At AMSA’s national convention in Washington, DC this last weekend, international aid hero Paul Farmer gave the keynote address to hundreds of enthusiastic medical students.  Dr. Farmer, a Harvard professor, is famous for his ground breaking work on tuberculosis and HIV/AIDS in Haiti, Russia and in Africa.  In his hour long time with AMSA he encouraged medical students to continue to work for human rights and improved medical care for the poor. Dr. Farmer encouraged students to demand more from government, in terms of aid and commitment to development and global health.  He was taking the place of Dr. Jim Kim, a fellow Harvard professor, who was recently named the 17th president of Dartmouth College.

You can learn more about Dr. Farmer by reading the biography, Mountains Beyond Mountains, by Tracy Kidder.

(From left to right: Julio Bracero, Susan Lewis, Jennifer Weinberg, Hana Akselrod, and Paul Johnson)

We certainly had a great time at convention! Each of us has a different background, yet we share the same passion for global health & human rights. In case you are wondering about the colorful background, the picture was taken at the groovy and most excellent Jaleo restaurant in Crystal City, Virginia.

Of course, the GP editors were very active and visible at the convention. There are plenty of pictures, but here is a nice one:

Julio Bracero and Congressman John Conyers (D-Michigan).

I had the pleasure of attending AMSA’s 59^th Annual Convention this past weekend with some of my fellow Global Pulse editors.On Saturday, convention attendees had the opportunity to learn about the link between global access to essential medicine and domestic efforts to limit the pharmaceutical industry’s influence in health care. The talk centered around a discussion of the issues contributing to the fact that around 10 million people in developing nations around the globe die each year due to a lack of access to existing vaccinations and medicines. This health crisis is influenced by the pharmaceutical industry’s common refusal to permit impoverished countries from manufacturing generic versions of life-saving brand-name medicines.

Sarah Rimmington of Essential Action (http://www.essentialaction.org/access/) spoke about global access to medicines, stressing the importance of introducing generic competition to the market as a means of driving down prices of essential drugs. The success of this strategy is evident in the case of HIV/AIDS medicines, which cost around $10,000-15,000 per patient per year around 10 years ago compared to approximately $90-130 per patient per year today with the introduction of generic medicines for developing nations, a 98% reduction in price of these life-saving medications. Several resolutions address this balance between adequate global access and innovation and development of new medications. For example, The World Trade Organization’s 1995 Agreement on Trade-Related Aspects of Intellectual Property (TRIPS) requireed all member countries to adopt U.S.-style patent rules for all products, including medicines. The 2001 Doha Declaration clarified that TRIPS should be interpreted to support the obligation to protect public health and promote access to medicines. The Doha Declaration affirms that WTO members may utilize the flexibilities in the TRIPS Agreement “to protect public health and, in particular, to promote access to medicines for all,” including the issuance of compulsory licenses. Compulsory licenses authorize price-lowering generic competition for products on patent.

Despite this declaration, the US administration has unfortunately not respected the spirit of this effort in several ways. For example, the US continues to negotiate intellectual property provisions in bilateral trade agreements leading to restrictions on the use of TRIPS flexibilities. Additionally, the US has employed threat tactics against countries using the flexibilities. A prominent example of this threat technique appeared in 2007 when the US Trade Representative placed Thailand on the Special 301 Priority Watch list, citing Thailand’s lawful issuance of compulsory licenses for two vital HIV/AIDS medicines and a heart disease drug. Special 301 is an annual review of trading partners’ intellectual property rules, highlighting nations judged to provide inadequate protection for patents, copyright, trademarks, and other forms of intellectual property. Similarly, the US Trade Representative placed Brazil on the Special 301 Priority Watch list due to their consideration of a lawful compulsory license to address the countries HIV/AIDs crisis (which it has since issued).

Efforts like Brazil and Thailand’s actions are supported by UNAIDS, Doctors Without Borders, President Clinton and many other public health and international development experts as well as the American people. A nationwide June 2007 poll of 2246 adults conducted by the Wall Street Journal-Harris Interactive showed 61% of Americans supported the use of compulsory licensing if it enabled developing countries to treat more patients, with only 20% opposed to such actions.

For more, check out the Access to Medicines Project

• Children of immigrants in the US are eligible for health coverage under current state laws and policies.  However, many parents are unaware of this and are fearful of seeking medical care for their children.  Furthermore, under previous policies, children and pregnant women who had been in the US for less than 5 years were excluded from these programs.  The recent reauthorization of the State Children’s Health Insurance Program (SCHIP) is an important step forward, extending coverage to over 4 million children of working immigrants and doing away with the 5-year waiting period.
• However, much work remains to be done in promoting the health rights of all immigrants and new American residents.  Some of the themes behind the persistent disparities in health care for Hispanics and immigrants in the US are lack of health insurance; lack of access to health services; shortage of health services and information in Spanish; and discrimination and fear of the system.
• The NCLR poses the following criteria for judging new health care reform legislation: inclusivity of all of the nation’s residents; equity in employer-based coverage requirements and quality of care; affordability; access; and respect for Latinos and other immigrants.

Link to Miami Herald article on the reauthorization of SCHIP.

Link to the NCLR’s Wave of Hope campaign page.

Coming in a future post:  what you can do to make your clinic/hospital more immigrant-friendly. 

As several of your dedicated editor team are currently attending AMSA’s national convention (this year’s theme: Win Back Our Profession, Arlington VA and Washington DC, March 12-15), we will try to post a few “live” (*where “live” means “adjusted for inadequate wireless access”) highlights and thoughts.  The convention kicked off today, with Dr. Paul Farmer delivering the keynote address.  Word on the street has it that videos of the speech will be available eventually; for now, all I can offer is my notes:

• On promoting global health in a world of limited international resources: The medical standard of care is something that doesn’t change based on where you as a doctor are. However, too often we apply geographic and administrative boundaries to determine who gets the standard of care and who does not.  “I do not mean to suggest that we de-link ourselves from sober economic considerations, but to say that our profession is committed to bringing a standard of care to wherever the need is.”
• On the argument for “appropriate” treatment for poor patients and the limitations of the traditional, profession-oriented medical ethics reasoning: when you are a doctor in a developing country seeing a child with cancer, the real question is not which specialist is best qualified to treat the cancer, but that there exists no structure for the prevention or access to treatment for this child.  The disturbing fact is that those who seem most bothered by the existence of immense health inequalities are not the heads of medical departments or medical administration; it is the students, who need to keep their ideals alive until they rise to the positions of professors and leaders.  To keep our commitment alive, Paul suggested that through the clinical and residency years, we make it a “point of discipline” to budget 5 hours a week for advocacy on the issues of reforming our profession in accordance with our ideals.
• On student activism: Remember that Partners In Health started as student activism.  Now it does lifesaving work for the poor through 32 public-sector institutions in 10 countries.  The things we do and say now can have ripple effects literally heard around the world.
• On Global AIDS in the Age of Obama: the problem is not, as some suggest, that there is too much money going to vertical programs on AIDS alone — “The problem is not that too much money is going into AIDS. Too little is going into poor people’s health around the world. Love, AMSA.”
• On making fun of a certain West-Coast institution: “This is probably going to end up on some blog.”

As I listened to her, I could not help wonder: how different would the U.S. “sick” healthcare system be if we had followed Dr. Elders’ advice? Her warnings on comprehensive sex education and health disparities, to name just a few, have turned out to be correct all along. Of course, many progressive health advocates, including us at AMSA, knew this from the beginning.

Favorite quote of keynote: “Condoms will break, but I can assure you that vows of abstinence will break more easily than condoms.”

There were so many highlights, and so many more memorable quotes, that we have decided to share 3 clips of her keynote address.

Clip #1:

[youtube:http://www.youtube.com/watch?v=txxpmoNVIEM 300 246]

Clip #2:

[youtube:http://www.youtube.com/watch?v=syqkdN7FxQM 300 246]

Clip #3:

[youtube:http://www.youtube.com/watch?v=06EXTLat4M4 300 246]

On Friday, March 14, Dr. Catherine DeAngelis, a nurse, pediatrician, and the first woman to be selected editor-in-chief of JAMA, gave an amazing keynote speech regarding evidence based prescribing and the pharmaceutical industry. From the influence of pharm reps on physicians, the ethical responsibilities of physicians towards their patients, and her own experiences as editor-in-chief of JAMA with not-so-honest studies by the drug companies, Dr. DeAngelis literally brought the house down.

The best part: she gave the keynote wearing an AMSA PharmFree t-shirt. Note the PharmFree sticker on her lapel as well. The video is a bit dark because the lights were dimmed, however the audio alone is worth it.

Dr. DeAngelis granted us an interview for the next issue of GP. How was the interview? You will need to read it in the next issue of GP!

[youtube:http://www.youtube.com/watch?v=Ic2YA4SFI1s 300 246]

Following Bill White’s welcome. Dr. David E. Persse spoke to AMSA about his experiences coordinating disaster relief for Hurricane Rita.

Unfortunately, the lights were dimmed for his presentation, so the video we have is on the dark side. Don’t worry, the audio is good.

We could have stayed 2 hours listening to Dr. Persse and all of his anecdotes – some harrowing, some with happy endings – and we would have not noticed the time at all.

[youtube:http://www.youtube.com/watch?v=ztacpFdk6S8 300 246]

Here are two short clips of Bill White’s keynote address to AMSA. Our apologies if the videos are a bit grainy, as the lights were dimmed during his speech:

Part #1

[youtube:http://www.youtube.com/watch?v=-hQplKC7Fcs 300 246]

Part #2:

[youtube:http://www.youtube.com/watch?v=okvtnbcgljI 300 246]

This posting will be updated soon, so stay tuned!

This blog has many goals, among them:

1) To further discuss and follow up topics that have been covered in Global Pulse.

2) To discuss topics that are timely and important, but have not been discussed in Global Pulse for one reason or the other. For example, it is difficult obtaining an article from a medical student in the middle of a war or conflict.

3) To provide student leaders in global health a forum in which to communicate directly to medical students. For example, writing about a relevant and timely topic regarding their area of expertise, or the organization they represent, or of a project they have done.

4) To cover, in real-time (or at least a couple of days later!) events that are relevant to Global Pulse, for example, this year’s AMSA convention, March 12-16, in Houston, Texas!

5) Finally, it is a way for the editors of GP to directly communicate with our readers.

We will debut this blog covering the GHAC events of the AMSA convention. GHAC stands for “Global Health Action Committee” for all of you that are not quite used to all of acronyms we use at AMSA. As the name implies, the convention will feature outstanding events related to global health, and we will try to blog about them so y’all can read about them. I arrived in Texas a couple of hours ago, and “y’all looking for a cab?” was the first thing that was hurled at me at the airport, and now I’m stuck with y’all!

Additionally, we will also discuss the events of AMSA’s first Environmental Health Leadership Institute.

We are extremely excited to expand Global Pulse with a blog. Please add us to your blogroll, or subscribe to our RSS feed, and pass the word on to your colleagues!

Julio Bracero, Editor-in-Chief, Global Pulse