A resident physician, a nonprofit founder and a lawyer debated national health care accessibility with prospective law and medical students at an event Monday.
The panelists offered perspectives on the roles of race, poverty and justice in health care access from their respective areas of expertise at the UCLA School of Law event. They discussed issues such as biases in hospitals and prisons, drug pricing and how students can effect institutional change.
Merith Basey, executive director for North America at Universities Allied for Essential Medicines and the event’s moderator, said she thinks biomedical research and development practices discriminate against people from low socio-economic backgrounds, citing price surges for drugs used to treat HIV/AIDS, hepatitis C and certain cancers.
“(UAEM) believes that no one should be sick because they are poor or be poor because they are sick,” Basey said.
UAEM is a global network of university and college students who aim to improve health care accessibility in poor nations by engaging with the research, licensing and patenting decisions at universities.
Liza Brereton, legal counsel at AIDS Healthcare Foundation and a UCLA School of Law alumna, said she thinks drug companies find ways to extend medication patents to prevent the sale of generic versions of the medication that cut into their profits.
Brereton said, in her experience with personal injury litigation, she has encountered pharmaceutical companies that concealed research and spent large amounts of money on marketing to push people to switch to more expensive versions of a drug.
“The pharmaceutical industry is the most profitable industry in the United States,” Brereton said. “Access to medication has lots of problems and disproportionally affects people of color and people living in poverty.”
Reshma Ramachandran, a family medicine resident at Kaiser Permanente and activist, said she examined relationships between professors and pharmaceutical companies and how these relationships affect medical education and prescription practices. She said these relationships can lead to biases in how professors train their students and price drugs.
“My patients make just enough money that they can’t get (the drugs they need) for free,” Ramachandran said. “The research and development budgets of pharmaceutical companies do not change even after they have gained their money back.”
Ramachandran said companies are not investing in research and development despite having the means to do so. For example, biotechnology company Gilead Sciences Inc. regained all of its manufacturing and production expenses in just 18 months after the release of a new drug, yet it did not increase its budget for research and development, Ramachandran said.
“Research and development is done by students who pay taxes, not the pharmaceutical industry,” Ramachandran said.
Adam Foss, founder and president of Prosecutor Impact, a nonprofit organization that aims to educate American prosecutors on how to connect with the black communities they serve, said he thinks health care inaccessibility is not just about cost, but also about a social or cultural disconnect between doctors and patients.
This disconnect can lead to implicit biases that worsen treatment outcomes, Foss said. Black women are four times more likely to die during childbirth, 70 percent more likely to die of cervical cancer and 50 percent more likely to die of breast cancer, Foss said.
Foss said people do not necessarily have to pursue a career in medicine or public health to leave an impact. He said students can make a difference by promoting discussion about health care accessibility and thinking more critically about the issue.
“Students can help by organizing and using their power at universities,” Foss said. “It’s important to take advantage of opportunities to stand up and get your voice heard. Ask yourself who is not in the room and why.”
Marlin Gramajo, a prospective law student who attended the event, said she chose to attend because it was the only event offered to prospective students that focused on critical race studies. She said she found the conversation informative and eye-opening.
“I thought it was a good mix of people from different points of entry to the problem,” Gramajo said. “The question that stood out to me was where are the impacted people.”
Ramachandran said the opioid crisis has deep roots in the pharmaceutical industry. The leading cause of death for people under 50 is drug overdose. While laws are now trying to curb drug use, the effects are already widely felt and this benefits pharmaceutical companies, she said.
“Between 2013 and 2015, the places with heavy opioid marketing in the form of dinners, gifts and academic events saw an 18 percent increase in mortality,” Ramachandran said.
Foss said the opioid crisis has entered prisons and, without proper treatment, people will go back to using drugs once they leave prison. He said instead of going after pharmaceutical companies who create the drugs in the first place, a new California legislation aims to criminalize young people who sell drugs that lead to overdoses. He said he thinks most people who sell on the street are addicts, so the war on drugs should focus on this more homogenous discreet population.
Ramachandran said UCLA, as one of the biggest recipients of funding from the National Institutes of Health, has a lot of influence over how the University of California negotiates patent licenses and contracts with pharmaceutical companies. According to the panel, the NIH has a yearly budget of $33 million for drug research.
For example, UCLA proposed blocking the production of the generic version of a prostate cancer drug in India. After India rejected the proposal, UCLA filed a patent claim appeal, which is currently being assessed by the High Court of Delhi.
Ramachandran said she is working with UC students to convince the UC Board of Regents to pay more attention to the implications of universities’ ability to prevent the production of generic versions of drugs. UCLA students from David Geffen School of Medicine will attend the UC Board of Regents meeting March 13 to ask the regents to reconsider the patent claim appeal in India.