A protester at a rally against the Trans-Pacific Partnership in Tokyo in 2014. (Shizuo Kambayashi/Associated Press)

The April 25 editorial “A healthy agreement” suggested the Trans-Pacific Partnership won’t significantly restrict access to medicines, including in developing countries. Some countries, including Guatemala, Jordan and Colombia, have seen dramatically higher prices for medicines under TPP-like rules. The effect of longer monopolies will not appear in aggregate data for years.

The study cited in the editorial examined only aggregate spending. Another study focused on drugs for which competition was arrested under the U.S.-Jordan trade agreement, finding medicine prices were significantly higher without competition. These higher-priced drugs weren’t purchased.

It isn’t surprising that aggregate drug spending is flat and sales of expensive, branded drugs haven’t increased. Governments and citizens often go without expensive medicines. Spending may remain constant, but patients face worse outcomes, a reality we encounter daily. When drug spending increases dramatically, governments and treatment providers, including in the United States, must make difficult choices among therapies.

The TPP introduces damaging monopolies. Yet even the status quo is a crisis. Too many patients worldwide cannot afford treatment. The patent system doesn’t address many health needs, including antibiotic resistance. Countries should reject the TPP. Doubling down on the current system isn’t just the wrong prescription; it’s also a deadly one.

Rohit Malpani, Paris

The writer is director of policy and analysis for Doctors Without Borders’ Access Campaign.