Cooperation? Or Not?
Both FDA and SFDA were going to pains to emphasize how closely they were cooperating on the heparin investigation.
This was curious. On February 28, FDA announced that despite conditions indicative of lousy QC and GMPs, there was no smoking
gun in the already-shuttered SPL plant in Changzhou. Agency inspectors were heading upstream in the supply chain, to the consolidators
and suppliers, including the rural mom-and-pop workshops. Some experts say, given the shortage of pig intestines due to the
"blue ear" epidemic, these operations currently provide wholesalers with as much as 70 percent of China's crude heparin.
Reporters from both the Times and the Journal had already gone upstream, filing stories from makeshift household workshops where men and women in aprons and gloves hand-process
pig intestines into pulp for raw heparin and sausage casing. Photos testified to their unsanitary conditions. As for QC, one
of SPL's wholesalers told the Times that his firm had never been inspected and that he, in turn, had no right to inspect "the pigs or intestines or facilities"
in the small villages where he purchased much of his crude heparin. "We are not the government," he said.
Weeks passed. Readers of the news may have imagined intrepid FDA inspectors, led by a closely cooperating SFDA official, trudging
unpaved, muddy roads from village to village to interview blood-covered workers. But, in fact, FDA never gained access to
the unregulated upstream supply chain.
On March 19, the Times broke the case wide open by nailing down the contaminant. It reported that independent scientists agreed that the look-alike
molecule was an apparently meticulously tweaked version of chondroitin sulfate, a cheap dietary supplement made from animal
cartilage and widely used in China for joint pain. "A child could tell you it's counterfeiting," Dr. Jawed Fareed, a professor
of pharmacology at Loyola University, told the Times. "This is a deliberate act of chemically manipulating a heparin-like substance and mixing it with heparin to increase the
It took FDA only two hours after the Times story appeared to announce the same findings. Dr. Janet Woodcock, veteran head of the FDA's Center for Drug Evaluation and
Research, reported that the copycat heparin had been chemically modified, was much cheaper to produce than pure heparin, and
did not come from a natural source. Although these facts together almost scream counterfeiting, Woodcock hung tough. "We cannot
rule in or out whether this was accidentally or deliberately introduced into the product," she said. "We are investigating
how it got in." She also said that further testing is required to determine whether over-sulfated chondroitin sulfate is responsible
for the deaths and allergic reactions.
Then she made a special point of praising "Chinese officials' cooperation in this investigation," contrasting it favorably
to their stonewalling during the pet food scandal. Visas were sped through, data shared.
But according to one source close to the investigation who spoke on condition of anonymity, Chinese officials were their usual
difficult selves, right down to delaying visas: "It was clear from the start that China has a different agenda than FDA in
getting to the bottom of this."
Nor does FDA's happy version jibe with Baxter chief science officer Norbert Reidel's pointed plea for access in a Baxter press
release that same day: "We're at a critical juncture in the investigation and further progress can be accelerated with the
cooperation of the consolidators and workshops."
Wang Fei-ling suggests that it's local officials, not SFDA, who have the different agenda. "The last thing any local government
wants is an investigation that will probably implicate them in all sorts of bribes and kickbacks," he says.
But now that the SFDA is in gear, a major criminal investigation will likely push everything else off their agenda.