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The government has a unique response to the public’s concern in China over issues raised by physicians that generic medications used in public hospitals are extremely inefficient.

Specialists say they believe the government’s drug procurement method, which incentivises the use of cheap generic drugs over unique brand-name medicine, has led to costs being cut at the cost of people’s health.

But leaders, quoted by many state advertising outlets on Sunday, say the issue is one of understanding more than truth.

According to one document, “different women’s responses to medications are just different,” and that claims about them being ineffectual “mostly come from people’s anecdotes and personal feelings.”

Common concerns about the status of drugs in common hospitals and pharmacies have not been adequately addressed by the standard reaction. A care system that is already in great stress as a result of a population that is rapidly aging is facing the most difficult situation.

The discussion around the use of generic medications started in December when the government made the list of almost 200 businesses that had won contracts to buy drugs to Chinese state institutions. Almost all were home makers of universal pharmaceuticals.

This intensified in January, when, in a video interview that went viral, the chairman of a medical office in Shanghai, shared his concerns about the drug purchasing program.

Zheng Minhua cited “antibiotics that cause allergies, heart force that won’t go down, anaesthetised people who didn’t sleep” and pills that did not clear the colon as being among the problems that had been encountered.

Dr. Zheng’s words were immediately understood and have since been condensed into a social media slogan that has been shared by millions in the past month. However, much of the discussion has since been censored on Weibo. Many people have come forward with their own negative experiences using allegedly subpar drugs.

” I underwent intestinal surgeries in 2024, which required me to consume laxatives beforehand”, one Weibo user wrote. They claimed that the drugs they were given had” no effect whatsoever” even after the dose had doubled and that they had to resort to drinking coffee to aid in bowel movement.

Some people are unwilling to use generic medications because of concerns raised about the efficacy of them.

A person on Xiaohongshu, China’s Instagram-like app, said that when hospital doctors prescribed them the generic version of an antibiotic, they immediately went online to buy the “original” “real” one, since the generic version “tasted different”.

” There have been many people catching colds recently. Many of them may have purchased this drug. Send reminders to your friends right away so they can check the brand before purchasing,” warned the user.

Although it’s not clear who was behind some of the most well-known posts about the procurement controversy. The heavily monitored internet in China has a strong culture of censorship, both from the authorities and the users themselves.

In a scathing, now-removed post by popular podcast host Meng Chang, he lambasted the lack of imported drugs in the public sector:” If this isn’t a bottom line, I don’t know what is”.

Public outcry has also been drawn attention to the challenges of getting imported drugs that people believe are of higher quality.

In response to authorities ‘ attempt to reassure people of the quality of generic drugs, one Weibo user wrote:” As long as we are allowed to buy brand-name drugs ourselves, I have no other complaints”.

It was introduced in 2018 as a way to lower state drug costs and involves local governments conducting tendering for about 70 % of state hospitals ‘ annual drug requirements.

In order to win these lucrative contracts, various drug manufacturers then compete to offer the lowest prices for the drugs.

This makes domestically produced generic drugs advantageous because they are frequently several times less expensive to produce because they do not pay for the expensive research and development costs associated with making generic medications that are produced elsewhere.

China has grown to be one of the biggest exporters of both finished goods to domestic customers and key ingredients to foreign companies, making it one of the biggest players in the global generic pharmaceutical market. In the expanding domestic market, thousands of generic drug manufacturers compete to sell their goods for competitive prices.

Generic medications must be tested and proven to be accurate in order for them to be eligible for China’s procurement process to be eligible for the country’s procurement system.

Beijing has given the drug procurement system credit for saving millions of residents more than$ 50 billion ( £40 billion ) in its first five years.

However, some drug manufacturers have offered products for incredibly low prices as a result of the procurement process. An aspirin tablet sold for less than one cent in one of the winning bids in December.

Are drug tablets that cost less than one cent edible? at the time, became a hot topic on Weibo.

Stacy Zhang, associate professor at NYU Langone Health, reported to the BBC,” The manufacturers who win the bids frequently set prices so low that they may struggle to produce high quality medications with the correct ingredients, which could lead to ineffective medications.”

She continued, noting that the procurement system “was not intended to restrict access to imported brand-name drugs,” but that it may still have “affected their accessibility.”

In a proposal that 20 doctors, including Dr. Zheng, submitted to Shanghai authorities last month, it was stated that” there are widespread concerns in the industry that procurement prices are too low, leading unethical companies to cut corners to reduce costs, affecting the efficacy of drugs.”

” Doctors are helpless because they have no choice, and there is no channel to escalate feedback”.

A recent article by Xia Zhimin, a doctor in Hangzhou, has added to the scrutiny. He made an emphasis on what he claimed were dubious data from the generic drug trials on the procurement list in it because it was the same as the information from the original drug whose basis it was based. Dr. Xia suggested that it serve as proof of fraud.

The National Medical Products Administration responded, claiming that his findings were the result of an “editorial error.” His article has since been removed.

Counterfeit drugs, which have pătrunded into both generic and brand-name drug markets across the world and are notoriously difficult to detect, are just one more reason to worry about quality. This is a global health issue, according to the World Health Organization.

” To enhance affordability, the introduction of cost-effective generics is essential”, Kevin Lu, associate professor at the University of South Carolina’s College of Pharmacy, told the BBC.

He added that” strengthened quality control” and” continued improvements in drug approval and manufacturing standards” were required for the procurement process.

China’s healthcare system is already in danger of being under increased scrutiny as a result of the controversy.

A rapidly ageing population has meant that the country’s total health expenditure has increased nearly 20-fold over the last 20 years, reaching 9 trillion yuan ($ 1.25 trillion, £1 trillion ) in 2023.

Across the country, public medical insurance funds are running thin. Local governments that had traditionally relied heavily on land sales to generate income are now saddled with debt as China’s economy is ravaged by a real estate crisis.

The healthcare system has been going through a trust crisis at the same time. Since the 2000s, violent attacks on doctors have risen, fueled by anger over the lack of resources and a decline in doctor confidence.

The ongoing controversy surrounding the procurement of drugs has at least been acknowledged by the state as a problem to be addressed, in contrast to those that have been deemed politically sensitive and heavily censored by authorities, such as the persecution of political dissidents and the repression of the Uyghurs in Xinjiang.

Authorities “attached great importance” to these safety concerns, according to the National Healthcare Security Administration in a statement released on January 19 that they would seek feedback on the drug procurement policy.

” The national centralized procurement is still in its early stages is undeniable. A public health expert was quoted by state media Life Times as saying that there are many pharmaceutical companies with varying production quality. The article also included recommendations for improved drug evaluation standards from other experts.

Authorities are now focusing on a system that is supposed to save both lives and money as they attempt to change the faltering image of the procurement system.

As one Weibo user argued, the savings from lower drug prices are but” a drop in a bucket” of China’s national healthcare costs. On the other hand, they wrote that “drinking poison to quench thirst” is equivalent to allowing potentially defective drugs to be widely used.