A rare display of public anger is unfolding in China over the quality of domestically produced medicines.
A prominent Shanghai surgeon pointed to anesthetics that do not put patients to sleep. A respected cardiologist in Beijing questioned the blood pressure medications that failed to regulate. A former editor at a leading online health platform went so far as to accuse domestic drugmakers of fraud.
The concerns spilled into public debate this week as some top doctors and hospital leaders called on the government to change how it buys drugs for its public hospitals.
The outburst of scrutiny, unusual in a country where authorities keep a tight lid on public criticism of the government, was a rebuke to Beijing's campaign to cut medical costs. Officials are working on China's national health care system, which is under financial strain in part because of a rapidly aging population.
The policy, which was introduced in 2018, Stimulates intense competition among drug manufacturers and has been successful in dramatically increasing drug prices. But this year, drugs abroad were largely absent from the government's list of medicines covered by China's national health insurance and offered in public hospitals.
The change has effectively taken out many foreign pharmaceutical companies that don't want to compete against Chinese companies that want to sell their drugs at rock-bottom prices.
Now doctors are sounding the alarm about the effectiveness of some domestic drugs. The doctors are looking for changes to give patients the choice to pay more for alternatives.
“There have always been grumblings that if you lower the price, manufacturers will cut corners,” said Helen Chen, a managing partner and healthcare expert at LEK Consulting in Shanghai. “Now there are some public voices saying it is happening.”
After years of failing to reduce costs, the government created a central bidding system that favored cheaper drugs, which in most cases were generics made by Chinese companies. In return, the government would be guaranteed to buy more from each supplier.
Public hospitals account for about 70 percent of China's drug market. Patients who use private clinics have easier access to a wider choice of medications, including foreign brands.
The annual bidding system, known as volume-based purchasing, has more than halved the price of most drugs and saved Beijing more than $50 billion in the first five years, according to the most recent government data available.
“The national purchasing system keeps prices low,” Zheng Minhua, the director of surgery at Shanghai's prestigious Ruijin Hospital, said in a video interview by a local state media outlet.
But, he added, “For such a low price, the quality of the drug can be unreliable,” citing several examples including antibiotics that have caused allergies, blood pressure medications that don't lower blood pressure and laxatives that don't do their job done.
Dr. Zheng was one of more than 20 doctors and Communist Party members who submitted a proposal to the government this week that would allow patients to obtain an original brand drug even if it was not on the approved purchasing list. Insurance reimbursement would be adjusted depending on whether the drug came from an original brand drug or a generic.
The head of cardiology at Beijing Chaoyang Hospital, Lu Changlin, submitted a similar proposal suggesting that doctors and patients should not be forced to use the drugs on the purchasing list.
The growing pushback from the medical community has been so strong that China's National Healthcare Security Administration, which is responsible for the nation's medical insurance, dispatched officials to Shanghai to speak to doctors and examine clinical data for the drugs.
“There are no regulations prohibiting the purchase or use of imported and branded medicines,” it said in a statement this week.
Following the public outcry, some medical professionals have begun investigating trials for some generic medications. In a post on social media, Xia Zhimin, a doctor at the Hangzhou Hospital of Traditional Chinese Medicine, compared data from the trials of original drugs with that of the same drugs in generic form and found too many similarities, raising questions about the or the data was fraudulent, said Dr. Xia.
“The numbers are exactly the same, even to two decimal places,” wrote Dr. Xia, the former editor-in-chief of Ding Xiang Doctor, a popular online forum for medical professionals.
“They are Chinese generic drugs that have poor quality,” he said.
In a statement on Friday, a unit of China's National Medical Products Administration acknowledged the duplicated data, saying it was the result of “editing errors when the relevant product information was disclosed.”
The issue has struck a raw nerve as many people feel a sense of uncertainty from China's downturn and sputtering consumer economy.
“If this isn't a bottom line, I don't know what is,” wrote Meng Chang, one Journalist and host of a popular podcast, in a social media post that was later deleted.
“The vast majority of good doctors are in the public system,” Mr. Meng wrote. “But now, when you want imported medicines and surgical equipment, you have to go to the private sector.”
Most Chinese families see doctors in a hospital when they are sick. National medical insurance, which varies from province to province, usually covers an average of almost three-quarters of the cost of any prescription drug.
On social media, some patients and doctors have said that the rise of generic brands in hospitals has made it difficult to find even original foreign brand medicines, such as Bayer's Avelox antibiotic medicine.
Li Xiang, a doctor from northeastern China, shared a story about how one of her relatives needed an imported medicine that was no longer available in public hospitals. But when she tried to contact a representative for the manufacturer, she was told the drug was out of stock.
Dr. Li criticized the government's purchasing system, saying it resulted in an oversupply of drugs that people don't want to use and too few alternatives.
“You say medical insurance is running out and you can't use it to buy imported medicines. I understand that,” Dr. wrote. Li. But, she added, she was willing to do anything, even sell her house, to secure the imported drug.
“I will not risk switching to other substitutes for fear that the medicine will not work and the condition will come back,” she wrote. “This is about the life of a family member.”
