The role of intellectual property rights on access to medicines in the WHO African region: 25 years after the TRIPS agreement.

BACKGROUND: It is now 25 years since the adoption of the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and the same concerns raised during its negotiations such as high prices of medicines, market exclusivity and delayed market entry for generics remain relevant as highlighted recently by the Ebola and COVID-19 pandemics. The World Health Organization's (WHO) mandate to work on the interface between intellectual property, innovation and access to medicine has been continually reinforced and extended to include providing support to countries on the implementation of TRIPS flexibilities in collaboration with stakeholders. This study analyses the role of intellectual property on access to medicines in the African Region. METHODS: We analyze patent data from the African Regional Intellectual Property Organization (ARIPO) and Organisation Africaine de la Propriété Intellectuelle (OAPI) to provide a situational analysis of patenting activity and trends. We also review legislation to assess how TRIPS flexibilities are implemented in countries. RESULTS: Patenting was low for African countries. Only South Africa and Cameroon appeared in the list of top ten originator countries for ARIPO and OAPI respectively. Main diseases covered by African patents were HIV/AIDS, cardiovascular diseases, cancers and tumors. Majority countries have legislation allowing for compulsory licensing and parallel importation of medicines, while the least legislated flexibilities were explicit exemption of pharmaceutical products from patentable subject matter, new or second use of patented pharmaceutical products, imposition of limits to patent term extension and test data protection. Thirty-nine countries have applied TRIPS flexibilities, with the most common being compulsory licensing and least developed country transition provisions. CONCLUSIONS: Opportunities exist for WHO to work with ARIPO and OAPI to support countries in reviewing their legislation to be more responsive to public health needs.

Neoliberal science, Chinese style: Making and managing the 'obesity epidemic'.

Science and Technology Studies has seen a growing interest in the commercialization of science. In this article, I track the role of corporations in the construction of the obesity epidemic, deemed one of the major public health threats of the century. Focusing on China, a rising superpower in the midst of rampant, state-directed neoliberalization, I unravel the process, mechanisms, and broad effects of the corporate invention of an obesity epidemic. Largely hidden from view, Western firms were central actors at every stage in the creation, definition, and governmental management of obesity as a Chinese disease. Two industry-funded global health entities and the exploitation of personal ties enabled actors to nudge the development of obesity science and policy along lines beneficial to large firms, while obscuring the nudging. From Big Pharma to Big Food and Big Soda, transnational companies have been profiting from the 'epidemic of Chinese obesity', while doing little to effectively treat or prevent it. The China case suggests how obesity might have been constituted an 'epidemic threat' in other parts of the world and underscores the need for global frameworks to guide the study of neoliberal science and policymaking.

Tobacco-control policies in tobacco-growing states: where tobacco was king.

UNLABELLED: POLICY POINTS: The tobacco companies prioritized blocking tobacco-control policies in tobacco-growing states and partnered with tobacco farmers to oppose tobacco-control policies. The 1998 Master Settlement Agreement, which settled state litigation against the cigarette companies, the 2004 tobacco-quota buyout, and the companies' increasing use of foreign tobacco led to a rift between the companies and tobacco farmers. In 2003, the first comprehensive smoke-free local law was passed in a major tobacco-growing state, and there has been steady progress in the region since then. Health advocates should educate the public and policymakers on the changing reality in tobacco-growing states, notably the major reduction in the volume of tobacco produced. CONTEXT: The 5 major tobacco-growing states (Kentucky, North Carolina, South Carolina, Tennessee, and Virginia) are disproportionately affected by the tobacco epidemic, with higher rates of smoking and smoking-induced disease. These states also have fewer smoke-free laws and lower tobacco taxes, 2 evidence-based policies that reduce tobacco use. Historically, the tobacco farmers and hospitality associations allied with the tobacco companies to oppose these policies. METHODS: This research is based on 5 detailed case studies of these states, which included key informant interviews, previously secret tobacco industry documents (available at http://legacy.library.ucsf.edu), and media articles. This was supplemented with additional tobacco document and media searches specifically for this article. FINDINGS: The tobacco companies were particularly concerned about blocking tobacco-control policies in the tobacco-growing states by promoting a pro-tobacco culture, beginning in the late 1960s. Nevertheless, since 2003, there has been rapid progress in the tobacco-growing states' passage of smoke-free laws. This progress came after the alliance between the tobacco companies and the tobacco farmers fractured and hospitality organizations stopped opposing smoke-free laws. In addition, infrastructure built by National Cancer Institute research projects (COMMIT and ASSIST) led to long-standing tobacco-control coalitions that capitalized on these changes. Although tobacco production has dramatically fallen in these states, pro-tobacco sentiment still hinders tobacco-control policies in the major tobacco-growing states. CONCLUSIONS: The environment has changed in the tobacco-growing states, following a fracture of the alliance between the tobacco companies and their former allies (tobacco growers and hospitality organizations). To continue this progress, health advocates should educate the public and policymakers on the changing reality in the tobacco-growing states, notably the great reduction in the number of tobacco farmers as well as in the volume of tobacco produced.

Policy commercializing nonprofits in health: the history of a paradox from the 19th century to the ACA.

UNLABELLED: POLICY POINTS: Health policy in the United States has, for more than a century, simultaneously and paradoxically incentivized the growth as well as the commercialization of nonprofit organizations in the health sector. This policy paradox persists during the implementation of the Affordable Care Act of 2010. CONTEXT: For more than a century, policy in the United States has incentivized both expansion in the number and size of tax-exempt nonprofit organizations in the health sector and their commercialization. The implementation of the Affordable Care Act of 2010 (ACA) began yet another chapter in the history of this policy paradox. METHODS: This article explores the origin and persistence of the paradox using what many scholars call "interpretive social science." This methodology prioritizes history and contingency over formal theory and methods in order to present coherent and plausible narratives of events and explanations for them. These narratives are grounded in documents generated by participants in particular events, as well as conversations with them, observing them in action, and analysis of pertinent secondary sources. The methodology achieves validity and reliability by gathering information from multiple sources and making disciplined judgments about its coherence and correspondence with reality. FINDINGS: A paradox with deep historical roots persists as a result of consensus about its value for both population health and the revenue of individuals and organizations in the health sector. Participants in this consensus include leaders of governance who have disagreed about many other issues. The paradox persists because of assumptions about the burden of disease and how to address it, as well as about the effects of biomedical science that is translated into professional education, practice, and the organization of services for the prevention, diagnosis, treatment, and management of illness. CONCLUSIONS: The policy paradox that has incentivized the growth and commercialization of nonprofits in the health sector since the late 19th century remains influential in health policy, especially for the allocation of resources. However, aspects of the implementation of the ACA may constrain some of the effects of the paradox.

Poison politics: a contentious history of consumer protection against dangerous household chemicals in the United States.

The history of consumer protection against household poisons presents a key case study of the uniquely American struggle to balance public health and safety with the interests of business. By the late 19th century, package designs, warning labels, and state statutes had formed an uneven patchwork of protective mechanisms against accidental poisonings. As household chemicals proliferated in the early 20th century, physicians concerned with childhood poisonings pressured the federal government to enact legislation mandating warning labels on packaging for these substances. Manufacturers of household chemicals agreed to labeling requirements for caustic poisons but resisted broader regulation. Accidental poisonings of children continued to increase until the enactment of broad labeling and packaging legislation in the 1960s and 1970s. This history suggests that voluntary agreements between government agencies and manufacturers are inadequate to protect consumers against household poisonings and that, in the United States, protective household chemical regulation proceeds in a reactive rather than a precautionary manner.

The rise of the eclectic cultural consumer in Denmark, 1964-2004.

Existing research on cultural stratification and consumption patterns rarely presents a cross-time comparative perspective and rarely goes back before the 1980s. This article employs a unique series of surveys on cultural participation collected in Denmark over the period 1964-2004 to map the historical development of three distinct cultural consumption groups (eclectic, moderate, limited) also identified in previous research. We report two major findings. First, the eclectic (or "omnivorous") cultural consumption group existed as far back as the 1960s and has since the 1980s comprised about 10 percent of the Danish population. Second, the major stratification variables-income, education, and social class-are strong predictors of cultural eclecticism in Denmark, and the predictive power of these stratification variables appears not to have declined in any substantive way over the past 40 years.

Local food activity in the Republic of Ireland and Great Britain.

Recent changes in local food supply systems have attracted substantial research interest, but little consideration has been paid to exactly where they occur. This article combines data from three studies to compare local food system development in England, Wales, Scotland and Ireland using a single index of food relocalisation, thereby exploring the usefulness of the Index across different social and political contexts. Four diagnostic indicators suggest that local food systems in the south west of Ireland and Britain are particularly well developed. The Index itself is a useful tool for making international comparisons, being easy to replicate and allowing the integration of different data sets. Perhaps its greatest utility is that it opens up new avenues for further research.

Rival ecologies of global commerce: Adam Smith and the natural historians.

This essay explores how the defense of global commerce pioneered in the Enlightenment was tied to the improvement of the natural order. Two rival ecologies, one made by natural historians and the other developed by Adam Smith and his liberal successors, vied for intellectual precedence as well as for practical application in the metropole and the colonies. Together they constitute the beginnings of an ongoing quarrel over the environmental foundation of capitalism.

Alberta's and Ontario's liquor boards: why such divergent outcomes?

The provinces of Alberta and Ontario have chosen very different methods to distribute alcoholic beverages: Alberta privatized the Alberta Liquor Control Board (ALCB) in 1993 and established a private market to sell beverage alcohol, while Ontario, in stark contrast, opted to retain and expand the Liquor Control Board of Ontario (LCBO). This article examines the reasons for the divergent policy choices made by Ralph Klein and Mike Harris' Conservative governments in each province. The article draws on John Kingdon's "multiple streams decision-making model," to examine the mindsets of the key decision-makers, as well as "historical institutionalism," to organize the pertinent structural, historical and institutional variables that shaped the milieu in which decision-makers acted. Unique, province-specific political cultures, histories, institutional configurations (including the relative influence of a number of powerful actors), as well as the fact that the two liquor control boards were on opposing trajectories towards their ultimate fates, help to explain the different decisions made by each government. Endogenous preference construction in this sector, furthermore, implies that each system is able to satisfy all relevant stakeholders, including consumers.

The agriburb: recalling the suburban side of Ontario, California's agricultural colonization.

This essay spotlights the development of Ontario, California, in the last decades of the nineteenth century. It demonstrates that many agricultural communities in California, particularly so-called agricultural colonies, represent a unique rural suburban type labeled here as "agriburbs." Agriburbs, such as Ontario, were communities consciously planned, developed, and promoted based on the drive for profit in emerging agricultural markets. Advertised as the perfect mix of rural and urban, they promised a superior middle-class lifestyle. On the one hand, agriburbs evoked the myths of agrarian security and virtue, a life on a farm in an environment that was good for both soil and soul. On the other hand, agriburbs were ideally urbane but not urban because of their many amenities that represented cultural symbols of modernity, refinement, and progress. An understanding of California's agriburbs deepens an appreciation for both the growth and development of California at the turn of the twentieth century and the diversity of suburban types across the American landscape.

Tobacco industry and public health responses to state and local efforts to end tobacco sales from 1969-2020.

BACKGROUND: In June 2019, Beverly Hills, California, became the first American city in the 21st century to pass an ordinance ending the sale of most tobacco products, including cigarettes, and it is unlikely to be the last. Knowledge of previous efforts to ban tobacco sales in the US, both successful and unsuccessful, may help inform tobacco control advocates' approach to future efforts. METHODS: We retrieved and analyzed archival tobacco industry documents. We confirmed and supplemented information from the documents with news media coverage and publicly available state and local government materials, such as meeting minutes and staff reports, related to proposed bans. RESULTS: We found 22 proposals to end the sale of cigarettes or tobacco products from 1969-2020 in the US. Proposals came from five states, twelve cities or towns, and one county. Most came from elected officials or boards of health, and were justified on public health grounds. In opposing tobacco sales bans, the tobacco industry employed no tactics or arguments that it did not also employ in campaigns against other tobacco control measures. Public health groups typically opposed sales ban proposals on the grounds that they were not evidence-based. This changed with Beverly Hills' 2019 proposal, with public health organizations supporting this and other California city proposals because of their likely positive health impacts. This support did not always translate into passage of local ordinances, as some city council members expressed reservations about the impact on small businesses. CONCLUSION: Tobacco control advocates are likely to encounter familiar tobacco industry tactics and arguments against tobacco sales ban proposals, and can rely on past experience and the results of a growing body of retail-related research to counter them. Considering how to overcome concerns about harming retailers will likely be vital if other jurisdictions are to succeed in ending tobacco sales.

Guatemala's green revolution: synthetic fertilizer, public health, and economic autonomy in the Mayan highland.

Despite extensive literature both supporting and critiquing the Green Revolution, surprisingly little attention has been paid to synthetic fertilizers' health and environmental effects or indigenous farmers' perspectives. The introduction of agrochemicals in the mid-twentieth century was a watershed event for many Mayan farmers in Guatemala. While some Maya hailed synthetic fertilizers' immediate effectiveness as a relief from famines and migrant labor, other lamented the long-term deterioration of their public health, soil quality, and economic autonomy. Since the rising cost of agrochemicals compelled Maya to return to plantation labor in the 1970s, synthetic fertilizers simply shifted, rather than alleviated, Mayan dependency on the cash economy. By highlighting Mayan farmers' historical narratives and delineating the relationship between agricultural science and postwar geopolitics, the constraints on agriculturists' agency become clear. In the end, politics, more than technology or agricultural performance, influenced guatemala's shift toward the Green Revolution.

[Drugs Bazar of Constantinople]. / Le Marché aux drogues de Constantinople.

A long while in The Egyptian Bazaar in Istanbul, which was one of the high place of oriental medicine and pharmacopoeia, were established the most famous apothecaries (aktar), herborists, manufacturers and merchants of perfumes, and so merchants of cotton. With that of Bursa, it was one of the greatest trade center for plants, drugs and exotic spices, uncommon and expensive. The products were landed along the southerly water-side of the Golden Horn. The travellers, who discovered with astonishment all the scents of Orient, the aromatic drugs, the mysterious perfumes, were charmed and most of them described particularly and in details this Drugs Bazar of Constantinople in their travelbooks. To day, the merchants of spices (baharatçi) who are in this place offer to their clients a large choice of aromatic products, homemade specialities and traditional medicines.

[Hypothesis on the reasons and consequences of the inspection of pharmacies and drugstores of Nancy by the Royal College of Medicine of this town on May 1st and 2nd 1787]. / Hypothèses sur les causes et les conséquences de l'inspection des pharmacies et des drogueries de Nancy réalisée les 1er et 2 mai 1787 par la commission du Collège royal de médecine de la ville.

On May 1st and 2nd 1787, the commission constituted by the Royal College of Medicine of Nancy proceeded to the inspection of the different pharmacies and drugstores of the town. This was one of its missions in agreement with the L article of its statutes. It appeared that the pharmacies were conveniently organized, but that it was not the same for some of the drugstores. Samples of drugs were distraint and pursuits engaged. Some weeks later, on June 4th, the College called some rules again and took some decisions relative to the professional activity of the droguists, owing to the "abuse and offends to the regulations". One month before (on April 27th), a lady of the town died some hours after the massive absorption of "nitre" (potassium nitrate) confused with Sedlitz salt (magnesium sulfate) by a droguist. Reports and papers of this moment fail to indicate any relation between the intoxication, the inspections and the decisions of the College. But their simultaneity incite to think to a cause-effect relationship. In the negative, the Royal College of Medicine carried fully its mission of survey of practitioners and of protection of public health.

Attempts to undermine tobacco control: tobacco industry "youth smoking prevention" programs to undermine meaningful tobacco control in Latin America.

We sought to understand how the tobacco industry uses "youth smoking prevention" programs in Latin America. We analyzed tobacco industry documents, so-called "social reports," media reports, and material provided by Latin American public health advocates. Since the early 1990s, multinational tobacco companies have promoted "youth smoking prevention" programs as part of their "Corporate Social Responsibility" campaigns. The companies also partnered with third-party allies in Latin America, most notably nonprofit educational organizations and education and health ministries. Even though there is no evidence that these programs reduce smoking among youths, they have met the industry's goal of portraying the companies as concerned corporate citizens and undermining effective tobacco control interventions that are required by the World Health Organization Framework Convention on Tobacco Control.

[The sale of mineral waters by the pharmacists (2nd part)]. / La vente des eaux minérales embouteillés [deuxième partie].

This text is the second part of a forward article about the history of minerals water's sold by chemists. It studies specially the evolution of containers and labels: they are the reflect of the application of law and technology.

The "corporatization" of U.S. hospitals: what can we learn from the nineteenth century industrial experience?

While broad parallels have been noted between the current "corporatization" of health care and developments in U.S. manufacturing in the late 19th century, there has been little in-depth analysis of these parallels. This article explores trends in the industrial organization of the hospital industry from the perspective of the manufacturing experience. Efforts to use corporate managerial techniques to rationalize hospitals have played an important role in the development of the modern structure of the hospital industry since the 1920s. But the emergence of multihospital systems is a new phenomenon. Some significant similarities exist between current conditions in the hospital industry and conditions in manufacturing at the time of the great industrial merger boom at the turn of the century. The subsequent experience of multiplant manufacturing firms created during the great industrial merger boom varied considerably. The characteristics of successful industrial consolidations are not present in the hospital industry; but motives for consolidation exist that were not present in manufacturing, while changes in the organization of production loom in the future.

[Relations between pharmacies and drug stores during the first years of Czechoslovak independence]. / Studie vztahu lékáren a drogerií v prvních letech samostatného Ceskoslovenska (1918-1928).

Union of chemists exploited the disputes between pharmacists and legislators for its own prosperity. In 1780 the sale of natural drugs was permitted to the chemists for first time and the Trade Rules of 1856 (later amended) gave them a possibility of production, preparation and sale of poisons and medicaments, unless they were reserved for pharmacists only (section 15, article 14). Among the first founders of chemist's shops belonged the pharmacists who could not establish their own pharmaceutical store due to lack of finance or complaints from their colleagues. The chemist's didn't have to fulfill the obligatory requirements for rooms and equipment, they were not regularly checked and they had less expenses and also lower prices. Their lower profit from the sale of medicaments was compensated by selling typical chemist's articles. The pharmacists brought the level of chemists nearly to the level of organized pharmacy (pharmaceutics supervisory committee, division into regions, a two-years special school, producing and purchasing cooperatives). However, around 1925 the pharmacists became aliens from the point of view of chemists. The chemists felt their own existence threatened and tried to refuse pharmaceutical studies as an approval for chemist trade and tried to limit the sale of cosmetics and dietetics in the pharmaceutical stores. Without bashfulness, they themselves dispatched and prepared medicaments on medical and veterinary prescriptions even though it was illegal. Later they tried to legalize this state during the discussions of the reform of pharmaceutical law. Protesting pharmacists did not have efficient support either from the pharmaceutics supervisory committee, Ministry of Health Care, or Chamber of Commerce. The state solution to this problem which lacked any concept, and together with inconsistency and disunity among pharmacists themselves contributed to deepen the problems between pharmacists and chemists. Unfortunately, pharmacists often focused on minor matters and omitted the essential problems of their profession.