[Ip-health] Foreign Affairs: A Bitter Pill - Can the Access to Medicines Movement Score Another Victory?

Thiru Balasubramaniam thiru at keionline.org
Tue Oct 20 01:55:04 PDT 2015


SNAPSHOT October 18, 2015

A Bitter Pill

Can the Access to Medicines Movement Score Another Victory?

By Fran Quigley

Mary-Jane Matsolo, wearing tight jeans, gold high-heeled sandals, and a
white t-shirt with navy blue block letters reading “HIV Positive,” strides
to the front of the Johannesburg conference room. “I’m the one who will
make you understand patent laws and intellectual property rights,” she says
to the dozen people gathered before her. “It’s what I do, and I do it very

At Matsolo’s prompting, everyone takes turns explaining why they are here.
One after another, advocates for persons with mental illness, diabetes,
epilepsy, and other diseases bitterly describe how the patients they
represent—and sometimes even they themselves—cannot afford the medicine
they need. A drug for depression and bipolar disorder is unavailable due to
its price; the same goes for medicines to treat epilepsy, cancer, and
reproductive health problems. “Most doctors never tell their patients that
these medicines will help them,” says one advocate. “Why would they, if the
people can’t get the treatment?” Others call out their agreement.

“OK, that’s good,” Matsolo reassures them. “That’s why we are here.” To
start her presentation, she shows the group the back of her t-shirt. It
reads, “Bad Patents = Death.”

Matsolo is a campaign officer for the South Africa-based Treatment Action
Campaign, known as TAC. She was born Nomathansanqua Matsolo in Port
Elizabeth, but her Facebook nickname is “Songbird.” This year, she released
an album entitled “Soul of a Woman,” and the album’s lead single got some
radio airplay in the Cape Town region. At home in front of a crowd,
Matsolo’s chief role at TAC is educating the public about HIV/AIDS. To her,
it is more than a job. A now-deceased older sister was HIV-positive, and
Matsolo watched her struggle with both her health and the stigma that came
with the disease. “Helping my sister and working with TAC turned me into a
teacher, a fighter, a motivator,” she says.

Matsolo’s preferred venues are deep in rural South Africa; her ideal
audience the country’s poorest citizens. Yet the scope of the affordable
medicine challenge has pulled Matsolo out of the countryside and into the
task of training other advocates. The United Nations Special Rapporteur on
the Right to Health estimates that 10 million people die each year because
they do not receive the medicine that would have saved their lives. The
culprits in many of these deaths, Matsolo and her colleagues at TAC say,
are patents on medicines. Patents are government-granted monopolies that
allow the holder to set the price without regard to the cost of manufacture
or fear of competition. Powerful multinational pharmaceutical corporations
hold those medicine patents, and defend them fiercely. TAC has a storied
history of pushing back against these patents and pulling down the price of
HIV/AIDS medicines. But, as the other health advocates in Johannesburg
attest, the prices of other types of critical medicines are still sky-high.

The session in Johannesburg is part of the Fix the Patent Laws campaign.
The campaign is a joint effort in South Africa by TAC and Médicins Sans
Frontières, the Nobel Peace Prize-winning provider of treatment in some of
the world’s most desperate settings. TAC and Médicins Sans Frontières,
known here as MSF, have recruited experts to analyze the current law and
have conducted media workshops explaining what is at stake. Protesters,
some wearing blind-folds to demonstrate the lack of scrutiny of drug patent
applications, have marched on the parliament building. But the
pharmaceutical industry has lobbied the United States to hold back trade
benefits with South Africa if it adopts new policies that do not strongly
protect medicine patents. Meanwhile, in 2014, leaked emails showed that
pharmaceutical companies planned to pay South African community
organizations to demonstrate grassroots opposition to reforms that had been
proposed in parliament. Now, that reform process seems to have stalled.

South Africa is just one country among many facing health crises due to
patented medicines; the World Health Organization reports that more than
one-third of the world’s population has limited access to needed medicines.
Legal protection for patented drugs has been a sticking point for
international trade agreements and is even an issue in the 2016 U.S.
presidential campaign. But it is South Africa that is reliably described as
“ground zero” in the struggle between the drug companies and access to
medicines activists. The biggest reason for the designation is that South
Africa was the site of the pharmaceutical industry’s most stinging defeat.
And TAC was the organization delivering the blow.

TAC soon launched a campaign of civil disobedience, including illegally but
openly importing a generic, and far cheaper, version of the AIDS medicine

As she begins the training, Matsolo spends little time reviewing the
history of activism for access to medicines. For everyone who lives in
sub-Saharan Africa, it is a well-known story. At the turn of the
twenty-first century, HIV/AIDS was rampaging across the continent. Recently
discovered antiretroviral medicine was known to be a hugely effective
treatment for the virus—it was so potent that its impact on patients was
known as the Lazarus Effect. The medicine was in wide use in North America
and Europe, but the high cost of the patented drugs meant that they were
available to just one of every 1,000 Africans infected with HIV. South
Africa was particularly hard hit, with HIV prevalence as high as 25 percent
among women of childbearing age. In the year 2000, more South Africans died
in their 30s and 40s than in their 60s and 70s.

TAC’s initial response was unimpressive. Its first effort, on Human Rights
Day in 1998, consisted of just ten people fasting in front of St. George’s
Cathedral in Cape Town, asking passers-by to sign a petition demanding that
the government provide medicine for pregnant women with HIV/AIDS. But TAC
had excellent organizational genes. Several of its founding members had
been active in the anti-apartheid movement. And the group received further
training from ACT-UP and other veterans of the passionate, dramatic
U.S.-based AIDS treatment campaign of the 1980s and 1990s.

TAC soon launched a campaign of civil disobedience, including illegally but
openly importing a generic, and far cheaper, version of the AIDS medicine
fluconazole. TAC’s co-founder, Zackie Achmat, was HIV-positive and often
ill. But in a dramatic decision that attracted international attention,
Achmat risked his life by refusing to take antiretrovirals until they were
widely available to South Africa’s poor. TAC became known for its spirited
demonstrations, usually including the South African toy-toyi protest dance
and chants around the theme of “Patients Over Patents.”

The iconic HIV-Positive shirts that TAC members and staff like Matsolo
still wear were created when AIDS activist Gugu Dlamini was beaten and
stoned to death after revealing her disease status on a radio show. Based
loosely on the apocryphal story of the King of Denmark wearing a yellow
star in solidarity with Jews during Nazi occupation, the HIV-Positive shirt
is worn by those struggling with the disease and those who aren’t.

TAC was particularly effective at combining mass mobilization with legal
action. When lawyers filed challenges to the high prices charged for
patented medicines or argued for ramped-up government AIDS programming, the
courtrooms were packed, and the streets outside were filled with thousands
of singing, chanting demonstrators. When the International AIDS Conference
was held in Durban in July 2000, TAC led over 6,000 protestors in a march
to the site of the opening ceremonies, taking advantage of the
international stage to pressure the drug companies and governments to
respond to the pandemic.

As TAC’s protests gained increasing attention, pharmaceutical companies
decided to go on the offensive; 39 multinational drug companies filed suit
to stop the implementation of South Africa’s law that opened the door for
international importation of generic medicines. At the urging of the
pharmaceutical industry, the U.S. Trade Representative accused South
Africa’s government of violating international law on intellectual
property. The United States then placed South Africa on a watch list that
suspended some trade advantages. The United States, which is home to five
of the ten largest pharmaceutical companies in the world, also filed a
formal complaint against the government of Brazil over that country’s
program to domestically manufacture AIDS medicine.

TAC and global AIDS treatment activists raised the stakes. Since the United
States was leading the charge against South Africa and Brazil, activists
relentlessly heckled U.S. Vice President and 2000 presidential candidate Al
Gore at his public appearances. They even interrupted Gore’s official
campaign announcement in his hometown of Carthage, Tennessee, chanting
“Gore’s Greed Kills,” until security kicked them out. Activists blocked
traffic outside the Washington office of U.S. Trade Representative Charlene
Barshekfsy. International media began following the story, and pressure
increased on the corporations and the Clinton-Gore administration. On March
5, 2001, the day that oral arguments on the pharmaceutical industry lawsuit
began in the High Court in Pretoria, TAC and other activists launched a
“Global Day of Action” against the drug companies. Marchers in major cities
carried signs saying, “Stop Medical Apartheid.” Others convened a mock
court hearing in front of the offices of GlaxoSmithKline and Bristol Myers
Squibb, finding the companies guilty of murder by blocking affordable
drugs. The activists re-labeled the companies "GlobalSerialKillers" and
"Big Murder Syndicate.”

TAC had created a public relations nightmare for the drug companies. Six
weeks after the global protests, they dropped their lawsuit. Soon after,
the United States withdrew all of its complaints against South Africa and
Brazil. In November 2001, governments at a World Trade Organization
ministerial conference adopted the Doha Declaration, affirming the rights
of nations to take measures to reduce the cost of medicines in response to
public health needs.

Continued protests by TAC forced the drug companies to allow generic
manufacturing and use of their patented AIDS drugs in South Africa. A TAC
legal challenge spurred the country’s government to create a broad HIV/AIDS
treatment plan. Drug prices fell by as much as 90 percent. The resulting
acceleration in treatment availability was breathtaking. In 1999, 20,000
South Africans were on antiretrovirals. Nearly three million are today.
Globally, the President’s Emergency Plan for AIDS Relief and the Global
Fund to Fight AIDS, Tuberculosis and Malaria, initiatives of the Bush
administration, now provide antiretroviral treatment for 16 million people.

It was a heady victory. The New York Times called TAC the most effective
AIDS group in the world. During a visit to an HIV clinic in Khayelitsha,
Nelson Mandela wore the organization’s HIV-Positive t-shirt. TAC was
featured in the documentary “Fire in the Blood,” with the triumphant scene
occurring when Zackie Achmat spoke outside the courtroom after the
pharmaceutical industry dropped its lawsuit. “We have made the mightiest
industry in the world shake in its boots!” Achmat yelled to the cheering

Greeff has seen young South African mothers with cancer go from treatable
to terminal, waiting in vain for the medicine that would have cured them.
“To me, this is a human rights issue,” she says.FEAR FREE

A decade and a half later, the industry seems to be well past its fear of
activists. Achmat and others have moved on from TAC. The historic gains of
the HIV/AIDS treatment efforts have largely held firm, but they failed to
spill over into other health areas. The most dramatic example is cancer,
the longtime enemy of Linda Greeff.

A Cape Town-based social worker, Greeff was a 31-year-old mother of two
young sons when she was first diagnosed with ovarian cancer. Surgeries to
remove tumors and an eventual hysterectomy were successful in addressing
the cancer, but she spent years struggling physically and emotionally.
After her recovery, Greeff and another survivor founded the group People
Living with Cancer. Like most disease-focused organizations, People Living
With Cancer concentrated on non-controversial awareness programs and
support services. It provided a toll-free advice line and a “cancer buddy”
system matching survivors with the recently diagnosed. It happily accepted
funding from drug companies. But Greeff grew increasingly disturbed. She
saw too many cancer patients going without care, despite the existence of
medicine that would ease their pain or even cure their disease. “I can’t
sleep at night knowing there are people out there who cannot get the
treatment they need,” Greeff says.

So she decided to attend this Fix the Patent Laws training, an exercise
that she admits is forcing her out of her comfort zone. Greeff has always
considered herself a helper, not an activist. The complexity of patent laws
intimidates her, as does the prospect of challenging the government and
multinational companies. It is not an unreasonable fear: as soon as Greeff
tentatively began participating in public events that questioned patent
drug pricing, her group lost some of its industry donations.

There have been significant advances in cancer medicines in recent decades.
A particular area of growth is in the area of biologics, which are produced
using living systems such as bacteria, or plant or animal cells. But new
cancer drugs are still under patent in most countries, which translates
into price tags that are unaffordable to the poor. Reminiscent of the
HIV/AIDS pandemic of the 1990s, millions of cancer patients in the
developing world now suffer without treatment.


A mother plays with her child in front of a drugs advertisement at a
shopping mall in Jakarta, October 28, 2008.

As an example, Greeff points out that many South African breast cancer
patients could benefit from trastuzumab, marketed by the drug company Roche
under the name Herceptin. Herceptin is a remarkably effective drug that can
decrease mortality by 30 percent for some types of the disease. Its
development was so impactful that the story was turned into a Lifetime TV
movie starring Harry Connick, Jr. Herceptin has become one of the ten
best-selling prescription drugs in the world, and Roche has made an
estimated $54 billion in revenue from it. But the drug is largely
unavailable for most South Africans, as its patented price is too high for
the government to include in its healthcare system. Greeff has seen young
South African mothers with cancer go from treatable to terminal, waiting in
vain for the medicine that would have cured them. “To me, this is a human
rights issue,” she says.

Like most South Africans, Greeff watched TAC’s aggressive HIV/AIDS
treatment demonstrations and litigation from afar. But now she believes her
cancer advocacy has to follow this same path. “What they have done with
HIV/AIDS—the mass mobilization, the legal expertise, the willingness to be
radical if need be—we need to be doing that now, too,” she says.

Yet it is clear that this broader coalition cannot simply mimic TAC’s
successful struggle for access to AIDS medicines. The messaging in that
fight benefitted from a remarkably straightforward equation: HIV-positive
patients with access to antiretrovirals lived long, healthy lives; those
without the medicine died. In contrast, the current struggle, in South
Africa and beyond, encompasses a dizzying array of medicines and diseases.
Privately, organizers worry that it will be hard to recreate the clear
moral consensus around all medicines. And there is this: although sharply
discounting the price of AIDS medicines was not welcomed by the
pharmaceutical industry, their eventual concessions amounted to a small
slice of their profit margins. The Fix the Patent Laws’ broader challenge
to the drug patent system is a frontal attack on the industry’s entire
business model. “They know we are not going to be quiet now,” Greeff says.
“And they have megabucks to fight us with.


Matsolo decides that it’s time to explain the ground rules for the coming
fight. “Who knows what TRIPS is?” she asks. Blank stares greet her. So
Matsolo describes the1994 Agreement on Trade-Related Aspects of
Intellectual Property Rights, aka TRIPS. Signed by 123 countries, TRIPS
transformed an uneven worldwide patchwork of intellectual property law into
a blanket of standards mandating protection for holders of patents,
copyrights, and trademarks. For patent holders, that protection features at
least 20 years of government-granted monopolies on their products, during
which time no other company or individual can manufacture or import these

Among the governments that have fought for access to affordable medicines,
India has been far and away the most successful.For medicines, TRIPS
radically changed the status quo. In most societies, there was little
precedent for patent monopolies to be granted to necessities like medicine.
For example, Germany’s patent law of 1877 labeled medicines as “essential
goods,” along with food and chemicals, and forbade any attempts to patent
them. Well into the latter half of the twentieth century, countries such as
Brazil, India, and Spain had strict limits on patenting medicines. But when
the TRIPS negotiations began in 1986, more than half of the countries
involved either had very limited patent protection for medicines or refused
to grant them at all.

This had become an increasing problem for multinational pharmaceutical
companies. Their industry, which once competed on the basis of
manufacturing innovation and price, had come to rely on the profits of
patented products. At one time in the mid-twentieth century, for example,
Pfizer, had a full 33 percent of its global sales accumulated by just two
patented drugs. So the industry pushed the U.S. government to make
intellectual property protection a priority in all trade negotiations. It
did not take the industry long to find willing partners on Capitol Hill and
in the White House. Drug companies are reliably at the top of the U.S.
lists in both lobbying expenditures and political campaign contributions.
Not surprisingly, the United States was the most passionate advocate for
TRIPS. Wielding its economic might, Washington offered incentives and
threatened trade sanctions until even the most reluctant countries signed

Yet a few nations still insist on following policies that allow for access
to affordable medicines. TRIPS includes some exceptions to its overall
strong pro-patent terms, including permission for countries to issue
compulsory licenses, which allow for generic production of medicines even
if they are under patent. Among the governments that have fought for access
to affordable medicines, India has been far and away the most successful.
So Matsolo introduces the group in Johannesburg to Shailly Gupta, who helps
lead MSF’s access to medicines campaign in India. Gupta is less flamboyant
than Matsolo, but she speaks about medicines with the same no-nonsense
intensity. Gupta hands out business cards with a picture on the back of a
gleaming gold ring, with a single round pill in the spot where a diamond is
usually placed. “Medicines should not be a luxury,” it reads.

Gupta explains that India’s resistance to patenting medicines has allowed
its generic drug manufacturing industry to grow to the point where the
country is known as “the pharmacy of the developing world.” Eighty percent
of the generic medicine used in poor countries is made in India. The Indian
government has set up strict criteria for patentability, and has issued
compulsory licenses for the generic manufacture of several medicines,
including a treatment for liver and renal cancer, which became 97 percent
less expensive after a generic version was made available.

Indian law is particularly tough on the common pharmaceutical industry
practice known as “evergreening.” Evergreening occurs when a new patent is
granted for minor revisions or for new uses of an already patented
medicine, thus extending the corporation’s monopoly control past the
original 20-year period. “It’s just tweaking something on the drug and then
going for a new patent on it,” Gupta says. Using South Africa as an
example, Gupta shows the group how evergreening works: In South Africa, the
company Novartis obtained a patent in 1993 for the drug imatinib, marketed
by the company under the name Gleevec, which treats chronic myeloid
leukemia. Before that patent was scheduled to expire in 2013, Novartis
obtained two additional patents on the drug, one in 1997 for a new form of
the compound and one in 2002 for the use of the drug to treat an
HIV-related infection. The drug is now on patent in South Africa until
2022, 29 years after the original patent was granted.

The South African advocates nod. It is a story they know well. But, Gupta
says, compare your situation with India, where evergreening is blocked by
the country’s patent laws. In 2006, India’s government rejected Novartis’
application for patents on its secondary uses of Gleevec. Without secondary
patents, the medicine costs 91 percent less than the South African version.
When Gupta reveals the price difference, the South African advocates’ eyes
widen. Gupta smiles, not quite able to hide her pride. In her country, 570
million people live on less than $1 per day, she says. Every penny that a
drug price is lowered translates into saved lives.

Novartis fought the Indian patent decision, and the company’s court appeal
mobilized advocates on both sides of the debate. Gupta and her MSF
colleagues collected nearly half a million signatures on a petition
demanding that Novartis drop the case. Thousands participated in street
demonstrations in front of Novartis offices worldwide, often carrying huge
inflatable pills and signs reading” “Novartis: Making a Killing in
Profits.” In 2013, the India Supreme Court rejected Novartis’ challenge and
upheld the country’s anti-evergreening rules.

Novartis’ appeal followed established court procedures. But the
pharmaceutical industry’s vigorous lobbying for maximum patent protection
has at times crossed over into ethically dubious territory. In January,
2014, a leaked email from Merck’s managing director for South and East
Africa, revealed the existence of a plan by as many as two dozen
pharmaceutical companies to direct $600,000 to fund South African front
organizations that would create the illusion of grassroots opposition to
patent law reforms. The ensuing “Pharmagate” scandal earned headlines
across the country. South Africa’s health minister, Aaron Motsoaledi,
angrily condemned the plan. “This document can sentence many South Africans
to death. This is no exaggeration. This is a plan for genocide,” Motsoaledi
told the newspaper Mail and Guardian. A cartoon in the Sunday Times
depicted “Big Pharma” with three divisions: research, profits, and “Third
World Genocide,” the latter led by a scythe-carrying Grim Reaper.


Advocates for access to medicines around the world are closely watching the
Fix the Patent Laws effort in South Africa, but they say that the ultimate
fix needs to be on a global scale. “We just have to get away from the
thinking that the way to fund medicine research is through higher prices
and the granting of monopolies,” says Jamie Love, an economist who directs
the intellectual property advocacy groupKnowledge Ecology International.

Love, a longshoreman-turned-staffer for Ralph Nader, has a blunt approach
that has angered many pharmaceutical companies and sometimes even a few
allies. But he is also a longtime collaborator with TAC, and he played a
key role in the historic HIV/AIDS treatment victory. It was Love who
convinced Indian generic drug manufacturer Cipla to make a dramatic 2001
pledge to manufacture and sell antiretroviral medicines at a cost of $1 a
day. That offer of a 96 percent reduction from the patented price gained
immediate international attention and helped ratchet up the pressure on
both drug companies and governments.

Love and other advocates say that intellectual property law for medicines
should be different from the law covering products like smart phones or
flat-screen televisions. If a consumer cannot afford the patent-influenced
price of the new iPhone or a high-definition TV, they say, that isn’t a
moral challenge, like the one that comes with the impossibly high price tag
on life-saving drugs. Many philosophers and economists agree, saying that
the nations that labeled medicines a public good for generations pre-TRIPS
were right. Jonas Salk, who invented the polio vaccine, refused to patent
it, saying that it belonged to the people. The creator of the first
synthetic malaria vaccine donated the patent to the World Health

Love regularly points out that even the United States, the world’s foremost
promoter of maximum patent protection, ignores patent laws when the need
arises. It has a lengthy record of issuing compulsory licenses for the
production of military technology. When the country was in the grips of the
anthrax scare of the fall of 2011, the government did not hesitate to
threaten Bayer with a compulsory license for its patented drug
ciprofloxacin, considered to be the best available treatment for anthrax

One matter is not in dispute: the pot at the end of the research rainbow is
only filled with gold if the discovered medicine can be sold at profitable
prices.Yet the question remains: Are patents necessary to incentivize
research for new medicines? That is the long-time argument of the
pharmaceutical industry. The companies admit that most medicines can be
manufactured for pennies per dose, but they say that patent-protected
pricing is essential for recouping their investment in research and
development—a number that is hard to pin down. A Tufts University study
estimated that it costs an average of $2.6 billion to bring a drug to
market, but there is a distinct lack of transparency in the private cost
figures, leading to other analysespegging the cost at a fraction of that.
Several state and federal lawmakers have proposed rules that would compel
transparency in the cost of medicine research. Regardless of the true
figure, advocates say, it is clear that drug companies spend more on
marketing and sales than they do on research.

One matter is not in dispute: the pot at the end of the research rainbow is
only filled with gold if the discovered medicine can be sold at profitable
prices. Inevitably, that means pharmaceutical corporations devote the vast
majority of their research to medicines that will be consumed by the
comparatively wealthy. Researchers Adam Mannan and Alan Story have pointed
out that the marketing costs of any of the current high-profile erectile
dysfunction drugs far exceed the global investment in developing a vaccine
for dengue fever, which poses a risk to 40 percent of the world’s
population. And little wonder: Viagra doubled Pfizer’s stock price within
days of its introduction.

Instead of spurring on drug research and development, the current patent
system has been accused of inhibiting it. Patents have the effect of
locking up knowledge, especially with the motivation under current law to
pile up “packet thickets” to discourage potential competitors from entering
the area.

It doesn’t have to be this way, Love insists. “The transformative change
comes with de-linkage,” he says. De-linkage is the term Love and others use
to describe a set of proposals that would break the connection between
medicine prices and the costs of research and development. These include a
variety of incentives such as grants, prizes, drug purchase commitments,
and even crowd-funding of research. Many advocates push for a research and
development treaty that would prioritize neglected diseases and ensure
access to the resulting medicines. This reform doesn’t need to mean the end
of the pharmaceutical industry, Love says “If you do the de-linkage right,
with real rewards for innovation, the companies that are good at innovation
will do just fine,” he says.

Nearly all of these reform proposals anticipate substantial government
investment. But taxpayers, particularly in the United States, are already
paying for the medicine research process. Globally, it is estimated that 30
percent of medicine research and development costs are shouldered by
governments through entities like the U.S. National Institutes of Health,
and another 10 percent by private philanthropy. Yet a 1981 U.S. law has
insured that the patents for even publicly-developed drugs usually end up
in the hands of private entities, meaning that taxpayers also pay for
monopoly pricing at the back-end of the medicine development process.

A recent example has been provided by U.S.-based drug company Gilead, which
prices its patented Hepatitis C drug sofosbuvir, marketed as Sovaldi, at
$1,000 per pill, a 1,000 percent mark-up over manufacturing costs. This
take-it-or-leave-it price tag has caused budget crises at the U.S. Veterans
Administration, which is reportedly spending $1 billion on the Gilead drugs
in the current fiscal year. State Medicaid programs face similar pressures
paying the patent price, and have taken to rationing Sovaldi. Yet the
drug’s development was actually funded by its customers, including the VA,
before Gilead bought the patent. Government payments for the blockbuster
drug pushed Gilead’s profit margin to nearly 50 percent in 2014.

 Such examples seem to be building momentum for reform. In July, 118
leading U.S. cancer physicians co-authored an article in the journal Mayo
Clinic Proceedings, decrying the average $100,000-plus annual cancer
medicine cost. As many as one in every five of their patients don’t fill
their prescriptions because of cost, they wrote. Ayalew Tefferi, a
hematologist at Mayo Clinic and the first signator on the article, told the
Wall Street Journal, “What we’re fighting is the greed.” The cancer
physicians joined an increasingly loud chorus calling for the U.S. Congress
to lift its ban on the Medicare program negotiating prices with drug
companies. U.S. President Barack Obama ran for office under a pledge to
allow the same kind of bargaining that keeps medicine prices lower in other
nations. But the idea was abandoned on the path toward the Affordable Care
Act. “Medicare is a guaranteed market,” Love says. “So the companies are
saying, ‘Let ‘er rip.’”

On the global stage, nearly every non-U.S. party to the proposed
Trans-Pacific Partnership resisted the U.S. Trade Representative’s push for
maximum drug patent extensions. The World Health Organization and other
international bodies are increasingly referring to medicine access as a
basic human right. Some national courts are backing up that argument. “I’m
absolutely optimistic that there can be big changes, and soon.” Love says.
“We just need to get the messaging right, and we need the political
leadership to step up. I mean, the benefits are so obvious.”


Back in Johannesbug, Mary-Jane Matsolo is wrapping up the training. It has
been a whirlwind tour through the TRIPS agreement, South Africa’s problems,
and the legal models in India. “Are we still there?” she asks.

The advocates nod, but several look a bit dazed. “This is a steep learning
curve for me,” Greeff admits later. “But it is good to be in a group: it is
a lonely place to advocate on your own.” The group concludes its sessions
by devising a plan to collect patient stories from their different disease
areas, co-sign an editorial on patent law reform, and send letters to
members of Parliament.

“These are exciting times, man,” Matsolo says later. “For years on these
medicines issues, it’s been TAC, TAC, TAC. Now we can say, ‘Hello, it’s not
just TAC speaking.” She continues, “Look, we know that pharma is a huge
well-oiled machine. That means we need to be an even bigger well-oiled
machine. Our job is to show people the connections. Because once they get
it, the passion, the drive, the fight, the anger—they all come out. We are
in the right, and we will be a force to be reckoned with.”

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