The People's Perspective on Medicine

Are Fears About FDA’s Generic Drug Oversight Justified?

There have been so many reports of problems with FDA's oversight of generic drugs, we have lost count. A new one from Bloomberg is the most shocking yet!

A year-long investigation by Bloomberg News has revealed substantial concerns about the quality of generic drugs. The four-part series is mind-boggling in its revelations. Here are the first three articles: Part 1: “America’s Love Affair With Cheap Drugs Has a Hidden Cost: Data, documents and interviews show how a focus on cutting prices has come with risks to consumer health.”  Part 2: “How a Tainted Heart Drug Made in China Slipped Past the FDA: Lag in U.S. recall highlights strains in global pharmaceutical supply chain.”  Part 3: “Culture of ‘Bending Rules’ in India Challenges U.S. Drug Agency: The FDA confronts creative improvisation in the world’s largest generic-drug exporter.”  We encourage you to read the articles about FDA’s generic drug oversight. We suspect that you will be as dismayed as we are.

How Worrisome is FDA’s Generic Drug Oversight?

According to the report, 90% of the medicines Americans swallow are now generic. The FDA does little, if any, testing itself, relying largely upon data from the manufacturers. This means that they trust generic drug companies to submit accurate data.

Can We Trust the Data?

Investigative journalist, Katherine Eban, wrote an article for Fortune Magazine titled Dirty Medicine” (May 15, 2013).  In it she notes that the Indian generic firm Ranbaxy paid $500 million in fines, forfeitures and penalties and pleaded guilty to:

“seven federal criminal counts of selling adulterated drugs with intent to defraud, failing to report that its drugs didn’t meet specifications, and making intentionally false statements to the government.”

Perhaps more damaging was a statement by a past head of the Office of Generic Drugs for the FDA. Gary Buehler led this program at the FDA for a decade. We ourselves had many interactions with him about problems we uncovered with generic drugs. He reportedly stated that the information the agency uses to approve generic drugs comes from the companies.

“‘We depend on that information to be truthful.’ The approval system ‘requires the ethical behavior of the applicant,’ he said. Otherwise, “the whole house of cards will fall down.’” [emphasis ours]

Generic Drug Oversight?

The Bloomberg articles document a number of egregious errors by generic drug manufacturers. Most people assume that they all occur abroad in countries like China, India or Taiwan. But here is a disconcerting story about Mylan, the second largest generic drug manufacturer. Inspectors descended upon a plant in Morgantown, West Virginia. Anna Edney of Bloomberg News notes that:

“A tipster raised concerns there might be unscrupulous activity at the factory where the generic giant makes some of its top-selling drugs.”

An FDA executive once shared with us the scary idea that the FDA has to rely on whistleblowers or tipsters to alert it to fraud. The only problem is that whistleblowers often have their lives turned upside down. Revealing secrets about bogus clinical trials or unscrupulous behavior can terminate a career in the pharmaceutical industry overnight. It’s not surprising that there are very few Pharma employees who are willing to blow the whistle on their employers.

In the case of the Mylan inspection, the Bloomberg report states:

“The inspectors suspected Mylan laboratory staff had recorded passing scores on drugs that originally fell short of U.S. quality standards.”

Anna Edney writes:

“The inspectors also found bins full of shredded documents, including quality-control records, in parts of the factory where every piece of paper is supposed to be saved. The list of alleged infractions became so long that a fourth inspector was added. A warning letter, the FDA’s strongest rebuke, was drafted.”

You might think this kind of FDA generic drug oversight would have led to strong reprimands. Instead, the FDA “apparently decided to take it easy on Mylan…” No warning letter was sent. The FDA counted on Mylan to fix the “data integrity” problem without an official spanking.

Problems with Generic Drug Oversight in China?

Bloomberg reports that one out of every 10 generic drugs approved by the FDA for the U.S. market now comes from China. That does not count medications made in India that use Chinese chemicals to formulate pills there.

Perhaps you have heard that major heart and blood pressure medicines called “sartans” (losartan, valsartan and irbesartan) have been recalled because of contamination. An FDA inspection of the Zheijiang Huahai Pharmaceutical Co. in Linhai, China back in May of 2017 revealed there might be significant problems at the plant.

The inspector recommended a strong warning letter be sent to the company that might have affected production. FDA managers back at headquarters in the U.S. apparently “overruled the inspector,” according to Bloomberg.

The Sartan Recalls Begin

On July 5, 2018, over a year later, the European Medicines Agency reported problems with Chinese-made valsartan from the Zhejiang HuaHai Pharmaceutical company in Linhai, China. Here is our first People’s Pharmacy Health Alert from a week later.

Valsartan Blood Pressure Pills Recalled over Cancer Concerns

The Never-Ending Recall:

This scandal just keeps getting worse. So many lots of valsartan (and valsartan plus HCTZ or valsartan plus amlodipine) have been recalled that we have lost count. Aurobindo recently recalled 80 lots amounting to more than 20,000 bottles with goodness knows how many pills in each bottle.

Bloomberg isn’t the only organization that has reported on the problem of FDA oversight. We have written about A Kaiser Health News expose just two weeks ago. Here is a link.

Can You Trust the FDA’s Generic Drug Oversight?

That is a question we leave up to you and your health professional. Bloomberg cites the results from an online-pharmacy startup called Valisure.  The company actually tests the medications that it dispenses.

According to Bloomberg:

“Since opening last year, it has screened about 100 drugs and found that more than 10 percent didn’t have the proper amount of active ingredient or didn’t dissolve as they should.”

We talked to the CEO, David Light. He assured us that Valisure’s online pharmacy tests every batch of medication it sells. We know of no other pharmacy in the U.S. that actually tests pills before selling them. Even the FDA rarely, if ever, tests generic drugs for quality or dissolution.

The People’s Pharmacy Perspective:

We were surprised to read tweets from the FDA commissioner that attempted to “counteract” the reporting from Bloomberg. Dr. Gottlieb wrote:

Scott Gottlieb, M.D.‏Verified account @SGottliebFDA 7 hours ago

“Americans should be assured generic drugs are just as safe and effective as brand counterparts and often made in same facilities. Selectively construed facts, to paint different portrait, can put patient care at risk. FDA is confident in the overall safety and quality of generics”

This comes after one of the largest recalls in FDA history involving contamination of losartan, irbesartan and valsartan with a probable carcinogen. We have asked the agency for a count of the number of pills that have been recalled but we do not expect an answer. Here is a link to the FDA’s website if you want to see which lots have been recalled. It is overwhelming.

There are now shortages of valsartan. We would not be surprised if other shortages also crop up. This is all because generic manufacturers have sold contaminated medicines.

Over the years we have written extensively about how we discovered that FDA’s oversight of generic drugs leaves a lot to be desired. You can read about that process in our book, Top Screwups. We don’t just leave you without an action plan. We offer ways to overcome the generic drug oversight problem. We also think that Valisure represents a whole new way for patients to regain trust in a pharmacy that dispenses generic drugs.

Share your thoughts about the FDA’s oversight of generic drugs in the comment section below.

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About the Author
Joe Graedon is a pharmacologist who has dedicated his career to making drug information understandable to consumers. His best-selling book, The People’s Pharmacy, was published in 1976 and led to a syndicated newspaper column, syndicated public radio show and web site. In 2006, Long Island University awarded him an honorary doctorate as “one of the country's leading drug experts for the consumer.” .
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While there are certainly conscientious employees at the FDA who would like to do the right thing, the FDA, just like most, if not all, of the public interest agencies in the US, is another “captured” toothless patsy serving the ruthless corporations they are supposed to regulate. It is thus not surprising the FDA is more interested in protecting corporate profits than public health.

Until the public wakes up to this fact and demands that Congress stop writing laws for their corporate bosses and start writing laws for the public who they are supposed to work for, it will only get worse.

I am continually told that generic drugs are just like the original, but I know this cannot be true. Lexapro was a Godsend for me until I had to take the generic. It never helped like the original and I suffered greatly because of this when I finally decided to go off it because it wasn’t helping. Nothing worked for me like Lexapro. Kind of heartbreaking. At one time years ago I took something called Fe-o-sol. Probably spelled wrong but it was an iron supplement. Worked fine. No problem. Along comes the generic version and I could not take it as it caused diarrhea. That’s when I realized that there can be a difference in the original vs. the generic. Something needs to be done about this.

I am very concerned about the flurry of recalls with our generic drugs, our food, our autos, and the list goes on and on. Buyer beware doesn’t have any clout when it is about medication for your
health.

I have wondered why its impossible to get anything but a generic brand anymore. Even if your doctor writes the script for name brand. The pharmacy tells you things like we don’t have it, we don’t know when we can get it, there’s no difference in the two. I know better. When there are so many making generics they are not the same. It’s become where pharmacies are nasty places. They do not like their jobs. I rarely take anything, but it’s out of control. Thanks for the links.

Well, after a lot of Tadalafil manufactured in India, ordered from a reliable Canadian pharmacy, and shipped from Singapore seemed to be ineffective, I reported it to the pharmacist. They replaced the medication with Tadalafil made in the UK. I have since re-ordered the UK product. It only costs a few cents more.

I think the whole drug industry needs to clean up its act. My daughter was fired from her job with a drug company when she refused to write a report on the safety of a new drug to the FDA. She had told the company several times that the studies were too small, not enough data and she would not risk a child’s life by writing the reports.

I am horrified to learn that Americans cannot trust their medicines to be what they are supposed to be. I hardly take any myself. But my husband with a weak heart takes lots each day.

I think the FDA needs to do its job, and is not. Many generics are made in the same manufacturing plants, in India and China. I don’t trust any of them to keep our medicine clean and to have the right amount of medication in each pill. We need to bring the manufacturing, ingredients and shipping back to the US, and to have regular FDA Inspectors check them to make sure they’re pure. The FDA should be mandated to hire more Inspectors, as well.

Apparently even fines in the multi-100 million dollar range are not enough to deter these companies from continuing to produce generic drugs that are dangerous to our health. Pharma just makes too much money, period! Ending purchasing from companies with egregious records and sending executives to prison might be a start to getting the industry on the straight and narrow. If heads of foreign countries cannot be tried in the USA then their counterparts here should be.

Maybe FDA oversight and responsibility ( and its budget!) should be turned over to the DEA (Drug Enforcement Agency) since DEA’s primary responsibility is to prevent dangerous drugs (cocaine, fentanyl, etc) from entering the USA! Seems these contaminated generic prescription drugs should be in that category too!

It is appalling that there is no FDA oversight or action against companies that cut corners. I am on Losartan and want to make sure the drug is not contaminated. Where do I turn?

How can I check on my specific medication? (metoprolol/toprol)

It has been well known that the FDA can’t provide proper oversight for drugs (never mind OTC ones), because they are not given enough money to do a proper job. Some even want to eliminate the FDA completely. But we consumers are stuck. I’ve been on some drugs for over 25 years, and when one pill doesn’t seem to work as well as another, we suck it up. What else can we do?

It is scary. Americans have to turn to generics even if they do not want them or feel safe because of insurance and their own pocketbooks. I use them because I have no choice. Years ago it was not this way.

I think USA should treat them like non generic medications; with thorough inspections.

This conversation is long overdue- I have been worried about the safety of generic drugs made with ingredients primarily from China and India for quite some time.

I’ve always said that generic drugs are “massaged” too much and include “fillers,” to which most people are allergic. For example, Allegra, which I use because I have seasonal allergies. Before Pharma decided that Allegra, which I was getting through a prescription service, is just as effective as the “new” over the counter Allegra (it is not!), I was paying $5 for a three month supply. I tried the one on the shelf. It doesn’t work!! I am now paying $20+ for Allegra D for a 20-day supply. The pharmacists have bought into what Pharma is saying. This is a royal rip-off.

I appreciate the way you keep the spotlight on prescription drugs, including generics and problems with the FDA. Our nation seems to be divided over healthcare, but one area I think we could all agree upon and benefit from is having our government do something about drugs. We are all being impacted one way or another, and no one seems to have any ideas as to how this part of healthcare alone could really be improved.

I take losartan, and I asked my pharmacist to determine if any of the medication I had taken was listed as contaminated. He said the contaminated drugs dated back to 2017. It does me absolutely no good to research whether my drugs were contaminated if I have already taken them. Drugs are usually taken immediately after purchase, so recalls are not worth much.

In the past few years I’ve had had problems with four generic drugs not performing like the original brands. In each case it has affected my health negatively and caused me additional difficulty due to doctor and insurance company intractability. It’s becoming increasingly frightening, in part due to the influx of unregulated medicines from China, and I have a bad feeling that this is going to get a lot worse before it’s addressed by the medical industry.

My doctor will NOT use generics. She says they’re not in the patients’ best interests.

Furthermore, she especially targets drug and supplements from China that ‘may’ suggest they’re bio/organic but cannot be verified by the regulators monitoring.

Our FDA is a joke!
The FDA needs a total overhaul!
It is totally corrupt and does not do its job to protect Americans like it should!
I learned years ago to check if a prescribed drug was available in the U.K.?
If it was not approved there do not take it! Same if it was pulled from the market! I found that many drugs were pulled from the market in the U.K. at times years before it was done in the U.S.!
Our FDA allows drugs to be sold here that are harmful and unsafe!

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