News Release

Health professionals must engage in the fight for fairer trade

Peer-Reviewed Publication

The Lancet_DELETED

"There is no denying that trade is a political issue. It is perhaps for this reason, and because many health professionals perceive trade as a complex, unrelated, or remote factor in their practice and busy working lives, that the health sector has traditionally avoided getting involved in trade debates. But the fact that trade directly and indirectly affects the health of the global population with an unrivalled reach and depth undoubtedly makes it a key health issue that the global-health community can no longer ignore." These are the opening words of the introductory Comment to The Lancet Series on Trade and Health, written by Lancet Editor Dr Richard Horton and Senior Editor Dr Rhona MacDonald.

They say: "Unfortunately, to date, the health sector has been a strikingly absent advocate in fighting for a fairer trade system... if doctors are to provide the best care for patients in their own countries, in addition to caring about the health of the global population, there is little excuse for the health sector to continue to neglect trade." They conclude: "Health professionals need to become engaged in the fight for a fairer trading system so that health has a chance of being considered as important as wealth. Our Series on trade and health is a first step in engaging health workers and health policy makers in trade issues. But we want to do more."

In the second Comment accompanying The Lancet Series on Trade and Health, Nobel Prize winner Dr Joseph Stiglitz, Columbia University, New York, USA, discusses intellectual property and patents, and the resultant inequality that results for poorer countries.

He says: "The fundamental problem with the intellectual property (patent) system is simple: it is based on restricting the use of knowledge. There is no extra cost associated with an additional person gaining the benefits of knowledge. Restricting knowledge is thus inefficient, but the patent system also grants (temporary) monopoly power, which gives rise to enormous economic inefficiencies... drug companies spend far more money on advertising and marketing than on research, far more on research for lifestyle drugs than on life-saving drugs, and almost no money on diseases afflicting the poor countries, such as malaria. The reason is economics: companies direct their research where the money is, regardless of the value to society. Poor people cannot pay for drugs, so there is little research on their diseases, no matter what the costs to society."

He concludes: "These adverse effects of trade liberalisation, and trade agreements on health are not inevitable. They are the result of how we have managed trade—to enhance profits of the drug companies, not to enhance the health of those in the developing countries. As I, and Richard Smith and other colleagues in another paper in this Series, have proposed, we can reform our trade regimes and the way we finance and encourage research into drugs so as to improve health—and even lower costs."

In the third Comment which accompanies The Lancet Series on Trade and Health, former Thailand health minister Mongkol Na Songkhla looks back on his nation's issuing of compulsory drug licences so that its poorest HIV sufferers could have access to vital antiretroviral drugs. Despite the action being perfectly legal under TRIPS flexibilities, it was a project that incurred retaliation and pressure from richer nations, eager to protect the trade interests of the big pharmaceutical companies.

He says: "While Thailand, with worldwide support from civil-society groups and academics, was battling against trade sanctions and threats imposed by the greater economies, inadequate support was provided by WHO and the World Trade Organization." He also refers to the double-standards seen in compulsory licensing When the USA and Canada used it for ciprofloxacin in response to the increasing threat of anthrax terrorism, they did not face sanctions.

But the actions of the Thai government have seen essential drugs reach many of their poorest citizens. Mr Songkhla says: "The information provided by the National Health Security Office indicates substantial improvement in access to medicines from the use of compulsory licensing. In September, 2008, for instance, the number of Thai people with HIV/AIDS and taking efavirenz in the public sector was 20 000, compared with only 5000 if the generic version had not been prescribed in the compulsory licensing plan."

He concludes: "While Thai patients benefit significantly from the use of TRIPS flexibilities, it is a moral imperative and global responsibility to ensure better access to essential medicines in other resource-poor countries. To achieve that goal, I call for policy coherence between global trade and health institutions—to put the human faces into their policy decisions."

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Lancet Press Office T) +44 (0) 20 7424 4949 E) pressoffice@lancet.com

Dr Joseph E Stiglitz, Columbia University, New York, USA T) +1 917 570 2069 /+1 212 316 0119 / +1 212 854 1481 E) stiglitzpress@gmail.com

Mongkol Na Songkhla, Ministry of Public Health, Bangkok, Thailand contact by e-mail E) mongkol@health.moph.go.th

For full Comment section see: http://press.thelancet.com/tradeandhealthcomments.pdf


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