Perspective on TPP in an unlikely place—a medical journal

The discussion and debate continues this week about the TPP (Trans-Pacific Partnership), TPA (Trade Promotion Authority (fast-track authority)) and TAA (Trade Adjustment Assistance.) Just today, House Republicans (along with 28 Democrats) voted to give President Obama the fast-track authority he desperately wants for the TPP trade agreement.

Over the last few months, I’ve heard plenty on NPR and read plenty in the Washington Post about TPP, TPA and TAA. I didn’t expect, however, to see any of the acronyms appear in a medical journal. But the New England Journal of Medicine surprised me by publishing this month the commentary “The Trans-Pacific Partnership — Is It Bad for Your Health?” It’s written by Yale law professor Amy Kapczynski who also directs the school’s Global Health Justice Partnership. She’s an expert in international law and global health, took on BigPharma when she was a first-year law student, and clerked for Supreme Court Justices Sandra Day O’Connor and Stephen G. Breyer.

Kapczynski relies on several Wiki Leak’d chapters to explain how the TPP could adversely affect public health. She notes that the anti-poverty and injustice coalition Oxfam and the medical-aid organization Doctors without Borders oppose TPP (here and here.) She writes:

“Their concerns stem primarily from the leaked Intellectual Property chapter and the effect that patents have on the prices of medicines. In the context of human immunodeficiency virus, for example, patents increase the annual cost of antiretroviral therapy from around $100 per person to $10,000 per person.”

“The TPP could impose obligations on developing countries that go far beyond any existing trade agreement. Indeed, some proposals in the leaked IP chapter seem directly targeted against innovative measures that developing countries have used to maximize the use of low-cost generic medicines.”

Kapczynski notes TPP’s implications for health in developed countries as well. She explains the agreement’s “data exclusivity” provisions:

“These laws prevent drug regulatory agencies like the Food and Drug Administration from registering a generic version of a drug for a certain number of years — and as a result can substantially affect the prices of medicines.  … The cost of medicines is no small concern in the United States today: spending on prescription drugs in the United States jumped 13% in 2014 alone. …The TPP could make moves toward more rational drug pricing in the United States difficult and even imperil existing provisions that help to contain costs for government programs.”

She refers to an analysis by Public Citizen on TPP’s potential effect on Medicare and Medicaid’s covered drugs and reimbursements policies.

In March, another WikiLeaks’ leak of a document—this one, a chapter on “investor-state dispute settlement”—is what Kapczynski calls a “bombshell.”

“It would empower foreign companies to sue member countries for hundreds of millions of dollars in damages in a wide range of cases in which they argue that their expected future profits have been undermined. …Such provisions have been included in trade agreements before. But the scale of the TPP would substantially increase the number of companies that could bring such challenges.  …[P]olicies covering a wide range of issues, from food and tobacco labeling, to patent law, to drug-pricing rules, to environmental protection could be challenged in participating countries — including, of course, the United States.”

Much of the debate about TPP, TPA and TAA is whether they are good or bad for US businesses and workers. It was appealing to read something new and thought-provoking. It gives me another reason to give TPP a thumbs down.