Better to Best: Thoughts on Global Health Care Systems

Why I’m even more skeptical about a Novartis exec joining the Gates Foundation

Posted in Health Rights, Human Rights, PharmFree by reshmagar on October 19, 2011

From MSF India – still unclear as to why a executive coming from a company that is trying very hard to deny access to an affordable version of a key life-saving leukemia drug is joining the Gates Foundation, an organization that prides itself in providing inexpensive vaccines and other drugs to developing countries worldwide.


Médecins Sans Frontières briefing note, 4 October 2011

Swiss pharmaceutical company Novartis issued a press statement last week in
response to the growing concerns regarding its latest legal challenge
against the Indian government. Ahead of the next hearing of the case in the
Indian Supreme Court set for 17 October 2011, Médecins Sans Frontières
addresses the issues Novartis raised in its statement.

BACKGROUND: The Supreme Court case is the final act in a legal battle over
the patentability of the salt form of the anti-cancer drug imatinib and
section 3(d) of the Indian patent law that stretches back over five years.
In 2006, the Indian patents office ruled that Novartis did not deserve a
patent for imatinib mesylate, a salt form of a life-saving cancer drug, on
the grounds that the application claimed a new form of a drug too old to be
patentable in India (see notes below). The company then embarked on a series
of lawsuits against the Indian government including the one that is
currently pending before the Supreme Court. In this case Novartis is
challenging a part of India’s patent law – Section 3(d) – which read with
other provisions of the patent law and the Madras High Court decision says
that a new form of a known medicine can only be patented if it is not
obvious and shows significantly improved therapeutic efficacy over the known

*What Novartis says: “price doesn’t affect access to medicines”.*

In its statement, Novartis writes “Acknowledging innovation by granting a
patent is unrelated to the access to medicines issue. Improving access to
medicines is a matter of making medicines available.”

This is not the entire truth. MSF has found, during its field experience in
working in many developing countries, that granting a patent has had a
direct bearing on access to affordable essential medicines. Granting a
patent on a medicine provides the patent holder with a monopoly on that
medicine, which in turn allows the company to charge a high price in the
absence of any generic competition. In fact, improving access to medicines
is a matter of not simply making the medicine available but also making it
affordable for patients and governments to buy. This is well documented.
When AIDS treatment first became available in the late 1990s, the price of
first line patented AIDS medicines was – even after discounts – US$10,439
per patient per year. Millions died in developing countries, particularly in
Africa, as prices were too high. Generic competition brought prices down
making treatment possible. In MSF’s experience, patents on medicines are a
key barrier to making medicines affordable, as it prevents access to those
who cannot afford it.

*What Novartis says: “this case will in no way impact access to medicines
to poor countries”. *

This is not true. If Novartis succeeds in weakening the interpretation of
section 3(d) for the purpose of obtaining a patent on imatinib mesylate, the
Indian Patent Office would have to apply the same standards of intellectual
property protection as wealthier countries like the US, granting far more
patents than required under international trade rules or envisioned by
India’s lawmakers.

It is not only about this particular medicine. The interpretation of the
clause has a direct bearing on the examination of patent applications
claiming salt forms, pediatric formulations and other improved formulations
of AIDS drugs, the generic versions of which are currently used by MSF in
its medical projects. This case would set a precedent in this regard.

This could lead to generic competition on many essential drugs ending
entirely and prices for these in both India and developing countries
increasing. This would have a devastating impact on not only people MSF
treats, but also on people the world over who rely on affordable medicines
manufactured in India. MSF buys 80% of the ARVs it uses to treat 170,000
people for HIV across the developing world from Indian generic
manufacturers, and donors rely on Indian sources in similar proportions.

It is crucial to preserve the public health safeguards of Indian patent law
– particularly Section 3(d). The future of generic production is largely
dependant upon the outcome this case.

Imatinib mesylate is a crucial anti-cancer drug sold by Novartis in India
for Rs.120,000 (US$ 2,400) per patient per month. Indian generic companies
sell generic versions for Rs. 8 – 10,000 ($160 – 200) per patient per month.

*What Novartis says: “Section 3(d) – as it relates to evergreening – is not
applicable at all to Glivec”. *

Novartis is seeking a patent in India on the salt form of imatinib (Glivec).
Claiming a patent on a salt form of an existing drug is a common and
well-known form of evergreening by pharmaceutical companies to extend the
patent life – and monopoly – of their drugs. And companies do this routinely
to prevent generic competition. An example of this is the AIDS drug
abacavir. Although the abacavir molecule was first developed and patented in
the 1980s, pharmaceutical company GSK applied for a patent in 1997 on
abacavir sulphate (salt form) in developing countries, with the intention of
obtaining a patent monopoly until 2017. Where the patent was granted this
has blocked access to affordable generic forms of abacavir in many
developing countries.

*What Novartis says: “Glivec has been granted a patent in nearly 40
countries and India should also follow suit”*.

This is a mistaken interpretation of international intellectual property
rules. Although the TRIPS Agreement obliges all members of the World Trade
Organization to grant patents on medicines, nothing obliges developing
countries like India to replicate patent systems of wealthy countries. An
important flexibility in this respect is the right of WTO Member States like
India to define the patentability criteria in accordance with their
particular national priorities. This is precisely what India did when it
amended its Patents Act in 2005. At the time of implementing TRIPS, India
felt that many countries were granting a large number of patents on new uses
and new forms of known medicines, which was becoming a key reason for
creating longer patent barriers and high prices in developing countries. So
along with patent protection for new innovative medicines, Indian lawmakers
introduced a specific provision, section 3(d), in its patent law that
excludes from patentability new uses and new forms of known medicines. The
system India has is not perfect, but it does prevent drug companies from
getting unjustified 20 year monopolies every time they come up with a new
use or a new form of a known medicine.

*What Novartis says: “medicines can be made available through access
safeguards in international agreements and, in the case of essential and
life-saving medicines, special pricing arrangements in developing
countries”. *

While this is correct – countries have the legal flexibility to issue
compulsory licences to generic producers on patented drugs where it hinders
access to essential medicines – measures like tiered pricing in our
experience are not the most effective way to make medicines affordable.

Novartis also seems to imply that countries can only act once patents are
granted. However, a lesser known key TRIPS flexibility is the right of a
country to take steps before a patent is granted to ensure that patent
applications on routine and obvious improvements of medicines are not
granted so that they do not disrupt supply of affordable generic medicines
to patients. India has chosen to adopt this safeguard with the introduction
of Section 3(d) in its patent law, while allowing patents to be granted on
new medicines from 2005.

*Notes for the editor: *
The basic molecule imatinib was first patented (US 5521184) in 1993. India
signed the WTO TRIPS agreement in 1995 and opened up filing of product
patent applications in India. In 1998, Novartis filed an application
1602/MAS/1998 on the mesylate salt of Imatinib. This case relates to the
1998 application.

Financial Times: Novartis executive to join Gates foundation

Posted in Health Rights, PharmFree by reshmagar on September 14, 2011

This makes me slightly uncomfortable…

September 13, 2011 9:03 pm

Novartis executive to join Gates foundation

By Andrew Jack in London

A top executive at Novartis is to join the Bill & Melinda Gates Foundation, cementing strong co-operation between leading pharmaceuticals companies and the world’s largest philanthropic organisation.

Trevor Mundel, 51, who heads of global development at the Swiss-based drug manufacturer, will in December take over as head of global health at the Seattle-based Gates Foundation, responsible for its $1.5bn annual budget, funding the development of new drugs, vaccines and diagnostics.

The decision is likely to herald fresh support for the drug companies’ commitment to tough intellectual property laws and support further Gates funding of their research, including for Novartis, which is already one of the most active in researching drugs and vaccines for diseases of the developing world.

However, it may antagonise some health advocates who have criticised patents – fiercely defended by drug companies – as providing a barrier to affordable access to medicines for the poor. Novartis has been in the forefront of the clash, as it gears up for a fresh defence of its patents in India for Glivec, a costly cancer drug.

Tido von Schoen-Angerer, director of Medecins sans Frontieres’ essential medicines campaign, said: “It is worrisome to see yet another industry executive in this powerful global health position. While he brings important skills to the Gates Foundation’s product development work, his new role is broader and includes shaping access and other health policies. The foundation will likely alienate many in the global health community, given Novartis’s relentless attacks on the Indian patent system to weaken access to affordable medicines.”

Mr Mundel becomes the second incumbent at the Gates Foundation with a background in the pharmaceuticals sector following Tachi Yamada, the former head of research at GlaxoSmithKline, who stepped down from his role as head of global health in June after five years.

Novartis is one of the drug companies with the most relevant experience for the Gates Foundation. It sells at cost large quantities of Coartem, the pioneering and highly effective malaria treatment, and donates drugs for other illnesses, including leprosy.

Mr Mundel said he had had little direct experience on drugs for the poor, stressing instead his past work on medicines, including Gilenya for multiple sclerosis and Ilaris for a rare inflammatory disease. But he highlighted his work in operating a research centre in Hyderabad in India.

“The Gates Foundation has a somewhat pharmaceutical [industry] problem or opportunity: a large portfolio of projects,” he said. “You have to accept there will be a certain attrition, find a way to focus your resources and [impose] data-driven milestones.”

AMSA Response to USTR Proposal for Trans-Pacific Partnership Agreement

Posted in Health Rights, PharmFree by reshmagar on September 14, 2011

On Tuesday, the US Trade Representative Office released a white paper with a proposal towards the Trans-Pacific Partnership Agreement. Document is attached below:

White Paper

Highlights and summary:

As part of this initiative, the Office of the United States Trade Representative (USTR) has
presented a variety of trade proposals to TPP partners that are aimed at promoting access to
medicines in TPP partner markets. These proposals are the product of a new strategic initiative,
Trade Enhancing Access to Medicines (TEAM), which is designed to deploy the tools of trade
policy to promote trade in, and reduce obstacles to, access to both innovative and generic
medicines, while supporting the innovation and intellectual property protection that is vital to
developing new medicines and achieving other medical breakthroughs.

The TEAM initiative reflects fresh thinking about trade and access to medicines. It is about
more than allowing access to medicines. It is about working with trading partners to develop
strong and common standards to help drive access – propelling the TPP countries to the front of
the line for important innovative medicines and for generic competition, while promoting U.S.
jobs and exports.

The paper goes on to list a set of goals the United States along with the countries under the TPP would address. Great goals, but not really a clear sense of how the goals would be achieved.

Knowledge Ecology International commented:
One has to read between the lines, and guess what the White House is trying to say (or avoid saying plainly). It appears as though USTR will demand TPPA partners agree to several years of exclusive rights in regulatory test data for new medicines, including biologic drugs. What we don’t know is how many years, when the clock starts to run, or how iron clad the protection is expected to be.

The Wall Street Journal published an article about this as well with an excellent comment from Peter Maybarduk, Public Citizen (+1.202 588 7755, +1. 202 390 5375,
It is insulting that USTR has released this paper on ‘access to medicines’ on the same day that it has tabled its most controversial and access-restricting provisions at the Trans-Pacific FTA negotiations — and then failed entirely to address those provisions, or the other access-restricting elements of its aggressive intellectual property proposal, in this paper. The Obama administration is heading rapidly in the wrong direction, at the expense of global public health. This paper is primarily window dressing for USTR’s pro-Big Pharma, anti-access to medicines status quo.

Another set of comments I quite enjoyed:

Sean Flynn, American University
The statement of the administration today continues its practice of actively thwarting the release of meaningful information about its positions in closed door international law making. The statement says little about what the administration’s actual trade policy on medicines issues is or what justifies it.
It does not explain any of the positions it has taken in the leaked intellectual property proposal;
It does not explain what its position is in the bracketed text on data exclusivity, patent term extensions or patent-pharmaceutical linkage;
It does not answer whether it has abandoned the May 10th agreement between the Bush administration and Congress safeguarding some TRIPS flexibilities in developing countries;
It does not include any evidence supporting how its policy positions promote access to medicines.
Thanks to leaked proposals, we know what the administration’s actual position is. This administration has endorsed a set of policy proposals in its trade negotiations with developing countries that is much worse for access to medicine concerns than those of any other past administration.
The administration is proposing to:
Grant patent rights on substances that are already discovered,
Increase in-transit seizures on medicines,
Extend monopoly rights through data protection that operate independent of patent rights,
Get rid of the so-called “May 10th” deal between the Bush Administration and Congress protecting key access to medicines flexibilities in developing countries,
Add a first ever restriction on the operation of pharmaceutical reimbursement programs as a cost saving mechanism in developing countries.
Calling this an “access to medicine” policy is Orwellian.

AMSA also released a response as well:

The American Medical Students Association (AMSA) appreciates the opportunity to offer comments on the proposed Trans Pacific Partnership Agreement (TPPA). As the nation’s oldest and largest independent organization for physicians-in-training representing more than 35,000 members, AMSA supports global health equity through international agreements that secure patients’ rights to life-saving medications in resource-poor settings and encourage investment in public health as outlined in the Doha Declaration.

AMSA strongly urges a revision of the proposed TPPA to ensure access to essential, affordable medicines for patients living in TPPA negotiating nations including the United States. It is critical countries be permitted to engage in parallel importation to ensure citizens’ access to inexpensive medications. Therefore, we recommend that the TPPA refrain from granting copyright holders the right to prohibit importation of their works. Consistent with President Obama’s 2012 budget proposal request, AMSA strongly urges that the term for data protection be limited to 7 years for biologic products. Similarly, pharmaceutical companies should not be eligible for new 20-year patents based on minor modifications to existing products that do not meaningfully benefit patients. Such provisions would allow for timely access to generic medications for suffering patients that could save lives.

When will governments and even pharmaceutical companies realize that their responsibilities should be for their constituents/clients rather than profits?

Gates Foundation Annual Letter: Hit or Miss?

Posted in Health Rights by reshmagar on February 1, 2011

The Gates Foundation released its 3rd annual letter recently. Check it out here:

If you don’t want to read it, here’s a basic overview from the man himself regarding the letter:

The greatest priority, according to Gates, is to eradicate polio.

In a blog post for the Huffington Post, Gates writes:
One of the major themes of the letter is the miracle of vaccines. Last year, Melinda and I announced that we were working together with partners to make this the Decade of Vaccines, and I wanted to use this year’s letter to explain why.

In particular, my letter focuses on the vaccine for polio, since it’s helped the world get to the threshold of something amazing: eradicating the disease altogether. We’re incredibly close and we need to finish the job.

We put together a video, called Vaccines Save Lives, to try to describe why vaccines are a miracle in a vivid way. I hope you enjoy it — and share it with your friends.

The New York Times had an interesting article talking about the response to the letter. Check it out here: Gates Calls for a Final Push to Eradicate Polio

Key points in the article:

Although that battle began in 1985 and Mr. Gates started making regular donations to it only in 2005, he has emerged in the last two years both as one of the biggest donors — he has now given $1.3 billion, more than the amount raised over 25 years by Rotary International — and as the loudest voice for eradication.

However, even as he presses forward, Mr. Gates faces a hard question from some eradication experts and bioethicists: Is it right to keep trying?

Although caseloads are down more than 99 percent since the campaign began in 1985, getting rid of the last 1 percent has been like trying to squeeze Jell-O to death. As the vaccination fist closes in one country, the virus bursts out in another.

In 1985, Rotary raised $120 million to do the job as its year 2000 “gift to the world.”

The effort has now cost $9 billion, and each year consumes another $1 billion.

By contrast, the 14-year drive to wipe out smallpox, according to Dr. Donald A. Henderson, the former World Health Organization officer who began it, cost only $500 million in today’s dollars.

Dr. Henderson has argued so outspokenly that polio cannot be eradicated that he said in an interview last week: “I’m one of certain people that the W.H.O. doesn’t invite to its experts’ meetings anymore.”

Recently, Richard Horton, editor of The Lancet, the influential British medical journal, said via Twitter that “Bill Gates’s obsession with polio is distorting priorities in other critical BMGF areas. Global health does not depend on polio eradication.”

“Fighting polio has always had an emotional factor — the children in braces, the March of Dimes posters,” Dr. Henderson said. “But it doesn’t kill as many as measles. It’s not in the top 20.”

Dr. David L. Heymann, a former W.H.O. chief of polio eradication, said he was still “very optimistic” that eradication could be achieved.

But if there is another big setback, he said — if, for example, cases surge again in India’s hot season — he might favor moving back the eradication goal again to spend more on fixing health systems until vaccination of infants for all diseases is better.

“When routine coverage is good, it’s no problem to get rid of polio,” he said.

Asked about that, Mr. Gates said, “We’re already doing that.” (Actually, one of the main criticisms the Gates Foundation and the MDGs has received was a lack of focus on strengthening and fixing health systems.)

I’m not really sure what to think. I definitely think it’s a noble goal to pursue the complete eradication of polio. But if it means deviating funds away from other issues that also need to be addressed, then perhaps it’s time to streamline priorities a little more.

What do you all think? Should the Gates Foundation be pouring more funds into polio eradication? Is this a realistic goal? What other alternatives are there?

One week till 2010 ends.

Posted in Health Rights, Healthcare Reform by reshmagar on December 24, 2010

My sister on the way to magical world of Harry Potter in Orlando asked me a question that I couldn’t really give an answer to – “What age has been your favorite age so far?” If she asked me this same question a few weeks ago when I was about to take my last exam for the semester, I would have probably said something along the lines of “2. Definitely 2. No tests, just naps and someone always around to cook and clean after me and if I got tired of walking, I was still cute enough to get someone to carry me around.” But I barely remember being 2 years old and although I’m sure it was a great year, it probably was just as good as being 23.

After going through all the years I could remember, I eventually told her that every year has been a good year and that maybe when I was as old as our parents, I would have a different answer. She then asked my mother the same question. Initially, she couldn’t think of her best year saying that all of them had been good but then changed her answer to “20 or 21” (pre-Dad, of course). I wonder if at age 40 or 50, I’ll think the same – that my 20s were the best years of my life. I actually hope not. Not because I want each year to get better and better as I get older but because I still feel as un-grown up now as I did at age 21 or even 18. Yes, I live in a different city from my parents, pay electricity, gas, and internet bills, and manage my own finances but I still catch myself thinking about what life will be like when I grow up. Not just in the sense of my career, but the person I want to become.

I initially thought this line of thinking was a good thing – instead of accepting the fact that the person I am now is the person I will be essentially in the future, I envision something else for myself. Now though I’m questioning whether or not that’s enough.

One of my favorite advisors from undergrad once told me his philosophy regarding work – that when he has a task to do be it grading papers or writing a recommendation, he would make it a point to not let that task hit his desk twice. In other words, he never set anything aside for later more than once.

Perhaps instead of waiting for my grown up status to hit, I should be more proactive in becoming that ideal person I envision myself one day to be. Instead of listening to the voice in the back of my head which reassures me that by 25 (or sometimes just to be safe, 30), I’ll be able to do this and that, I should start now.

This year has been filled with similar future due dates – healthcare reform, looking at the progress of MDGs, trying to bring us out of the global economic crisis, voting on referendums to stop crimes against humanity, rebuilding countries post-disaster, etc. Looking back on my posts, I noticed that my frustration on such topics stemmed from not having the perfect version of each item.

With healthcare reform, I was saddened by the lack of public option and the fact that the bill barely addressed cost.

With the MDGs, dates were pushed further back past 2015 and only specific topics were addressed.

With rebuilding countries such as Haiti and Pakistan, it was uncertain when the once emergency help would end and lead to sustainable growth.

But instead of lamenting these events, I think now I should be looking at them as victories that will lead to better solutions. Yes, we have no public option and no cost control (yet), but we finally have universal access and billions of dollars going into restructuring the system into something affordable with high quality. The MDGs may not be fulfilled by 2015 but for the first time, countries are galvanized to do something…and not only within their own borders, but across the globe. Billions of dollars are being pledged by the wealthiest nations and people to eradicate diseases and provide basic needs such as clean water. Haiti and Pakistan, countries that are still suffering from past natural disasters are receiving aid in the form of funds and volunteers daily. NGOs and local groups are working with governments around the clock to figure out how to usher these countries into stability.

Things are being done little by little. And with all of these efforts, I can’t help by hope that it will eventually lead to the better future we all envision for the world.

At the IHI National Forum in Orlando, I was able to see Dr. Atul Gawande and Dr. Eliiott Fisher, the Director of The Center for Health Policy Research at Dartmouth Medical School speak. The title of their talk was “How Will We Do That?: Redirecting the Medical Arms Race to Higher Quality, Lower Cost, and Better Health.” At the end of the talk, Dr. Gawande looked at all the people in the room – medical students like myself, doctors, nurses, pharmacists, hospital administrators, CEOs, CFOs, COOs, engineers and told everyone that their collective effort in bettering quality and lowering cost at their own institutions is what would eventually lead to a real and tested solution for our nation’s healthcare. He made a good argument for this looking back at a past American crisis in food and how a solution was found through the work of individual farms.

Listen to the talk for yourself: How Will We Do That Redirecting the Medical Arms Race to Higher Quality Lower Cost and Better Health

To read more about what has been done and the better it will lead to, check out this article about the Gates Foundation: Five Years In, Gauging Impact of Gates Grants
In summary, their shortlist of accomplishments:
1. Dried Vaccines
2. Lab in a Box
3. Mosquito ‘Olfacticides’
4. ‘Exhausted’ Immune Cells
5. A Better Banana
6. And a Better Cassava
7. Mosquitoes and Bacteria
8. Stem Cells to Muscles

From the article: Over all, [Bill Gates] said: “On drawing attention to ways that lives might be saved through scientific advances, I’d give us an A.

Yep, I agree. At least they’re doing something.

Happy holidays everyone! Instead of waiting for the new year to begin a resolution, perhaps it’s time to start now.

Today is International Human Rights Day.

Posted in Geneva!, Health Rights by reshmagar on December 10, 2010

Today, the Human Rights Risk Atlas released its results after evaluating 196 countries on their performance across 30 categories such as human security, civil and political freedoms, and labor standards. The report shows that 92 countries are now in the “extreme” or “high risk” category compared to 83 last year.

Here is a map showing the 2011 results:

Courtesy of Maplecroft

While disappointing, this should not stop us from celebrating those who are actively fighting for human rights around the world. The UN put up profiles of such people:

Courageously combating discrimination against homosexuals: Otgonbaatar Tsedendemberel (Mongolia)

Mr. Tsedendemberel is the Advocacy Programme Manager for the Lesbian, Gay, Bisexual and Transgender (LGBT) Centre based in Ulaanbaatar, Mongolia. The LGBT Centre is the first-ever Mongolian non-governmental organization mandated to uphold, protect and ensure the human rights of sexual minorities. The Centre submitted a report on LGBT rights in Mongolia to the UN’s Human Rights Council in 2010, risking their personal safety to do so. When Mongolia was reviewed by the Council’s Universal Periodic Review process in November 2010, Mr. Tsedendemberel traveled to Geneva to conduct advocacy and to “make sure the often suppressed voices of the Mongolian LGBT community were heard at the United Nations.”

Speaking out for indigenous rights: Dora Alonso (Guatemala)

Eighteen-year-old Dora Alonso is from Guatemala’s vast Mayan indigenous community and raises her voice against discrimination towards all indigenous people, in particular women and girls. She is a member of Guatemala’s Children’s Parliament, a national organization for Mayan, Xinca, Garifuna and Ladino children and youth. The Parliament’s work focuses on the promotion of health, education, gender equality, respect for identity and the prevention of sexual exploitation and child abuse. The Parliament also promotes non-discrimination of people living with HIV/AIDS. In her own role, Dora is responsible for the Parliament’s communications arm, providing information about the organization and implementing prevention campaigns.

Documenting human rights violations around the world: Roberto Garretón (Chile)

During the Pinochet dictatorship in Chile, Mr. Garretón was arrested for publishing an article on human rights violations by the regime. He was a member of the Vicaría de la Solidaridad, an organization symbolic of the struggle for human rights, which spoke out against repression under Pinochet, defended the rights of torture victims and prisoners and sought to locate the disappeared. Mr. Garretón’s personal background lends itself to his work as a human rights lawyer and his current role as a member of the UN’s Working Group on Arbitrary Detention, which considers petitions from individuals or groups concerning cases of arbitrary deprivation of liberty. From 1994 to 2001, Mr. Garretón also served as the UN Special Rapporteur on the situation of human rights in the Democratic Republic of the Congo, documenting human rights violations in that country.

Using the law to combat racial and other discrimination: Gay McDougall (USA)

Currently serving as the first United Nations Independent Expert on minority issues, Ms. Gay McDougall is a human rights lawyer with a long history of activism in civil rights. Growing up in segregated Atlanta, Georgia, Ms. McDougall was excluded from many public places as a child. She was the first black student admitted to her college and faced discrimination and racism on a daily basis. She went on to become Executive Director of the US-based international non-governmental organisation Global Rights between 1994 and 2006. Among her many international roles, she has served as an Independent Expert on the UN treaty body that oversees the International Convention on the Elimination of All Forms of Racial Discrimination and was one of five international members of South Africa’s Independent Electoral Commission, which successfully organized and administered that country’s first non-racial elections.

Breaking a vicious cycle of discrimination against Roma communities: Sri Kumar Vishwanathan (India/Czech Republic)

Mr. Sri Kumar Vishwanathan, originally from India, has been a human rights defender of the Roma for 14 years. He has worked tirelessly to build bridges between Roma and non-Roma communities and his leadership and initiative led to the creation of the Common Life Village in Ostrava, Czech Republic, where families of both Roma and non-Roma ethnicities live together as a single community. He has also established dialogue between the Roma and the police forces, starting a project where Roma women work as assistants (inter-cultural mediators) with the police to help break the vicious cycle of exploitation of Roma families by thugs from their own community. He has also been consistently involved in providing assistance to Roma families who have been victims of brutal racist attacks. He still lives with his family in one of the most repressed Roma ghettos.

Providing hope and inspiration to HIV positive patients: Me Maphallang Ponoane (Lesotho)

Ms. Me Maphallang Ponoane has experienced firsthand the high levels of stigma and discrimination against people living with HIV and AIDS. As a widow and mother of four children living in Lesotho, southern Africa, she bravely decided to disclose her HIV status to her family, community and her entire district. In 2004, after recovering from a long HIV/AIDS-related illness, Ms. Ponoane joined a support group in her district. The group is now mandated to mobilize communities against stigma and discrimination and to provide care and support for members. Ms. Ponoane works as an “expert patient” and lay counselor in the government hospital in Quthing, promoting positive living for both HIV-positive and tuberculosis patients.

To read more about courageous human rights defenders, go here: Human Rights Day 2010

Their stories of fighting injustice in the face of potential failure and sometimes even threats to their own life should inspire and encourage us. Innate in all of us is the ability to know when wrong is wrong and when wrong stares us in the face, how can we not want to do right?

Today, I think of the following speech from Gandhi:

While most of us may not be in the field right now, there are things we can do from our own home. In January, there will be a vote on whether the oil-rich South part of Sudan should be independent from the rest of Sudan. Many experts fear that independence will plunge the country back into civil war. Already, 2 million people were killed in a 20-year war that ended in 2005.

Various organizations such as the Enough Project are calling upon the U.S. to exert its influence to pressure both the North and South parties to have a peaceful referendum and to negotiate post-referendum arrangements.

Visit for breaking news, world news, and news about the economy

You can do something about this. To find out how, go here: Take Action to Stop a War Before It Starts

Sign the petition. Attend an event in your area. Become a human rights defender today on International Human Rights Day.

Eradication Count = 2?

Posted in Geneva!, Health Rights by reshmagar on November 17, 2010

Eradication of infectious disease is defined as the reduction of the disease’s prevalence in the global host’s population to zero. Not negligible numbers or within a regional population. That would be elimination. So far, there have been 8 attempts to eradicate specific infectious diseases.

Only 2 have succeeded – that of smallpox and rinderpest (unofficially).

Alarming news regarding recent outbreaks and epidemics have caught my attention:

Polio in Central Asia and the North Caucasus Federal Region of the Russian Federation (WHO)

13 November 2010 — The risk of further international spread of the ongoing polio outbreak in Central Asia and the North Caucasus Federal Region in Russia continues to be high.

In Central Asia, genetic sequencing of the poliovirus isolated from a child paralyzed in Kazakhstan on 12 August 2010 has confirmed ongoing circulation of the virus which caused the Tajikistan outbreak and subsequently spread to the Russian Federation, Turkmenistan and possibly Uzbekistan. In the Russian Federation, the detection of an additional case of polio with onset on 25 September in the Republic of Dagestan confirms ongoing poliovirus transmission in the North Caucasus Federal Region.

For more information regarding the polio outbreak, go here: Polio in Central Asia

Cholera continues to spread as response scales up (from PAHO)

The cholera outbreak continues to spread throughout Haiti, impacting five departments and tens of thousands of lives. On November 11, the Ministry of Public Health (MSPP) released the latest case count: 796 deaths and 12,303 hospitalized cases (as of November 10). These numbers reflect data sent by the departments to the Directorate of Epidemiology and now include cases reported by NGOs and the Cuban medical mission.

Number of Hospitalized Cholera Cases from Oct 20 to Nov 9 (PAHO)

Number of Cholera Deaths from Oct 20 to Nov 9 (PAHO)

For the full report, go here: Cholera Outbreak

Polio in Congo – update (WHO)

9 November 2010 — 184 cases of acute flaccid paralysis and 85 deaths have been reported from the site of the acute poliomyelitis outbreak centred in Pointe Noire, Republic of Congo. Four cases have been confirmed to have been caused by wild poliovirus type 1 and laboratory testing continues. The majority of the reported cases and deaths have occurred in the population aged over 15 years.

Genetic sequencing has determined that the cases are caused by a poliovirus most closely related to that circulating in neighbouring Angola. Congo had recorded its last case of indigenous polio in 2000.

Nearly all cases have been reported from the port city of Pointe Noire, with cases also reported from Niari (5), Bouenza (2), Brazzaville (1), and Kouilou (2).

For more information, go here: Polio Outbreak in Congo

This was published in May 2010:

Wipe out polio? Experts give it one last shot
Critics say efforts to eradicate deadly virus should be abandoned

AP Medical Writer
(I’ve italicized some sentences I found a bit shocking…)

GENEVA — For years, the world has been on the brink of wiping out polio, the deadly disease that can paralyze and kill children.

At the World Health Organization’s annual meeting of health ministers this week, experts are unveiling what they describe as a new strategy to get rid of the feared disease.

But others say there is little new and that if this effort fails, there are serious questions about whether to continue the campaign should be raised.

Some experts say eradicating polio is impossible and should be abandoned. With a new target of stopping the virus by the end of 2012, this may be WHO and partners’ best chance to get rid of polio before donors run out of money and patience.

Since WHO, the U.S. Centers for Disease Control and Prevention, UNICEF and Rotary International set out to eradicate polio in 1988, they have come tantalizingly close. By 2003, cases had dropped by more than 99 percent. But progress has stalled since and several deadlines have been missed.

Polio has virtually disappeared from the West but is entrenched in a handful of countries, namely Afghanistan, India, Nigeria and Pakistan. The disease mostly hits children under five and is spread via dirty water.

WHO’s new strategy targets problems in each country, provides more WHO monitoring, like more teleconferences, and holds governments more accountable. New outbreak response plans are also in place. Still, it is uncertain if more WHO oversight — which countries are free to ignore — will make a difference.

Others said WHO has always tailored programs to focus on local problems in different countries.
“I’m not sure how the new strategy differs from the ones adopted in 2007, 2004, and 1999,” said Dr. Donald Henderson, who headed WHO’s smallpox eradication program. He said the strategy’s main elements have mostly all been seen before.

Polio cases fell sharply last year and experts are optimistic they may have turned a corner, though the disease’s high season hasn’t yet hit.

Patience wearing thin?

Dr. Paul Adovohepke, who heads UNICEF’s polio team in Nigeria, said rumors about the vaccine’s safety — which resulted in a year-long suspension of polio campaigns in 2003 — seem to have subsided. He has seen Nigerians ask vaccinators to go into their homes to give the polio vaccine to their kids. “(That) was not possible in 2003,” he said.

But recent surprises, like an outbreak in Tajikistan, which had been free of the disease for years, show how unpredictable the effort remains. WHO says it is still possible to get rid of polio and that to give up now would set loose a deadly virus.

“You don’t eradicate polio from 124 countries by doing it wrong,” said Dr. Bruce Aylward, who directs WHO’s polio department. “Either we finish eradication or we let the virus out and between 200,000 to 400,000 kids every year will be paralyzed.”

Experts worry that as the effort enters its 22nd year, donors’ patience and wallets are running thin. Sustaining the effort costs about $750 million every year.

The Bill & Melinda Gates Foundation, one of polio’s top donors, could not say how long they plan to bankroll the effort, but said the next three years are “critically important.” The foundation said their polio donations are reconsidered every year.

“You can’t forever say you can do it and expect resources to keep coming in,” said Scott Barrett, an economist at Columbia University who tracks polio. “Eradication efforts by definition cannot go on indefinitely.”


The world is also very different now than when the drive to stamp out polio began. Two of the countries where the virus is spreading — Pakistan and Afghanistan — are plagued by conflict which make it nearly impossible to vaccinate enough kids.

Experts had also assumed the polio virus in the vaccine could never spark big outbreaks. They were wrong. Since 2005, a vaccine-derived epidemic has been spreading in Nigeria and similar epidemics are certain to erupt in the future.

“There might be a different assessment today about the feasibility of eradication, but I don’t know what that decision might be,” said David Heymann, who previously ran WHO’s polio program.

Others said that to give up on polio would set a devastating precedent. Smallpox is the only disease ever to have been eradicated, and that took only a decade. Officials are still trying to get rid of guinea worm, and similar plans have been floated for malaria and measles.

Henderson suspects polio targets will be continually pushed back every few years. He said while officials are inching closer to eradication, future surprises could unravel the campaign. “What do you do when you have a tiger by the tail?” he asked.

Ellie Ehrenfeld, who sits on WHO’s Advisory Committee for Polio Eradication, said the current situation is encouraging, but has a tinge of deja vu. “We have been very close before, and then things blew up,” she said.

If polio is not stopped in the next few years, she said serious questions should be raised about whether the program should be scrapped. “It’s theoretically possible to eradicate polio,” she said. “Whether or not we can do it is entirely another matter.”

If this strategy doesn’t work or hasn’t been working, isn’t it time to go back to the drawing board instead of giving up? Show donor countries something new and pilot test in a region to reassure them their money is going to a good place? Point out the danger of these new outbreaks?

I just don’t know how you could not want to help him either:

Healthcare is a right.

Posted in Health Rights, Healthcare Reform by reshmagar on November 9, 2010

To address why I think healthcare is a right or should be a right:

To address this question would entail me defining what human rights are according to me. Instead, I will frame this question in terms of why the United States government should consider healthcare to be a human right.

In 1948, one of the most important documents of the past century was drafted and adopted by the United Nations – the Universal Declaration of Human Rights. This document has become instrumental in the creation of multiple international treaties, regional human rights instruments such as Human Rights Watch, national constitutions as well as both international and national laws.

48 countries voted in favor of this document. 0 countries voted against. 8 abstained – Byelorussian USSR, Poland, Ukraine SSR, USSR, South Africa, Yugoslavia, Saudi Arabia and Czechoslovakia. The United States most notably not only voted in favor of this document, but gave birth to its most prominent champion – Eleanor Roosevelt.

Eleanor Roosevelt with Spanish Version of Universal Declaration of Human Rights (courtesy of Wikipedia)

Article 25, Section 1 states the following:
Everyone has the right to a standard of living adequate for the health and well-being of himself and of his family, including food, clothing, housing and medical care and necessary social services, and the right to security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in circumstances beyond his control.

In signing this document, the United States agreed that healthcare is in fact a human right and a “common standard of achievement for all peoples and all nations, to the end that every individual and every organ of society”. The document also clearly states that these standards were not just some universal fluff we should all believe in but rather a responsibility of the member states to implement and ensure “among the peoples of territories under their jurisdiction”.

The United States has not rescinded their signature from this document. In fact, if anything, the U.S. loves touting their efforts in creating and advocating for the declaration. In Geneva at the U.S. Embassy, there is an entire room dedicated to Eleanor Roosevelt and the Universal Declaration of Human Rights. On July 4th, it was mentioned twice by the ambassador in a speech. Clearly, we still support it and in doing so, the U.S. has clearly stated that healthcare is a human right and will strive as a nation to uphold this right.

Personally, as a medical student, I believe that a doctor’s duty is to treat patients with the best medical care possible. That means independent of insurance, socioeconomic status, race, sexual orientation, gender or even if I don’t like the patient, my duty is to treat them. I would not be able to look myself in the mirror if I had to turn someone away for a reason other than I did not have the medical capabilities to treat them. In my mind, that would be just plain wrong.

What. Just. Happened?

Posted in Health Rights, Healthcare Reform by reshmagar on November 5, 2010

I don’t get it.

For the past few days, I’ve tried to wrap my head around it, but I still don’t get it. I must be missing something. Something big. Because no matter how hard I try to fathom what happened Tuesday, the reasoning eludes me.

I remember hearing about its beginning. Sometime in early 2009 when the Obama administration offered to help homeowners who were facing foreclosure refinance their homes, the name first came out. A name I hadn’t heard of since AP U.S. History to be honest – the Tea Party. Then tax day came and I heard again of this name in reference to small protests around the country. I brushed it off believing it was a small response to the election of our new president. No big deal.

But then the stimulus bill happened. Health care reform happened. In the time of what should have been a victory over such great progress, we instead entered a time where the loudest cheers were of dissent – screams of words like “death panels” and other irrationally formed catchphrases. Further divisions were made in our government between parties and within themselves. Voices that I had thought were silenced long ago like that of Sarah Palin re-emerged…and more dangerously so, with an audience. The efforts of the Obama administration became an uphill battle, with the President always on the defensive.

Some call the Tea Party a movement of grassroots libertarians protesting that the government is invading Americans’ lives inappropriately. And yet, we see these same people who cry out “Less Government!” run for office…becoming apart of the establishment…infiltrating themselves into our lives.

Some call the Tea Party a movement of “disaffected Republicans”. I’m so sorry, GOP. I would never ever want my political party to include people like Christine O’Donnell and John Boehner – candidates who have no experience or educational background to represent a state, much less the 6th grade. I mean, come on, look at them:

Christine O’Donnell Blanks on First Amendment

Are you kidding me? Seriously?

During the summer, I thought these candidates were a huge joke. I was working abroad at the time and my fellow co-workers laughed at these candidates along with me thinking the same as I was – “Oh they’ll never win the primary.”

But then they did. I was baffled, perplexed, flummoxed…angry. Who was voting for these people who had no political platform besides “We hate Washington. We’re outsiders. We’ll bring a fresh face to office.”

After the recent wins of the Tea Party this past Tuesday (one being in my own home state of Florida…), I decided then to look up their stance on healthcare reform…and that’s when I almost cried. Their ultimate goal is to get healthcare reform repealed. Would this or could this happen? Probably not. (Fingers crossed.) But their efforts in doing so signifies one key thing – they were willing to take back the acknowledgement that the U.S. government had made after centuries of ignoring or denying – that healthcare is a right. Not health. HealthCARE. In wanting the Affordable Care Act to go away, the Tea Party is in fact saying the opposite – that healthcare is privilege that not ever man, woman, or child in this country can access.

If you think about this, this is totally contradictory to their stance of being the outsiders to Washington. If healthcare reform in the alternate universe of hell is taken away, in time the only people under the current system who probably would have coverage still would be the wealthy and government officials. By taking away healthcare reform, they would taking away something from the “everyman” and “everywoman” of the United States and giving it to their biggest enemy – the establishment.

Regardless, I believe Obama and his supporters can pull through. Maybe even the Democrats altogether – maybe instead of having 4 parties of Dems, Republicans, Obama, and Tea Partiers, we can have 3 with one being slowly phased out into nothing. And one day, I can maybe look back on this event in future generations’ AP U.S. History textbooks as the Rise of the Crazies (Tea Party Pt. 2).

This picture today on the Huffington Post front page actually gave me hope:

Perhaps, Obama has decided to finally stop caring about what Congress thinks? Perhaps, Obama will now run the U.S. government as it has been run for around the last 60 years – executively without giving the reins to people who claim they will vote on issues not based on their constituents or what’s best but rather, how they feel? Perhaps.

Double standards.

Posted in Health Rights, Healthcare Reform by reshmagar on November 4, 2010

This past week I saw a patient who has a long history of epilepsy leaving her unable to work. While I was doing a physical exam on her, she told me about her husband who was waiting patiently outside. He had recently lost his job as a janitor and was “pounding the pavement” looking for new work. His skills though were primarily janitorial. He did not have access or know how to use a computer – a skill that most employers were now looking for. After weeks of looking for a new job, he decided to enroll in free computer classes. It was time to readjust to the new job market.

Like this patient’s husband, I’ve heard of and seen many others forced by the declining economy to learn something completely unfamiliar to them. My dad in fact decided to get an MBA through night classes to ensure that he would still be a competitive candidate should his current job as a research scientist at a local hospital go under. With new technology being introduced into the market and our daily lives at lightning speed, this is a reality we all must face.

It’s ironic, however, that while we live in a country inundated with gadgets (in Rhode Island, for example, there are more MRI scanners than in the entire country of Canada) and with the government continuously investing in innovation, we continue to invest in old humanitarian solutions. Solutions, however, that we would never use for ourselves but only for the developing world.

The United States is the top donor to the World Food Program (WFP) which identifies places even in the most remote areas of the world which are suffering from starvation and asks its beneficiaries to donate food supplies or money to alleviate hunger. While the WFP’s mission is to eradicate hunger, they also strive to ensure nutrition. Based on their website, it seems as though according to the WFP, hunger equals malnutrition.

Child Malnutrition Worldwide




See this child?

Child with Kwashikor

This child’s problem is probably not hunger but rather, a deficiency in protein in his diet or in other words, Kwashikor. Hunger solved, malnourishment still a problem. What are the consequences of this condition? Long term impacts on his development, inability to create antibodies in response to vaccines, and even death.

195,000,000 children will suffer from malnutrition this year alone. That’s 195 million children of the brink of growing stunted, unable to defend themselves against diseases, or dying.

The United States aids greatly in alleviating the hunger of such children but does little to help their malnourishment. To contribute to the WFP, the US subsidizes corn farmers to grow crops to make a corn-soybean meal mixture and spends millions of dollars on shipping these bags of meal to places the WFP has identified as being hit hardest by malnutrition. This meal has no real nutrition value however besides carbohydrates and calories.

Within our own country however, we have an aid program set up called WIC (Women, Infant, Child) which gives nutrient rich food – milk, eggs, bread – to those that can’t afford or have access to such foods. Families in the US do not get corn-soybean meal. Other countries do. Why do we have this double standard?

I understand that this program provides a great economic opportunity for corn farmers in America. After failed attempts to create a market for corn becoming the next big source of fuel, government subsidies for a good cause helps to sustain the livelihood of these farmers.

But maybe it’s time for the farmers to readjust just like the many others who have had to in recent years. Maybe it’s time for the farmers to move from making useless corn-soybean meal for other countries – food we here in the US would never eat – to something that would actually treat the problem of childhood malnutrition.

One woman has started to do this by starting the first Plumpy’nut factory which produces this brand name nutrient rich paste introduced 5 years old made locally and distributed in famine stricken areas and shown to reduced mortality. The factory is right here in Barrington, Rhode Island:

In the United States, Plumpy’nut’s sole manufacturer and chief promoter is a 38-year-old mother of four from Barrington, R.I. Navyn Salem doesn’t have a background in medicine or aid work. She first glimpsed the potential of Plumpy’nut three years ago on “60 Minutes.” Since then, Salem has devoted herself to making the product for export to needy nations like Haiti. Though her Providence factory, a joint venture with Nutriset, has all the trappings of a business, selling its wares to relief agencies under the name Edesia Global Nutrition Solutions, the operation is registered as a nonprofit foundation and was established with seed money from Salem and her husband, Paul, a private-equity financier. Dancing along the nebulous line between capitalism and charity, Salem casts herself as a marketer, offering a neatly packaged solution to a tragic and no longer intractable malady. (Full article found here: The Peanut Solution)

The United States needs to put their government subsidies into new ventures that will actually help people. Perhaps they can create a new industry with the corn farmers making Plumpy’nut to be a conglomeration of local ingredients including corn. Or maybe it’s time for the corn farmers to learn a new skill – one that is more apt for the times.

Doctors Without Borders has created a petition to implore governments at the G8 Summit to supply humanitarian food aid that meets the nutritional standards for infants and young children. You can sign the petition here: Overcoming Childhood Nutrition – The Time to Act is NOW.

Watch the video below to see the dramatic effects of fixing childhood malnutrition. The solution is there. We just need to invest in it.