read your book. there are thousands of books in any book store. there are hundreds of thousands of books in any big library, and you got a lot of competition. the first thing you want to do, if you're an author, is to at least have somebody pick up the book. and so when i was thinking of a title issue thousand what i can title this book that would get somebody to take a peek, read the first paragraph. and i thought, well, nigger. nigger is a strange career of a trouble self-word. and i thought that would -- just think hard about words, think hard about examples, get the readers attention. that's what i was trying to do with the title.

process ease of human life. >> good afternoon. thanks for coming out this afternoon. i know that there are so many events taking place all over the campus, but this is a very special one. my name is pat thomas. i teach health and medical journalism at the university of georgia's great college of journalism and mass communications. so pleased to see so many of my colleagues and students here today. the author. washington is very special to me. she and i met 20 years ago when we were both at the harvard medical school.

she was on a solution to there and i edited the harvard letter. we connected and we have been friends ever since. it lost time that she was a the university of georgia she was touring behind her remarkable for stomach medical apartheid but on a slew of awards on the national book critics circle of the best nonfiction of the year award. we are pleased to bring her back this year with her second book and that have made her visit possible the university of georgia office of diversity, the graduate programs, the professional program for the journalism department and my own graduate program in health and medical journal some. is a journalist who morph into an author who gained an international reputation as a medical moral high thinker.

she is the voice we need to hear in the public dialogue and on a practical level she helps explain to us why medicine works the way it does and why tall costs so much. let's welcome harriet washington [applause] >> good afternoon. good afternoon. [laughter] all right. thank you so much. is my heartfelt thanks for bringing me here yet again. in more ways than one coming here is about coming home and for that i am very, very grateful. i have a lot to say to you today. i'm not actually going to get to all of it, but i just want to caution you that if i should skip over a slight as i am speaking and it's something you were fascinated by be sure to ask a question about it in the q&a section. also i'm not in the habit of

reading my slides. you are academics you can read them for yourselves. i'm interested in touching upon things hopefully will have a little more depth on what you can read. that is what i'm going to talk about my most recent book which is actually a critique of american medicine that's a multilayer critique. but i am principally concerned about is the ethical and moral consequences of the corporation's alliances of medicine. although they may or may not have been well-intentioned, the consequences seen and unforeseen have been disastrous for american medicine for all the fuss and i hope to eliminate exactly why. i liked data. i'm going to try to eliminate wide by showing you figures to show why medicine man not be exactly the way they appear

either in the congressional media or in medical journalism itself including peer reviewed medical journals. but first i want to go back in time a little bit and think about what medicine once was. i'm not pretending there is any kind of golden age of medicine during which there was no grafting after money but as a culture of madison was once very different from the corporate culture. it was probably an illustration of that and the fight against polio which opened up. in the march of dimes. i remember as a student coming to school every fall and we have apprehension about who would not be there, but desks would be empty. there were always kids missing and they often had polio. and when i got a fever orchil or stomachache my parents first thought was always i hope it's not polio. polio in many ways occupied the area of culture that a document today to read as a scourged, it

was mysterious, carrying out parts of the population and we were hellbent on trying to put an end to it and we did, not one but to actually. he appeared on the show and they asked him what are you going to do now? we have this vaccine devotees went to want it. the demand is went the incredible. who holds the patent? he said the american people i think. could you patent some? this was not unusual. this was the mentality and the american medical research culture. the feeling that grubbing after money, seeking profit, the maximum profits from the patents on the active molecules and medicine was not really noble calling of research. it wasn't what the research is all about. it attracted -- research was interesting in that it required

a long arduous course of studying. and it attracted. brilliant people. it was very competitive and very difficult and yet it didn't go very well. these people were not motivated by money. they were motivated by things, the intellectual competition. they wanted to be seen as benefactors. they wanted to win prizes. these were all the motivations that drove them and drove them very well and to the modality seeking a lot of bad answers to our medical crises. penicillin, st etds, streptomycin, of course the polio vaccine many important medications were devised by researchers who were not concerned about money. they worked in universities and universities themselves or different. they couldn't have looked more different. corporations still seek to maximize their profits. universities were actually

centers of science in the public interest. they were centers of research at the was clearly focused on the society beat a medical, social, what ever, and it attracted people who were drawn to that role. so the university had a unique role in pursuing the public interest and there was true of medical research as well. in fact there were laws and regulations that band the universities from using the discoveries made with government subsidies but couldn't license in the corporations or sell them to corporations in most cases, so there was a very, very clear member and ten corporations and universities. it's not there anymore. i'm going to talk about what happened when it dissolved. so, one of the consequences also maybe not the most important consequence is the cost of medication. i think i noted here that when

medicaid and medicare were passed in the 60's it's interesting there was no provision there for the cost of medication, the health of the elderly and the encore paid for their drugs. why? because drugs were so cheap. it wasn't needed. drugs were cheap because university researchers working in the university's device to them, they were then marketed and there was an animus against this and there were some in that that had a hard time when he actually sold his patent to the university he then took it back because he was afraid of what people would think if they knew that he had sold his drug to a profit-making company. so, drugs were cheap. they are not cheap anymore. there's also ha a innovation. if you look at the patau figures you would find that depending on the year, the trend where hundreds of drugs were devised every single year. hundreds of new drugs. and yet there was a mentality among the corporations, and

among the legislators for whom they were whispering. that that wasn't enough. because there were lots and lots of molecules that were not being made into drugs. many, thousands of them as a matter of fact. and so there are rows and ms that we had all of these patents on drugs lying fallow and there wasn't anything with them. we need to have hospitals and medical centers partly with corporations so we can do for love of these drugs that are lying fallow. rich was a center of indiana, and he was a senator who listened and he began complaining on the floor of congress that we have got 28,000 patents made in the universities that are not being developed. they're just lying their collecting dust. we spent $30 billion collecting. 30 billion-ton 1985 become and so he sought to convince his fellow congressmen that we need a wall to ease the corporation

of universities and she was successful but he was successful under a very strange pattern because initially it was voted down. initially congress wanted no part of it and more importantly derry to become very powerful senators were against so following the lead senators voted down. but, even though he lost which bayh went on to lose the election, not a good year for him, and jimmy carter was a lame-duck. at the end of the year there's an emergency session called specifically to pass the financial legislation, and bush wanted to reinvigorate the law. he wanted another try at getting this act passed because bob dole was his partner. but he was worried about long, he was in opposition to him, and for his part he commented to

people i think i will give him a break. he's leaving office. he's been a good boy, so he calls him and says you know what to take that patent bill. you've earned it. very interesting language. he tells him he's got the bill passed before there is any vote. but he was right because of the very end of the year in the last hour the bill was in the past. they would sell to the corporations. now they were going to have the 28,000 patents made into medications with all these new medications with all of these off. not exactly. because what happened is that the university's and corporations did indeed partner and they did indeed make a lot of money by doing so, a lot of money that did not translate into more and better medications for you and me and part of it had to do with some cultural changes in medicine the

resulted. unfortunately madison began to take on more and more of the coloration of the corporate mentality. now researchers like the corporations became jealous of their patents. we can't work together with the university of researchers on the same problem because we want to have the patent only on the patent can we sell it to the drug company and make a great deal of profit. we cannot share of information with them. any collaboration must be done internally, and even then the profits are actually lawsuits when they are set to collaborate. also, when drugs were the highest and assigned to corporations, the corporations now paid researchers to do research. some of the research departments of many medical schools begin to look more and more like a

department of a corporation. they are receiving the funds for research, the research dollars are actually paying the salaries of the researchers. where did the loyalty why? was it with the american people or the loyalty with the corporate need to maximize the patent profits? also, what happened to all of these new medications? to the of thousands of drugs a year instead of hundreds? no. instead of using the innovation decline. can anyone is approximately how many new drugs were accrued last year? there were hundreds of drugs accrued in the year before 1980. during the ball park. there were 21. the year before, 26. some years have been even more because you can see it in 2000. only 15.

innovation has dried up. so come on to become although this change in medical research was sold on the basis of having access to new and better drugs we have access to fewer drugs and are those drugs better? are they better? not exactly. one can't generalize that important drugs have been developed but a lot of drugs that have been developed are neither new nor are they better. there are many more copycat drugs that have already been tested and approved for indication and the corporations seem to patent the don't want to move the grip on the patent covered a lot to maximize their profits. what do they do? to take this molecule and they tweak it slightly. when i see slightly i mean slightly. the changes. is it a molecule are left-handed and right-handed version? they see if the right and the diversion would also work or

maybe an extra of the left and right handed version might work. if so they have a new drug and a new patent. so this is not exactly a new drug is a copycat. we have five fewer drugs devised every year and they tend to be for more trivial disorders i'm glad to discuss a bit later. so the bayh act was not the only law passed in 1980. also, there were the decision by the supreme court that for the first time a product of nature can be patented, a living thing can be patented. now begin to get patent held on a gene on a genetic sequence, on a biologically important animal programmed to always develop, on a plant. so the fact that something is losing was no longer to patenting. things had been patented sporadically for the rauf and legal challenges. it's eliminated the legal

challenge. i don't know if any of you have read about it or followed it, but very recently the supreme court said that the case on the breast cancer gene patents. these patents could be affected because of the law passed in 1980. liked the fact that made it much easier for the universities to partner and john, a patent was actually taken out on this human being the product of his body even though his doctor never told him when he moved his spleen she is doing it for research. he told him he was doing it to treat his leukemia. when his doctor to cut the spleen and isolated she took out a patent on the product of his body, a very pretentious president i think. i love this quote. it really sums up what happened since 1980. the use of science this appears

to the detriment of the interest of society. it's now the patent at the center of american medical research. what do i mean and i say that drugs are we too expensive? i suspect you already know without me telling you that drugs are too expensive. but even on a was completely staggered to see how extensive they are. we're talking about hundreds of thousands of dollars for treatment. how did this happen? drug companies want to deny their everyday expenses. they explained they have to be expensive because they invest so much money bringing them to market, and in 2001 to report that sort of the interest by the pharmaceutical manufacturers claiming every new public can cost $102 million to bring to market. i was advised reports to a

billion dollars. two years ago it was upwards to billion dollars. on the claim by the drug companies is $2 billion for every new drug on the marquette and that's where the medications are so expensive. economists looked at this and said no i think the figure you want is closer to a hundred million dollars. they said that's not chump change its ought to billion dollars either. there's 150 come 240 million public citizen's even lower, 110 million. so, why the white diversions, why do they claim the responding to billion and why are the groups providing low-cost indications to people here claim that it is so much cheaper? because the report is deeply flawed. it's not accurate. when they look at the cost of

drugs, they look at the very atypically expensive drugs even the drugs that are brand new they are not copycat drugs the spoke of, the new molecular entity of the totally different totally new drugs. those are expensive and rare most drugs do not fall in that category. they also get a small subcategory of the drugs, the few for which no money in its development. that is also rare because the government will invest money in the research and university and when the researchers find something that is worth defending only then do they stay in as a partner and start controlling the additional research needed for the approval of etc. so, a few drugs, relatively few don't have that initial support so they look at that small segment also the report didn't correct the industry from the of

the largest of any industry in this country and they are so high that for every dollar they spend the only lose 66 cents. so these are big benefits and they do not figure into this report. also, the charge an opportunity cost. i'd never heard of opportunity costs before. opportunity costs for by john stuart mill's and in the financial sense that you pay if you surrender to pursue activity in one direction at the expense of another. if i have $10 i guess i'm going to go to the movies with him and by a movie to get ahead in my savings account would have earned interest. that is my opportunity cost. if i had invested for long enough, the interest would have doubled the $10 billion that is exactly what he did in this report. they said these drug companies spend money on research. they could buy a stock in

starbucks with that money or on a global hunger relief and they would have benefits from it but they are giving that up to devote their funds to the drug development. isn't that what the exist to do? if these drug companies were to expend the resources and starbucks or global hunger relief they wouldn't be drug companies anymore and that is the opportunity cost does not apply to read what they receive a tax benefits and actually it's not an investment for them to drugs it's part of what they do. the cost doesn't apply. this would cut the remaining figure in half. so we can see how easily you can fall from the 2 billion figure to something that's closer to 100 million that's why the claim is baseless.

what do the high drug prices mean? you know what they mean. if we are that we know somebody or close to somebody who can't buy the medication who can't get care, who can't get health insurance or who live haven't had a test or treatment they need? so we know that this is really significant but here it is quantified of it. half the people in this country fall into one of those categories. even those people are employed and have health insurance are not immune because employers have been consistently making employees more and more because of the research -- i'm sorry because of their insurance and medications. so now we have the background and we see what happens and we understand what this was in terms of drug costs. but interestingly, this confluence of industry research organizations designed only of the pages but researchers itself, and this is the thing i

felt was deeply troubling and i wonder why people are not more aware of this. chris perish as a researcher at the australian university and he has endured his entire career 20 years to a liver cancer drug is very promising liver cancer drug at this stage 3 trial doing extremely well called pra 88 and it looks promising. he had acquired a corporate partner to was very happy about that. because his corporate partner allowed him to finish work on the drug, it funded his research. he didn't really care, he said, but when he partnered with this group in his university, they told him look, we have to excel the patent to this new pro-forma, this new company. so you no longer own the patent to rely just what the drugs and he did. at the end of the stage 3 trials right before it was about to

obtain approval they shut it down. they ended the trial if it were not going to pursue the drug we don't like it and we aren't going to market. why did they want it? the liver cancer drugs and although it isn't a large problem in this country liver cancer is the number three killer globally and there aren't that many good drugs for it, desperately needed. they said we are not interested any more. why? because two other drug companies are devising the cancer drugs that would compete with it in the marketplace. they said we don't want this drug unless it is going to be a blockbuster. it won't be a blockbuster because of the competition of other drugs therefore we are going to pursue something else not worth our time and money to see this to the end. what is a blockbuster drug? a blockbuster drug is usually a drug that takes a net least $1 billion of profit a year. we're talking about a 310 billion-dollar industry. so, that's actually, you know,

that's the watershed if you do not take a billion dollars a year it is performing and you are not worth our time. the interest of the liver cancer patients around the globe don't back into the corporate model. what other thing have we seen with devising new and better drugs? are the drugs really better? that all depends on your point of view. the drug companies certainly think so. but looking at it and globally it seems clear they are not better drugs because if you look at the disease that killed people in the greatest numbers across the globe these are the diseases that they are not at all interested in devising. and the answer is very simple. malaria which is quite prevalent affects people who are poor and can't afford the drug is and therefore they aren't making the assessment. though malaria drug recently

guess what kind of drug it is its to treat malaria for the wealthy western travelers to help them avoid contradicting malaria. stevan when the drugs are devised in the developing world they are to protect people like us wealthy westerners. succumb if you look at the sleeping sickness i think that is a perfect example because there are only a handful of drugs most of them are as bad as a disease one of them is a compound of arsenic into trees and you don't have to be a chemist to know that that is bad news. what happens is if you are desperate seeking treatment in western africa your -- the drugs may kill you, and i think it's like one in four people like julie bye from the treatment. moreover, if you -- if you're to the point you go into a coma and

is a drug cannot bring you back to the brink. it can help people that go into the final stages of the disease. so this is a tragedy to the absolute tragedy. however, a job was found that only not treat people safely but it would bring them back to the brink. this is wonderful. the company i'm not going to name right now because i don't want to spend my time in litigation with the company decided to call it for awhile in partnership with doctors and borders a very good thing the company extra partnered with doctors without borders in order to make sure that people in west africa have access to the drug. but they only did that for a few years because after while it was quite clear that no one in that part of the world could afford the drug they were losing money. i think it's wonderful that they were willing to do this, they were willing to make sure people had the drug problem of course

is in very difficult they did it for short period of time it wasn't nearly enough to treat the problem with a handful of people. so they withdrew from the african market. that doesn't mean --. it doesn't mean that you cannot buy the pharmacy. anyone of us can get it there is no sleeping sickness in this country so why would we need? if you leave it is being marketed for women who have facial hair the commercials come on tv sometimes. if you are embarrassed by your facial hair and don't want to use a razor, get this. it's a cream you put on your face, it's $50 a month with a prescription and will banish your facial hair. so the western women can buy this drug for their facial hair

but west africans cannot obtain it and that is what is wrong with medicine today. that is wrong with the corporate partnership. i would take a minute to say these corporations i criticize them heavily. i think they deserve it but i also want to know that they are not in business to promote health no matter what they say, no matter what those heart wrenching commercials say they are not in business to maintain or restore health. they are in the business to make a profit. so i do criticize them, but i have more criticism from the government because the government is a debate is supposed to protect our health and involved here. it's our tax dollars to fund initial research. we have an investment here. as pointed out we end up paying for our drugs twice. whatever the initial development of the tax dollars and when it was on the market we pay the prices. so the government should step in and other countries the

governments have stepped in and say the company drugs are too expensive or if you are not going to distribute this drug at a price people can afford, we are going to take that from you and give it to somebody else. that could be done in this country for the radio receivers come for certain television technologies but not medication. so there's a shared responsibility here. the government has a response ability to do this. and why don't they do it? in my opinion this is not being done because of a very cozy relationship between these companies and legislators. the lobbying is completely out of control. the have the highest number of lobbyists and pay them the most pivotal and a lot of these lobbyists are former legislators. here they are cutting deals with former colleagues to make sure that the drug prices don't go down. to make sure that we are locked

into paying high prices, and to make sure that they are permitted to sell the trivial medications and ignore critical health problems without any adherents from the government. >> also about the fact there are so few medication for these killers, but part erectile dysfunction we've had 14 drug since 1996. and it doesn't kill anybody, although almost 600 men have died from taking them? so, it's very sad where our priorities seem to lie or the pharmaceutical company's priorities seem to lie >> so of what effect his corporate control research had on the deval the world? for anybody these are the children that have been a result of taking full of light. it was just turpitude in europe

and was treated pretty widely peter was given to pregnant women as and a sedative, and for their sleeping problems. but after a while even though it had been improved in europe, the children were born that had a devastating birth defect. everybody knew their articles were even as a kid you couldn't avoid them. this will never happen again. we can never allow this to happen again. now, why were american people affected because there are only 11 children in this country were with this and thousands abroad because of the fda. frances kelsey the test point correctly i'm not convinced the drug is safe. the drugmakers said we are going to sue the fda if you don't approve them everybody else is selling it won't you?

they said no we are not lead to do it. and of course americans were safe from tragedy but what has happened today? the picture on the right is also the picture of a baby with this and he also has it because his mother was given this medicine. it is being tested only in the developing world. only in brazil, cuba, other parts of africa, it's not being tested in the west. it's a horrible ethical misstep. it's not only that these people assume all the risks. and none of the benefits of testing. what they have said to me when i asked about it is leprosy is rampant in places like brazil and nigeria so we are doing them a favor with a new drug. no, we are not. because this drug efficient treat these conditions would never make it to these people.

they can't afford it. and more to the point of the pharmaceutical companies cannot devise drugs for people in the developing world. for a long time researchers told me that there was an unspoken kennon that you didn't test for use of the tropics by the developing world. people there couldn't afford it and they didn't even want to explain why they were not using the drug there. but the data will also tell you the economist michael kramer route 333 drugs tested by pharmaceutical companies within a 25 year span guess how many were developed for the people of the developing world for the people that live in the tropics? so, these people are not a pretty but they are a priority for the testing of these drugs. so, the testing is done by european and american

researchers in these countries and there are lots of social justice violations. for example, for what might when it is prescribed to people in the west for a condition like leprosy they are warned that you've got to take the two forms of contraception. you can't be pregnant on this drug. they are also labeled with the picture of a deformed baby, but i don't think that labeling is the most clear thing. if you don't already know, you might wonder what it is you are looking at. there's the picture of a baby on here but what does that mean? so these people are being warned. however, it's quite certain that in some trials people in the developing world are not warned. for example, the packaging material in west africa until 1978 described as completely harmless without side effects.

and many of these people are delivered. the of the unborn to the women and they were distinctly traced to the women that had been given this. there's no question about it. this also the question whether it might be excreted in scene in which means that men might take precautions, too. so they have all of these violations of the developing world. the developing world women might be told, they are told to take the contraceptions to read it can't go to the drugstore and buy them and many contraceptions are beyond the financial reach and also there are cultural reasons they cannot obtain the contraceptions. they are illegal or the religious leaders for beta their use. so, these are people who are not able to protect themselves and get this is where the research is being carried out. one might wonder why. you know, i think the west would be more logical place because here at least they can protect

themselves. as you can see the developing world is not the market for these companies. the problem is, the problem is, but the decision has been a financial one. the journal shows pharmaceutical companies conduct one in every three trials in the developing world and the was more than a year ago. it may be more now. why? they can conduct cheaper trials, faster, important for fda approval, and they are higher quality in the developing world they can get a better quality and more experience. although a lot of our discourse providing jobs to the double the world has been well we can't afford to do this these people are so poor that's why they can't afford health care. the support they can't afford drugs and we can't afford to be

the world's beneficiary and give them free drugs which can give drugs to these people but we can't afford it. i say we have a debt here. these countries are setting us a lot of money by allowing us to conduct cheap trials so we are in their debt. we have an obligation to provide them a family with free drugs to offset the excess risks and as i mentioned in some cases we shouldn't be conducting the trials of people can't protect themselves if you get the disease burden around the world is a very interesting pattern. very, very high when it comes to infectious diseases. yet all of these medications that are needed are missing. a lot of the focus is on the hiv as it should be, there are other things that much easier and

cheaper. for the civil, vaccines in the developing world, vaccines are very easy and cheap because you don't have to make a diagnosis you don't have to have a lot time or monitoring. it's a one-shot deal. every child gets a vaccine it's easy to administer and it's not very expensive necessarily because the bill gates foundation has partnered with the drug company among others to provide a very cheap vaccines to the building world. we have to keep in mind it's not a matter of importing western vaccines and medications. the special challenges in the developing world include the fact that the health care practitioners are scarce. you don't want it to be intractable. you want the refrigeration is not always an option. so these things have to be kept in mind. even so they were able to take a 70-dollar vaccine and distribute it for 50 cents in the developing world and it's important to me that for was a local companies are part of the

partnership. and in my opinion this is where the future lies for them. because as i talk about how this new model doesn't work for patients and it doesn't work for the researchers because they run the risk of having the plug pull on them. to think about what it means to them to have to drive the pipeline of drugs, 15, 26 drugs a year that's not nearly enough for them to make a profit. they see in the patent expired. a blockbuster drugs come up with rapidity in the last few years and the drug companies are suffering. there is still making a great deal of money but the fall from the number one spot to number three spot in just a few years. the system isn't working terribly well for them either. i think that they should become aware of the fact that the developing world is a huge untapped market for them. instead of thinking in terms of

charging the serious crisis and bankrupting people charging hundreds of thousands of dollars a year for drugs the should think about the fact that providing the relatively cheap drugs to many people in the developing world can prove a ultimately as lucrative. and there are people like the impact on our of yale the economists are actively working on these kind of models they might consider adopting. and as an ethicist i am deeply concerned about the effect of the corporations on research ethics. research a fix has been informed by corporate control. even those that are supposed to be the guardians, the watchers, people that critique everything. even they are in beijing when i consider very troubling activities. more and more are joining the ethical board of the pharmaceuticals. and i see this as a distinct problem. you know, if someone is doing things that are resulting in

death of people, resulting in people not being a to afford their drugs and people going bankrupt trying to pay for their drugs, i am not going to be on their corporate board or any of their boards. i'm not going to advise them. .. another disturbing new trend is the fact that corporations have discovered that recruiting

people for clinical trials takes a lot of time because you have to explain the trial and you have to pay your commission and for four and consent in nutshell. when the principle tenant was the voluntary consensus of the subject is absolutely essential but that is not true today any more. to getting in 1990 continuing in 1996, a series of changes to the code of federal regulations set of allowed researchers to conduct research on people who do not give their consent. if you are unconscious and a trauma victim you can be enrolled in research and people like that have been enrolled in research without your consent. they don't have to tell you about it afterwards and they don't have to obtain your family's consent. it's very easy to look up if you look under regulations, 21,

50.23, 50.24 there it is in black and white, very chilling development and american laws. it is remained under our radar for two long. i read a few articles about it. i am deeply concerned about this and the largest study ended in 2007. 20 people around this country and the artificial blood it was testing turned out to be harmful. it turned out more people who received it suffered heart attacks and deaths than people who got the standard of care. you would think this would lead to more research without consent but instead a new study was approved that enrolled 21,000 people. from 700 people to 21,000 people across this country and canada. number one trauma centers and they are testing wide varieties of emergency agents and people who have suffered traumas. traumas, anything from a gunshot

went to a car crash to a heart attack. 21,000 people and yet when i have spoken to ephesus and said are you disturbed about this until you find it disturbing what i heard most often was yes but you have to understand it's very rarely used. this is not something that affects most people. is really rarely used. i don't think 21,000 people is rare and i don't think that is an ethical defense. if i kill somebody i can go to court and say but i very rarely kill people. wrong is wrong. and yet this is being done and offended. informed consent is going the way of the dodo and one troubling aspect is if you look at these consents i am seeing a a lot but of the word consent that when you read the descriptions they are united by their failure to provide consent, their failure to allow a person to say yes or no to medical research, very troubling trend in american surgery at my

concern is that we don't stop it now, it's going to continue to escalate before most people are even aware of it. i want to wind up soon because i do want to leave time for questions but again i really want to summarize by saying that in my opinion pharmaceutical companies have been responsible for a lot of pain and suffering, and a lot of unnecessary heartache and they have a chance to redeem themselves now. if they take the opportunity to embrace new research that will benefit people in the developing world, they will benefit more people in this country. to change their focus from maximizing patent profit to maximizing distribution of their medications at a lower profit, they might ultimately make our money. and if they don't see things that way it's the responsibility of the government to do so. the government should exercise its power to force these companies to do what is right if they choose not to do the right thing. that is essentially what i have to say to you.

thank you so much for listening to me. [applause] i was told if anybody has questions and i hope a lot of you do, just time for the mic to mike to get over to you. so we can be sure to record you properly. >> i see motivation is a big factor and less motivation switched from the incentive for research and collegial competition to profit. what happened was profit went down, but it's hard to take us out of that mentality. other than saying because people would get angry at the government, i mean the incentive to get out more medicines is going to increase your profit and we are finding the same thing in the american economy now today.

corporations want to make more money, but they can only do it if they recognize that we are a team working together. there is no middle classified annex, how can i make more money? is? is there any kind of broke graham or understanding or push other than little groups like this to try and bring this awareness about? >> i think it's really important for people, especially groups like this to try to make their legislative are aware of the fact they are they're concerned about many developments because in california xavier becerra after being a constituent actually drafted the law and dave wheldon joined with him and it was a law against gene patenting. that is only part of what has to happen. this issue began in the log has to be ended in the law. the big hurdle is congress because right now we have legislators who have not been

paid as far as i know actually, these legislators have been elected by us and get their behavior is squarely in line with the interest of the pharmaceutical companies and against our medical interest so we have to get rid of these lobbyists. we have to outlaw them. they have no place in health care design. they have no place in decisions about medical care and yet they are observing a huge influence. get rid of of the lobbyists and lecture legislature know that you are concerned about this. i always tell people you know, i tell people to take action where they are. whatever group you are involved with, that is a group you should try to tell your outrage about this and have them approach your lawmaker and of course they won't do it on their own. i think the law will be where it ends because companies are not going to do the right thing of their own volition. if that had been the case they would have done it already. they do it occasionally and sporadically but not in the consistent way that we need.

>> the fda came up with a statement that says that only drugs can cure illness, and i was reading a book by jeffrey trudy and it went into the statement that you made about lobbying and congress and the pharmaceutical companies. what do you think about the idea of revitalizing the option of natural supplements in this country, because that is revising herbal options and that sort of thing to help with curing illness. >> that is a very insures in question. i am not aware of the book that

you were alluding to put the question about alternative and complementary medicine, in the closet earlier today we were discussing this very issue. my take on it is alternative and complementary remedies are only all tentative until they are shown to work and then they are absorbed by conventional medicine so the demarcation between the two is actually artificial. i ashley, me, not public to most people but i view it as not alternative and complement to conventional, i look at what works and what doesn't work. to me that is -- and to know what works one has to tested vigorously. there is some sentiment that i don't agree with that alternative and complement j. medications don't have to go through western-style testing in order to be thought of as efficacious. i don't agree with that and interestingly if you look at germany they have a long tradition of rigorous testing alternative supplementary medication.

and it has been very useful. they have a good body of evidence for things that work and things that don't work. that is what we need to do. the way that alternative remedies are too often promulgated is not evidence. it is simply anecdote. people will say i have used this for 20 years and it has worked well and they chart outpatient a and give it praises. that is not evident. it may not be accurate and it may not be applicable to other people. everyone deserves to have medications that we have done our utmost to make sure they are effectively safe and that is the only way we are going to get them no matter what kind of education it is. >> i have a thalidomide question. if they are testing it in third world countries for diseases that primarily affect the third world like leprosy and the example that you mentioned, where's the economic incentive for them there in testing with

thalidomide? >> that is a good question and to me, what i ask is, is this actually the reason it is being tested? is this the application they have in mind because the figure i gave you about the foreign medications, the 4300 odd, that would indicate it would not be used but that is a useful thing to say when someone like me asks why are you doing this research in nigeria but not in connecticut? i wonder if that is the real indication. [inaudible] i was wondering what you think of the ethics behind that in the second question i've have is once a drug becomes extremely

profitable what is the impetus to ever have a become obsolete so if like a disease were to be cured would we not know about it because the drug is so profitable? >> right. the director consumer as to what you're talking about where pharmaceutical companies bypass a physician and go right to you, the television viewer and they sing the praises of their drug and then they deal with the side effects and problems we too quick way for mortal man to read or hear. and then what happens? you go to your doctor and demand that drug. that is the way it works. no country except the u.s. and new zealand allows this. other countries to not allow this because they understand that if you are bypassing your physician, these companies are not informing you correctly about the drug. they also know the capitalizing on lay christians lack of information, and they also

understand there is an obscure but very subtle, very strong pressure on physicians. physicians will prescribe these drugs partly because they are human and they understand that if you don't get the drugs from them you will get the drugs from someone else so it's an enormous amount of pressure on them and that is why other countries don't remitted and that is why we should not permitted either in my opinion. >> i am interested in curing the disease. the disease -- would that not dry up their revenue stream? that is a perennial question and quite frankly i don't know the answer, but i do know that for whatever reason, to be honest with you, don't think that is a question we really need to answer because i don't think we are in much danger of these companies devising new drugs that are actually going to cure disease. for a much more direct financial reason and that is these companies are much more

interested in a quick return in a big return on their dollar and that often doesn't mean finding cures. that means finding -- devising a test for a particular drug, a genetic element, utilize a test for the ailment and take out a patent on that and now no one else can use your test. when pie round device to test for hepatitis c, the price of the hepatitis c in london and great britain skyrocketed six times as high. why? chiron's lawyers said cease and disist, we own the patent. you have to user test and that is what they did. i think the app is a son cheaper and patent explication devising tax, devising lifestyle disorders, gastric distress. the dtc ads never tell you if you have daily gastric distress,

stop living on pizza and hamburgers. they don't say that. they say take our pill and they capitalize on people's insecurities. toenail fungus, dysfunction. they have half the men in america convinced that their normal occasional failure to function is a disease which is very profitable for them so i think because of that focus i'm not sure we have to go to the point where we say was it worth their while to find a cure because it wasn't worth their while to find a treatment for a certain illness. is worth there will while to find cheaper experimentation. >> we are on the university university campus and technology transfer has been very good to

the university and universities are always striving to make it better by transferring these corporate entities. should we all be disbanding our technology transfer activities? by kami go back? what i'm asking is can we go back to that time when researchers actually had to make a choice between academia and business and they couldn't actually devote -- can we ever go back there? >> we could go back and i think it would be a good thing to go back. whether we will go back i don't know because its true universities make a great deal of money. very successful universities but unfortunately, the method does not filter down to people. the people who don't need money but need effective treatment that they can afford. so, we could repeal it which i propose to my book that i propose it, i'm pretty sanguine

about the chance of that happening. i am not thinking that is going to happen anytime soon. it would be a good step. i think sometimes we are so afraid of not being progressive, not going forward. there is a nigerian proverb, and what is says is, it is not wrong to go back for that which you have forgotten. in this case we have forgotten something. in our zeal to make money we have forgotten to put patients at the center and i think it would be a very good idea to basically effective divorce between corporations and universities. now, that may not happen and is probably not going to happen so what should we do? i think that the government should observe very serious pressure -- might exert very serious pressure on pharmaceutical companies. first get rid of the lobbyists. like in shakespeare, first kill all of the wires.

vana exert very strong pressure on these companies to partner with groups like doctors without borders which have been occasionally able to do it wholesale to adopt new marketing like the health impact fund which does that instead of charging a lot of money for a drug. you are going to be paid for your drug based on how many lives you saved, based on how many people you have helped. that is a beautiful motto because not only does it guarantee a windfall, but in not model every life is the same. the same with saving lives with americans -- africans. the government shoots put serious pressure on these companies to adopt these models and if they don't, the government should force them. they should only funds the companies that will adopt those models. that is what i think should happen. >> how corrupting if at all do

you think the massive amount of advertising dollars have on the news industry? >> the news industry, not medical but news industry? >> well yes, because if you look at the nightly news for example, i mean two-thirds of it are drug advertisements. what would happen to that and do you think that has an impact on coverage? >> i'm not in a position to say for sure. i will say i would be surprised if it doesn't but in terms of the massive media i would not single out drug advertisements, because money in all its forms can address the influence if you're not very careful and of course you know the news media are a pearl so it varies from publication to publication. you have some publishers who have a strong sense of wanting to keep a journal's independent

and and and then you have publishers who are, i don't know, what did they call it in l.a., the serial killer because he was -- with a serial fortune and people were claiming it had effect on the news coverage there so it varies but definitely advertising is a way of exerting pressure and in my career i have actually seen it done. i've seen a case where we did not run stories as a result of advertising so i can't speak with any authority about exactly how often it happens but i'm sure that it does happen. >> what has been the most tangible, hopeful result of your book from the drug companies, from lawyers, from the government? >> government? >> they love it. [laughter] the most hope will?

i wouldn't say that you know the most hopeful reaction has come from the drug companies at all. i think they have actually been very smart. they have not reacted much to it which is the smart thing to do. they want to draw as little attention as possible to it so you know they have essentially ignored it which is fine with me. the most hopeful aspect of what i have discovered is certainly seeing that these partnerships between drug companies and groups like the ones i mentioned, doctors without borders, the gates foundation, they are ephemeral. they never last very long but we have seen some examples of them doing what they set out to do and i dream of a world of which these companies will work hand-in-hand with these groups who are devoted to the health of people and we hit some kind of healthy medium. i'm not against them making a profit. i am just against them making such a huge profit on the backs of other people that other

people suffer and die. that is what i'm against. there is a happy medium there and whether we will achieve that i don't know but that is the most hopeful thing. i'm hoping i am hoping things work out that way. mentioned earlier the fact that you can make effective vaccines for 50-cent windows and i don't know if you are thinking of the meningitis vaccine initiative. >> that was one of them. >> but there was a transfer in intellectual property from u.s. government to an optional drugmaker, a true partnership and funded by more than $100 million of gates foundation money and they made a 50-cent vaccine that works the same, plus 80 to $100 it does in the pediatricians office in the united states. so that brings to my mind the idea of offshore drug manufacturing. we know that india, it is an

enormous drug manufacture now. do you think these international drug makers are part of the solution, part of the problem or where do they fit in? >> unfortunately, they are not doing very well right now and part of it has to do with the scripps agreement, the world trade organization has laws dealing with intellectual property that they have imposed on developing world. india was able to duplicate important drugs that they are keeping but he can do that legally anymore because india's laws governed patents on manufacturing processes, not on competition so they could duplicative drug legally, you'd now and distribute it. what they have to change was the way was manufactured that tripp has forced india to adhere to the patents of the west where the competition of the drug is what is protected so india can

no longer duplicate the drug as cheaply as it used to and this i think is an enormous problem, imposing a patent scripture supposedly to protect our intellectual property but as i say in the book i don't think a lot of this is intellectual property. a lot of it was raided from the third world to begin with so for that reason i think it is the law as it is going to make it very difficult are the offshore companies to work unless they are working in concert with the american pharmaceutical companies who are now part of the problem. so the trip trips back laws need to be -- they need to be eastward developing countries so they can find their own way of providing drugs to the people since we have decided not to do that and they should not be forced to respect our patents when we are not forced to respect their patents. now it is not reciprocal.

they should be able to ignore our patents of impunity. that is only justice. >> no this is, you have said a lot of unpleasant things about large pharmaceutical companies and i'm not questioning what you said, but you said to me privately that there have been moments of generosity and moments where we have seen drug companies behave in good ways. would you mention one or two of those ways? >> talking about the partnerships that they made for example, with the gates foundation and with the impact fund and with others that are dedicated to the health of the people and developing worlds. as you mentioned low cost vexing, i mentioned all of these things and i think these things are very important. the problem is it hasn't been a sustained partnership but that is what i want to happen.

they will be able to make a profit and stay in business so that is what i would like to see and i expect that is what they would like to see as well, i hope at least. anybody else?