The FDA has banned imports of 28 drugs manufactured by Ranbaxy Laboratories after it discovered quality issues at two manufacturing facilities. Ranbaxy is one of world’s largest generic drug manufacturers. Its corporate offices are in Gurgaon, India.

The FDA has found no evidence that consumers have been harmed and views its move to be preventative in nature. In particular, FDA tests revealed no evidence of contamination, incorrect potency or unsafe ingredients in drugs produced at offending facilities.

The FDA instituted the prohibition after finding ineffective sterilization procedures, inadequate protections against contamination from allergy-causing ingredients, and incomplete records at the plants.

The FDA can inspect facilities of companies that export products to the US, but it has no regulatory control over them. All it can do is prohibit companies from exporting to the US.

The FDA has been hassling Ranbaxy about its production processes since 2006. Ranbaxy has addressed many but not all issues that the FDA had raised.

The prohibited drugs include those for diabetes, high cholesterol, allergies, acne and high blood pressure. The only drug not produced by other generic manufacturers is ganciclovir. This medication will be allowed into the US after careful inspection and additional assurances from Ranbaxy.

Ranbaxy’s response to the ban is here.

Adm. Mike Mullin, the chairman of the Joint Chiefs of Staff arrived in Pakistan on Tuesday for hastily arranged briefings regarding an incursion September 3 by US commandos based in Afghanistan.

Pakistani military leaders declared recently that they would attack all foreign forces that crossed the border and threatened the country’s sovereignty.

The US is frustrated by Pakistan’s ambivalence regarding Taliban and al Qaeda militants that use its territory as a safe haven for attacks on US and NATO forces in Afghanistan. Until recently, US forces used airstrikes, artillery attacks and Predator drone attacks to deal with insurgents that had fallen back into Pakistan, so the US commando raids into Pakistan represent a change in strategy. Apparently, President Bush gave the go-ahead for commando attacks in July without notifying anyone in the Pakistani military or government.

The US embassy in Pakistan requested that Mullin come in person to discuss matters with Prime Minister Yousaf Raza Gilani and the nation’s top military commander, Gen. Ashfaq Parvez Kayani.

Recently we described how the US health system increasingly relies on foreign medical students to address manpower shortages in general internal medicine. Foreign nurses are streaming into the US for the same reasons, but sometimes things work out unfairly for them.

The US has experienced a nursing shortage for at least the last 15 years. Some predict we will have only 2/3 of the nurses we need to deliver care in 2020. The shortage has prompted 17% of US hospitals to recruit foreign staff, and more than 300 nurse recruiting agencies are out there to help. In 2004, 4% of our RNs were educated abroad; the number is higher now.

But foreign nurses have experienced a gamut of problems in the US: they are posted to jobs below their skill levels, end up working for providers other than the ones they signed contracts with, and occasionally they get unreasonably low salaries.

Now, a coalition of health providers has promulgated a code of ethics designed to shield foreign nurses from unfair employment practices in the US. The voluntary code summarizes relevant employment laws and suggests training and support for these nurses. The code is meant to be used by prospective US employers who might not know what rights foreign nurses have.