To the Editor.
—I wholeheartedly agree with Dr Chelala1 that the US and Cuban governments should enter into negotiations focused on supplying food and medicine to the island nation. His article is well documented. However, an even stronger case could be made using data independent of Cuban sources.The leverage exerted by the United States through the enactment of the Cuban Democracy Act of 1992, which limits Cuba's access to medicines worldwide, is immense. About half of all new patented drugs that have reached the status of world-class since 1975 are produced by US drug companies.2 In addition, the act restricts the sale of medicines from US international subsidiaries by requiring that the president of the United States first certify, through on-site inspections approved by the president, that all the components of a given shipment of medicines were used for the purpose intended.3 This means that the