Access to medicine and the dangers of patent linkage: lessons from Bayer Corp v. Union of India

In February 2010, the Delhi High Court delivered its decision in Bayer Corp v Union of India in which Bayer had appealed against an August 2009 decision of the same court. Both decisions prevented Bayer from introducing the concept of patent linkage into India's drug regulatory regime. Bayer appealed to the Indian Supreme Court, the highest court in India, which agreed on 2 March 2010 to hear the appeal. Given that India is regarded as a global pharmaceutical manufacturer of generic medications, how its judiciary and government perceive their international obligations has a significant impact on the global access to medicines regime. In rejecting the application of patent linkage, the case provides an opportunity for India to further acknowledge its international human rights obligations.     

Barriers to achieving a cost-effective workforce mix: lessons from anesthesiology

As pressures to control health care costs increase, competition among physicians, advanced practice nurses, and other allied health providers has also intensified. Anesthesia care is one of the most highly contested terrains, where the growth in anesthesiologist supply has far outstripped total demand. This article explains why the supply has grown so fast despite evidence that nurse anesthetists provide equally good care at a fraction of the cost. Emphasis is given to payment incentives in the private sector and Medicare. Laudable attempts by the government to make Medicare payments more efficient and equitable by lowering the economic return to physicians specializing in anesthesia have created a hostile work environment. Nurse anesthetists are being dismissed from hospitals in favor of anesthesiologists who do not appear "on the payroll" but cost society more, nonetheless. Claims of antitrust violations by nurse anesthetists against anesthesiologists have not found much support in the courts for several reasons outlined in this essay. HMO penetration and other market forces have begun signaling new domestic physician graduates to eschew anesthesia, but, again, Medicare payment incentives encourage teaching hospitals to recruit international medical graduates to maintain graduate medical education payments. After suggesting desirable but likely ineffective reforms involving licensure laws and hospital organizational restructuring, the article discusses several alternative payment methods that would encourage hospitals and medical staffs to adopt a more cost-effective anesthesia workforce mix. Lessons for other nonphysician personnel conclude the article.     

Access to treatment as a right to life and health

In some countries in Latin America, in the absence of leadership from governments, activists have had to resort to the courts to obtain access to HIV/AIDS treatments for people with HIV/AIDS. In his presentation to the XIII International AIDS Conference (abstract TuOrE458), Edgar Carrasco, of Acción Ciudadana Contra el Sida (ACCSI), discusses the process that was followed in Venezuela. The presentation describes the very limited access people with HIV/AIDS had to antiretroviral therapies and treatments for opportunistic infections under Venezuela's health and social security systems. It provides details of lawsuits that were launched on behalf of several individuals living with HIV/AIDS, and that resulted in the courts ordering the government to provide treatments for these individuals and, eventually, for all people with HIV/AIDS in Venezuela. The presentation concludes that recourse to the courts is a useful tool for activists and that civil actions launched on behalf of people with HIV/AIDS can serve as an example for people with other chronic diseases.     

Getting the story from child witnesses: exploring the application of a story grammar framework

Abstract

Investigative interviews with children about alleged abuse were analysed to determine the degree to which the child's responses adhered to a story grammar framework, and whether the presence of story grammar elements was associated with interviewers’ adherence to best-practice (i.e. open-ended) questioning. The sample included 51 interviews with child witnesses from across Australia. The interviews were administered by a police officer with children (37 girls and 14 boys) aged 3–16 years (M age = 103.82 months, SD = 34.21 months). The interviewers’ questions were categorised as open-ended or specific and the children's responses were classified as a story grammar element, context/background information, or ‘don't know’ responses. The majority of interviewer questions were specific in nature and the majority of children's responses were context/background details. Open-ended questions were more successful in eliciting story grammar from children. Of the story grammar elements, the interviewers’ specific questions usually targeted setting and attempt details. These findings suggest that improvement in the narrative coherence of children's reports of abusive events can potentially be achieved by increasing interviewers’ use of open-ended questions.     

A temporal analytical approach to decentralization: lessons from Brazil's health sector

This article introduces a new concept to the study of decentralization processes: policy dynamism. At its core is the notion that the sequential and temporal process of health decentralization affect the nature of intergovernmental relationships and municipal bureaucratic capacity. Examining the case of Brazil, I argue that the rush to decentralize health services to municipalities has, in the absence of sufficient financial and technical assistance from the federal and state governments, increased state-municipal conflict over the management of health policy, limiting municipalities' ability to increase bureaucratic capacity. Consequently, some states have attempted to recentralize reforms, generating further conflict between both subnational levels of government. While some municipalities have tried to overcome these problems by creating associations and working with international organizations, several bureaucratic obstacles remain. This article attributes these outcomes not to federal institutions and economic constraints (the traditional approach in the literature) but rather to the noninstitutional, temporal policy dynamics of decentralization.     

Impulse control and criminal responsibility: lessons from neuroscience

Almost all of the world's legal systems recognize the "M'Naghten" exception to criminal responsibility: the inability to appreciate the wrongfulness of action. This exception rests on the assumption that punishment is morally justified only if the defendant was able to choose whether to do wrong. Jurists and jurisdictions differ, however, on whether to extend M'Naghten's logic to cases where the defendant understood the wrongfulness of an act but was incapable of resisting an impulse to commit it. In this article I ask whether contemporary neuroscience can help lawmakers to decide whether to adopt or retain this defense, known variously as the "irresistible impulse" defense or the "control" or "volitional" test for insanity. More specifically, I ask firstly, whether it is empirically true that a person can understand the wrongfulness of an act yet be powerless to refrain from committing it; and second (assuming an affirmative answer to the first), whether the law of criminal responsibility can practically accommodate this phenomenon? After canvassing the relevant neuroscientific literature, I conclude that the answer to the first question is "yes." After examining the varied treatment of the defense in the United States and other nations, I also give an affirmative answer to the second question, but only in limited circumstances. In short, the defense of irresistible impulse should be recognized, but only when it can be shown that the defendant experienced a total incapacity to control his or her conduct in the circumstances.     

Commercialization strategies of technology: lessons from Silicon Valley

Science and technology incubators play an increasing role in contributing to the entrepreneurial, venture and economic development. This paper is concerned with the strategies for technology commercialization and supports of new venture development. The study has applied the cluster-based strategies of the US Silicon Valley to the case of Thailand. The findings highlight the role of the National Science and Technology Development Agency’s Science Park and the National Innovation Agency’s Innovation Park in supporting technology commercialization and development of the national innovation system. The future challenges to create effective system for entrepreneurial development and implications for entrepreneurial business management are discussed herein.     

Access and allocation in earth system governance: lessons learnt in the context of the Sustainable Development Goals

International Environmental Agreements: Politics, Law and Economics - Researching socio-ecological justice issues in earth system governance can be operationalized through an Access (securing...     

Effective sexual harassment policies: unexpected lessons from Jacksonville Shipyards

Although many employers recognize the need for an effective sexual harassment policy, they have received only limited guidance from the EEOC and the courts on how to draft and implement one. This article examines a recent decision, Robinson v. Jacksonville Shipyards, in which the court imposed a comprehensive sexual harassment policy. This article suggests that employers should consider adopting similar policies to better protect themselves from liability for sexual harassment.     

Case-mix payment for nursing home care: lessons from Maryland

Even before Medicare adopted case-based payments for hospitals, some state Medicaid programs employed case-mix payment systems for nursing home care. Their purpose was less to promote cost containment than to improve access to nursing homes for the most costly patients. This paper evaluates one such system, adopted by the state of Maryland in 1983 as part of an overall reimbursement reform. Using data on nursing home patient characteristics, costs, and staffing, as well as interviews with officials and various providers of care, the article shows that Maryland's system was successful in shifting nursing home service away from light-care and toward heavy-care patients. Furthermore, the shift occurred without inducing readily measurable declines in quality of care and with little additional administrative cost (partly because the state built its case-mix system on preexisting patient review activities). Although states could learn from and improve upon Maryland's experience--most notably in offering incentives to improve quality of care and in targeting community care on the light-care patients that nursing homes become less willing to serve--Maryland demonstrates that case-mix payment can change nursing home behavior in desired directions without substantial negative consequences.     

Contraband and violence: lessons from the Southeast Asian case

This article looks at the intersection between contraband and violence in Southeast Asia. I argue that the two activities are often linked and play off one another in specific, contextualized ways. To make this case, I examine instances of smuggling in the history of the region; through the trade in human beings, both historically and today; through the transit of narcotics, again historically and today; and via the conduit of a range of other contraband cargoes. Race, religion, memory and geography all factor into the outcome of when smuggling may take on violent forms. I chronicle these occasions throughout the width and breadth of the region, stretching from the Thai/Burmese border in the north to the island world of Insular Southeast Asia in the south. Throughout the essay, I pay particular attention to the larger milieus of commerce, politics, and society that condition moments when acts of smuggling may in fact turn violent. **NB: Most of the field-research for this piece (including local newspaper article accumulation) was done in the late 1990s under a Fulbright grant. A subsequent Faculty Fulbright in 2004 supplemented much of this earlier research, and also allowed me to travel to a number of other locales to make observations on this topic.

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Oversight of HMRC soft law: lessons from the Ombudsman

An investigation of the role which the Ombudsman plays in tax law, on which comparatively little has been written, reveals that the body makes an important and distinct contribution. There is now almost universal acceptance that tax law is overly complex and indeterminate. If the primary law offers few answers to the taxpayer, then HMRC’s role as administrator of the system becomes apparent. Soft law elaborating upon how HMRC will apply the primary law to a given class of taxpayers is rendered indispensable. In practice however, HMRC soft law has often been found to be deficient. Analysis of the current oversight arrangements for HMRC soft law immediately reveals the genesis of these issues. Select committees exercise Parliamentary control, whilst an independent body performs external audits. These entities however only incommensurately examine the soft law. Into this void steps the Parliamentary and Health Service Ombudsman, a body which has ‘carved for itself a distinctive niche’ in the public law framework. The paper accordingly seeks to elaborate upon the important role that the Ombudsman plays in scrutinising HMRC soft law and the lessons which can be derived from this analysis.