Book Reviews
International Public Health: Patients' Rights versus the Protection of Patents
Yves Beigbeder
ISBN: 0-7546362-1-6 2004 173 pages Ashgate, Aldershot, UK
Stacy M Carter
School of Public Health, The University of Sydney, New South Wales, Australia
I found this book both fascinating and frustrating. The frustration begins with the title, which does not clearly reflect the author's purpose. The book focuses on United Nations' (UN) organisations, in particular the World Health Organisation (WHO), and their recently established partnerships with corporations and corporate-sponsored foundations. Beigbeder states:
The main object of this book is to weigh the costs and benefits of this 'new partnership' or alliance, to assess the compatibility of the global mandate of the UN organisations concerned with public health with the profit objectives of business firms, to set possible limits on their interaction (p.10).
The author addresses this purpose mostly via a compendium of case studies: details of intersections between specific UN organisations, transnational corporations (TNCs) and others over the last fifty years. The book is in four parts plus an introduction and a conclusion. The introduction characterises international health policy as a contest between governments, rich and poor, and three constituencies: TNCs, NGOs, and intergovernmental organisations (IGOs) such as the UN, The World Bank, the World Trade Organisation (WTO), WHO and regional organisations. Part One sets out a history of relationships between the constituencies. Part Two presents three issues over which the constituencies have clashed: the promotion of breastfeeding and its substitutes, access to essential drugs, and HIV/AIDS. Part Three discusses private-public partnerships in four areas: onchocerciasis, poliomyelitis, malaria and tuberculosis, and vaccines and immunisation. Part Four focuses on the WHO's war with the tobacco industry.
Beigbeder has spent time in UN organisations including WHO, and the book's style and content seem to reflect this, although he makes clear that it was written 'in a personal capacity' (p.11). Beigbeder's sources include UN and WHO officials and he adopts 'the vantage viewpoint of WHO' (p.10): a straightforward reporting style and with empirical rather than philosophical or theoretical questions. Constituencies' arguments, descriptions of events, economic and epidemiological data and intricate detail of WHO codes and conventions are collated with little intrusion aside from the most even-handed summations. There were times when I wanted less description, more analysis, and a more transparent admission of the author's own position, which was partly implied via the ideas presented as given: that the WTO is creating health inequities and this is a bad thing, for example, an idea contested by exponents of unfettered trade liberalisation.
Beigbeder sometimes gets caught up in details without clearly relating them to his broader purpose. However, the details also provide the fascination I referred to earlier. Anyone interested in the specific cases discussed is likely to find, if not new brand material, then a useful drawing together of information from a WHO perspective. Beigbeder's strength lies in his acknowledgment of the ambiguities and his maps of the very complex relationships - and sometimes lack of relationship - between organisations and initiatives on each issue over time. His commitment to balance means that both the best and the worst relationships between IGOs and TNCs are presented. The best is undoubtedly Merck & Co's generous donation of ivermectin for onchocerciasis treatment. Less straightforward examples include the Global Alliance for Vaccines and Immunisation which Beigbeder tentatively suggests, mostly through others' words, may be privileging corporate interests over the needs of developing countries, and the 'mess' of malaria initiatives. The worst is the tobacco industry, for which Beigbeder reserves special and uncharacteristic condemnation. He argues that the tobacco industry is an 'enemy' based on the harmfulness of cigarettes, the fact that WHO does not need the tobacco industry and the evidence found in internal tobacco industry documents, which have enabled tobacco TNCs to be scrutinised in greater detail that any other industry.
In keeping with most writing in the public health literature, Beigbeder's automatic exemption of other TNCs from this 'enemy' status seems incompletely justified and inconsistent with his own documentation of major problems arising from the conduct of some non-tobacco TNCs. The baby food industry undermines regulation and monitoring of its products and practices. The pharmaceutical industry blocks access to essential medicines in poorer countries, distorts the market for drugs in richer countries by influencing prescribers and by selectively publishing and promoting only favourable research, and is now facing US consumer litigation for withholding risk information. Beigbeder also describes blackmail - his word - of UN organisations by the US Sugar Association, which threatened to lobby the US Government to withdraw hundreds of millions of dollars of funding if UN organisations discouraged sugar consumption. One can only imagine what might be revealed if the public had access to the internal documents of non-tobacco industries.
Despite the author's largely even tone, careful avoidance of oversimplification, and courteous, prevaricating final conclusions, this book left me more convinced than ever both that TNCs are inevitable players in international public health, and that their contributions should be viewed sceptically. If contextualised in the broader literature, Beigbeder's illustrations are detailed enough to enable sociologists, public health professionals and postgraduate students to make up their own minds.
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