Of drugs for severe illnesses and as a result of this work that i was doing on drug pricing in the United States looking at these issues, i eventually began to get more aware of the International Discussions about the u. S. Could do and what was happening in the countries in 1994, i was invited to argentina and brazil by people that have picked up my name as someone working on these issues and i really became aware for the first time the extent to which the United States and the state department and through the trade office and the whole apparatus of the Foreign Policy was putting pressure on the developing countries to extend and put in place monopolies on pharmaceutical drugs so wha a lf developing companies have excluded the pharmaceutical drugs from the patent system and you could buy drugs from argentina and others and at that point also from brazil and the u. S. Was pushing all these countries to put those in place but also going way beyond that. And i remember when i was at argentina the first time the United States was putting pressure on argentina and the congress wouldnt pass. They signed onto the World Trade Agreement and they already agreed to put into effect a system of patterns on the drugs by the wto agreement so in a way that battle is already over. They agreed they would start granting patents for the pharmaceutical drugs. Drugs. It is just a question of when that would take place and the United States wante wanted to ho happen roughly ten years before they were required under the wto rules. So the congress wouldnt pass the law because the domestic drug manufacturers were influential in argentina said the white house was pressing the president of argentina to invoke. Argentina had just been a democracy a short period of time and it was causing a political crisis because the idea that they could dictate walls through executive orders and things like that was considered a step backwards in a dictatorship for democracy and i was struck at the time in the equation of looking at the democracy on the one hand and a pid of the price of drugs on the other hand the u. S. Was jumping right in. Now if you fastforward that through today, right now, just this week there is a dispute we are involved in with columbia, trying to do an extensive cancer drug for leukemia that generated about 47 billion already for a drug company cannot even an American Drug company commits invented on nih and grants in the United States in terms of the Early Development but the patent rights are owned by a Swiss Company and the senator had his staff meet with the embassy recently and see if that report frothereport from the emf the nature of columbia braves the monopoly on this drugce the per capita income in columbia, if they do that it would have negative consequences for the u. S. Funding of the Peace Process which if you think about it and its sort of an astonishing linkage between peace in a place like columbia. When i work on these issues i do a lot of work and im not going to go through everything that weve been working on but i will say that to really understand the nature of the power thats involved in trying to do with the issue, but he talked about his true and i started working on this at about 9,000 people at a dying for the lack of access into the summer between ten to 15,000 people in Subsaharan Africa that are receiving the drugs. Today theres nothing 10 Million People as a result of these efforts not just me and my colleagues but the people he talked about a. Of Doctors Without Borders and all these different organizations of the drug study group as a whole range of groups that were involved in this and its been a big Success Story but at the root of all the disputes, just to understand as i mentioned the power thats involved for several years my wife took a drug thats a cancer drug for women about one fifth of Breast Cancer patients have this and it is generating about 500 million a month. The Swiss Company was developed initially by a u. S. Subsidiary and the company wanted to develop the drug of and of course and they finally did. But if you can imagine, thats one drug for one company. Its not even the biggest selling drug nowadays. There are more that generate more cash than that. Whathe political problem do you think you could imagine you couldnt solve with 500 a month with a super high profit margin so when you deal with abuse issues the profits are so large on companies my wife now takes a drug that costs around 150,000 a year and instead of 5,000 a week it probably costs 3,000, trying to remember between the Sticker Price and the negotiated price. Thats the kind of merging are talking about. Every time somebody tries to fix things come anytime there is an effort at refor of reform commid by the way and just goin im juo skip the slide. Every time you try to argue that a price is too high for drug, like for example the drug for Prostate Cancer invented at ucla licensed to a Japanese Company of costs 129,000 per year in the United States and other countries in europe including switzerland or norway or sweden the price is less than half in some countries it is a quarter even though this is a drug invented on u. S. Dollars so when we try to change the price they say you will collaborate hurt the effort to collaborate. They were rounding up in terms of sales or a bigticket item likbig ticket itemlike prostatee United States in every single time can every drug, every disease the answer is if you do anything to move the price of the drug down coming to undermine the r d and because people care about innovation and because they know somebody that doesnt have the drug they recognize the value of having a pipeline of new drugs they feel powerless to address this issue and accept anything it essentially you are in a negotiation where you are asked whether or not the price youre willing to pay to keep your wife alive to keep your son alive and keep your neighbor alive. Often that is a big number people are often priced out of the system routinely about 80 of the worlds population is completely priced out of the market and it will be a long time before its widely available in the countries. Almost no women that had positive Breast Cancer got this drug that kept my wife alive for the last six years and that is a system that we accept because people think it is necessary. The important thing that we are working on right now that is forwardlooking is to change this situation that we are in and what we are trying to do is dlink the cost of the pharmaceutical drugs from the financing. Right now you granted a monopoly on a lifesaving drug thats how you fund. And you sit around and people are consistently shocked when a forprofit drug Company Charges a high price of a drug that you will die if you dont get and every year, every month they are surprised this happens year in and year out its considered a surprise. There should be a learning curve that goes along where you realize that its predictable if you grant the monopoly to some profit maximizing firm you will observe a high price if its effective. So the idea is to get rid of it altogether and just make every drug a generic drug from day number one. [applause] you cannot regulate monopolies in the Public Interest in this case. They have too much money, they have too much power. Theyve gamed the system one way or another. We dont regulate them. They regulate us. Thats whats going on right now in the monopoly. If you get rid of the monopoly, you have to replace it with something that also provides robust funding. So one element would be to have the trade agreements on that patent extensions and property protections and a million other things on the trade agreements 30 signed to raise the price of drugs and instead of that, the idea is to have them focus on National Obligations in things like that to focus and put into place different measures and incentives with direct funding cut subsidies etc. But to get them to focus on funding rather than high prices and not make it the focus of the agreement could make r d to focus. Thats one step. Another step is to reinvent the idea so instead of granting a monopoly you give them money in the design it in such a way that the system works on an efficient set of rewards. Senator sanders introduced several bills we worked on for example and i just have time for this one example we are off now to about 14 billion a year just in the United States market for hiv drugs. Over the past 30 years weve had about one new drug developed per year on average so if you think about it, 14 billion is a lot of money to pay for one new drugs per year. These are drugs you can buy for less than 1 of the price by the fda approved suppliers outside of the United States through the peps pepfar program. Sweep aside 3 billion a year as the reward for people to develop new chemical entities for hiv drugs which is for the United States, not the whole world and that is a very big reward system can and it eliminates the monopoly so what you are looking at is a 10 billiondollar per year freeing up resources which is based on what youre currently doing. We are treating a lower number of patients today then some african countries do because the prices are high. Sometimes the patients are not tested in jails because the authority doesnt want the obligation of paying for these. We have higher infection rates than we should because we have less utilization of the drugs. But you can do that. We can do it for cancer. The good part for us, i basically have 45 seconds so im not going to be able to go through much of my talk here but we are committed to this. Recently the ceo of one of the Largest Pharmaceutical Companies in the world, Glaxo Smith Kline looks for ways to implement the d. Linkage. A number of countries proposed developing countries propose a fraction of the budget for Cancer Treatment be satisfied to reward the developers of new drugs. But they get the drugs as generics. They dont pay 3,000 a week for a cancer drug they pay 5,000 a week and extended treatment to people and make it more equal and fair. But they recognize the importance of innovation so they set aside a different way to finance them to change the Business Model. Its like the Business Model for telecommunications was radically transformed by the way the internet pricing is done so youre not yelling at somebody to hang up the phone every time they are talking to their mother or friend or Something Like that. Youre not afraid to send a message because on the margin thats free even though you pay to have the service you dont pay to use the service and thats what we are looking at we want the price of the drug to almost be free but we are willing to pay to get the drug, the first copy out the door. So its a change in the Business Model and it will make the world a better place and will be the most transformative thing you can imagine for equality when t comes to access for care and its a very Important Campaign and im fully committed. Thank you very much for the opportunity to be here today. [applause] now we know [inaudible] getting the republicans running the cooling system to turn it off. [laughter] it is a little cold. [inaudible] [laughter] now you know why jamie got the award for civic courage. By becoming his group, Knowledge Ecology International budget is the equivalent to less than one days compensation package of david, but then one day his compensation package of mario up there. The next speaker i first met him he was a finishing sophomore majoring in civics and he came up to me and said can i go to washington this summer and work on problems affecting people with disabilities and i said of course. He was a paraplegic from a motorcycle accident after his freshman year. He was on the ground floor of the movement, one of the greatest success movements in history. Those of you have older age will remember that we didnt even see a student with a physical disability in school. Out of sight, out of mind. They didnt want to take the students up the stairs. They were segregated. And now look there are accesses all over. Buildings have been renovated and retroactive. There is still a lot to do about whether it is racing down connecticut avenue with wheelchairs joyously talking to one another, whether it is access to schools hospitals theres been tremendous progress and hes right on the ground floor here he was part of the demonstration, he was the brilliant inventor of the resilient wheelchairs he and a few others broke the monopoly of london selling high priced and reliable flimsy wheelchairs. He doesnt patent inventions for anybody to use. Hes teaching many people mostly women how to be build from materials that are strong, durable and inexpensive and in those countries if you dont have a wheelchair is almost a death sentence and every year his network manufactures 15,000 wheelchairs and he will tell you that is only part of it. You will also see a demonstration of a view that he expresses in his incredible definition of people with disabilities purchase what he called his group from his Nonprofit Group were away and wheelchair. [applause] and i give you will hodgkins. Put your feet into strips of the wheelchair in the third world. There you are. Because your sign has been snapped racing down the rough and narrow streets. Somehow youve survived the impact and made it home on medical care. Here you are without a clue how to stay alive. You badly need to know how people manage to stay alive that you have no way to move beyond. The few wheelchairs in the country were designed long ago for hospital use and they rarely last long. Most are discovered in a large pile behind the national hospital. Your family begs to help, but what can they do and who will feed the children . If you are like most will plead to get out and they will beat you back into your friends will say she died of a broken back. I snapped my spine in illinois. Wheelchairs were plentiful in the u. S. But far from optimal. Since the early 1950s, a Single Company have monopolized the u. S. Industry and debated with monopolies do best raising prices for cheaper products. Whatever you do. Every single day, coming down rock, over my teacher ran, fighting to get in and out of your house. An american chair just does not work. Its got to be much, much tougher than what the gringos get by with. [applause] a few years later, while working in washington d. C. As naders reader, i was faster break down the wheelchair of an attorney at the extremities exchange commissiocommissio commission. The tone of the monopolist manufacturer both of our chairs was bragging to its stockholders and its subsidiaries were dumping shares overseas in effect really keeping foreign competition out of the u. S. I responded that while the price of the companys newest chair, the average Indian Sports model socalled was 750 into todays money in england, the same chair listed for 2750 in the u. S. 1973. When did this in the u. S. Disability Rights Movement had tried to import the low priced seamless chairs to the u. S. , their orders were refused. The Exchange Commission attorney told me that refusing these purchases was an illegal restriction of International Trade and should be challenged. That attorney was evident camp, an active republican who later became the head of an equal Employment Opportunity commission under president bush the first. Following kims advice, i went to the london shore room of Everson Jennings and ordered 10 short chairs, asking that they be sent to washington d. C. Everson jennings refused saying that our Parent Company does not allow us to ship to the western hemisphere. Journalist Jack Andersen reported this violation and president carters attorney general griffin bell open an antitrust investigation. That investigation moved very slowly until 1977 when ralph nader and Deborah Kaplan of the rightcenter challenged ballot in the public forum shortly after the doj filed an antitrust lawsuit. In 1979, a settlement was reached, perhaps prodded by the likelihood of a new administration that would be very friendly to monopolies. The settlement was a classic Consent Decree in which the monopolists war that they had never broken the law and promise to never do it again. Competition in the u. S. Wheelchair industry, prices fell and improved. While some american wheelchair raiders found better wheelchairs, very little of this improvement trickle down to the poorer 80 of the world. The cost of imported real chairs were far too high for developing countries where people with disabilities are the poorest of the poorest of the poor. What is needed is a locally based industry where wheelchairs can be brought anywhere and be prepared anywhere else. The new american chairs, made of exotic aluminum titanium carbon fiber cannot be repaired in the poorer countries. Steel can be repaired almost anywhere. This is why the vast majority bicycles have been made of steel for well ove