Media reports indicate that the Obama administration is reportedly trying to stop an effort by poorer nations to strike a new international bargain. Such a move would allow them to get around patent rights and import cheaper Indian and Chinese knock-off drugs for cancer and other diseases, as they did to fight AIDS.
Rich nations and the pharmaceutical industry agreed a decade ago to give up patent rights and the profits that come with them in the face of an AIDS pandemic that threatened to depopulate much of Africa.
But they see deaths from cancer, diabetes and other non-communicable diseases as less of an emergency and, in some cases, the inevitable consequence of better and longer living.
According to the New York Times, the debate has intensified in recent weeks, before world leaders gather at the United Nations on Monday and Tuesday to confront surging deaths from non-communicable diseases, which cause two-thirds of all deaths.
It is only the second global health issue that the United Nations General Assembly has deemed urgent enough to call a meeting to discuss.
Participants in the negotiations, which include non-governmental organizations, described the Obama administration's position on the issue and provided e-mails from European diplomats that laid out the American stance, which has been adopted in the agreement's working draft.
Chinese and Indian drug makers have taken over much of the global trade in medicines and now manufacture more than 80 percent of the active ingredients in drugs sold worldwide.
But they had never been able to copy the complex and expensive biotech medicines increasingly used to treat cancer, diabetes and other diseases in rich nations like the United States, until now.
These generic drug companies say they are on the verge of selling cheaper copies of such huge sellers as Herceptin, a drug used for treating breast cancer, Avastin for colon cancer, Rituxan for non-Hodgkin's lymphoma and Enbrel for rheumatoid arthritis.
Their entry into the market in the next year - made possible by hundreds of millions of dollars invested in biotechnology plants - could not only transform the care of patients in much of the world but also ignite a counterattack by major pharmaceutical companies and diplomats from richer countries.
The debate turns on whether diseases like cancer can be characterized as emergencies, or "epidemics."
Although the draft agreement for this week's meeting at the United Nations offers no support for poor nations seeking freer patent rules to fight cancer and other non-communicable diseases, their advocates have vowed to continue fighting to loosen those restrictions not only this week in New York but in continuing international trade negotiations around the world as well.
United States officials repeatedly declined to explain the American position, though Mark Toner, a State Department spokesman, said Friday, "Regardless of what you call it, this is clearly such a pressing challenge globally that world leaders are gathering in New York next week to discuss ways to confront this threat."
The United States government has a long history of pushing for strong patent protections in international trade and other agreements to protect important domestic industries like pharmaceuticals and ensure continued incentives for further inventions.
The new biotech copycats are likely to stir sharp debate among advocates for the poor.
Already, some contend that the billions spent to treat AIDS have crowded out cheap and simple solutions to other afflictions of poverty, like childhood diarrhea.
The copycats will be less expensive than the originals, but they will never be cheap. It is unlikely that many African nations will be able to afford such a costly medicine for breast cancer, when far cheaper ones for colon and testicular cancer are going wanting.