Universities Allied for Essential Medicines (UAEM) is a group composed of students, faculty, and researchers at numerous member universities in the US, the UK, and Canada, who are dedicated to increasing access to essential medicines, especially for those who cannot afford life-saving therapy such as HIV/AIDS drugs. Multiple barriers to access exist: high prices, lack of infrastructure (from transportation to the clinic to clean water), lack of political will, and insufficient funding of treatment programs. This "systematic inability of individuals in developing countries to obtain existing medicines" is known as the "access gap" (see Amy Kapczynski et al., Addressing Global Health Inequities: An Open Licensing Approach for University Innovations, Berkeley Technology Law Journal, 20(3), 2005). A related obstruction to effective treatment of diseases prevalent in developing countries is the 90/10 "research gap"â€" a term describing the fact that 90% of research funds go towards 10% of the world's disease burden, leaving diseases that primarily impact the global poor massively underfunded (ibid). UAEM has been formulating and advocating potential solutions that can help close both of these devastating gaps. Background

Universities are the modern engines of basic science research and they are filing more patents than ever before. According to the Association of University Technology Transfer Managers, the number of patents issued to respondents of a survey of leading research universities more than doubled between 1993 and 2003 (AUTM Licensing Survey, 2002). Universities have reaped large sums from pharmaceutical inventions such as Xalatan, a glaucoma drug invented at Columbia University, and some of the antiretroviral drugs for HIV such as stavudine (also called d4T, Yale University), abacavir (University of Minnesota), lamivudine (Emory University), and enfuvirtide (Duke University).

More research means more pharmaceuticals, which is ultimately a great thing; however, newer patented medical technologies usually have high prices for two reasons. First, there is the high cost of research and development due to clinical trials among other factors (see Richard G. Frank, Editorial, New Estimates of Drug Development Costs, Journal of Health Economics, 22, 2003). Secondly, since the patent owner has a monopoly on the product, i.e. no competitors, they can usually set the price significantly above the cost of production (see James Love, Pharmaceutical Research and Development and the Patent, International Journal of Health Services, 35(2), 2005). Such prices are usually too expensive for most people living in developing countries. Sadly, they are often the people who need the technologies the most (see http://www. accessmed-msf.org/).

With universities patenting and licensing more than ever, the university should not neglect its dedication to the public good and thus should do everything in its power to promote access for those people who cannot afford the resulting technology. This does not imply that the university should go into the development business, but it does mean that the university, as the patent holder, can adopt intellectual property (IP) policies that lead to more affordable drug prices in developing countries. It can be done: Yale and Bristol Myers Squibb singlehandedly reduced the price of stavudine (d4T) in South Africa by more than 95% by agreeing not to enforce the patent there. The d4T story, however, is one of a retroactive reaction to a bad situation. It has taken years for prices on other AIDS drugs to come down. Millions have died in the meantime, and more will follow. UAEM is in favor of a proactive approach in hopes of reversing this tragic trend. Strategies

Members of UAEM are trying to convince universities to adopt the Equitable Access License (EAL) as part of their IP policies. The EAL relies on generic competition as the lynchpin for ensuring affordable medicines in places where the therapies are needed most because generic competition is one of the best ways to keep prices down (see Oxfam's Briefing Paper No. 26). The EAL is proactive in that before the drug is even completely developed, all parties agree to allow generic production for the purpose of selling the pharmaceutical products in low-and middle-income (LMI) countries. Since medicines are usually developed under more than one patent, all technologies associated with the end product, such as patents owned by the university and others, would be subject to this open license.

Also contained within the EAL is an attempt to address the research gap through a neglected diseases research exemption that removes intellectual property hurdles to conducting research on neglected diseases. In addition to the EAL, UAEM is advocating a broader range of actions that universities can take to help close the access and research gaps. For example, we encourage innovative collaborations between universities and public-private partnerships (PPPs) or non-profit organisations to enhance neglected disease research as well as development.

What You Can Do

We hope that all of you, as medical students around the world who care deeply about public health, will become involved in the campaign to close the access and research gaps. With respect to the research gap, you can locate and liaise with entities in LMI countries that would be able to commercialize university research outcomes into medical products for neglected or non-neglected diseases. In terms of the access gap, your advocacy work can be directed towards your university and your government. If your university does research, you can work with them to ensure that they incorporate proactive solutions like the EAL in their licenses to ensure access to technologies that sprout from their research. You can pressure your government and research institutions to ensure that clinical trials in your country follow ethical standards, ensuring access to successful medications even after a study stops. Or you can raise awareness and lobby your government against additional barriers to access such as trade agreements that extend patent rights.

At the very least, you can become educators who raise awareness about the severity of these gaps and their detrimental impact on health conditions, especially those of low income countries.

We hope that our future doctors understand that writing the prescription is only half the job. Making sure patients have access to medicines can often make just as much difference in improving their health.

To find out more about Universities Allied for Essential Medicines, please go to http://www. essentialmedicine.org

David Scales (USA)Yale Medical SchoolStephanie W. Wang (USA)Princeton Graduate School