- Email: [email protected]
Trade agreements and public health: role of WHO
CORRESPONDENCE
causative link between prerelease and the rapid uptake of spironolactone. As such, we would propose the following questions for possible researchers: Do pre-release and fast-track publication attract readers to specific articles and thereby enhance the uptake of new and important research findings? Are there objective and reproducible criteria against which all articles could be tested to determine whether their immediate importance is such to warrant fast-track publication or prerelease? WAG is supported by a Population Health Investigator Awaed from the Alberta Heritage Foundation for Medical Research, Edmonton, Alberta, Canada, and received sabbatical support from the Department of Medicine and the Institute for Social and Preventive Medicine, Lausanne, Switzerland
*William A Ghali, Jacques Cornuz *Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada T2N 4N1; and Department of Medicine and Institute for Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland (e-mail: [email protected]) 1
2
3 4
5
McNamee D, Horton R. Fast-track to publication in The Lancet. Lancet 1997; 349: 970. Goldbeck-Wood S, Robinson R. BMJ introduces a fast tract system for papers. BMJ 1999; 318: 620. Angell M, Kassirer JP. The Inglefinger rule revisited. N Engl J Med 1991; 325: 1371–73. Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med 1999; 341: 709–17. Lechat P, Packer M, Chalon S, Cucherat M, Arab T, Boissel JP. Clinical effects of beta-adrenergic blockade in chronic heart failure: a meta-analysis of double-blind, placebo-controlled, randomized trials. Circulation 1998; 98: 1184–91.
Trade agreements and public health: role of WHO Sir—Your Dec 41 editorial stated that the World Trade Organisation (WTO) should make public health a criterion in the new round of negotiations. At present, health is regarded as an object for negotiation in the same way as any of the other 160 services listed in the WTO’s general agreement on trade in service. Similarly, the TRIPS agreement (trade-related aspects of intellectual property rights) lists the patent-application requirements in the pharmaceutical sector. Both sets of agreements are to be redefined during the course of the millennium round and will have consequences with respect to access to health care for all member states of the WTO. The content of WTO agreements favours the implementation of commercial regulations over those
580
concerning public health. The World Health Organisation (WHO) fears that this liberalisation of the health sector will mean that the populations of the poorest countries will suffer discrimination, particularly over access to medicines. WHO has a mandate to make public health a priority in trade agreements,2 but has been relegated to the background in the WTO decisionmaking process. WHO Director Gro Harlem Brundtland confirmed this situation when she said that WHO was invited to Seattle “not as a participant, but as an active and vocal observer”.3 WHO is therefore unable to participate in the negotiations and defend its position. WTO’s efforts to exclude the United Nations from the negotiations has been made clear from the beginning: when the organisation was created in 1994, a diplomatic incident occurred when the then UN SecretaryGeneral Boutros Boutros-Ghali was invited only as an observer. WHO is now looking for allies to back it up in the face of the powerful WTO. Brundtland issued an invitation to “governments, industry, NGOs and other partners to establish with WHO an appropriate mechanism for monitoring the actual effect of the new trade agreements”.4 The WTO committee on sanitary and phytosanitary measures (SPS) recognises that governments have the right to take necessary measures to protect the health of their people, but only on condition that these are not applied for the purposes of protectionism and do not present an unnecessary barrier to trade. This prioritising of trade is particularly shocking. Because WHO requires that any epidemic outbreak is reported to its international health regulation, it is now concerned that there is a risk of potential conflict between respecting this requirement and conforming to SPS restrictions.5 The member countries of WHO are practically the same as those that make up the WTO. However, the contradiction between the interests of each body does not seem to perturb them. With the risk that public health will be dominated by purely commercial considerations, will WHO have the political and financial means to defend the position of the most vulnerable countries? Laurent Aventin Médecins Sans Frontières, Rue Dupré 94, 1090 Brussels, Belgium (e-mail: [email protected]) 1 2
Editorial. Sleep less in Seattle. Lancet 1999; 354: 1917. Revised drug strategy: resolution WHO 52.19, 52nd World Health Assembly. Geneva: WHO, 1999.
3
4
5
Brundtland GH. International trade agreements and public health: WHO’s role. Presented by video at the Conference on Increasing Access to essential Drugs in Globalised Economy. Amsterdam, Nov 25–26, 1999. Brundtland GH. Speech of the WHO Director-General, Dr Gro Harlem Brundtland. In: Globalization and access to drugs, perpectives on the WTO/TRIPS agreement, Velasquez G, Boulet P, Health economics and drugs. DAP Series no 7. Geneva: WHO 1999; 63–68. WHO. Public health and trade: comparing the roles of 3 international organizations. Wkly Epidemiol Rec 1999; 25: 193–201.
Judgment by peers Sir—When I was a young man, even before I had qualified in anything, I could make an observation, do an experiment, or take up a pen and write to The Lancet as if I were writing to my auntie. Now I have to convince someone that what I say is suitable for this journal and I am to be judged by my peers! Nasty things peers, often wishing they had done the work themselves. Suitability is like asking a preclinical student why he wants to become a doctor. Quite invasive I think. Several copies as well! Ridiculous. Not all is bad in the new approach. I wrote a series of terrible poems and the rejection letters were so kind I have kept them. Incidentally, bets have been made on this letter. My children say I have a 30% chance of publication, my grandchildren say I haven’t a hope in hell. Seriously though, I think that you should retain a small space for the minor observation as you used to. Cut down on the editorial. Patrick F James Homewood, Swallowcliffe, Near Salisbury, SP3 5PW, UK
DEPARTMENT OF ERROR Disability and art II—In this Disability series panel (Aug 28, 1999, p 759), the dates for Pierre Auguste Renoir should have been 1841–1919. Why we need large, simple studies of the clinical examination: the problem and a proposed solution—In this Viewpoint by Finlay A McAlister and colleagues (Nov 13, 1999, p 1721), the last sentence on page 1721 should be, “The LR expresses the probability that a given finding will occur in a patient with, as opposed to without, the target disorder”. Second thoughts about safety of St John’s wort—In this Commentary by E Ernst (Dec 11, 1999, p 2014), references 5, 6, and 7 in the panel should be 6, 7, and 8. Functional somatic syndromes—In this Correspondence letter by Jane Colby (Dec 11, 1999, p 2078), the website address in the third paragraph should have been http://www.jafc.demon.co.uk/yaonline/docs/ brain.htm.
THE LANCET • Vol 355 • February 12, 2000
causative link between prerelease and the rapid uptake of spironolactone. As such, we would propose the following questions for possible researchers: Do pre-release and fast-track publication attract readers to specific articles and thereby enhance the uptake of new and important research findings? Are there objective and reproducible criteria against which all articles could be tested to determine whether their immediate importance is such to warrant fast-track publication or prerelease? WAG is supported by a Population Health Investigator Awaed from the Alberta Heritage Foundation for Medical Research, Edmonton, Alberta, Canada, and received sabbatical support from the Department of Medicine and the Institute for Social and Preventive Medicine, Lausanne, Switzerland
*William A Ghali, Jacques Cornuz *Departments of Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada T2N 4N1; and Department of Medicine and Institute for Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland (e-mail: [email protected]) 1
2
3 4
5
McNamee D, Horton R. Fast-track to publication in The Lancet. Lancet 1997; 349: 970. Goldbeck-Wood S, Robinson R. BMJ introduces a fast tract system for papers. BMJ 1999; 318: 620. Angell M, Kassirer JP. The Inglefinger rule revisited. N Engl J Med 1991; 325: 1371–73. Pitt B, Zannad F, Remme WJ, et al. The effect of spironolactone on morbidity and mortality in patients with severe heart failure. N Engl J Med 1999; 341: 709–17. Lechat P, Packer M, Chalon S, Cucherat M, Arab T, Boissel JP. Clinical effects of beta-adrenergic blockade in chronic heart failure: a meta-analysis of double-blind, placebo-controlled, randomized trials. Circulation 1998; 98: 1184–91.
Trade agreements and public health: role of WHO Sir—Your Dec 41 editorial stated that the World Trade Organisation (WTO) should make public health a criterion in the new round of negotiations. At present, health is regarded as an object for negotiation in the same way as any of the other 160 services listed in the WTO’s general agreement on trade in service. Similarly, the TRIPS agreement (trade-related aspects of intellectual property rights) lists the patent-application requirements in the pharmaceutical sector. Both sets of agreements are to be redefined during the course of the millennium round and will have consequences with respect to access to health care for all member states of the WTO. The content of WTO agreements favours the implementation of commercial regulations over those
580
concerning public health. The World Health Organisation (WHO) fears that this liberalisation of the health sector will mean that the populations of the poorest countries will suffer discrimination, particularly over access to medicines. WHO has a mandate to make public health a priority in trade agreements,2 but has been relegated to the background in the WTO decisionmaking process. WHO Director Gro Harlem Brundtland confirmed this situation when she said that WHO was invited to Seattle “not as a participant, but as an active and vocal observer”.3 WHO is therefore unable to participate in the negotiations and defend its position. WTO’s efforts to exclude the United Nations from the negotiations has been made clear from the beginning: when the organisation was created in 1994, a diplomatic incident occurred when the then UN SecretaryGeneral Boutros Boutros-Ghali was invited only as an observer. WHO is now looking for allies to back it up in the face of the powerful WTO. Brundtland issued an invitation to “governments, industry, NGOs and other partners to establish with WHO an appropriate mechanism for monitoring the actual effect of the new trade agreements”.4 The WTO committee on sanitary and phytosanitary measures (SPS) recognises that governments have the right to take necessary measures to protect the health of their people, but only on condition that these are not applied for the purposes of protectionism and do not present an unnecessary barrier to trade. This prioritising of trade is particularly shocking. Because WHO requires that any epidemic outbreak is reported to its international health regulation, it is now concerned that there is a risk of potential conflict between respecting this requirement and conforming to SPS restrictions.5 The member countries of WHO are practically the same as those that make up the WTO. However, the contradiction between the interests of each body does not seem to perturb them. With the risk that public health will be dominated by purely commercial considerations, will WHO have the political and financial means to defend the position of the most vulnerable countries? Laurent Aventin Médecins Sans Frontières, Rue Dupré 94, 1090 Brussels, Belgium (e-mail: [email protected]) 1 2
Editorial. Sleep less in Seattle. Lancet 1999; 354: 1917. Revised drug strategy: resolution WHO 52.19, 52nd World Health Assembly. Geneva: WHO, 1999.
3
4
5
Brundtland GH. International trade agreements and public health: WHO’s role. Presented by video at the Conference on Increasing Access to essential Drugs in Globalised Economy. Amsterdam, Nov 25–26, 1999. Brundtland GH. Speech of the WHO Director-General, Dr Gro Harlem Brundtland. In: Globalization and access to drugs, perpectives on the WTO/TRIPS agreement, Velasquez G, Boulet P, Health economics and drugs. DAP Series no 7. Geneva: WHO 1999; 63–68. WHO. Public health and trade: comparing the roles of 3 international organizations. Wkly Epidemiol Rec 1999; 25: 193–201.
Judgment by peers Sir—When I was a young man, even before I had qualified in anything, I could make an observation, do an experiment, or take up a pen and write to The Lancet as if I were writing to my auntie. Now I have to convince someone that what I say is suitable for this journal and I am to be judged by my peers! Nasty things peers, often wishing they had done the work themselves. Suitability is like asking a preclinical student why he wants to become a doctor. Quite invasive I think. Several copies as well! Ridiculous. Not all is bad in the new approach. I wrote a series of terrible poems and the rejection letters were so kind I have kept them. Incidentally, bets have been made on this letter. My children say I have a 30% chance of publication, my grandchildren say I haven’t a hope in hell. Seriously though, I think that you should retain a small space for the minor observation as you used to. Cut down on the editorial. Patrick F James Homewood, Swallowcliffe, Near Salisbury, SP3 5PW, UK
DEPARTMENT OF ERROR Disability and art II—In this Disability series panel (Aug 28, 1999, p 759), the dates for Pierre Auguste Renoir should have been 1841–1919. Why we need large, simple studies of the clinical examination: the problem and a proposed solution—In this Viewpoint by Finlay A McAlister and colleagues (Nov 13, 1999, p 1721), the last sentence on page 1721 should be, “The LR expresses the probability that a given finding will occur in a patient with, as opposed to without, the target disorder”. Second thoughts about safety of St John’s wort—In this Commentary by E Ernst (Dec 11, 1999, p 2014), references 5, 6, and 7 in the panel should be 6, 7, and 8. Functional somatic syndromes—In this Correspondence letter by Jane Colby (Dec 11, 1999, p 2078), the website address in the third paragraph should have been http://www.jafc.demon.co.uk/yaonline/docs/ brain.htm.
THE LANCET • Vol 355 • February 12, 2000