US obliteration of Caribbean boat was a clear violation of international ‘right to life’ laws – no matter who was on board

Trump claims the US has the right to destroy boats and kill passengers on the high seas if he suspects they are doing something bad

Mary Ellen O'Connell, University of Notre Dame

The moment before an alleged drug boat was hit in a
targeted U.S. strike. @realDonaldTrump/Truth Social

The U.S. government is justifying its lethal destruction of a boat suspected of transporting illegal drugs in the Caribbean as an attack on “narco-terrorists.”

But as an expert on international law, I know that line of argument goes nowhere. 

Even if, as the U.S. claims, the 11 people killed in the Sept. 2, 2025, U.S. Naval strike were members of the Tren de Aragua gang, it would make no difference under the laws that govern the use of force by state actors.

Nor does the fact that protests from other nations in the region are unlikely, due in large part to Washington’s diplomatic and economic power – and Donald Trump’s willingness to wield it.

Protest is not what proves the law. Unlawful killing is unlawful regardless of who does it, why, or the reaction to it. And in regard to the U.S. strike on the alleged Venezuelan drug boat, the deaths were unlawful.

Domestic U.S. legal issues aside – and concerns have been raised on those grounds, too – the killings in the Caribbean violated the human right to life, an ancient principle codified today in leading human rights treaties.

Killing in war and peacetime

The International Covenant on Civil and Political Rights is one such treaty to which the United States is a party. Article 6 of the covenant holds: “Every human being has the inherent right to life. This right shall be protected by law. No one shall be arbitrarily deprived of his life.”

Through rulings of human rights and other courts, it has been well established that determining when a killing has been arbitrary depends on whether the killing occurred in the context of peace or armed conflict.

Peace is the norm. And in times of peace, government agents are only permitted to use lethal force to save a life immediately. The United Nations’ Basic Principles on the Use of Force and Firearms by Law Enforcement Officials reinforce this peacetime right-to-life standard, noting “intentional lethal use of firearms may only be made when strictly unavoidable in order to protect life.”

The principle is also supported by the fact the U.S. has bilateral treaties regarding cooperation in drug interdiction. The Coast Guard has a series of successful Maritime Law Enforcement Agreements – known as Shiprider Agreements – with nations in the Caribbean and elsewhere. They commit U.S. authorities to respecting fundamental due process rights of criminal suspects. Such rights obviously do not include summary execution at sea.

Bypassing these bilateral and international treaties to dramatically blow up a ship not only violates law, but it will, I believe, further undermine trust and confidence in these or any other agreements the U.S. makes.

How RFK Jr. celebrated Labor Day

Ozempic’s surge in popularity for weight loss has sparked new concerns over its potential effects on muscle mass and strength.

Research Shows Surprising Muscle Loss

By University of Utah Health

The widely used diabetes and weight-loss medication Ozempic has seen a rapid rise in popularity, and with it, mounting questions about its potential side effects. One concern is the reduction of “lean mass” (body weight that is not fat), which has led to speculation that the drug could be lowering muscle mass and strength.

A recent study in mice found that muscle size did not decrease as much as expected, yet some muscles still became weaker. This finding underscores the need for clinical trials to better understand the drug’s full impact in people.

“If we want to really help the individuals who may be losing muscle mass, then we need to know that they’re actually losing muscle mass,” says Katsu Funai, PhD, associate professor of nutrition and integrative physiology in the University of Utah College of Health and the senior author on the study. “We have data in mice that suggest that things are not as straightforward as they might seem.”

The results appear in Cell Metabolism.

Shut up and get out

After the horrific church shooting in Minnesota, Bobby Kennedy Jr. blames - without evidence -  the shooter's apparent use of anti-depressants (SSRIs) for the massacre of children. Enough of this fool.

Round-up of new Rhode Island legislation and how it will affect us

2025 General Assembly session passed 826 new laws. Here are some highlights

By Uprise RI Staff

Uprise RI - Rhode Island's Advocate | RI News & Opinion

This is an ongoing series breaking down the new laws coming out of the General Assembly this summer. The ink is dry on a number of bills that will reshape pieces of daily life here in the Ocean State. Here are the first three installments combined.

No cell phones in school, access to the beach and getting more doctors

First, let’s talk about the classroom. A new law, H5598, will require every public school in the state to implement a policy prohibiting students from physically accessing their personal electronic devices during the school day. Before you panic, there are a few key points here. The law makes clear exceptions for students who need devices for medical reasons, for an IEP or 504 plan, or to assist with language learning. So, a student monitoring their glucose on a smartwatch is fine. The goal is to reduce distractions and get kids focused on learning, not TikTok. School districts have some time to figure this out, as the law doesn’t take effect until August 1, 2026.

Next, for anyone who has ever stared at a stretch of coastline and wondered, “Can I actually walk there?”, bill H5686 offers a bit of clarity. This law amends the duties of the Coastal Resources Management Council (CRMC) by requiring municipalities to officially identify, list, and display all CRMC-designated public rights-of-way on their official maps. We believe this puts the responsibility squarely on towns to make public access points clear to the public, preventing these paths from becoming forgotten or obscured over time. If a town fails to do so, it doesn’t change the legal status of the right-of-way. This is a small but meaningful step in the continuing effort to protect public access to the shore.

Finally, in a move to address the state’s physician shortage, S0347 creates a new, tiered licensing system for internationally-trained physicians. The program allows doctors trained abroad to obtain a limited, supervised license to work in a designated shortage area. After a period of assessment and after passing all required U.S. medical exams, they can progress to a restricted license for independent practice in that shortage area, and eventually, to a full, unrestricted license. It’s a pragmatic approach that could connect underserved communities with qualified doctors who are currently sidelined by licensing hurdles.

URI’s medicinal garden offers up-close look at the roots of modern medicine, open to the public

Learning from some very old school medicine

Kristen Curry

URI’s Youngken Medicinal Garden offers an up-close look
at the roots of modern medicine and is open to the public
for both formal and self-guided tours. (URI Photo)

We don’t know if Heber W. Youngken Jr. was a Joni Mitchell fan but his namesake garden at the University of Rhode Island neatly reverses her 1970 hit, replacing a parking lot with a paradise.

The garden is named after the College of Pharmacy’s founding dean, a pioneer in the study of medicinal plants. Now, with 300 medicinal plants, the courtyard and garden are a living art installation on the URI campus. It’s also one of the largest established medicinal gardens in New England, showcasing plants that help treat diseases ranging from anxiety to heart disease to cancer.

Elizabeth Leibovitz, medicinal garden coordinator in URI’s College of Pharmacy, would like to welcome more visitors to explore the garden.

Good medicine

Undergraduate pharmacy students harvest plants from the garden,
then head to the chemistry lab to identify medicinal components.
(Photo Matthew Bertin)

Gardens are good medicine with ‘outdoor therapy’ increasingly recognized as a useful antidote to a stressful day or news cycle. During the school year, Leibovitz is busy as a resource for students and faculty in URI’s Medicinal Garden, but she is also available to share her knowledge with visitors at any time of the year.

The medicinal garden lies between Woodward, Avedisian and Tyler Halls, where that former parking lot used to be. The garden was originally started near Fogarty Hall in 1957 by Youngken, URI’s first dean of pharmacy. He wanted students to know and understand pharmaceutical plants, many of which have a long history for treatment or use. Today, the garden is an outdoor classroom for URI pharmacy classes.

Trump Voters Wanted Relief From Medical Bills.

Surprise! For Millions, the Bills Are About To Get Bigger.

Noam N. Levey 

Donald Trump rode to reelection last fall on voter concerns about prices. But as his administration pares back federal rules and programs designed to protect patients from the high cost of health care, Trump risks pushing more Americans into debt, further straining family budgets already stressed by medical bills.

Millions of people are expected to lose health insurance in the coming years as a result of the tax cut legislation Trump signed this month, leaving them with fewer protections from large bills if they get sick or suffer an accident.

At the same time, significant increases in health plan premiums on state insurance marketplaces next year will likely push more Americans to either drop coverage or switch to higher-deductible plans that will require them to pay more out-of-pocket before their insurance kicks in.

Smaller changes to federal rules are poised to bump up patients’ bills, as well. New federal guidelines for covid-19 vaccines, for example, will allow health insurers to stop covering the shots for millions, so if patients want the protection, some may have to pay out-of-pocket.

The new tax cut legislation will also raise the cost of certain doctor visits, requiring copays of up to $35 for some Medicaid enrollees.

And for those who do end up in debt, there will be fewer protections. This month, the Trump administration secured permission from a federal court to roll back regulations that would have removed medical debt from consumer credit reports.

That puts Americans who cannot pay their medical bills at risk of lower credit scores, hindering their ability to get a loan or forcing them to pay higher interest rates.

Six Months Into His Presidency, Trump Has Created a Global Humanitarian Catastrophe

Deaths from disease and famine have already begun and it's more than Gaza

Olivier De Schutter for Common Dreams

Photo: Mohammad Abu Samra for the IRC

As the UN’s independent expert on poverty, I am no stranger to harrowing statistics. 

But few numbers have shaken me like those emerging in the wake of the Trump administration’s suspension of U.S. foreign aid. According to new estimates published in The Lancet, these funding cuts could result in more than 14 million deaths by 2030, a third of them young children.

These deaths will not be the result of droughts, earthquakes, pandemics, or war. They will be the direct consequence of a single, lethal decision made by one of the wealthiest men to ever walk this planet.

On his first day back in the White House, Donald Trump handed a death sentence to millions of people. Hours after taking office on January 20, 2025, he signed Executive Order 14169, ordering a pause on billions of dollars of foreign aid under the guise of a “90-day review” to ensure aid was aligned with his “America First” approach.

Six months later, the U.S. Agency for International Development (USAID) has been dissolved, and the entirety of America’s global humanitarian aid workforce will be terminated over the summer. The findings of the “review” have not been published.

FDA Layoffs Could Compromise Safety of Medications Made at Foreign Factories, Inspectors Say

With Bobby Junior protecting us, who needs inspectors?

By Victoria Malis, Katherine Dailey and Sadie Leite, Medill Investigative Lab, and Debbie Cenziper and Megan Rose, ProPublica

Inspectors charged with safeguarding America’s drug supply say they are reeling from deep cuts at the Food and Drug Administration despite promises by the Trump administration to preserve the work of the agency’s investigative force.

Dozens of people who help coordinate travel for complex inspections of foreign drug-making factories have been let go, and though some have since been rehired, inspectors said the ongoing strain of policing an industry spread across more than 90 countries has exhausted staff and could compromise the safety of medications used by millions of people.

For years, inspectors have uncovered dirty equipment, contaminated supplies and fraudulent testing records in some overseas factories — serious safety and quality breaches that can sicken or kill consumers. Last month, ProPublica reported that a generic immunosuppression drug for transplant patients could dissolve too quickly when ingested, increasing the risk of kidney failure. The drug was made at an Indian factory with a history of quality violations that was banned from the U.S. market. The company previously told ProPublica it believes the medication is safe.

In April, more than 3,500 FDA employees were laid off under U.S. Department and Health and Human Services Secretary Robert F. Kennedy Jr., a roughly 15% reduction in force. “We aren’t just reducing bureaucratic sprawl. We are realigning the organization with its core mission and our new priorities in reversing the chronic disease epidemic,” Kennedy said.

TACO Trump is back on his destructive tariff spree

An embarrassing exercise in economic and diplomatic futility

Stephen Robinson

Donald Trump just escalated his mindlessly self-destructive trade war against our (former) economic allies — again.

On July 7, Trump sent rambling letters informing 14 nations, including major trading partners Japan and South Korea, that the US government was slapping them with significantly higher tariffs as of August 1. 

These tariffs are separate from his previously announced sectoral tariffs on automobiles, steel, and aluminum. (This week, he also announced a 50 percent tariff on copper imports for August 1.) 

Trump sent more letters sporadically through the week, with an especially bonkers one to Brazil threatening a 50 percent tariff if the government proceeds with its prosecution of Trump’s partner in coups, Jair Bolsonaro.

Then, Trump announced a new 35 percent tariff on Canada, citing debunked claims about the country turning a blind eye to fentanyl flowing into the United States.

Trump’s new August 1 deadline is completely arbitrary, and his tariff numbers aren’t grounded in any rational economic policy. As everyone seems to understand but the president and his sycophants, these new tariffs will result in increased prices on goods Americans need and can’t magically produce ourselves. Other nations won’t shoulder the costs from tariffs. We will.

The letters all read mostly the same, like shockingly incoherent spam e-mails with the recipient’s name in an obviously different font. They are filled with alarming typos, random Capitalization, and sloppy errors. For instance, Trump’s letter to Željka Cvijanović, the chairwoman of the presidency of Bosnia and Herzegovina, begins with “Dear Mr. President.”

Two DiMario bills get passed

South Kingstown Senator Alana DiMario bills on ADHD drugs and PFAS in fertilizers pass

Lawmakers approve bill allowing 90-day prescriptions for ADHD medications 

The General Assembly today approved legislation sponsored by Rep. Michelle McGaw and Sen. Alana M. DiMario to help relieve a burden on patients, parents and physicians by tripling the amount of non-opioid, non-narcotic Schedule II prescription drugs — including most commonly prescribed ADHD medications — that can be dispensed at one time.

The legislation (2025-H 5866B, 2025-S 0795), which now heads to the governor’s office, will allow up to a 90-day supply of such drugs to be dispensed at a time.

Currently, Schedule II drugs are limited to a 30-day supply. The result is that those who rely on such drugs for chronic conditions such as ADHD must contact their prescriber every 30 days, and the prescriber must then contact the pharmacy to provide authorization. If the pharmacy does not have the proper dosage of the drug in stock, the pharmacy must notify the patient, and then the patient or prescriber must find a pharmacy that does and repeat the process.

Over the last two years as the nation has experienced a shortage of the prescription drugs to treat ADHD, the 30-day limit has meant a time-consuming monthly hassle for those who rely on them, sometimes resulting in hours of phone calls and long drives to locate a pharmacy that has the drug at the proper dosage in stock.

Neronha outlines fix for R.I.’s broken health care system

Litigation, legislation, collaboration 

By Alexander Castro, Rhode Island Current

Photo by Alexander Castro/Rhode Island Current

Rhode Island Attorney General Peter Neronha took a break Wednesday from his breathless legal pursuit of President Donald Trump’s administration to chase a different foe: pharmacy benefit managers, or PBMs.

“The cost of drugs is astounding,” Neronha told reporters gathered at his South Main Street office in Providence. “Pharmacy benefit managers…operate in a very secretive and shrouded way…Because they have 80% of the market, they’re able to use that market power to drive drug prices sky high and keep that difference.”

A lawsuit filed Tuesday in Rhode Island Superior Court against three of the nation’s biggest PBMs — CVS Caremark, Express Scripts, and OptumRx — is perhaps the sharpest prong among many in a sweeping plan to restructure the way Rhode Island funds health care unveiled Wednesday morning. All of the initiatives in Neronha’s heavy slate of proposals are meant to remedy what Neronha called a “spectacular failure” that has been years in the making.

“It was looming then,” Neronha said Wednesday of the state’s health care crisis when he took office in 2019. “It’s here now.” 

In about 34 minutes of opening remarks, Neronha detailed his office’s new list of efforts to effect major change, from boosting mediocre Medicaid reimbursement rates to filling absences in primary care practices. The entire plan is available on a new website, titled “A Way Forward,” which went live during the press conference.

Trump pulls US out of world agreement to fight pandemics

World Health Assembly adopts Pandemic Agreement, ups funding for WHO

Lisa Schnirring

In a historic development, the World Health Assembly (WHA) at its plenary session today adopted a Pandemic Agreement, which is designed to better prepare the world and form a more equitable response to the next pandemic.

The WHA, made up of World Health Organization (WHO) member states, is the WHO's decision-making body. Yesterday, the Pandemic Agreement passed the committee A with 124 voting in favor, none against, and 11 abstaining.

In the making for 3 years, the agreement has been the subject of intense negotiations by the Intergovernmental Negotiating Body appointed by WHO member states. In a WHO statement today, Teodoro Herbosa, MD, secretary of the Philippines Department of Health and president of this year’s WHA, said, now that the agreement has passed, health leaders must urgently implement its key elements, which include systems to ensure more equitable access to life-saving pandemic-related health products.

"As COVID was a once-in-a-lifetime emergency, the WHO Pandemic Agreement offers a once-in-a-lifetime opportunity to build on lessons learned from that crisis and ensure people worldwide are better protected if a future pandemic emerges," he said.

Pharmacists Stockpile Most Common Drugs on Chance of Targeted Trump Tariffs

You should consider doing the same as a hedge against supply chain disruptions especially for generics

Jackie Fortiér and Arthur Allen 

In the dim basement of a Salt Lake City pharmacy, hundreds of amber-colored plastic pill bottles sit stacked in rows, one man’s defensive wall in a tariff war.

Independent pharmacist Benjamin Jolley and his colleagues worry that the tariffs, aimed at bringing drug production to the United States, could instead drive companies out of business while raising prices and creating more of the drug shortages that have plagued American patients for several years.

Jolley bought six months’ worth of the most expensive large bottles, hoping to shield his business from the 10% across-the-board tariffs on imported goods that President Donald Trump announced April 2. Now with threats of additional tariffs targeting pharmaceuticals, Jolley worries that costs will soar for the medications that will fill those bottles.

In principle, Jolley said, using tariffs to push manufacturing from China and India to the U.S. makes sense. In the event of war, China could quickly stop all exports to the United States.

“I understand the rationale for tariffs. I’m not sure that we’re gonna do it the right way,” Jolley said. “And I am definitely sure that it’s going to raise the price that I pay my suppliers.”

Squeezed by insurers and middlemen, independent pharmacists such as Jolley find themselves on the front lines of a tariff storm. Nearly everyone down the line — drugmakers, pharmacies, wholesalers, and middlemen — opposes most tariffs.

Slashing drug imports could trigger widespread shortages, experts said, because of America’s dependence on Chinese- and Indian-made chemical ingredients, which form the critical building blocks of many medicines. Industry officials caution that steep tariffs on raw materials and finished pharmaceuticals could make drugs more expensive.

Why Do Americans Pay More for Prescription Drugs?

Big Pharma profit

By David Armstrong for ProPublica

Source: Public Citizen

In the U.S., the price of Revlimid, a brand-name cancer drug, has been increasing for two decades. It now sells for nearly $1,000 a pill. In Europe, the price has been consistently lower — in some countries by two-thirds.

I started reporting on Revlimid after I was prescribed the drug following a diagnosis of multiple myeloma, an incurable blood cancer. Stunned by the high price, I found that the drugmaker, Celgene, had used Revlimid as its own personal piggy bank for more than a decade, raising the price in the U.S. whenever it saw fit.

Even with lower prices in Europe, Celgene still made a profit there, a former executive told Congress. That added to the more than $21 billion in net earnings the company made after Revlimid was introduced in 2005.

Of course, Revlimid isn’t the only drug with a price disparity. Americans pay more in general for prescription drugs than people in other wealthy countries. And costs keep going up, saddling patients with crippling debt or forcing them to choose between filling prescriptions or buying groceries. So why do we pay so much more? And is anything being done about it?

In most other wealthy countries, governments set a single price for a drug that is usually based on analysis of the therapeutic benefit of the medicine and what other countries pay. In the U.S., drug companies determine what to charge for their products with few restraints. Insurance companies can refuse to cover a drug to try to negotiate a lower price, but for some diseases like cancer, that poses a risk of public backlash. 

Legislators unite across party lines to protect 340B discount prescription program

Under-the-radar drug discount program helps make medicine more affordable 

Rep. Jon D. Brien, Rep. Megan L. Cotter and Rep. Marie Hopkins —an independent, a Democrat and Republican from three very different areas of the state — are joining forces to call for the passage of legislation to prevent practices that subvert a critical prescription drug discount program.

The legislation (2025-H 5634), sponsored by Representative Brien and cosponsored by Representatives Cotter and Hopkins, prohibits insurers, pharmacy benefits managers and other payors from engaging in discriminatory practices against community hospitals, clinic and other health care provider agencies that purchase prescriptions through the federal 340B discount program.

The 340B program is a lifeline for community health centers, safety-net hospitals and rural clinics. It allows them to purchase medications at reduced prices and reinvest those savings into direct patient care — providing things like primary care, behavioral health, dental services, and addiction treatment to tens of thousands of Rhode Islanders, regardless of income or insurance status. 

Under 340B, prescription drug manufacturers must enter a pharmaceutical pricing agreement that discounts the drug for qualified entities that serve vulnerable populations, in order to have the drug qualify for coverage by Medicaid and Medicare Part B.

The 340B discount doesn’t rely on taxpayer dollars. It’s a self-sustaining program that makes health care more accessible and more affordable.

But over the past few years, some pharmaceutical companies and pharmacy benefit managers (PBMs) have undermined the intent of the program. They’ve limited which pharmacies providers can work with, imposed unfair restrictions, and reimbursed 340B providers less—sometimes solely because they’re using a discount program designed to help patients.

Which are the worst states with drug problems?

Red states, heal thy selves

Rhode Island comes in at 21st (whew) just missing making this list. Connecticut ranks 48th

Trump's next target: generic drugs

The drug plans for most Americans require use of generics instead of brand names so expect big price hikes

By Sasha Abramsky, Truthout

Over the last couple of weeks, even as tariffs have wreaked havoc on markets around the world, President Donald Trump and U.S. Commerce Secretary Howard Lutnick have repeatedly teased the notion of slapping hefty tariffs on imported pharmaceuticals. Lutnick has said these are likely to be introduced before the summer.

Trump’s rationale for placing tariffs on medical drugs is, like most of his other major policy initiatives, framed around national security: It makes no sense, he says, to be reliant on other countries for supplies of medicines.

Certainly, in the long run, it would be a good thing for the U.S. to have the capacity to make more of its own medicines, not least so that in a pandemic, when supply chains break down, people can still access medications stateside.

However, whatever the merits of that argument, Trump’s plan will make a bad situation worse. One can’t simply will the infrastructure and supply chains for the production of large amounts of medicines into existence overnight.

The U.S. has a good base for manufacturing branded medicines — those under patents — but generic drugs are overwhelmingly produced overseas. Last year, according to the United Nations trade database, the U.S. imported a whopping $213 billion worth of pharmaceutical products.

In reality, if Trump slaps tariffs on pharmaceuticals made in India and other global hubs for medicine manufacturing, patients in the U.S. will have to pay more for their generic medications. Or manufacturers will simply choose to export their drugs elsewhere, resulting in shortages of medicines; that’s what has happened in post-Brexit Britain, where at times even basic drugs have been in short supply in recent years, and where growth in medication imports has been lower than for any other G7 nation.

Since many insurance formularies either don’t cover the non-generic patented drugs made in the U.S. or charge patients huge co-pays for these medications, even if the supply could be ramped up to cancel out the hit to generics, the price tags would likely be unaffordable for tens of millions of people.

Supreme Court will decide on right-winger case to end coverage for preventative care

Court to hear challenge to ACA preventative-care coverage

By Amy Howe

The court will begin its April session today with Kennedy v. Braidwood Mgmt. (Katie Barlow)

The Supreme Court will hear oral arguments on Monday in yet another dispute over the separation of powers. The case is a challenge to the constitutionality of the structure of a relatively obscure section of the Department of Health and Human Services. But although the issue may sound like a technical one, the court’s ruling could have real-world implications for U.S. patients – particularly those who use the highly effective HIV-prevention drugs at the center of the dispute.

Under the Affordable Care Act, health insurers and group health plans must cover “preventive health services” at no additional cost to the patient. The Affordable Care Act does not specify what those “preventive health services” are. Instead, the law gives the U.S. Preventive Services Task Force – an independent panel of experts – the power to determine which preventive services insurers must cover.

The task force is made up of 16 volunteers, each of whom serves a four-year term. Members of the task force and their recommendations are required by law to be “independent, and to the extent practicable, not subject to political pressure.”

The task force’s recommendations for required preventive-care services include contraception, cancer screenings, statin medications, and human-papilloma-virus vaccines. In June 2019, the task force recommended that pre-exposure prophylaxis, known as PrEP, medicine that is highly effective at preventing HIV, be included as a mandatory preventive-care service.

EDITOR'S NOTE: I benefit personally from this provision of the ACA by getting my statin prescription for free - a savings of $120 a year. I also get annual vaccinations and cancer screenings at no cost. The religious fanatics who brought this case have no idea how much damage this can do.  - Will Collette

The plaintiffs in this case are four individuals and two small businesses that have religious objections to the requirement that insurers and group health plans provide coverage for PrEP. They believe the drug coverage “encourage[s] homosexual behavior, intravenous drug use, and sexual activity outside of marriage between one man and one woman.” The lead plaintiff, Braidwood Management, is a Christian-owned business that provides health insurance to its 70 employees.

Tariffs on Canadian drugs will strain US supply chain

How a malignant narcissist handles America's med supply

Stephanie Soucheray, MA

Donald Trump’s trade tariffs on Canadian pharmaceuticals are expected to increase costs in the United States and strain drug supply chains, according to an analysis published in the Journal of the American Medical Association (JAMA).

Pharmaceuticals will no longer be exempt from the Trump administration's 25% tariff on goods produced in Canada.

Writing in a research letter, scientists at the University of Toronto and their colleagues at Hertie School in Berlin and at the University of Pittsburgh, say the United States imports 400 different ready-for-use medications from Canada, 28 of which have no alternative supplier. 

Though not the largest source of medical drugs in the United States, Canada represents a significant player in the drug landscape. 

Straining this supply chain could trigger drug shortages and jeopardize patient care.

"The proposed tariffs could affect a wide range of medications, from antibiotics to mental health treatments," said Mina Tadrous, PharmD, PhD, lead author and assistant professor of pharmacy at the University of Toronto, in a university press release. "Straining this supply chain could trigger drug shortages and jeopardize patient care. We know that drugs with only one manufacturer and rapidly shifting supply chains increase the risk of shortages."

Potential $750 million cost increase 

In a comprehensive analysis of US pharmaceutical sales in 2022 and 2023 based on the National Institutes of Health's DailyMed package inserts database, the authors found that 22,082 drug products were sold in the US market from the fourth quarter of 2022 to the third quarter of 2023, of which 411 (1.9%) were manufactured in Canada, representing $3 billion in sales.

Of the 411 Canadian drug products, 79% (323) were generic, and 21% (88) were brand-name products, including 20 (4.9%) under patent protection. Also, drugs with final production in Canada result in a subset of the pharmaceuticals, which would be subject to tariffs. 

"We estimate that $3 billion in US pharmaceuticals depend on Canadian manufacturing, with 25% tariffs adding $750 million in cost," the authors wrote. "Extending tariffs to larger suppliers (eg, China, India, Europe) could worsen the predicted effects, providing rationale for pharmaceuticals being exempt from tariffs to avoid increasing health care costs and worsening disruptions in US supply."

Tadrous said the authors recommend that pharmaceuticals should be exempt from tariffs to prevent higher healthcare costs and worsening supply chain disruptions. 

"Our work highlights that perhaps the U.S. should consider removing medications from its list of imports, in line with previous tariffs, to avoid disruptions to supply chains and potential shortages that may affect U.S. patients," he said.