Public anger in China is the growing ineffectiveness of concerns raised by doctors about generic drugs used in public hospitals, which has led to a rare government response.

Doctors say they believe the country's drug procurement system encourages the use of cheap generics rather than original branded drugs, which leads to costs at the expense of people's safety.

But officials quoted in multiple state media on Sunday that the issue is one of the problems of perception rather than reality.

One report says different people simply respond differently to the drug, claiming that they are ineffective “because of people’s anecdotes and subjective feelings.”

The official response has barely caused public concerns about the reputation of drugs in public hospitals and pharmacies. This is the latest challenge that has been under tremendous pressure on the healthcare system due to the rapid aging of the population.

The debate over the use of universal drugs began in December, with authorities announcing a list of nearly 200 companies that have won contracts to sell the drugs to Chinese state hospitals. Almost everyone is a domestic manufacturer of ordinary drugs.

This intensified in January, when, among directors of the Shanghai Hospital department, he was concerned about the drug procurement system in video interviews.

Zheng Ming quoted "Antibiotics that cause allergies, blood pressure will not drop, and anesthetized patients who cannot fall asleep", and laxatives that do not clear the intestines are one of the problems encountered.

Dr. Zheng's words immediately resonated and were condensed into a social media slogan that had been viewed millions of times in the past month - although many discussions on the topic have since been reviewed on Weibo. Many people come forward and share their bad experiences with so-called unqualified drugs.

"I underwent intestinal surgery in 2024, which requires me to take laxatives beforehand," wrote a Weibo user. They said that even after the dosage was doubled, the drugs they were given "have no effect" and they would not Don't turn to drinking coffee to help clean the gut.

Concerns about the efficacy of generic drugs have caused distrust and has made some people reluctant to use them.

A man on Xiaohongshu, a Chinese Instagram-like app, said that when hospital doctors prescribed a universal version of antibiotics, they immediately went online to buy the "original" and "real" one because the universal version "tastes differently."

User warned: "A lot of people have had a cold lately. Many of them may have purchased this medication. Send your friends a reminder immediately and have them check the brand before purchasing."

Some of the most popular posts discussing the procurement controversy have been removed, although it is unclear who is currently. China's strictly monitored Internet has a strong censorship culture of authorities and users themselves.

In a stern, now adapted post by popular podcast host Meng Chang, he slammed the public sector for lack of imported drugs: “If that’s not the bottom line, I don’t know what it is.”

Public anger is also focused on the difficulty of obtaining imported drugs that people believe are better quality.

"When authorities try to assure people the quality of the general drug quality, as long as we are allowed to buy branded drugs ourselves, I have no other complaints."

It was launched in 2018 and is a way to reduce state spending and involves local governments providing tendering procedures for approximately 70% of state hospitals’ annual drug demand.

Various drug manufacturers then compete to offer the lowest prices for drugs that win these profitable contracts.

This provides an advantage for domestically produced generic drugs that contain the same active pharmaceutical ingredients as the original patented drug, but are usually cheaper several times as they do not include the high costs of research and development.

China has become one of the world's largest players in the global general medicine market, exporting finished products to foreign consumers and exporting key ingredients to foreign companies. At home, thousands of generic drug manufacturers compete to sell their products at competitive prices in the ever-expanding domestic market.

In order for generic drugs to be eligible for the procurement process in China, they must be tested and determined to be similar to the brand version of the drug.

Beijing has saved millions of dollars in its first five years more than $50 billion (£40 billion) of residents, crediting the drug procurement system to it.

However, the procurement process has enabled some drug manufacturers to provide medicines at low prices. One of the winning bids last December was the sale of aspirin tablets for less than a cent.

"Does the pill cost less than a cent?" became a hot topic on Weibo at that time.

"Manufacturers who win bids usually set prices so low that they may struggle to produce the right ingredients, which may cause the drug to be ineffective," NYU Langone Health associate professor Stacy Zhang told the BBC.

She added that while the procurement system is “not intended to limit access to imported branded drugs,” it may still “affect its accessibility.”

Last month, a proposal submitted by 20 doctors, including Dr. Zheng, said: "The industry is widely concerned in the industry that procurement prices are too low, prompting unethical companies to cut corners to reduce costs and affect the efficacy of drugs."

“Doctors are helpless because they have no choice and no channel to upgrade feedback.”

A recent article by Hangzhou doctor Xia Zhimin added a review. In it, he highlights what he is talking about is suspicious data from generic trials on the purchase list - it is the same as data based on the original drug. Dr. Xia suggested that this could be evidence of fraud.

The National Medical Products Administration responded that his findings were due to "editorial errors." Since then, his article has been deleted.

In addition to the focus of quality, there are also fake drugs that have penetrated into the general and branded drug markets around the world and are well known to be difficult to detect. The World Health Organization described this as a global health issue.

Kevin Lu, associate professor at the University of South Carolina School of Pharmacy, told the BBC that “to enhance affordability, it is crucial to introduce cost-effective generic drugs.”

He added that the procurement process requires “strengthening quality control” and “continuous improvements in drug approval and manufacturing standards.”

The controversy is when China's healthcare system is already under increasing restrictions.

The rapidly aging population means that the country's total health spending has increased nearly 20 times over the past 20 years, reaching RMB 9 trillion ($1.25 trillion; £1 trillion) in 2023.

Nationally, public medical insurance funds operate in seldom. The deficit has emerged in certain provinces where local governments rely heavily on land sales to earn revenue and are now struggling with debt as the real estate crisis swept through China's economy.

Meanwhile, the healthcare system has been experiencing a crisis of trust. Violent attacks on medical staff have risen since the 2000s, inspired by lack of resources and anger at the belief in doctors.

With issues seen by the authorities as politically sensitive and scrutinized, such as persecution of political dissidents or the persecution of Uyghurs in Xinjiang, at least the ongoing dispute surrounding drug procurement is recognized by the state, which is recognized by the state, It is a problem that has been solved.

The National Healthcare Administration said in a statement on January 19 that authorities took these safety issues “very seriously” and would seek feedback on drug procurement policies.

“It is undeniable that state-centralized procurement is still in its infancy. Many pharmaceutical companies have different production quality,” State Media Life Times quoted a public health scholar. Other experts cited in the article call for improvements in drug evaluation criteria.

All the scrutiny now covers a system designed to be a win-win: Save lives and save money.

As one Weibo user said, the savings from lower drug prices are just a "decline" in China's national health care costs. On the other hand, they wrote that allowing widespread use of potentially defective drugs is similar to "thirst from drinking poison."