t exist if you don’t look at it?

Look at the bottom of your teacup, or at the label in your shoe.  It may say Hecho in Mexico or Made in Italy.  Now look at the label on any bottle of branded medicine in your medicine cabinet.  Do you see Made in XYZ ?

In “We Still Don’t Know Who Makes This Drug,” (Health Affairs, 2020) the writers observe: “Under current policy, the required labeling of prescription drugs sold in the US does not disclose the name of the actual FDF manufacturer, nor the manufacturer of its APIs. Neither do the labels disclose the location of the drug’s API or FDF manufacturer (although the labeling typically discloses the name and contact information of the company marketing the drug, that is, the ANDA holder.)”  If you do see Made in USA on a label, that only means that the medicine was packaged and labelled in the USA.

This is only a blog post; specialist researchers have written whole books seeking to untangle the complicated workings of the pharmaceutical industry.

Coming back to the balloon business, what it adds up to is not quite the butterfly effect.  You know … “the flap of a butterfly’s wings in Brazil sets off a tornado in Texas”, one event leads to other events that we wouldn’t normally consider connected.  A balloon is shot down off the coast of South Carolina and a week later, your pharmacy runs out of paracetamol. 

Our customers want their medicines – in adequate supply and on time.  We want to serve our customers.  At least on our level, it’s that simple.  But the pharmaceutical business is big business and it has so many levels.  We look at our shelves, stocked with hundreds of formulations, produced by many manufacturers.  Every single medicine has a back-story – somebody developed it,  both the ingredients and the pill we take were produced in a specific place by a specific method.  We think of what we have been reading and the problems set forth by learned writers. 

Something needs to be done.  To protect America?  Yes! To protect our customers?  Yes!  To protect the environment, not just in America but all over the world?  Yes!

But what ?  Nothing is simple at all.


is a conscientious pharmacy.

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