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.

That "Bulky Commodity, Tobacco".

Tobacco, like other popular commodities, both reflected the rhythms of early modern empires and contributed to them. People, goods, and ideas crossing the Atlantic Ocean often traveled as freight in vessels bound upon other business, and much of that was tobacco business. Using a variety of historical examples, the current article explores tobacco's economic, cultural, and labor-related worlds to show how one plant shaped institutions of human enslavement, altered colonial ecologies, offered new sensory possibilities, and ruined fortunes. Although now perhaps better known within medical contexts as a significant, preventable cause of death, tobacco as it is understood today is also a highly political, economic, and cultural product, characteristics that have shaped human relationships to the commodity over the centuries. The 17th and 18th centuries, for example, saw a dramatic rise in tobacco consumption in Europe alongside an influx of colonial natural products across the continent. The tobacco trade offered power and profit to some, exploitation and enslavement to others. It underwrote the rise of prominent merchant and political families while shaping the daily routines of countless enslaved men, women, and children tasked with growing the plant. Tobacco leaves also offered hopes of medical treatment and trustworthy business dealings, as well as a moment of respite on a long voyage. At every stage of its evolution into a global commodity, tobacco's meanings and roles changed, becoming more fully integrated into European empire and its structures of power and profit in the process.

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.

The 20-year impact of tobacco price and tobacco control expenditure increases in Minnesota, 1998-2017.

INTRODUCTION: Tobacco control programs and policies reduce tobacco use and prevent health and economic harms. The majority of tobacco control programs and policies in the United States are implemented at local and state levels. Yet the literature on state-level initiatives reports a limited set of outcomes. To facilitate decision-making that is increasingly focused on costs, we provide estimates of a broader set of measures of the impact of tobacco control policy, including smoking prevalence, disease events, deaths, medical costs, productivity and tobacco tax revenues, using the experience of Minnesota as an example. METHODS: Using the HealthPartners Institute's ModelHealth™: Tobacco MN microsimulation, we assessed the impact of the stream of tobacco control expenditures and cigarette price increases from 1998 to 2017. We simulated 1.3 million individuals representative of the Minnesota population. RESULTS: The simulation estimated that increased expenditures on tobacco control above 1997 levels prevented 38,400 cancer, cardiovascular, diabetes and respiratory disease events and 4,100 deaths over 20 years. Increased prices prevented 14,600 additional events and 1,700 additional deaths. Both the net increase in tax revenues and the reduction in medical costs were greater than the additional investments in tobacco control. CONCLUSION: Combined, the policies address both short-term and long-term goals to reduce the harms of tobacco by helping adults who wish to quit smoking and deterring youth from starting to smoke. States can pay for initial investments in tobacco control through tax increases and recoup those investments through reduced expenditures on medical care.

An Analysis of the United States and United Kingdom Smallpox Epidemics (1901-5) - The Special Relationship that Tested Public Health Strategies for Disease Control.

At the end of the nineteenth century, the northern port of Liverpool had become the second largest in the United Kingdom. Fast transatlantic steamers to Boston and other American ports exploited this route, increasing the risk of maritime disease epidemics. The 1901-3 epidemic in Liverpool was the last serious smallpox outbreak in Liverpool and was probably seeded from these maritime contacts, which introduced a milder form of the disease that was more difficult to trace because of its long incubation period and occurrence of undiagnosed cases. The characteristics of these epidemics in Boston and Liverpool are described and compared with outbreaks in New York, Glasgow and London between 1900 and 1903. Public health control strategies, notably medical inspection, quarantine and vaccination, differed between the two countries and in both settings were inconsistently applied, often for commercial reasons or due to public unpopularity. As a result, smaller smallpox epidemics spread out from Liverpool until 1905. This paper analyses factors that contributed to this last serious epidemic using the historical epidemiological data available at that time. Though imperfect, these early public health strategies paved the way for better prevention of imported maritime diseases.

Commerce, conflict, and contamination: yellow fever in early-independence Veracruz in the US imaginary, 1821-1848 / Comércio, conflito e contaminação: imaginário estadunidense sobre a febre amarela na recém-independente Veracruz

Abstract While commercial links between Mexico and the United States through the port city of Veracruz brought significant economic and social advantages in the early nineteenth century, public health concerns around yellow fever produced fascination and fear among US audiences (in southern and eastern port cities) from times of peace until the US invasion and occupation of Mexico (1846-1848). This article addresses the complex linkages between commerce, conflict, and contamination in reference to the port city of Veracruz and the United States in Mexico's early decades of independence. More specifically, this article addresses the concern in early nineteenth-century US periodicals around yellow fever outbreaks and potential contamination, showing the constant presence of yellow fever in Veracruz in the US imaginary.

Resumo Enquanto os vínculos comerciais entre México e EUA por meio da cidade portuária de Veracruz trouxe vantagens econômicas e sociais significativas no início do século XIX, preocupações em torno da febre amarela produziram medo e fascínio entre o público estadunidense (em cidades portuárias do sul e do leste) desde os tempos de paz até a invasão e ocupação estadunidense do México (1846-1848). O artigo aborda os complexos vínculos entre comércio, conflito e contaminação relacionados à cidade portuária de Veracruz e aos EUA nas primeiras décadas da independência do México. Especificamente, trata a preocupação com surtos de febre amarela e a potencial contaminação encontrada em periódicos estadunidenses no início do século XIX, mostrando a presença constante da febre amarela em Veracruz no imaginário estadunidense.

Was Kaposi's sarcoma-associated herpesvirus introduced into China via the ancient Silk Road? An evolutionary perspective.

Kaposi's sarcoma-associated herpesvirus (KSHV) has become widely dispersed worldwide since it was first reported in 1994, but the seroprevalence of KSHV varies geographically. KSHV is relatively ubiquitous in Mediterranean areas and the Xinjiang Uygur Autonomous Region, China. The origin of KSHV has long been puzzling. In the present study, we collected and analysed 154 KSHV ORF-K1 sequences obtained from samples originating from Xinjiang, Italy, Greece, Iran and southern Siberia using Bayesian evolutionary analysis in BEAST to test the hypothesis that KSHV was introduced into Xinjiang via the ancient Silk Road. According to the phylogenetic analysis, 72 sequences were subtype A and 82 subtype C, with C2 (n = 56) being the predominant subtype. The times to the most recent common ancestors (tMRCAs) of KSHV were 29,872 years (95% highest probability density [HPD], 26,851-32,760 years) for all analysed sequences and 2037 years (95% HPD, 1843-2229 years) for Xinjiang sequences in particular. The tMRCA of Xinjiang KSHV was exactly matched with the time period of the ancient Silk Road approximately two thousand years ago. This route began in Chang'an, the capital of the Han dynasty of China, and crossed Central Asia, ending in the Roman Empire. The evolution rate of KSHV was slow, with 3.44 × 10-6 substitutions per site per year (95% HPD, 2.26 × 10-6 to 4.71 × 10-6), although 11 codons were discovered to be under positive selection pressure. The geographic distances from Italy to Iran and Xinjiang are more than 4000 and 7000 kilometres, respectively, but no explicit relationship between genetic distance and geographic distance was detected.

Hashish in Morocco and Lebanon: A comparative study.

BACKGROUND: In the 1960s and the 1970s, Morocco and Lebanon became major producers of hashish for export to markets in West and Central Europe, Africa and the Middle East. By using a comparative approach, this paper aims to evaluate changes in production in the traditional areas of cannabis cultivation in the Rif (Morocco) and the Beqaa (Lebanon) and to better understand the role that these countries play in current trends in the global cultivation and consumption of cannabis. METHODS: The comparative approach takes in account the historical and institutionnal context, and the perception of cannabis in those two country. We rely on primary field research done in the Rif (from 2002) and in the Beqaa (from 1995) in the form of interviews and observations with farmers and intermediaries. Acreage and production estimates of hashish for both countries have been triangulated from different sources. RESULTS: Maghreb and Middle East have a long history of consumption, production and marketing of cannabis. Over the past 12 centuries, migration, trade and different spiritual practices and trends have led to the expansion of cannabis markets. This long period is marked by stages and rifts caused by foreign interference, a worldwide prohibition of cannabis at the beginning of the 20th century and increased global demand in the 1960s and the 1970s. Morocco and Lebanon are among the most important producers of hashish to be exported for trade for the last fifty years. The global prohibition of cannabis and the global sustained demand have created opportunities for poor farmers in the Rif and the Beqaa regions to survive and get wealthy. It is difficult to understand the reasons why areas producing cannabis are steadily increasing. If the Rif and the Beqaa share some features (such are marginalized areas of production, repressive legislation, huge international demand, range of comparable tasks and Mediterranean climate suitable for growing cannabis, etc.) then a comparison between the two countries makes it more easy to notice differences in contexts, in local and international markets (Stability in Morocco, instability in Lebanon; traditional market in Morocco, absence of local market in Lebanon, etc.) In Morocco, the stability and specialized skills among Moroccan growers of hashish have enhanced a competitive economy with various production areas, products and qualities, but also prices and strategies due to competition between Moroccan and European producers. Moreover, Morocco produces cannabis for its significant local market. CONCLUSION: As shown by comparing Morocco and Lebanon, allows us to examine their perverse effects caused by a global prohibition. The criminalization of growers has only increased their marginalized situation. The enforced eradication of cannabis has limited the cultivation for a short time but not in any sustainable way (resumption of cannabis cultivation in a time of conflict in Lebanon; replacement of local variety by hybrids in Morocco). The cultural heritage of cannabis and its social functions should not be ignored. In the light of the new global changes in the cannabis cultivation (Import substitution, technical progress in developed countries, etc.), hashish producers in the south countries are likely to face uncertain future.

Alexandria, An emporium in the Silk Road, and the Traffic of Unusual Medicines.

In Ancient times, an active trade of exotic and peculiar drugs tool place along the Silk Road. Coming through China, India, Central Asia, Armenia, including Colchis, Arabia, Nubia as far as Greece and Rome, it was centered during Ptolemaic and Roman times in Alexandria, the world Emporium, remarkably advanced in scientific medicine. Physicians required a variety of active ingredients for their pharmacotherapy, following various related branches of medicine. These included: 1) herbal remedies: including toxic plants 2) polypharmacy: missing together all kind of drugs 3) dreckapotheke or copropharmacy, employing unclean materials 4) organic therapy, using exotic or domestic animal products 5) aromatherapy, lined to essential oils and perfumes 6) 'medical astrology and botany', regarding the laws of sympathy in the natural world 7) alchemy and magic medicine: with occult knowledge

The 19th Century Origins of Facial Cosmetic Surgery and John H. Woodbury.

John H. Woodbury was an incredibly entrepreneurial, self-trained dermatologist who, between 1870 and 1909, built an empire of cosmetic surgery institutes in 6 states, with 25 physician/surgeon employees and an advertising budget of $150,000/year (1892 data). Under his management, his surgeons, and perhaps Woodbury himself, performed multiple facial cosmetic surgeries, including early versions of browlifts, frown excisions, lower facelifts, mid-face lifts, rhinoplasties, double-chin reductions, and dimple creation. In addition, Woodbury developed a proprietary soap and cosmetic line, which he sold to Jergens for $212,500 in 1901 (retaining a 10% royalty). Woodbury's story has been unknown until now because this nonacademic concentrated his publishing in articles and advertisements in lay magazines. Woodbury's life ended in bankruptcy, litigation, and suicide when the corporate practice of medicine and advertising were made illegal. In his legal proceedings, Woodbury conceded that he was not a doctor, although he went by the title. Regardless, his surgical innovations are of major historical significance, as these cosmetic procedures are the first of their kind to be noted in the lay or academic press and predate, by years and even decades, the previously earliest known cosmetic surgeries in the United States.

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.

[Remedy for shortage or risk for national security? The search for oil in Switzerland]. / Lösung für das Knappheitsproblem oder nationales Risiko? Auf Erdölsuche in der Schweiz.

Over several decades, geologists, entrepreneurs, politicians, and public authorities dealt with a potential petroleum occurrence in Switzerland. They provided scientific expertise, granted concessions, invested capital and sank bore holes. Although the endeavour was never successful economically, it reveals how closely related geopolitical situations and the exploitation of natural resources were. This article investigates the search for crude oil in Switzerland from the 1930s until the 1960s, combining a history of science and technology perspective with a history of the political regulations and economic considerations concerning the extractive industry. It traces the changing fears and hopes about potential oil occurrences in Switzerland: From an investment to overcome future shortages, to the risk of imperial desires if oil would be found in abundance.

[Medicine in notafilia--part II].

Only a few countries in the world have issued banknotes featuring portraits of doctors and health workers who have made their people and medicine world famous. The hereby presented banknotes are those issued in Germany featuring the portrait of Dr. Paul Ehrlich, a Nobel laureate; the Austrian banknotes with the portrait of a Nobel laureate Dr. Karl Landsteiner and of Dr. Sigmund Freud, the founder of modern psychoanalysis; the Greek one featuring the portrait of Georgios Nicholas Papanikolaou, who was a pioneer in early detection of pre-cancerous cervix lesions in women and who gave his name to the test "Papa test"; and, the one issued in Sweden featuring the portrait of Carl von Linnd, a court physician and the first President of the Royal Swedish Academy of Science.

HIV/AIDS information by African companies: an empirical analysis.

This article investigates the extent of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome Disclosures (HIV/AIDSD) in online annual reports by 200 listed companies from 10 African countries for the year ending 2006. Descriptive statistics reveal a very low level of overall HIV/AIDSD practices with a mean of 6 per cent disclosure, with half (100 out of 200) of the African companies making no disclosures at all. Logistic regression analysis reveals that company size and country are highly significant predictors of any disclosure of HIV/AIDS in annual reports. Profitability is also statistically significantly associated with the extent of disclosure.

El Habano and the world it has shaped: Cuba, Connecticut, and Indonesia.

In the half century since the 1959 Cuban Revolution, El Habano remains the premium cigar the world over; but both before and since 1959, the seed, agricultural and industrial know-how, and human capital have been transplanted to replicate that cigar in a process accentuated by upheavals and out-migration. The focus here is on a little-known facet of the interconnected island and offshore Havana cigar history, linking Cuba with Connecticut and Indonesia: from when tobacco was taken from the Americas to Indonesia and gave rise to the famed Sumatra cigar wrapper leaf; through the rise and demise of its sister shade wrapper in Connecticut, with Cuban and Sumatra seed, ultimately overshadowed by Indonesia; and the resulting challenges facing Cuba today. The article highlights the role of Dutch, U.S., British, and Swedish capital to explain why in 2009 the two major global cigar corporations, British Imperial Tobacco and Swedish Match, were lobbying Washington, respectively, for and against the embargo on Cuba. As the antismoking, antitobacco lobby gains ground internationally, the intriguing final question is whether the future lies with El Habano or smokeless Swedish snus.

The history and global market of oral home-care products: [review]

This literature review reports the history and the current market of oral home-care products. It provides information extending from the products used by our ancestors to those currently available, as well as on the changes in the supply and consumption of these products. Although the scientific knowledge about oral diseases has improved greatly in recent years, our ancestors had already been concerned with cleaning their teeth. A variety of rudimentary products and devices were used since before recorded history, like chewing sticks, tree twigs, bird feathers, animal bones, tooth powder and home-made mouth rinses. Today, due to technological improvements of the cosmetic industry and market competition, home-use oral care products available in the marketplace offer a great variety of options. An increase in the consumption of oral care products has been observed in the last decades. Estimates show that Latin America observed a 12 percent increase in hygiene and beauty products sales between 2002 and 2003, whereas the observed global rate was approximately 2 percent. A significant increase in the per capita consumption of toothpaste, toothbrush, mouthrinse and dental floss has been estimated from 1992 to 2002, respectively at rates of 38.3 percent, 138.3 percent, 618.8 percent and 177.2 percent. Pertaining to this increased supply and consumption of oral care products, some related questions remain unanswered, like the occurrence of changes in disease behavior due to the use of new compounds, their actual efficacy and correct indications, and the extent of the benefits to oral health derived from consuming more products.

O povo das águas pretas: o caboclo amazônico do rio Negro / The people of the black waters: the Amazon caboclo of the Negro river

Apresenta uma descrição historicamente contextualizada do povo que vive ao longo do rio Negro, afluente brasileiro da bacia do Amazonas. Processos de constituição da população e das comunidades são identificados, nas fontes, a partir da experiência social cotidiana dos partícipes do processo histórico estudado, o qual percorre o século XX até a metade de sua última década. No rio Negro, o contato entre a sociedade brasileira e os diversos grupos indígenas que ali viviam, autóctones e catequizados, foi determinante para a constituição da identidade cabocla do território. A partir do último quartel do século XIX, a nomenclatura consolidou-se e vulgarizou-se, tendo na empresa extrativista um forte elemento propagador, em um contexto em que predominam as relações sociais constituintes da cultura do barracão.

The article constructs a historically contextualized description of the people who live along the Negro river, a Brazilian affluent in the Amazon basin. Drawing on information about the daily social experience of the participants from the dawn of the twentieth century through the mid-1990s, the processes by which the population and communities took shape are identified. On the Negro river, contact between Brazilian society and the autochthonous, catechized indigenous groups living there was determinant in shaping the territory's caboclo identity. Starting in the last quarter of the nineteenth century, this nomenclature took root and entered the popular lexicon. Extractivist activities played a major role in spreading the term, within a context where the predominant social relations derived from the 'cultura do barracão'.