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As more lawmakers support importation in response to the rising cost of medicines, four former commissioners of the US Food and Drug Administration wrote an open letter to Congress on Thursday to warn that the idea is “a complex and risky approach.”

The former agency heads argue that routine importation is “likely to harm patients and consumers and compromise the carefully constructed system that guards the safety of our nation’s medical products.” And they maintain that the ‘closed distribution system’ overseen by the FDA ensures that good manufacturing practices are followed and the quality of the supply chain is protected.

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