Future Physicians Call for Transparency in Global Pharmaceutical Policy

By Mary Carol Jennings

In the setting of the upcoming elections, my Senator, Jim DeMint, recently wrote a letter of opinion to the Washington Times opposing a global HIV/AIDS, tuberculosis and malaria bill that will provide life-saving medications and prevention against infectious disease in the developing world.  Though the White House and a broad bipartisan coalition of legislators and community groups support this bill, his statements suggest that he considers this bill a superfluous, expensive government investment. 

When DeMint has called for our leaders to reduce the programâs funding beyond the scope, even, of his own countering bill, he also calls against extensive grassroots efforts based in South Carolina â his own constituents. Though every Senator has the right to block a bill, my Senatorâs radical stance, out of touch with the desires of his base, threatens the democratic process to which the heart of America is so attuned.

In sorting through recent developments in the world of pharmaceutical policy, a parallel failure of democracy presents itself. 

The 1995 World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property, or the TRIPS Agreement, sets provisions aimed at protecting Intellectual Property: patents on information, on research, on pharmaceuticals â including the medications that funding for PEPFAR will be used to provide to patients. However, as developing countries begin to invest in local pharmaceutical industry, it becomes apparent that these provisions often prevent competition between generics and name-brand equivalents. When patients have no choice between an expensive brand-name drug or an affordable generic drug, pharmaceutical industry interests are represented at the expense of patient interests.  

The original Trade Act of 1974 was enacted to create a private industry role for advising the U.S. President on international trade policy and negotiations. A set of 26 boards now advises the Office of the United States Trade Representative, or the USTR, which advises the President. These committees are tasked with ensuring that U.S. international trade policy represents a broad rangeâfrom public health to that of private corporate industryâof vested interests.

As I would like to bring the attention of the people of South Carolina to bear on a certain stance of Jim DeMint, in 2005 the Center for Policy Analysis on Trade and Health, or CPATH, brought to public attention the non-representative nature of the USTR advisory committees. CPATH and a group of experts analyzed these panels and found only the incidental public health representative â but realized that many slots were filled with delegates with strong ties to the pharmaceutical industry and large corporations.

Upon this realization, the public health advocacy community initiated a comprehensive campaign, demanding a voice for the public health community on key health-related committees advising the USTR. CPATH made known they would file suit if no increase was made in the transparency and public accountability of the process through which new drug policies are set.

Since 2005, the nominations process for public health representatives has been opened, and nominations for public health representatives have poured in from civil society groups.  But not until 2007 was the first âpublic healthâ voice selected: a lawyer with a Masters of Public Health degree named Michelle Forzely. She has been affiliated with the Global Health Council (GHC) as a consultant for a few years, but it remains unclear why this group was the one chosen to have a representative, and unclear why a consultant, rather than a member or leader, was selected to represent public health for the GHC.

Nonetheless, with the appointment of this consultant, the USTR admitted the need for a public health voice in American international trade policy. In her representative capacity, Ms. Forzley serves as a member of Industry Trade Advisory Committee on Intellectual Property Rights, ITAC 15, but most members of the Global Health Council are unaware her role existsâand unaware of her strong history of ties to the pharmaceutical industry.

Ms. Forzleyâs website cites a focus on âCombating Corruption in the Pharmaceutical Sectorâ, but her expertise in this area is in anti-counterfeiting work, with little regard to the public health interest of regulating corruption to control costs for life-saving medications. Counterfeit drugs are a serious threat to public health, but laws regulating and penalizing their distributors must be created and administered separately from those governing the manufacture and distribution of affordable, life-saving generic medications: these are two very different issues.

In short, this appointment for the GHC representative is a start, but perhaps an inadequate solution. A piece of legislation introduced last August 2007 by Representative Van Hollen (D-MD) with Representative Waxman (D-CA) as a key co-sponsor calls for ensured public health representation on the U.S. trade advisory boards.  As Congress involves itself in increasing the transparency of American trade policies, groups like CPATH must continue to expose opportunities to increase the voice of advocacy for public health, and grassroots groups must continue to support and join this call.

Though we know that DeMint was elected to represent South Carolina, he will only act in a truly representative manner if he takes steps to ensure that his actions and untenable position on HIV/AIDS are not a target of a broad national coalition organizing demonstrations to support the passage of PEPFAR in Washington D.C., Chicago, and Boston on June 26th.

When American leaders attend the G8 summit in Japan this July, the voices of public health must demand that the small group of Senators that Jim DeMint has identified himself with will not stand in the way of advancing Americaâs investment in global public health with a $50 Billion investment in sustainable leadership to fight HIV/AIDS, Tuberculosis and Malaria.

Mary Carol Jennings is the Jack Rutledge Legislative Director for the American Medical Student Association (AMSA), based in Washington, DC. As AMSA's health policy fellow, she is taking leave between her third and fourth years of medical school at the University of South Carolina School of Medicine to work on both legislative and advocacy approaches to extending health care access to all people.