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  • Thinking About Going Abroad?

    The weather outside might still be frightful, but there are many upcoming opportunities that are delightful! Summer will be here before we know it and it is time for you to start thinking about how you will spend your time. If you are thinking about spending time abroad, read on.

    You may be asking yourself, with so many programs offering similar things, which program should I choose? Several factors can help you decide which program to select. The most important factor to consider is personal safety. Research the political situation of the country you are interested. Check out www.travel.state.gov for a listing of countries that are on the State's Department Warning List. 

    Housing is another important factor to consider. Some programs have host families or dorms that house participants, while others offer no accommodation.

    Cost is always relevant. You may want to ask the program what is included in any fees. For example, do they provide transportation within the country, or does the student have financial responsibility for all transportation? Do the programs organize excursions, and how much extra might they cost? On occasion, they may even provide cellular phones.

    Finally, assess your objectives. Is language acquisition or strengthening a primary objective? Do you want to go as an observer or do you want hands-on activity? Ask the program specific questions to make sure that your objectives will be met. You should also be aware of what types of environments you enjoy working in. Are you an independent person who wants to work in environments where there is less structure? Or do you enjoy working with a group in a very structured program? Also examine your program's approach to service. Is it compatible with your value system? Consider whether the program is religiously based, grassroots based, or paternalistic.

    Good luck in selecting a program! For additional information, visit AMSA's Going Abroad Toolkit. There are checklists and a worksheet for comparing different programs. 

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  • Vote NO on Fast Track

    This moment could not be more important. Our years of work against the Trans-Pacific Partnership (TPP) are boiling down to this moment.

    Hours ago, U.S. Representative Dave Camp and Senator Max Baucus introduced a bill for Congress to grant President Barack Obama Fast Track trade authority. If Congress approves this bill, it will give away its constitutional authority to protect us from the numerous threats posed by the TPP.  

    Write now and demand that your representative commit to you in writing to vote “no” on Fast Track.

    If the Fast Track bill passes, the TPP could be signed before Congress votes on it. Then the deal could be rushed through Congress with no amendments and limited debate. Fast Track trade authority is how Clinton and Bush passed the WTO, NAFTA, CAFTA and other disastrous “trade” deals.

    The TPP would empower foreign corporations to sue governments in international tribunals if a country implements environmental, public health or other public interests policies that undermine corporations’ “expected future profits.” It would create new incentives to offshore more American jobs.

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  • How a Free Trade Agreement Threatens Your Health and the Health of the People You Care About

    Reshma Ramachandran and David Carroll warn that the Trans-Pacific Partnership will trample over access to affordable medicines. They drafted this article for PLOS: http://tinyurl.com/l488n2z

    Last month, Wikileaks posted the complete Intellectual Property (IP) Chapter of the secretly-negotiated Trans-Pacific Partnership Agreement (TPP) confirming public health advocates’ worst fears of the agreement’s impact on patients worldwide. The TPP is the largest free trade agreement to date between the United States and 11 other countries (Australia, Brunei, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, Vietnam) comprising over 40 percent of global GDP. This landmark agreement is expected to “set the standard for 21st century trade agreements going forward.” While free trade agreements are designed to lower barriers for the importation and exportation of goods between countries and strengthen the global economy through mechanisms such as lowered tariffs, the TPP goes far beyond past traditional trade regulations with the inclusion of over 20 chapters on a variety of non-trade related issues including domestic food safety, health, labor, environmental policies. Two of these chapters on investment and intellectual property will have far reaching consequences on the public health of populations worldwide. The TPP has been shrouded in secrecy, with only the negotiators and an “advisory committee” of over 700 industry representatives allowed to read drafts of the agreement. Even congress and congressional staffers have been barred from examining drafts of this far-reaching agreement.

    Since the previous leak of the IP Chapter in 2011, several professional and civil society organizations including Doctors Without Borders, American Association of Retired Persons, Public Citizen, and the International Federation of Medical Students Associations have sent letters and presented at the closed-door negotiating rounds to the United States Trade Representative (USTR) expressing concerns that the proposed provisions patients will severely restrict access affordable, innovative medicines. The Wikileaks posted text revealed that the USTR and Obama Administration have decided to aggressively prioritize the interests of multinational pharmaceutical and medical companies over patients worldwide and at home. In fact, according to emails submitted to Intellectual Property-Watch under the Freedom of Information Act, the USTR has actively solicited the input of industry groups, giving them special access to the negotiating text while consumer and health groups have had to resort to requesting special meetings with negotiators. The USTR is also one of the best examples of a revolving door between government and industry. Since the turn of the century, at least a dozen USTR officials have taken jobs with companies that favour stronger copyright and patent protection. Peter Maybarduk, Director of Public Citizen’s Global Access to Medicines Campaign, described meetings with US negotiators as, “…a complex diplomatic exercise, it’s not like a frank exchange of information about what is actually happening.”

    Indeed, the recently leaked TPP chapter reflect these corporate interests as evidenced by the still-included provisions. In the text, the USTR has proposed a number of provisions that will further strengthen patents and data exclusivity for pharmaceuticals. Such provisions will bar the entry of generic competition into the market allowing for brand-name drug companies to retain their monopoly market and set drug prices at exorbitantly high prices. These provisions include:
    • Lowering patent standards allowing for “evergreening” or the granting of patents for newer forms of existing medicines including new formulations or minor modifications even in the absence of a therapeutic benefit
    • Mandating that surgical, therapeutic, and diagnostic methods must be patented making medical practitioners in TPP member states liable for infringement and restricting their choices for treatment
    • Imposing data exclusivity on all pharmaceuticals, including biologics with the minimum period for this class to be set at 12 years (despite the fact that the White House is publicly in favor of a 7 year data exclusivity period and the FTC has stated that there is no need for any data exclusivity period at all) thereby not allowing drug safety regulators from accessing clinical data to grant market approval for generic and biosimilar drugs
    • Adjusting patent term periods to account for “unreasonable delays” including patent prosecution periods ranging from two years to more than four years extra further delaying generic drug entry into the market
    • Adjusting patent term periods for regulatory approval periods allowing for patent extensions for both new pharmaceutical products as well as methods for producing or using new pharmaceutical products halting any potential innovation
    • Linking patent status and drug marketing approval causing drug regulatory authorities to take on the additional task of early patent enforcement, allowing for bogus patents to be a barrier to generic drug registration

    Such proposals go beyond current U.S. and international law including the World Trade Organization’s Trade Related Aspects of Intellectual Property Rights (TRIPS) Agreement. Additionally, the TPP has the potential to jeopardize millions of lives in the participating countries by driving up the costs of medicines significantly. Even in the United States, there has been a public outcry from physicians regarding the high cost of medicines. Earlier this year, over 100 oncologists came together to write a perspective piece in the journal Blood calling the prices of brand-name cancer drugs “astronomical, unsustainable, and perhaps even immoral.” The United States health care system has in fact greatly benefited from the entry of generic competition. On May 9, IMS Health released a report entitled Declining Medicine Use and Costs: For Better or Worse?, which found that many Americans had forsaken much needed doctor visits, medicines, and other treatments as they struggled to afford health care. In light of this, it is appalling that U.S. negotiators would continue to push provisions that would further exacerbate the cost burden of healthcare for patients not only abroad, but at home.

    The week following World AIDS Day, trade ministers will convene again in Singapore as a potential “end game” to the negotiations planning on making large trade-offs on various trade topics including copyright, Internet issues, and medicines in order to make a grand announcement that they “have a deal” by the end of the year. Despite opposition from both civil society and other TPP governments, the USTR is aggressively pushing the participating countries to accept these dangerous IP provisions during this meeting to finalize the agreement. The USTR recently claimed that the “United States is a leading voice for strong [intellectual property rights] protections and for access to medicines for the world’s poor, including in developing country [Trans-Pacific Partnership] partners”. These good intentions are admirable but are overshadowed by the actions of the USTR, as it continues to trade away health and true innovation to cater to Big Pharma profits. To keep the promise of an AIDS-Free Generation and the ability to provide access to affordable medicines, the trade ministers must put a stop to these harmful provisions at the upcoming Singapore meeting.

    If you want to make a difference, you can write or tweet to USTR Michael Froman and tell him to stop attacking access to lifesaving medicines here. Organisations can write too and feel free to use our recently sent letter as a template.

    Reshma Ramachandran is a joint medical and public policy student at Alpert Medical School at Brown University and Harvard Kennedy School. David Carroll is a medical student at Queen’s University Belfast. They can be found on Twitter @reshmagar and @davidecarroll.

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  • ‘Be the Generation’: Medical Students Fight to End AIDS, TB, and Malaria

    In the weeks leading up to World AIDS Day (December 1) and the fourth replenishment conference of the Global Fund to Fight AIDS, Tuberculosis, and Malaria (December 3), medical students have been advocating for the U.S. to make bold investments in fighting these three diseases.

    The Global Fund to Fight AIDS, Tuberculosis and Malaria is the main multilateral funder in global health. It successfully channels 82% of the financing to fight TB, 50% of financing to combat malaria, and 21% of financing for HIV/AIDS. On December 3rd, 2013 in Washington, DC, world leaders will make new commitments to replenish the Global Fund. These pledges will determine the amount of funding that will be available to fight AIDS, TB and malaria globally between 2014-2106.

    Last week, a group of students from Harvard Medical School held meetings with staff members of Senators Ed Markey (D-MA) and Elizabeth Warren (D-MA). They asked the Senators to urge President Obama to make a $5 billion pledge to the Global Fund over the next three years. Just a few weeks earlier, students from Michigan State University had a meeting with staffers of Representative Benishek (R-MI) to discuss the Global Fund and ask Rep. Benishek to sign on to a letter in support of global AIDS funding.


    Photo: Students from Harvard meet with a staffer in Sen. Warren’s office to advocate for the Global Fund.

    In addition to conducting legislative visits, medical students have been successfully generating media attention on the Global Fund replenishment. Students from the Medical College of Virginia/VCU recently published an op-ed in their local newspaper, as did students from the Kentucky College of Osteopathic Medicine (article unavailable online).

    Medical students have also continued to advocate for the President’s Emergency Plan for AIDS Relief (PEPFAR), asking their members of Congress to sign a bipartisan letter in support of PEPFAR. Thirty-eight Senators and Representatives signed the letter initiated by Representative Barbara Lee (D-CA) and Senator Tom Coburn (R-OK), calling for President Obama to double the number of people on antiretroviral treatment through PEPFAR from 6 million to 12 million by 2016. In a remarkable show of support, on November 19th the U.S. Congress unanimously passed legislation to extend PEPFAR’s authorization for another 5 years.

    For the first time in history, we have the scientific advances to effectively fight HIV, TB, and malaria. Now we need the political will. If you would like help organizing advocacy events at your school, please reach out to the AMSA AIDS Advocacy Network at aan.chair@amsa.org.

    As Global Fund Executive Director Mark Dybul noted, we can be the generation to defeat these diseases. Are you in?

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  • Healthcare issues across the globe: Part II

    By Aliye Runyan, MD
    AMSA Education and Research Fellow


    Professionalism

    The conversation surrounding professionalism was fascinating and brought to light a huge unmet need in global medical education. The speaker from the World Federation of Medical Education (WFME) spoke about tenets of professionalism: social accountability of the physician, training to take into account needs of the changing face of medicine, adaptability, training students to understand their global responsibility, and of the need for role models for students. Another speaker pointed out threats to professionalism, including commercialization of medicine, the role of pharmaceutical companies and industry, the deteriorating doctor-patient relationship, and that there are MANY medical schools with no formal curriculum on ethics and professionalism. She described attempts at some formalization, but also brought to light the issue that a lot of professionalism standards are from a Western cultural mindset, and do not take into account vastly different cultural standards from Latin America to India (two of the examples she used). She stressed that professionalism attributes must be integrated throughout medical school curricula and not just taught as a standalone course (as many in the US are).

    This brought to mind incredible potential for the IFMSA pre-departure training for clinical exchanges (bilateral, international exchanges of clinical year medical students) to include a (student developed, faculty advised) curriculum on professionalism and medical ethics issues with a culturally sensitive perspective. Perhaps this could even be the beginning of cross-institution and student-faculty collaboration of professionalism courses that may eventually be integrated into formal medical education.

    Burnout and self care during training

    Burnout of trainees occurs as a result of many factors, including lack of time for self care, growing cynicism towards the system of practice, little time actually spent with patients, and as a result of poor role modeling from higher level physicians who can promote unprofessional behaviors towards patients and colleagues. Furthermore, there are hospital systems in many countries in which residents commonly work 36 hour shifts, a dichotomy from other systems which have recognized the unsafe consequences of such extended work with no sleep. There is the need to raise awareness of work hours reform, as well as proper role modeling for physicians in training.

    One speaker noted "new med students go from naive and idealistic [committed to the profession] to knowledgeable and cynical". Development of unhealthy (to the physician) and unprofessional behavior (toward patients and/or colleagues) is a function of context more than education - the hidden curriculum and role modeling. There was a call to action to redefine the definition of excellence for both teachers and students, leading to policy changes in assessment and promotion, which would ideally lead to those most qualified and in line with professional and healthy behavior to move to teaching positions and be promoted within the training process.

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