Now that the Ministerial Trans Pacific Partnership Agreement (TPPA) meetings in Atlanta are completed New Zealanders are one step closer to being locked into a comprehensive new set of rules.

At this stage we still don't know the details of what Minister Groser's self-confessed "ugly compromises" are, but we know enough to be certain the agreement has us on the road to stagnation in health and to drive up the cost of medicines. The only question is, by how much?.

It is difficult, at this point, to trust that the government has fully assessed the pros and cons of the deal for New Zealanders now and in the future.

If we look at what Ministers have said we see alarming confusion. Two months ago, in the weeks before the Maui round of negotiations, the TPPA was billed as a high-quality deal without any additional cost to health, or threats to PHARMAC. From the time of the Maui meeting, expectations have been markedly down-sized.

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The Prime Minister, John Key, conceded that the cost of medications would increase "by a little", "for a little longer". Then, like a wounded warrior, Trade Minister Tim Groser, reassured the public that he would snatch whatever deal he could to ensure that New Zealand was not left out. Oh yes, and he also mentioned that dairy access could be far from ideal. In essence there was a concerted effort to dampen expectations.

In the last few days, another dramatic turn around and suddenly the TPPA will deliver a bonanza far better than the Free Trade Agreement with China.

There are only two possible reasons for such dramatic shifts; either our negotiators simply haven't figured out the short-, medium-, and long-term implications of the deal, or the public is purposely being misled. Neither reason is satisfactory, given the profound secrecy of the deal and the level of public concern in relation to it.

We've been told repeatedly that the increase in the cost of medicines won't be dramatic. Quite right - the extra costs from prolonging monopoly rights will be like watching a tree grow; it's slow but gets bigger all the time. True, none of the technical rule changes will affect "the fundamentals of PHARMAC" either. Mostly they chip away at the foundations of the intellectual property regime that operates before PHARMAC gets a look in. Where there are changes to PHARMAC, they will nibble at its bargaining power and we hear will also mean higher administrative overheads.

But the biggest concern of the majority of Doctors for Healthy Trade supporters is that the TPPA will bring stagnation on actions to control the products that make people sick in the first place - tobacco control, managing junk food advertising to children and cutting down on fossil fuels being turned in to carbon emissions and climate change.

We've had curious double-speak from Ministers on this issue. On the one hand is their appalling slow-down on tobacco plain packaging, because they're worried about the risk of being sued in a trade dispute.

On the other hand is the recent statement by the Prime Minister that New Zealand has always been safe from trade law claims. Of course we've not been sued under existing agreements - the few agreements we have to date are only with countries that hardly ever sue.

The TPPA now catapults us into agreements with more countries, one of which is the most trade litigious country in the world. According to United Nations Conference on Trade and Development, 98 countries have been on the receiving end of trade law suits from disaffected companies.

Most of the claims have come out of just a handful of countries. The USA tops the list, with twice as many cases being brought by US-based transnational companies than by those based in any other country.

So if the current low risk of being sued has produced this "chilling effect" in tobacco control, then joining an agreement with serial litigant USA means we're heading for the freezer.

Are we reassured by ministerial spin? No.

Dr Pat Neuwelt is an Auckland medical academic and member of Doctors for Healthy Trade.
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