Pills and Patents

It's never been clearer than in the battle between patents and generics: all around the world and in the USA, Big Pharma's "free market" is the arch enemy of public health.

The story of the ruling by the Supreme Court of India against Novartis is told clearly in the lead article of today's NY Times : "Low Cost Drugs in Poor Nations Get Lift in Court", by Garnier Harris and Katie Thomas (4/2/2013).  If you don't have access to it, here are  extended quotes, which I'll follow with a comment:

"People in developing countries worldwide will continue to have access to low-cost copycat versions of drugs for diseases like H.I.V. and cancer, at least for a while.

"Production of the generic drugs in India, the world’s biggest provider of cheap medicines, was ensured on Monday in a ruling by the Indian Supreme Court.

"The debate over global drug pricing is one of the most contentious issues between developed countries and the developing world. While poorer nations maintain they have a moral obligation to make cheaper, generic drugs available to their populations — by limiting patents in some cases — the brand name pharmaceutical companies contend the profits they reap are essential to their ability to develop and manufacture innovative medicines.

"Specifically, the decision allows Indian makers of generic drugs to continue making copycat versions of the drug Gleevec, which is made by Novartis. It is spelled Glivec in Europe and elsewhere. The drug provides such effective treatment for some forms of leukemia that the Food and Drug Administration approved the medicine in the United States in 2001 in record time. The ruling will also help India maintain its role as the world’s most important provider of inexpensive medicines, which is critical in the global fight against deadly diseases. Gleevec, for example, can cost as much as $70,000 a year, while Indian generic versions cost about $2,500 a year…. (my emphasis — LW)

"Gleevec is widely recognized as one of the most important medical discoveries in decades. In a televised interview, Ranjit Shahani, vice chairman of the Indian subsidiary of Novartis, said that companies like Novartis would invest less money in research in India as a result of the ruling. 'We hope that the ecosystem for intellectual property in the country improves,' he said.

"India exports about $10 billion worth of generic medicine every year. India and China together produce more than 80 percent of the active ingredients of all drugs used in the United States.

"In Monday’s decision, India’s Supreme Court ruled that the patent that Novartis sought for Gleevec did not represent a true invention. ….

"Leena Menghaney, a patient advocate at Doctors Without Borders, said that the ruling was a reprieve from more expensive medicines, but only for a while….

"Others decried the ruling, saying it was further evidence that India does not respect the intellectual property rights of pharmaceutical companies. Last year, India granted what is known as a compulsory license to a generic drug manufacturer to begin making copies of Bayer’s cancer drug Nexavar, and revoked Pfizer’s patent for another cancer drug, Sutent. Both companies have appealed the decisions.

“ 'It really is in our view another example of what I would characterize as a deteriorating innovation environment in India,” said Chip Davis, the executive vice president of advocacy at the Pharmaceutical Research and Manufacturers of America, the industry trade group. “The Indian government and the Indian courts have come down on the side that doesn’t recognize the value of innovation and the value of strong intellectual property, which we believe is essential.'

"In the United States, companies can get a new patent for a drug by altering its formula or changing its dosage. The companies contend that even minor improvements in medicines — changing a pill dosage to once a day instead of twice a day — can have a significant impact on patient wellness. But critics say a majority of drug patents given in the United States are for tiny changes that often provide patients few meaningful benefits but allow drug companies to continue charging high prices for years beyond the original patent life.

"They point to AstraZeneca, for example, which extended for years its franchise around the huge-selling heartburn pill Prilosec by slightly altering the chemical structure and renaming the medicine Nexium. Amgen has won so many patents on its expensive erythropoietin-stimulating drugs that the company has maintained exclusive sales rights for 24 years, double the usual period. A result of this practice is that the United States pays the highest drug prices in the world, prices that only a tiny fraction could afford in India, where more than two-thirds of the population lives on less than $2 a day.

"While advocates for the pharmaceutical industry argue that fairly liberal rules on patents spur innovation, a growing number of countries are questioning why they should pay high prices for new drugs. Argentina and the Philippines have passed laws similar to the one enacted in India, placing strict limits on patents. And Brazil and Thailand have been issuing compulsory licenses for AIDS drugs for years under multilateral agreements that allow such actions on public health grounds.....

"The United States government has become increasingly insistent in recent years that other countries adopt far more stringent patent protection rules, with the result that poorer patients often lose access to cheap generic copies of medicines when their governments undertake trade agreements with the United States. Washington is currently negotiating the terms of a new Pacific Rim trade agreement, called the Trans-Pacific Partnership, which might be completed later this year. The pharmaceutical industry has lobbied the United States to require other countries to enforce tougher patent restrictions, although the details are still being worked out."

. . . . . .

The story doesn't need a heck-of-a-lot of comment. The developing countries will not accomodate Big Pharma at the expense of the health needs of their vast populations. Neither should we. The lament that  research and innovation will suffer if people can afford their medical needs is a serenade of fear — fear that super profits will erode if access to proper medical care gains universal recognition as a human right. What's more, the rapid progress of many developing countries in the production of generics gives the lie to notions that all wisdom, initiative and competence reside in our part of the world and depend on satisfying the greed of the drug and insurance monopolies. 

The fact is that the developing countries are doing far more to improve the access of most Americans to affordable medicine than our vaunted "free enterprise" establishment. Thank you, India.

Obama vs. Obama in Jerusalem

My last blog was written before Obama’s speech to students in Jerusalem. The two aspects of Obama, often so frustrating on our political home turf, were on full display.

Obama did everything he could to indicate that he and Netanyahu were in lock-step on Iran, including the option of military action; he went even further than previous administrations in increasing the enormous US investment in Israel’s military superiority in the region; he reaffirmed the blockade against Gaza and opposition to UN recognition of Palestine; he backed off from demanding that the aggressive settlement push be stopped. In sum, Obama renewed the blessings of the United States on the occupation that most of the world condemns.

On the other hand, he chose to give his main speech to the youth, not to the Knesset. He asked them to put themselves in the shoes of Palestinian youth, who deserve to be free in a state of their own, not living under an occupying army. As students interviewed by the NY Times remarked, he spoke of justice, settler violence, and occupation, words “that Netanyahu doesn’t want to hear.” He urged them to devote themselves to peace, to make their leaders change direction, to insist on renewed efforts toward “two states”. It was Obama inspiration at its best, and the students responded with enthusiasm.

Actually, the students the Times interviewed recognized both sides of Obama in Jerusalem.  Among the eight interviewed, two were Palestinian. I wish I could reproduce their comments here, because, while differing one from the other, they were generally insightful and refreshing. But I can’t give you a link to the Times article because of frustrating restrictions that limit access to subscribers — another small reminder of the “haves and have-nots” of the digital age. Nor will it help to give you the date of the article, because it appeared in an Internet version, not in any print edition as far as I can tell. The only way I can get this to you is to have the Times email the link; so, if you want it, click on comments (below this post) and include your email address.

* * * * *

A couple of thoughts more before I leave “Israel and Palestine”, for a while at least — 

1) As discouraging as “two state” prospects may now seem, it's worth asking what is meant by a “one state solution.” That idea comes from very different sources with very divergent motivations and goals. Some mean one integrated state with guarantees for full equality and human rights for all. Some mean state power in the hands of one ethnic or fundamentalist religious group, whether it be a majority or, in the case of the settlers, a minority “chosen” to rule over “biblical lands.” In any case, can anyone conceive of a “one state solution” at this stage of history coming about other than by war and conquest?

2) Netanyahu and his think-alike advocates in the United States say that Israel’s security takes precedence over every other concern, including the risks of war against Iran and the consequences of the expanding occupation. But history shows that there never can be an occupation that doesn’t evoke resistance; there never has been a movement of resistance to occupation that didn’t lead some to acts of violence against the occupiers.

What we come back to again is the central imperative, mounting pressure worldwide to end the occupation and to prevent a new war.

Israel and Palestine

“The Arc of the Moral Universe Is Long, but It Bends Toward Justice”   MLK

The long arc of history may bend toward justice, but that’s hardly self-evident in the conflict over Israel and Palestine. As time goes on, more and more “facts on the ground” are thrown in the way of hopes for a just resolution.

The “settlers” push on. On the eve of Obama’s visit, there is news: “New Apartments Will Complicate Jerusalem Issue — Israeli residences are being sandwiched into the fabric of Arab East Jerusalem…” (NY Times, March 16, 2013) By now, most Palestinians and Israelis have lost whatever faith they had in the so-called “peace process” and “two state solution.” Palestinian leadership, despite tentative unity gestures between Hamas and Fatah, remains divided on how to resist the occupation and on ultimate goals. Despite Israel’s military strength — as well as its favored status and vast support from the US government and private interests — its expanding occupation and repeated resort to massive force have isolated Israel among nations and aroused widespread condemnation.

Perhaps the recent Israeli elections signify that things are not entirely bleak. The ultra-right and religious fundamentalists were weakened. Although domestic issues were dominant, it appears that the Israeli public and most of its military and civilian leaders don’t share Netanyahu’s gung-ho attitude toward war with Iran.

* * * * *

The questions are too many and too complicated to try to consider in one Op-Ed piece. I encounter differing attitudes among my friends and in the current events discussion groups that I attend. In some aspects, my thinking is far from fixed or confident.  Here I do want to express some things I find troubling about a debate that would focus now on whether the ultimate “solution” resides in a one state vs. a two state formula. This is relevant to the way some issues of conscience are presented by philosopher Joseph Levine in a challenging article, On Questioning the Jewish State (NY Times, March 9, 2013):

"Defenders of Israeli policies routinely accuse Israel’s critics of denying her right to exist, while the critics (outside of a small group on the left, where I now find myself) bend over backward to insist that, despite their criticisms, of course they affirm it. The general mainstream consensus seems to be that to deny Israel’s right to exist is a clear indication of anti-Semitism (a charge Jews like myself are not immune to), and therefore not an option for people of conscience."

The essential target of Levine’s challenge “is found in the crucial four words that are often tacked on to the phrase ‘Israel’s right to exist’ — namely, ‘… as a Jewish state’.”

I agree fully that no state should define itself by institutionalizing favored status for a particular ethnic or religious populace. Nevertheless, many states fit that description to one degree or another, and where they do, discrimination against the “other”, inequality and oppression are always present. Israel is no exception. As an occupying power ruling by force over Arab populations, it has earned comparison to former colonial and apartheid regimes. 

There surely are issues of conscience here, but to conflate them with the question of whether Israel should exist can only divide people of conscience. It deflects from urgent problems where conscience should weigh in now.

The way in which states may evolve, and new ones may arise, will be determined not by formulas, but by people, their struggles and some unforeseeable events. Whatever one conceives of as the eventual solution, conscience should drive people to fight for change in Israel, Palestine, and, probably above all, in the USA. Both for people unwilling to give up on the possibility of two viable states and, I’m sure, for people who think as Professor Levine does, the givens are: an unrelenting fight to end the occupation and reverse the settler grabs; support for a unified state of Palestine; the fight within each and every country for full equal rights and the separation of church and state.

Perhaps the most vital matter of conscience and humanity, especially in the United States and Israel, is absolute resistance to war against Iran or anywhere else. Today, the first day of Obama’s trip, puts in focus the biggest obstacle to progress: the unprecedented scale of US military investment in a regime that is committed to expanding occupation and acts of war.  

Of drones and war

The weird, treacherous world of drones….. 

The first genuine old-fashioned filibuster in a very long time …. Rand Paul, supported by a few GOP colleagues, bravely resisted the pressure of his bladder for 13 hours!

The object of the heroic protest was restricted: the Administration’s ominous refusal to promise that drones would never be used to assassinate Americans on American soil. That’s no small matter in these bizarre times when the incredible often becomes commonplace. Yet, as Bishop Tutu has angrily called to attention, that’s hardly the voice of conscience; rather it can be taken as another unashamed avowal of “American exceptionalism”.  Drones can take “other” lives on “other” soils on demand from Washington — overriding sovereignty, legality, due process and concerns about the “unintended” elimination of all who happen to come within target range.

Now that land wars have proved unwinnable (from Vietnam to Iraq to Afghanistan), the attempted alternative is assassination (without borders) by drones and Special Forces under command of an unprecedentedly military CIA. But it may turn out that drone and CIA warfare will prove as counterproductive and unsustainable in present times as traditional war. For one thing, drone attacks are only practical when the target is in countries too weak or underdeveloped to retaliate. So as Africa and parts of Asia become expanding targets, blowback also expands against superpower arrogance and perceived contempt for the lives of people of color. The Gallop poll finds that 92% of Pakistanis, whose country suffers the highest concentration of drone strikes, now condemn the United States. 

Of course, the new weapons featured in this latest theory and practice of war can’t be contained “for US use only”. Here and abroad, military, police and control freaks all want drones. And they are accessible in all conceivable varieties. As with computer hacking, another potential instrument of intervention and modern warfare, the necessary imagination and skills are not exclusively American.

If the CIA can conduct global war operations without legal or moral restriction, may not others act or retaliate in kind? Just the other day, the US military disclaimed authorship for two drone attacks that occurred in Pakistan; it must have been the Pakistan military…. or somebody else!

This is a tough world and answers often seem out of reach. What we know is that in our times the mindset of war as a solution— whether by armies, drones or doomsday weapons — makes things terribly worse. Problems and enemies proliferate; friends are lost.

Whatever forms of narrowly focused force may sometimes be necessary and legally justifiable, any promise for a better future demands breaking with war and all its reinventions. Only rabid hawks are never ready to give up on war.  The hard part is to overcome the entrenched global policies of military and economic interventionism that, decade after decade, drag us down the path to war.

headlines...

Sometimes headlines tell a whole story. 

These are clipped from the front page of the New York Times on two successive days, Monday and Tuesday of this week. (Click to enlarge.) And the headline to come on Wednesday? Here's the preview via digital news:         

Record High Close for Dow 

Who can take a look at what's happening and still be in denial? Nothing hurts the 1% — recession, sequester or "recovery"; the billions keep coming, no limit. No limit either to the burdens put on the rest of society, especially those who struggle the most. They take hit after hit from the skewed priorities and values of the obscenely unfair system that calls itself "free enterprise."

The problem is much deeper than can be understood as a political contest between the GOP and the Democratic Party. Major constituencies that favor the Democratic Party certainly want to change the miserable state of affairs. They are trying to move the country in a more progressive and humane direction, although the record and role of dominant Democratic leadership is often part of the problem, It is itself too cozy with and complicit in the enormous power that big money holds over Washington and all of the country's politics. Still, if we are to move forward, it's necessary to face up to the absolute need to break the GOP's stranglehold on Congress, its dog-in-the-manger blockade of government.  That's very hard to accomplish even though the GOP seems to be in desperate straits. Whatever progress can be achieved right now if public anger is brought to bear on Congress, it's not too early to look to next year's mid-term elections. Conventional wisdom says low voter turnout is inevitable in an off-year election, and shameless gerrymandering has the game fixed in advance.

Can the pundits be proved wrong (once again)? Given what the economic royalists have done to the country, is there enough public anger (and the will to organize) to beat the odds? 

What do you think?

Something Old, Something New

For first visitors, some background:

This website picks up where Leon’s Op-Ed left off when Mac closed down its website services a couple of years ago. The previous website was established soon after September 11, 2001 with the operational input of a computer expert, nephew Fred Taub of Seattle, who contributed all the technical know-how to keep it going. There were numerous postings over the years, and many of the commentaries written after 9/11 and during the first years of the second Iraq War were compiled in a book published in 2003.

This reincarnated website provides the tools with which even an amateur can run the whole thing, and that’s what I’m now doing.  As before, my themes will vary: current events, books, music, movies and some personal reflections on a long life — probably in that order. If I don’t change my mind, topics on the near horizon are drones, my reaction to Ian McEwan’s latest book, Sweet Tooth, and a beautiful movie, The Sessions.

For now, it’s two short items: about a statue on Treasure Island, San Francisco, and an email exchange of opinions about Harry Truman.

On Treasure Island, there is a huge and marvelous statue of a dancing woman. It’s called “Bliss”. It has been there since 2010, but we saw it for the first time recently and were bowled over by its beauty, size, spirit and imaginative design. We went over to the hangar where it was created and where different artists are working on very large sculptures of various kinds. Our luck was to find the creator of  “Bliss”, Marco Cochrane, in his work place. He’s a great person. He told us all about his work and his model for “Bliss.”  He told us of the life experiences that shaped his strong social conscience and his perception of women. He celebrates women’s capacity to overcome against age-old constraints and, for very many, personal encounters with extreme brutality. If you haven’t been to Treasure Island, the view of San Francisco and the Bay is one of a kind. And “Bliss is not to be missed.

   

* * * * *

Here’s a comment a friend emailed to me about Harry Truman and my comment in response:

Dear Leon,

I’ve been reading David McCullough’s biography of Truman and now have new respect for Truman.

 
Here’s a portion that really interested me.  It is just after the end of the war.  Speaking of Truman it says:  “His troubles had begun with his first postwar message to Congress, only days after the Japanese surrender ceremonies.  Sent to the Hill on Sept. 6, the message was 16,000 words in length and presented a 21-point domestic program that included increased unemployment compensation, an immediate increase in the minimum wage, a permanent Fair Employment Practices Committee, tax reform, crop insurance for farmers, a full year’s extension of the War Powers and Stabilization Act, meaning the government would keep control over business and federal aid to housing to make possible a million new homes a year.”  And Truman added “We must go on.  We must widen our horizon further.  We must consider the redevelopment of large areas of the blighted and slum sections of our cities so that in the truly American way they may be remade to accommodate families not only of low-income groups as heretofore, but every income group.”

A couple of pages further, there is this:  “For those Republicans and conservative Democrats who had been happily claiming that the New Deal was as good as dead, that the “Roosevelt nonsense” was over at last, because they “knew” Harry Truman, it was a rude awakening.  Not even FDR had ever asked for so much  “at one sitting,” complained House Minority Leader Joe Martin, and many of Truman’s own party in Congress were equally distressed, equally disinclined to go along with him.  The same conservative coalition of Republicans and southern Democrats that had stymied Roosevelt since 1937 stood ready now to block his successor.  The House Ways and Means Committee, with 14 Democrats and 10 Republicans, voted to reject the unemployment compensation proposal, and shelved any further consideration of aid to the jobless.”

Sound familiar?

J. R.

Dear J.R.

I've just read what I wrote in the paragraphs below in answer to your comments on Truman. I fear I'm in my new blogging mode, thinking a little more of some abstract general audience rather than carrying on a conversation with you. Writing op-eds is something I like to do, but a face-to-face talk would be a lot more comfortable.

Relying on my memory (not very good, especially when pushed back some 65 years), I think there is a strong parallel between Harry Truman and Lyndon Johnson. Both took on the presidency suddenly and unexpectedly. Both were conservative Democrats and both surprised everyone by championing significant domestic policies in the New Deal tradition. Although both were Southerners and neither had previously been considered unfriendly to the racist Dixiecrats, both were associated with important reforms that seriously challenged Jim Crow, and it was Truman who banned official segregation of the US military. Truman's embrace of liberal domestic policies became particularly pronounced in the 1948 election campaign in response to Henry Wallace's challenge from the left. 

Lyndon Johnson's presidency ended in dismal failure because his administration became defined by its stubborn commitment to the Vietnam War, its "anti-communist" rationale and false domino theory. However, Truman's reputation as a successful president has actually been embellished over time, even though he did things in the name of "anti-Communism" that should never be forgotten or, in my opinion, forgiven. We can't know what was uppermost in his mind when he ordered the atomic cremation of Hiroshima and Nagasaki. How much weight was given to preventing the potential loss of American lives (in exchange for masses of destroyed Japanese civilian lives)? How much was political, acting before the Soviets could join in an invasion of Japan and stake a claim to a significant role in post-war arrangements? Whatever... to justify the use of the atomic bomb back then would be to suggest that there may be circumstances that justify the use of nuclear weapons in the future.
 
With the beginning of the Cold War, which both sides fueled, Truman's Administration ushered in the National Security Act of 1947 and the Attorney General's list of "subversive" organizations. This was the beginning of the far-flung "red scare" that did so much damage to civil liberties and reached its peak in McCarthyism. 1947 was also the year of enactment of the Taft-Hartley Act, which set the foundation for the union-busting crusade that reaches new extremes to this day. Truman opposed Taft-Hartley and it passed over his veto, but he used it twelve times as President.

As you see, I can't cheer for Truman. But life is complicated. Somehow we're compelled to get our heads around the fact that some presidents, political leaders and even movements may do some good things and some horrible things as well. 

Best,

Leon