Public discourse on public health

The following alarming predictions appeared on the front page of The Asian Age (AA) on 23 March 2005, alongside a report on the passage of the Patent (Amendment) Bill 2005 in the Lok Sabha the previous day despite a walkout by the Opposition, chiefly the National Democratic Alliance led by the Bharatiya Janata Party.

• Price of life-saving drugs to go up by at least 10-20 times. A cancer drug that now costs Rs. 9000-Rs. 12,000 may shoot up to Rs. 1.20 lakhs.

• Patients suffering from cancer, HIV/AIDS and heart diseases most affected. Anti-retroviral drugs for HIV patients may jump from Rs. 7000 to nearly Rs. 2 lakhs for a one-year course.

• Cost of drugs for hypertension, stroke, ulcer, depression and osteoporosis is likely to go up to international levels. Prilosec, used to treat ulcers, costs $2.45 in India, as against $105.50 in the US. The Bill will soon raise the Indian price to American levels.

On page 3, the daily carried two reports related to the Bill. One, based on a press conference held by national and international voluntary organisations in Delhi, quoted health activists from Asia, Africa and Latin America. They alleged that the Bill threatened to shut down the generic production of new drugs and that, as a result, life-saving medicines would become unaffordable, especially in developing countries. The other report quoted a representative of the international humanitarian organisation, Medecins sans Frontieres (Doctors without Borders) in Mumbai. According to her, "The life and health of hundreds of thousands of people globally depends on decisions taken in India this week."

Clearly the Bill involved an issue of great concern to citizens: public health at the very least and, possibly, even the most fundamental of human rights - the right to life.

Did the Indian media provide a public forum for debate on the issue and enable individuals and institutions to contribute their thinking on a matter of considerable importance to countless people, not only within the country but across the world? A quick survey of six daily English newspapers published in Bangalore suggests that it did not. In fact, the reports mentioned above were the only ones in the week before the Bill became law that alluded to the fact that the issue had to do with people and their health. The rest treated it as a tug of war between political parties/ideologies, between multinational and domestic pharmaceutical industries, or a combination of the two. Neither the headlines nor the copy provided any clue that the issues under discussion could drastically affect the lives of ordinary citizens. Readers who managed to plough through the jargon and the legalese were unlikely to have got a sense of the possible impact of the proposed law on their access to medicines.

Background

The Patent (Amendment) Bill 2005, passed by the Lok Sabha on 22 March and the Rajya Sabha the next day was meant to replace the Patents (Amendment) Ordinance, 2004, promulgated on 26 December. It was introduced in the lower house of Parliament by Mr. Kamal Nath, Union Minister for Commerce on 18 March. Interestingly, both the Bill and the Ordinance were based on an earlier draft legislation that had been tabled in Parliament by the NDA government in December 2003, but had lapsed due to the dissolution of the Lok Sabha prior to the 2004 general election.

The controversial law, bringing in a third amendment to the Indian Patents Act, 1970, relates to India's obligations under the global agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS), adopted in 1994 as one of a package of agreements that member states of the World Trade Organisation (WTO) must adhere to. Under the agreement, developing countries like India were obliged to introduce patent protection for pharmaceutical and agro-chemical products by 1 January 2005.

Health and trade activists had been warning for some time that the various drafts of the legislation had not even made proper use of the limited flexibility available within TRIPS, especially in the context of the 2001 Doha Declaration on Public Health. They pointed out that, despite several ambiguities and deficiencies, the latter does state that the agreement should be interpreted and implemented in the light of WTO member countries' right to protect public health and promote access to medicines for all.

A Group of Ministers set up in August 2004 by the post-election United Progressive Alliance (UPA) government to examine the implications of the legislation inexplicably decided not to invite comments from civil society on what could be a matter of life and death for countless citizens. In October 2004 the Fourth People's Commission on Review of Legislations Amending Patents Act, 1970, chaired by former Prime Minister I.K. Gujral, and made up of several eminent and knowledgeable members, concluded that the interests of the Indian people must be protected by, at the very least, taking advantage of the leeway available within TRIPS. It also called for "a full-scale national debate" on the issues involved.

Media coverage

If the government and even political parties did not see fit to generate such a debate, the media could have stepped into the breach and created a platform for a healthy, illuminating discussion on the issues involved. As a first step, they could have tried to ensure that both basic information and the various conflicting points of view on the subject were available to the public in an accessible form. That would, in turn, have enabled citizens to form informed opinions and contribute their ideas on a matter that is bound to affect their lives.

Health advocates and lawyers in different parts of the country have been attempting to generate public discourse on the proposed legislation since at least November 2004 - through meetings, rallies, press releases and conferences and even articles specially written for the press. Very little of the information and critiques they have made available found their way into the media in the run-up to the passage of the Bill. The Ordinance, which coincided with the tsunami, was more or less eclipsed by the disaster. But if the final draft of the Bill was preceded by extensive consultations with all stake-holders, as the government claimed in Parliament, those discussions were hardly reflected in the media.

A February rally in Delhi against the Patents Ordinance and Bill. (Pic: Lawyers Collective).

Indeed, all was quiet on the media front even on Friday, 18 March, the day the Bill was introduced in Parliament, although there were reports on related matters. "Boon for the sick - drug prices to fall" claimed a headline on the front page of the Bangalore Age section of AA, quoting the Additional Commissioner of Commercial Taxes on an expected eight per cent drop in the prices of medicines with the introduction of the Value Added Tax (VAT) system from 1 April. Vijaya Times (VT) had a business story on an overseas acquisition by Glenmark Pharma. The Hindu (H) carried a business page report on a meeting in Delhi where global civil society organisations were attempting to persuade the G-20 group of nations to resist pressures at the next round of talks of the WTO. None of them made even a passing reference to the Patent Bill waiting in the wings.

On Saturday, 19 March, only The Hindu had a front page story on the introduction of the Bill in Parliament. The AA placed its story on page 2, VT on page 6, The Times of India (TOI) and The New Indian Express (NIE) on page 9, and Deccan Herald (DH) on page 11 (albeit opposite the editorial page).

The following are some of the events and issues featured on the front pages of papers that did not deem the Patents Bill worthy of page 1 -- in addition to the widely covered controversy over the denial of a U.S. visa to Narendra Modi and the proposal to hike fuel prices: the cricket match in Kolkata, Harshad Mehta's shares, tigers in the Sariska National Park, a humorous discussion on condoms in the Rajya Sabha, cheap air fares, the astronomical salaries offered to graduates of the Indian Institute of Management - Bangalore, and the effect of a bird-hit slows on race car driver Narain Karthikeyan's prospects.

Headlined "New Patents Bill introduced amid protests," the front page Hindu report mentioned that a majority of members across the political spectrum, including parties supporting the United Progressive Alliance (UPA) government, had objected to the adoption of the ordinance route. Interestingly, the report revealed that Congress benches in the Lok Sabha were practically empty on a day when such an important Bill was being tabled, while unlikely partners ranging from the Left parties and the Samajwadi Party to the BJP and the Shiv Sena were all on the same side, opposing the Bill. The follow-up stories on page 12 went into the technical details of the suggested amendments to the Bill and reported that several amendments proposed by Left parties had been accepted. A summary of interventions in Parliament included the suggestion that life-saving drugs would be out of reach if the Bill went through in its original form.

The AA's page 2 report mentioned that the "controversial" legislation had been tabled despite opposition from a range of parties mainly because none of the latter had insisted on voting at the time of the introduction. According to the report, "Had the Left pressed for the division, then the fate of this bill would have been different as the UPA did not have requisite strength in the House at that time."

The page 6 news agency report in VT, based on the press conference held by Left parties, was headlined, "Left goes soft on Patents Bill." The same page featured a report on a Rajya Sabha discussion on a law to prevent discrimination against AIDS patients in work places. Despite the fact that people suffering from HIV/AIDS are among those likely to be severely affected if the new Bill was passed, no link was drawn between the two.

The wording of the TOI report on page 9 implied that those opposing the legislation were attempting to prevent the government from abiding by its commitment to the WTO. The report also hinted at backstage political negotiations to ensure that the Bill got through. A page 7 report on plans for legislation to protect "AIDS patients" did not make any reference to the Bill that was likely to push up the cost of HIV/AIDS treatment.

The NIE, in its single column report at the bottom of page 9, chose to play up the political angle: "Left tones downs stand on Patents Bill." Deccan Herald's page 11 report, headlined "Patent Bill tabled amid fierce opposition," highlighted the fact that "Opposition members said the House did not have the legal competence to pass the Bill which, they claimed, threatened fundamental rights."

The only daily that acknowleged the Bill the day after it was introduced was AA, which had a bylined report on the government's compulsions in the matter since the Ordinance would lapse if it was not ratified by Parliament within six months. The other national news dominating front page headlines on Sunday were: Modi, cricket, Karthikeyan, and Value Added Tax.

On Monday, DH, VT and NIE had page 4 reports on the Meet the Press programme with Ramvilas Paswan, Union Minister for Steel, Chemicals and Fertilisers, organised by the Mysore Reporters Guild. The headlines highlighted his assurances on drug prices ("90 % drug prices to remain stable," "Task force for drug price control mechanism," "No increase in drug prices" respectively). None of the other papers made even this oblique reference to the Bill. Meanwhile, there was a sports bonanza on page 1 that day (cricket, Karthikeyan and Pankaj Advani's World Billiards Championship). Other national news that made front page headlines were the petrol prices and the Supreme Court's order in the Jharkhand case. Narendra Modi was temporarily displaced.

On Tuesday, 22 March, The Hindu had a brief, single column report on Page 1 announcing that the debate on the Patents Bill had been deferred. More reports followed on Page 11, most of them focussing on developments on the political front vis a vis the Bill. A related report revealed that two journals published by the Council of Scientific and Industrial Research (CSIR) figured in the compulsory reference list of the patent treaty of the World Intellectual Property Organisation.

The AA placed the news on page 2, VT in the news capsule column on page 6, DH in a single column report in the top right corner of page 7, NIE on page 9 and the TOI on page 13 (Business Times). But Modi was back on the front page. Also covered on page 1 were cricket (but of course; DH even had an edit on "Super Sunday"), Sri Lankan cricketer Muttiah Muralitharan's wedding, President A.P.J. Kalam's comments on dubious means of government formation, Rahul Gandhi's maiden speech in the LS and the United Breweries takeover of Shaw Wallace.

On Wednesday, 23 March, all six papers front-paged news of the Bill being passed by the Lok Sabha. In The Hindu it was the lead story. The focus of most reports was on who had won the battle of wits between the various political parties: LS adopts modified Patents Bill - The Left claimed victory after 10 of the 12 changes it suggested were accepted, BJP said the Left flaunts red flag only outside Parliament and waves green flag inside (DH), Patent Bill passed as Left drops objections (AA), LS passes Patents Bill with Left support (TOI), Patents Bill passed with Left touch (VT), Left clears the way for Patents Bill (NIE).

Neither the DH box explaining patents, nor the details of the Bill's provisions, including accepted amendments, in VT and NIE cast much light on the significance of the new legislation and/or its possible impact on the lives of ordinary citizens. There was no evidence of any attempt to help readers understand technical terms such as "pre-grant opposition" and "compulsory licensing."

Furthermore, the government's assurances about the continued availability of drugs at affordable prices, as well as its capacity to meet domestic health emergencies seemed to be taken at face value.

The views of the lawyers and health advocates, including some from overseas, who had been campaigning on the issue were largely ignored by the media. Only AA seems to have bothered to even cover the press conference addressed by health activists from Africa, Asia and Latin America. This is despite the fact that timely media advisories were sent out by activists from the day after the Bill was introduced in the Lok Sabha. These included offers of interviews with Indian and international health advocates, a press conference featuring them, as well as a detailed critique of the Bill released on the day it was passed by the Rajya Sabha. According to activists, even a paid public service advertisement they wanted to place in the Delhi edition of a newspaper was subjected to interference from the daily's legal department, which resulted in a watered down version of the original. A television channel that extensively covered the press conference on 22 March finally broadcast a story which made hardly any reference to the views expressed at the event.

What is more, the media did not seem to think it necessary to solicit the opinions of doctors and other health professionals on the issue. The views of the Indian Council for Medical Research and institutions of scientific research were missing from the media. Even the responses of the pharmaceutical industry were barely covered, even on the business pages of the dailies (the only exception was a piece in the NIE on 24 March). Under the circumstances, it is hardly surprising that ordinary citizens had no say at all. In other words, reporting on the issue was largely confined to the limited debate that took place in Parliament and amongst political parties.

The first edit on the subject that week appeared in the NIE: "Realism at last: Left shows it can govern in the times of WTO." It suggested that the compromise between the government and the Left to facilitate the passage of the Patents Bill was a laudable example of how legislation ought to be managed. It was appreciative of the Left parties' interventions aimed at improving the Bill and critical of both the bureaucracy (for shoddy drafting) and the BJP (for what it described as evasive tactics).

Only The Hindu, AA and VT thought the Rajya Sabha's approval of the Bill the next day worth highlighting on the front page. News that made it to page 1 that day concerned cricket, the sibling rivalry at Reliance Industries, Pervez Musharraf's comments on Kashmir, an oil slick off the Goa coast, and a Telugu film star's attempted suicide.

The Hindu also had an edit on the subject on Thursday. Headlined "Two cheers for patents," it provided a detailed, critical analysis of the new legislation. Admitting that the "deficient Bill" had been amended "in good but not complete measure" to achieve "a happy compromise of sorts," the edit concluded that "the government must not treat TRIPS as a closed chapter." Instead, it suggested, "India must effectively and persuasively advocate a much greater relaxation of key Articles relating to public health."

Only the NIE carried a special story on the subject that showed any evidence of independent initiative at any point during the week. The prominent piece at the top of page 9 (opposite the editorial page) on Thursday was headlined, "After the Bill, Patent debate continues." However, three quarters of the report was based on comments from domestic pharmaceutical industry sources, while the rest focussed on the response of a single international non-governmental organisation: Oxfam.

This then was the sum total of the media's contribution to the debate on the Patent Bill in the critical seven days between its introduction in Parliament and its passage into law. The TOI did carry an edit on the subject on 26 March, dismissing fears of soaring medical bills (at least for a few years) and other such "scare-stories," and proposing instead that the Bill be seen as "an opportunity, not a threat."

"Free and independent media are essential to democratic principles and practices," said Arne Wessberg, President of the European Broadcasting Union, in 2003. "Broadcasting open to pluralism of opinion and cultural diversity offers the widest public access to the knowledge, education and information required by an active citizenry."

The question is: has the Indian media lived up to its responsibility to ensure that citizens have access to key information and the full range of opinions on the Patent Bill? Are even newspaper readers - let alone the larger public -- today equipped to understand and deal with the implications of the new law (if any) for their own health, if not that of fellow citizens with fewer resources? I know I am not.