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Shortage Effects on Clinical Trials and Future Hopes, 2. Active ingredients for European products are made at 4420 sites in India, 2794 in China, 1936 in Europe, and 599 in the US.9 Medicines are cheaper to make in developing countries, but disruptions to infrastructure are more likely, distant factories are difficult to inspect frequently, and long supply chains are fragile. } Troy Trygstad, PharmD, MBA, PhD: So, Erin, again, you travel the country working on these issues. Erin Fox, PharmD, BCPS, FASHP: Yes. In order to understand what is causing drug shortages and to enable evaluation of potential solutions, ASPE conducted an analysis of the underlying factors that lead to periods of shortage in the prescription drug market. Troy Trygstad, PharmD, MBA, PhD: It is fair to say that there are more single points of failure today in the supply chain than there were in the past, when they might have been buffered by 2, 3, or 4 folks in the marketplace. Troy Trygstad, PharmD, MBA, PhD: Where do most active pharmaceutical ingredients come from? border-radius: 0; ISPE is also concurrently conducting a study on clinical trial packaging to help industry better understand how packaging and labeling of clinical trial medicines is viewed from the perspective of patients. */ All of those additional materials can pose some manufacturing problems. [CDATA[/* >