This is not intended to be a political commentary.

The present administration is, in my view, assiduously attempting to return the United States to an introspective, insular nation. Whether that proves beneficial in the long run is something on which I will not comment. Benefit and detriment, however, given our role in the world, need to be measured not just on a domestic scale, but on a global scale. While not without its flaws, I think few appreciate the significant advantages of the "global village" concept. However, the immediate consequences of many of the current administration’s policies, particularly tariffs, will have fairly significant consequences. A particular concern is the escalating trade conflict with China, specifically, with regard to export of rare earth elements which directly impact health care.

There are 17 rare earth elements. The export of seven of these from China has been suspended. This suspension occurred on April 4, 2025. Rare earth elements are quite a challenge to mine and difficult to separate. China currently mines 70% of all rare earth elements (Myanmar, Australia, and United States making up the remainder), and processes 90% of them. The processing is quite complicated, frequently requiring more than 100 steps. In the case of two particular rare earth elements, dysprosium and terbinium, used for heat resistant technology, China processes 99.9% of them. On May 12, the United States and China agreed to reduce tariffs, but China noted an exception: rare earth export controls apply to all countries. Therefore, rare earth exports are not subject to tariff agreements. Additionally, while the particular company is entitled to apply for permission to receive these exports, the application takes a minimum of 45 days. The impact of this action has been felt in the past—in 2010 China halted all rare earth exports to Japan, with Japan nearly running completely out of materials.

Why should those involved in health care be concerned? The restriction of export of three rare earth elements will directly affect health care around the world. Lutetium (Lu 177) is a radiopharmaceutical agent used in oncology. Yttrium targets radiological procedures. In the world of spine, restrictions on gadolinium exports may be significant. Gadolinium is the central component in gadiolinium-based contrast agents (GBCAs). Currently, GE Healthcare (Chicago, Illinois) has reported that they have an "extended inventory." Bayer (Munich, Germany) expects no immediate impact due to their "diverse network" of suppliers. Additionally, Bayer is actively engaged in developing GBCAs that will use up to 60% less gadolinium.

This sort of forward thinking will, hopefully, prevent the inevitable price increases in the short-term that will result should this so-called Trade War continue. Whether this will be a speed bump or a complete halt to traffic is, at this point, unclear. What is clear is that, yet again, the cost of health care will increase, the availability of crucial resources will decrease, and access to quality health care worldwide will once again suffer.