Understanding Xtandi - UCLA DGSOM AMSA/AMA Podcast Ep. 1 with Reshma and Cory

In our first AMSA podcast, we had the pleasure of inviting Dr. Reshma Ramachandran to talk about her inspirations for health advocacy and explore the controversies behind the patent lawsuit lodged by the University of California before the High Court of Delhi for the prostate cancer drug Xtandi.

To move directly to the issue, go to minute 9 of the audio and the transcript.

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Transcript: (Click on the colored words to be linked to relevant websites or further readings)

Cory: what’s up med students, thanks for tuning in to our first podcast episode, for the UCLA America Medical Student Association: AMSA, if you wanna just use that. I am Cory Johnson, I am delighted to be joined by Dr. Reshma Ramachandran. She is a family medicine resident at Kaiser Permanente Los Angeles medical center. She graduated from the Brown School of medicine in 2015 and received a Master in Public Policy from Harvard Kennedy School. Before residency, she worked as a research faculty at the John’s Hopkins Bloomberg School of Public Health, as part of the Innovation+Design Enabling Access or IDEA initiative. Here she focuses on issues, such as anti-microbial resistance, as well as drug pricing at both the federal and state levels. She also currently serves as a board member for the NGO, Universities Allied for Essential Medicines. And I have heard you just come back from your honeymoons, is that right? (1:01)

Dr. Reshma: yeah, pretty recently, and now I am back in residency, and no sleep basically.

Cory: Well congratulations on your marriage and welcome back to UCLA!

Dr. Reshma: Thank you so much for having me, I have been part of AMSA for years, I actually joined before medical school back in 2008, and served as the AMSA intern when the Affordable Care Act was actually being debated on Capitol Hill. So it was really great to see an opportunity for us as medical students to be a part of changing health care in the US, and to be able to provide better opportunities for access for our patients even while we are in training, so it is really great to see that UCLA has an AMSA chapter, and is doing so much to provide resources for those students. (1:45)

Cory: Awesome, so to start off, we just want to talk about your health advocacy. So, the Minnesota Senator Al Franken once said: “It is easier to put on slippers than to carpet the whole world.” And we all know that health advocacy can sometime feel like carpeting the whole world, so what prompted you to partake such an arduous journey? (2:09)

Dr. Reshma: I think probably recently people might have felt a little down at advocacy and policy given the kind of the political climate that we are in. But maybe as of yesterday with some recent victories in certain states, there might be an uplifting in terms of the role of advocacy to make change. (2:25)

So for me as medical student, I am pretty frustrated when I was kind of in different clinics and hospitals, and there is only so much you can do in the exam room, there are a lot of challenges that our patients face that, are not going be cured by a single drug, by treatment, and often times, there are just barriers even in accessing care. (2:44)

Remember one of the first instances for me was: I was in a community hospital in Northern Ireland as part of my doctoring clerkship in my first year. And there was a patient who came in, who didn’t have insurance, and she was coming in for an asthma exacerbation, and the only reason she was there was that she couldn’t afford her albuterol inhaler anymore. And there wasn’t a free clinic that could offer her an albuterol at a low enough price she could actually afford it and still be able to provide for her family - She was working, on the side as well with three kids. And so just seeing patients like that multiple times over my first two years in medical school, kind of a constant struggle of not being able to do more in the exam room, and the role for us, as physicians and physicians in training, to be advocates for patients outside of the exam room, to the policy makers, to the public, to people who don’t see the reality of what our patients face every day. I saw that as an opportunity to be involved in the advocacy. And I think we have a privilege. We are in the white coat. You probably already see it right now. When you are wearing the short white coat even around the hospital, people talk to you differently. People look up to you. They respect you. There is a different tone of voice that people often times take when seeing people in white coats. (4:03)

And I think there is a power in having the white coat, it is a real privilege that we should be able to harness, to be able to make changes. Not just for patients we see day to day, but really for all patients as much as possible. (4:15)

And our role as physicians, unfortunately, is not just limited by our jobs, is not limited by coming in for our shifts, we have to face the realities of what our patients face outside the exam room too. So, I think as doctors, it is hard to turn off the idea of doing as much as we can for our patients, even when we were among our friends and families. Because often times, people come up to us for advice about different things, and so in some ways, everyone becomes our patient, and in taking that mentality I think there are a lot of opportunities especially in organized medicine, with AMSA, with other great student groups to really be involved as a collective to make change in this country and really around the world. (4:55)

And you can see the power in that, we see doctors on Capitol Hill all the time lobbying for different causes, and imagine if we could harness that power to really make effective changes for our patients. (5:03)

And we saw that now, with affordable care act fights, we see patients and physicians standing arm in arm, to call for policy maker to ensure universal access to health care, and I am hoping that there is a future where our medical school curriculums really have that integrated as part of our learning, that is not just about learning the pathophysiology, the anatomy, but also learning how we can use our role as physicians to make a change for our patients beyond the exam room. (5:29)

Cory: That’s wonderful. As we’ll talk about a little bit more detail later in the episode, you are currently involved in a controversial debate over a prostate cancer drug known as Xtandi that is particularly pertinent to UCLA. But before we do that, I just wanted to get an idea of how you personally would approach advocacy, since it has a lot of what-if nuances, how do you take a stand on an issue and then stick by what you just did? (6:09)

Dr. Reshma: It think it’s really tough. The one nice thing is that as physicians and physicians in training, there is always a guiding post that we have, which is we want to do the best we can for our patient. So that is usually the motivation that drives myself, and I think a lot of my colleagues who work at advocacy. That’s really great because we can always turn to that and think, is that position I am taking going to help as many people as possible? Or are they going to be disadvantage by the position I am taking, and I think that helps in terms of being able to assess out our positions and also being able to sleep at night advocating for what we do. (6:42)

I can give an example. When I was in medical school, I got really involved with the conflict of interest issue and that means a number of physicians in both the academic community, but really around the country often times have financial relationship with pharmaceutical companies and medical device companies, and that sometimes can affect medical education but also our prescribing behavior. (7:05)

And as a medical student, we often times look up to those people as our mentors, and when we hear them talk about a certain drug, or when they give a lecture, we don’t know their relationships with those companies. It sometimes makes us feel a little uncomfortable, but also makes me hesitated as a medical student to really bring up the issue in the classroom setting. (7:26)

But I think for a number of us that worked on these issues, we created a scorecard as part of the AMSA to grade medical school on their conflict of interest policies. To see whether or not they are having the faculty members to disclose these financial interests and whether or not they have a curriculum in medical school on conflict of interests. And I think having that made us feel better, as medical students that our education has been protected, that was evidence based, that was really about the patients, and we are getting the best education possible. And that really helps in terms of overcoming our fear of being vilified by maybe some of our faculty members and being uncomfortable to bring up these issues around faculty that might have these relationships. (8:10)

And I think It really helps to spark a discussion on how we felt as, when we become a physicians, how we handle those conflicts as well in a real world setting. Because we are gonna be there regardless of whether or not you are working in an outpatient clinic, or you are working in a big tertiary care hospital. I think often times just thinking about what is best for the patients and what is really best in terms of being evidence faced, and being really in line with medical professionalism, really is a guiding post for us. (8:33)

And we are lucky that way, we have that guide post. We have that north star, in making sure we are doing the best we can for our patients.

Cory: That’s wonderful! So, we all know that health advocacy as we heard earlier is a very very difficult path to go through, but doable, if we stick to it. You are currently involved in a story. Finally let’s talk about Xtandi and what has gone down so far. So could you give us a brief summary? (9:05)

Dr. Reshma: Sure. So the drug Xtandi, that is the brand name version of enzalutamide, which is a prostate cancer drug. It is usually for prostate cancer that has been really resistant to other treatments. It’s marketed right now by a Japanese firm called, Astellas Pharma. And it was actually developed with the support of NIH funding, and also Department of Defense grants right here at UCLA. In the US, the drug is really expensive, it sold at about 129,000 dollars /year /patient, which is more than 2-4 times the price in other high income, high GDP countries, such as Canada, and UK. (9:48)

Now UCLA holds three patents on this drug, which like other universities, they license to other pharmaceutical companies. So they licensed it to “Medivation” which is a San Francisco bio-tech firm. This firm later entered into a collaboration agreement with Astellas Pharmaceuticals to further develop the drug, and marketed it within the United States. (10:10)

Last March, UCLA sold its royalty interest, so any money percentage from the profit on the patents from the drug to Royalty Pharma, and they receive 1.14 billion USD for this deal. Medivation in last September was actually acquired by Pfizer, so now we have two big companies, Astellas Pharmaceutical, and Pfizer, which really have the profits coming out of this drug. (10:32)

So in India where prostate cancer, is among the top ten types of cancers, this drug doesn’t have a patent, and that allows for more affordable generic competitions to enter the market. And UCLA in response to this, which developed the drug with US tax payer’s money, so our money through taxes, goes to NIH and Department of Defense, which gets filtered into different research grants, including the one that paid for the development of this drug, has now fired a patent claim with Delhi High Court. So, they can secure Astellas and now Pfizer’s continued monopoly on this drug. (11:07)

So, documents acquired by The Wire magazine pointed to UCLA, filing the suit at the quest of the pharmaceutical companies, Medivation, now Pfizer and Astellas. This is concerning for two reasons: UCLA developed the drug with public money, and holds the patents, but has given up any role in setting the price of the drug. When they actually sold/licensed the drug to Medivation, they didn’t put any protections to say: “Hey if you’re gonna be selling this drug in other developing countries, let’s make sure they are affordable. Or for certain patient’s population that cannot afford the drug, can we make allowances or some sort of contracts that lower the price of the drug?” (11:44)

Which they have the power to do in negotiating these types of agreements. And UCLA instead of fighting on behalf of the patients that can’t afford these drugs, who arguably funded the drug, or funded the research for this drug with their tax payer’s dollars, and is fighting now the legal battle on behalf of Pfizer and Astellas. (12:01)

So here in the US, the drug like many other drugs has become increasingly inaccessible due to its high price. And a number of insurance companies, because of its high cost, have actually placed very restrictive pre-authorization requirements to dissuade providers from prescribing this lifesaving drug, despite it being the first line therapy for certain types of prostate cancer. For instance, for people who have BlueCross or BlueShield, they have to go through a really lengthy pre-authorization process, or each provider has to provide justifications where they have filled a number of other treatments that also cost of a lot of money, before they can get access to this drug. (12:37)

And globally, Xtandi is actually one of the top selling cancer drugs, expected to in the top 5 by 2022, which is great news for Astellas and Pfizer, but not having a patent in India, which is considered the pharmacy for developing world, would be bad news for them. (12:52)

For me, the concerning thing is that UCLA in court documents has presented itself as an educational institution committed to protect its innovation. But from other documents that have been acquired by news sources like the Wire magazine, there are numbers of documents are showing that UCLA is acting as a proxy for Pfizer and Astellas in firing this patent claim. (13:14)

Over the past year, several organizations including patient groups, such as the Union for Affordable Cancer Treatment, and 56 other NGOs from around the world, and academics from Yale, Harvard, Johns Hopkins, have all urged UCLA and University of California board of regents to drop the patent claim in India. (13:30)

Now John Mazziotta the CEO of UCLA health system actually replied that, in technical detail, the patent appeal in India has been filed and has been controlled and managed by another quest of Medivation or Pfizer, and its commercial partner Astellas. And he says Medivation is a commercial licensee for Xtandi, and a licensee usually has a significant role in prosecution of patent applications, including paying for its cost, and choosing which countries to pursue patent. So, this is contrary to how UCLA actually represented itself in its court documents, saying they’re acting independently, wanting to protect innovation. (14:06)

For me as a provider and being a part of the health care system here in LA, and also being very well acquainted with a number of patients that go to UCLA, it is disconcerting to see that, in another country, where this cancer drug is extremely burdensome for its price. UCLA is taking steps to further preventing its access. (14:26)

Cory: So, one thing I did see in a letter from the CEO was that, he said the drug would not even be available to people if it wasn’t for these companies, so it seems that there are a lot big players involved. We have the NIH and the Department of Defense who funded the research, led to the discovery. We have UCLA, who utilized the NIH funds to go through everything and developed all that, the drug, the patent rights. And UCLA licensed it to Medivation, and sold the royalty rights to a Royalty Pharma, receiving over half billion dollars, for the sale, and set price of the drug at almost 130 thousand dollars a year. It is more than I have made in my entire life. So I understand how that is a lot of money. (15:30)

It has actualized profit returns of around 300 million dollars over just 9 months. In India, the branded drug remains largely unaffordable, and it was around roughly 4,200 dollars in USD. Which in developing world, it is a lot of money. (15:50)

So, with all of that said, am I correct in my numbers so far? And in response to the UCLA files, and patents claim to prevent this from happening. That I personally don’t agree. I think this should be something that’s more widely available. One thing that confuses me a little bit is how Medivation was able to set the price so high. And how it is difficult for different countries … and how they can set the price differently in different countries. As we just said it was about 130,000 dollars here, where in India it is lower. (16:40)

The wholesale price is around 20.12 dollars in Canada compare to 69.41 dollars here as another example. Is there no regulation or possibility of importing a cheaper counterpart from overseas? (16:59)

Dr. Reshma: Yes, it’s a really good question. I think there has been a number of efforts here in the US for various drugs to actually lower the price for certain drugs just like this one. There are different ways in theory that this could happen. The US is not like any other country across the world that does not negotiate drug prices. (17:19)

There has been a lot of resistance for multiple bills that has been introduced to the congress to actually have Medicare at the very least to negotiate drug prices. Often times discounts are awarded to Medicare and Medicaid. But here in the US, pharmas set the price, at which they anchor the negotiations. So, imagine if you are negotiating with someone, who knows all the R&D cost, who knows all the input cost, who knows how much it would be to produce a certain amount for the patient populations. So they have all their cards behind, in front of them, but you can’t see them. And you are trying to negotiate with that person, and they set the price really high. (17:57)

It is kind of impossible for the government or anyone else without transparency to come and say hey, we want you to set the price at this rate, at this level based on this information that we have, because we don’t have any information to do so. And so, different bills in different states, including here in California has been introduced to actually mandate transparency of pharmaceutical company drug prices. But pharmaceutical company has spent billions of dollars lobbying against these types of bills. (18:24)

Similarly, the Medicare negotiation bills that been introduced, have also been lobbied heavily against. There is also conflict of interest with a number of our congressmen unfortunately, in which they received a lot of money from pharmaceutical companies to actually protect their interest as well. We do still have a lot of money in politics and unfortunately money does speak. Sometimes more loudly than our patients at home, who are not taking their medication because they have to decide between treatment or their rent. (18:53)

Because of that, we see the US really lagging behind other countries in terms of drug pricing. And now we’ve reached a tipping point in the US, where it’s comed to national attention, where we have millions of people around the country, who are on Medicare or Medicaid who don’t take their treatments at all. Or skip doses, especially for cancer drugs, because they can’t afford them. And right now, we have a number of bills in congress, including another Medicare negotiation bill that’s been picking up steam. And we have congressmen and senator who have signed on to it. And it seems there might be some hope to actually lower the power of pharmaceutical companies in terms of setting prices. (19:31)

There are other mechanisms by which we have already in law, that the US could actually lower drug prices. Especially for specific drug like this, they are already burdensomely expensive. One thing is called march-in rights, where the US government theoretically could say: hey we are in the public health crises. If a number of people with prostate cancer who cannot afford the drug, it was tax payers/government’s money that went into developing this drug with NIH and DOD grants. And we want to award the patent/license to generic company so they can introduce a competitor to lower the prices. (20:06)

In the US it has never been done with pharmaceutical drug. This has been done with other industry in which government money has gone into R&D. There has been one time with an anthrax treatment that this actually occurred where the US actually threatened to use the march-in rights: this idea of march-in rights, in which they award the license to another company to lower the price. And it was for ciprofloxacin, a really common antibiotics, which at the time was a treatment for anthrax, and was not available at a low enough price to treat enough people who were infected by the bacteria. And so the US threatened it and in response the company actually lowered the price just by threat alone. (20:43)

So, there is very powerful verifications for using this type of mechanisms and shows you by the company lowering the price automatically with threat that the price of this drug can be set arbitrarily if they aren’t able to lower automatically. (20:57)

So it’s concerning that we have really no control over how the price is being set. But there has been multiple times including this drug Xtandi, in which NGOs and different medical societies has submitted in petitions to ask NIH to use march-in rights to award the license to generic company and last year an organization called Knowledge Ecology International, submitted a march-in rights petition, showing how much more expensive this drug was compared to other countries, how much government money overwhelmingly went into the discovery of this drug. And the NIH director Frances Collins responded saying that he cannot award the license to generic competitor. (21:42)

There are some speculations about why this is. There wasn’t a real reason given in response. But some speculation is that NIH does rely on their relationships with the pharmaceutical companies to be able to say: hey we have a discovery of a drug, that we helped to finance, but we want to take it to market. So, they want pharmaceutical companies to be a part of this process, and they are afraid by not actually allowing the license to be transmitted over to the pharmaceutical company, they will never come to market, there would be no interest if they start threatening to actually use march-in rights. (22:13)

But it is never being done before, and I think we are at a point where, if people cannot afford this drug in the first place, how are they going to make a profit. Are we going to come to a breaking point where our health system goes bankrupt, and that’s what is going to be the impetus for NIH or other government agencies to actually award a generic license for these drugs that people cannot access right now. (22:37)

So, again and again we keep putting these merchant rights petitions. But the NIH has been hesitant to actually award it. It is a little unfortunate. But hopefully now with so many patients telling their stories of their not being able to afford this drug amongst many others, there might be a shift in the usage of this type of mechanisms. (22:55)

Cory: Interesting. So, one thing that also confused me about the whole process was that, since the government funded it with the taxpayer’s money, and the taxpayer’s money went into NIH and the DOD to create all these products, why don’t these government agencies own the patent to it, why do UCLA … (own the patent)? (23:19)

Dr. Reshma: So UCLA, when they received money from the NIH, there’s often an agreement, in which UCLA will retain the patent right for whatever gets developed on its campus. You might have seen this when you do research at UCLA, when you sign up the lab, you often times have to sign an IP agreement, that whatever you do here on campus is gonna be UCLA’s intellectual property. So, they will have discretions to do with what they want. (23:41)

This is all set up as an incentive to get universities to be engaged in the development of new drugs. If you just gave the grant and NIH still retained the IP, and there was a fear that university would not be incentivized to be doing the early drug discovery work. If they didn’t see a downstream profit-making mechanism off of it, and clearly from the $1.14 billion deal that they had with Royalty Pharmaceuticals or Royalty Pharma from selling their royalty rights, clearly it paid off. And I think oftentimes university hoped that whatever IP they that produced here on the campus, even it is from government funding, will lead to a bigger deal that will give the university billions of dollars. But at expense, right? (24:32)

So, I think that’s where the tension comes with us as physicians in training and us being taught that we need to keep our patients at the center of our focus, but at the same time having a business interest as part of our health care system as well. (24:43)

Cory: Why do you think UCLA sold the patent to begin with when Medivation could make a much larger profit without caring any of the risks of the research? And doing these you have those who can afford who cannot afford those large monopoly prices not benefiting from such an amazing scientific breakthrough. (25:07)

Dr. Reshma: Yeah, I think it was through the Technology Transfer Office in UCLA, the UCLA health system, they probably calculated that the amount of, doing the negotiation process that they could make $1.14 billion dollars with one deal, instead having to go through the lengthy process of being involved in manufacturing getting percentage of royalty and having to negotiate the royalty rate for whatever the profit is. (25:31)

Maybe hindsight is 2020, and now that this drug is expected to be in the top 5 by 2022. UCLA health system might have wished they retained the rights for this drug in the US. We will never know. But I think the 1.14 billion dollars signs on that deal was very appealing for the university. And we see a number of universities for various of drugs actually selling early on after the drug has gone to the market, the royalty rights for big billion-dollar deal, because it helps finance projects here at the university, immediately instead of having to wait a long term for profits to be garnered over period of time. (26:12)

But I am sure there was a calculated business interest and also a lot of length to see what is the opportunity cost now versus later, and to see it would be much more lucrative to have something now and continue on the early stage drug discovery research here, and hopefully other deals like this in the future with other drugs. (26:32)

Cory: Money now is much more enticing now than money later.

Dr. Reshma: Exactly.

Cory: The University of California board of regents has claimed that they are obligated to use their best efforts to keep the patent license to Medivation from lapsing? How do you interpret that? Do you think it is the true motivation behind the lawsuit? (26:53)

Dr. Reshma: It is concerning because there is a big discrepancy between how they presented themselves in the actual court documents: No mention of Medivation, Pfizer, Astellas. Yet in other statements, both to the NGO who asked them why are they pursuing this patent claim in India. And also from UCLA health CEO, it does seem like they are acting on the behalf of the licensees. And perhaps when they negotiate the agreement, there were some sorts of clause in there that UCLA health system would be taking responsibilities of perusing patent claim in other countries. That is a possibility. That agreement is not disclosed, so we could not know the detail of it. (27:36)

But it is concerning that UCLA health system decided to put these companies ahead of patient interest. They really put profits before patients on the deal in defending and acting as a proxy for these companies. I would have imagined that these companies would be filing the patent claims on this, and maybe having UCLA as part of the suit as well given that they hold the patents in the US, but it seems that they are hands-off except in the background in terms of telling them where to file a patent claim and to telling them that they needed to continue entering into these sort of law suit in developing countries and controlling access. And that for me is concerning, because I would hope that a health care system would be acting on behalf of patients, not profits. (28:21)

Cory: So how do you think withdrawing or winner the lawsuit may affect the future of just drug development in general? Do you think it will disincentivize drug innovation? (28:40)

Dr. Reshma: There is a fear of that the pharmaceutical companies might say, if universities and NIH are gonna come around and say we are gonna set pricing negotiation, and have generic competitors come to the market, we won’t be incentivized to do business with them. But you know I think they should call the bluff. Because honestly a number of studies have looked at this, the government accountability office, studies from Harvard as well, from Hopkins … and if we look at the number of public funds, or taxpayer’s money that’s going to novel research, versus pharmaceutical funding, it is overwhelmingly public money that is going to novel research, that makes cures at the end of the day. Rather than in the pharmaceutical R&D, which is heavily invested into me-too drugs and copycat drugs. At some point, pharmaceutical companies need to have a new drug on the market, so they can retain profit, and that’s what we saw with a number of cancer drugs that come out, such as the cases of hepatitis C drugs and with Epipen. It is really they rely on our universities, and government dollars doing the risky research to actually have a business at the end of the day. (29:44)

(* Epipen was another example of medical device developed completely by the US army whose patent sold to pharmaceutical companies and pricing controlled by the profit-driven industry.)

And without that public money and without having universities labs, I don’t see a model in which pharmaceutical R&D can be sustainable with just me-too drugs on the market. (29:54)

Cory: So, it’s been a pleasure talking with you. But before we go, I just wanted to know, what has been done and what can we do? Dr. Reshma: there are so many opportunities now, especially for you guys as physicians in training here in UCLA, becoming a future alumni in UCLA, and really gonna holding the name of the university to make a difference on future access to these drugs. So, what has been done already, there has been a number of letters been sent to UCLA health system, the board of regents by different NGOs, including patient groups, as well as physician groups such as national physician alliance, and organizations like Universities Allied for Essential Medicines. UAM is actually an organization started by students. Medical students, law students, public health students, that all came together and saw that universities weren’t ensuring that the drugs that were made in their labs on campus, were being made accessible down the line, when they were licensed out to pharmaceutical companies. (30:56)

And so some students from the University of California of San Diego went to a board of regents meeting recently, where they brought up this issue to the entire board, and to ask them to drop the patent claim in India. And we need more efforts like this, because it reached newspapers, the Wire magazine, LA times, for instance, when these letters are coming out. But we need more momentum to hold the University (UCLA) and the health system accountable. (31:19)

And I think there is a great opportunity to continue to do that especially as physician in training, because you guys will be dealing with patients who at the end of the day won’t be able to access this drug. Already as a primary care physician I have seen a number of my patients with prostate cancer who rely on this drug on a day-to-day basis. And the fact that I know their copay is extremely high for this drug, and they are making financial decisions about this drug, is already disheartening, and I don’t that to be the reality for million of patients around the world suffering from prostate cancer. So one opportunity would be to join UAM as putting together a letter. They are trying to get students, alumni from across the UCs, to send to the University Board of Regents, and the health system again, to ask them once more to drop the patent claim, and also requesting a meeting with the UCLA tech transfer office, which is responsible for pursuing this lawsuit, or this patent claim in India, and finding faculty champions really. I think the dean at the school of medicine, who has made really good statements about the needs for access to health care, who really holds high importance, talking about public health and advocacy, and even having physicians from the department of urology who had patients that are suffering from prostate cancer relying on this drug, to come out and say we are standing behind students, patients, to ask the University, the place where we practice and also held it accountable abroad in terms of ensuring access to health care.(32:48)

And then there is a Board of Regent meeting coming up at the end of January, we will be putting up a call through the UAM, and we love to have students to join, and there is an opportunity to offer testimony to UC board of regents, to ask them again, to drop the claim and act

ually engage them in conversation about this issue. I think the more pressure we can put on this issue the better, I could also tell you a success story for this. (33:12)

So other university and other students have done this. I was at Hopkins, last year there as a reach faculty member and students there were amazing for Universities Allied for Essential Medicine, and also AMSA. They came together and actually got the university for a multi-drug resistant Tb drug that they had licensed out to pharmaceutical company to actually enter into a negotiation with the medicine’s patent pool, to make that drug accessible and affordable for a number of developing counties. So this is a humanitarian license. (33:40)

This also happened at Yale, with some of the first HIV medications, students there were responsible for having Yale University to ensure humanitarian licensing for those drugs as well. (33:53)

In addition to that, at the University at California, they have signed on to a global access licensing provisions or humanitarian access licensing provisions. They actually have a policy in place, saying they would commit to ensuring access to the drug that they produced on campus. But what we were seeing is this practice is not happening; so holding them accountable to a policy that they already have would be amazing. And it would be great to have medical students on board as well to advocate now as physicians in training, for your patients in the future.

Cory: Thank you very much Reshma, it has been a pleasure to have you. This has been very informative and a wonderful conversation. I hope it’s been helpful for our listeners and I hope it motivates further advocacy and further support for the community at large. Thank you again and that concludes our first AMSA podcast.

Note: the above track is a concise version. For the complete track with bonus questions, please listen to the following track.

Special thanks to Reshma Ramachandran, Cory Johnson, Jason Qian, Emily Lin and Kayla Gu for the interview and the audio production. To contact us, please email Kayla Gu.

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