International human rights conventions and associated litigation are credited by a number of contributors with galvanizing (or potentially galvanizing) positive change, but another theme explored was the role of international trade agreements. Many commentators express concern that such agreements have exacerbated and perpetuated global chasms in access to health and health care. Reflecting this concern, in their contribution, Ruth Lopert and Deborah Glee- son emphasize the impact of American interests in bilateral and regional trade agreements on access to medicines. They emphasize how in addition to the so- called TRIPS-plus intellectual property protections, American trade negotiators have attempted to restrict other countries’ domestic policies on the pricing and provision of pharmaceuticals as well as the regulation of direct-to-consumer advertising. Lopert and Gleeson discuss how these provisions reflect the growing influence of trade objectives and industry interests on pharmaceutical policies worldwide. They warn that
these aspects of trade agreements, as exemplified in the current negotiations for the Trans Pacific Partnership Agreement, can seriously constrain advances made in the context of public health. Lopert and Glee- son argue that it is critical for Trans Pacific Partner- ship countries to recognize the potential costs to society of the U.S. agenda so that a better balance between economic and health objectives can be found.