Four Lessons for Developing Countries from the Trade Negotiations Over Access to Medicines

After the Agreement on the Trade-Related Aspects of Intellectual Property Rights (TRIPS) came into operation in 1995 developing countries have found themselves in a process of continual negotiation over intellectual property rights and access to medicines. These negotiations have taken place in the World Trade Organization and in the context of free trade agreements. The paper suggests that the only real win for developing countries has been the Doha Declaration on the TRIPS Agreement and Public Health in 2001. What have been the lessons for developing countries in a decade of negotiations over access to medicines? Drawing on themes of rule complexity and regulatory ritualism the paper discusses four key lessons for developing countries. It concludes by arguing that developing countries will do better if they adopt a networked governance approach to negotiation rather than continuing to rely on traditional coalition formation.     

Litigating the science of breast cancer treatment

Beginning in the late 1980s, many health insurers refused to cover high-dose chemotherapy with autologous bone marrow transplant (HDC/ABMT) for high-risk and metastatic breast cancer patients. Insurers denied coverage because there was no persuasive evidence of clinical effectiveness. In response, many women sued to compel coverage. After years of litigation and the expenditure of approximately $3 billion, randomized clinical trials (RCTs) showed that the procedure was no more effective and possibly more harmful than conventional therapy. To understand whether and how litigation contributed to the diffusion of the procedure, we conducted a series of case studies that examine the litigation tactics and strategies used by defense and plaintiffs' counsel. Despite the fact that HDC/ABMT lacked proven scientific effectiveness, insurance defense attorneys were unable to stop the procedure's diffusion. Plaintiffs' attorneys had a much easier and more sympathetic story to tell and were able to exploit vulnerabilities facing the defense.     

Classification of premium and regular gasoline by gas chromatography/mass spectrometry,principal component analysis and artificial neural networks

Detection and correct classification of gasoline is important for both arson and fuel spill investigation. Principal component analysis (PCA) was used to classify premium and regular gasolines from gas chromatography-mass spectrometry (GC-MS) spectral data obtained from gasoline sold in Canada over one calendar year. Depending upon the dataset used for training and tests, around 80-93% of the samples were correctly classified as either premium or regular gasoline using the Mahalanobis distances calculated from the principal components scores. Only 48-62% of the samples were correctly classified when the premium and regular gasoline samples were divided further into their winter/summer sub-groups. Artificial neural networks (ANNs) were trained to recognise premium and regular gasolines from the same GC-MS data. The best-performing ANN correctly identified all samples as either a premium or regular grade. Approximately 97% of the premium and regular samples were correctly classified according to their winter or summer sub-group.     

Area-specific increased density of mu-opioid receptor immunoreactive neurons in the cerebral cortex of drug-related fatalities

In animal experiments and in cell culture, chronic morphine treatment has been followed by "up-regulation" as well as "down-regulation" of the mu-opioid receptor (OR) number. The present postmortem morphometric study of morphine-related fatalities of drug-addicts (n=13, 20-35 years old, with blood unconjugated morphine levels from 27.1 ng/ml to 458 ng/ml, m.v. 198.5 ng/ml) versus a non-addicted control group (n=13, 10-44 years old) was intended to examine, whether chronic opiate exposure affects the numerical density of mu-OR expressing neurons in the human neocortex (areas 11, 24 and 25 according to Brodmann). For the immunohistochemical procedure, vibratome sections (100 microm) were incubated with a monoclonal antibody against the mu-OR, diluted 1:100, and immunolabelled sites were visualized using an immunoperoxidase protocol. The numerical densities of OR immunoreactive neuronal profiles and Nissl-stained central profiles were assessed morphometrically (camera lucida-drawings). In both groups, the anti-mu-OR-immunoreactivity was mainly localized in pyramidal neurons of layers (L) II/III and V and in multiform neurons of L VI. In the areas 24 and 25, the density of the immunoreactive neuronal profiles did not display a significant difference between the two examined groups. In the area 11, however, the number of immunolabelled neuronal profiles amounted to 2777+/-206 mm(3) in the drug-related fatalities and to 2320+/-124 mm(3) in the control group and thus was significantly increased.     

Analysis of 1989-1999 homicide crimes in the catchment area of the Bonn Institute of Forensic Medicine with reference to selected aspects

195 cases of homicide, grouped according to juridical assessment, were retrospectively analysed with regard to individual characteristics of perpetrators and victims, circumstances, and mode of commitment. The involvement of underage victims and perpetrators as well as differences between the urban and rural areas studied were taken into special consideration. To summarise, the majority of the offences studied was carried out by a male perpetrator with a mean age of 35 years driven by personal motives or greed in his immediate vicinity and affected family members or close acquaintances. The fatal injuries were mainly attributable to sharp or blunt force. With regard to killings of children, a higher prevalence of female victims and male assailants, emotional motives and an even higher importance of the social vicinity were found. Particularly in victims younger 12 years of age, manual modes of commitment without application of any tools were predominantly encountered. The comparison of urban and rural areas revealed a higher homicide rate in municipal areas especially of offences with a loose relationship between victims and assailants (greed, sexual assault). In contrast, rural areas exhibited higher rates of bodily harm with fatal consequences as well as offences by highly intoxicated assailants.     

STR genotyping and mtDNA sequencing of latent fingerprint on paper

A systematic study was conducted to investigate whether DNA can be successfully extracted from latent fingerprints deposited on ordinary paper and analysed using short tandem repeat profiling and mitochondrial DNA sequencing. In order to evaluate the performance of latent fingerprint analysis in a criminal case, experiments with varying conditions were carried out to improve our understanding of low copy number (LCN) DNA typing. After optimising the extraction methods to achieve increased sensitivity, the examination of touched paper can routinely yield the STR profile of the individual who has touched it. A fingerprint can therefore be considered as a potential source of DNA for genetic identification. Nevertheless, the findings of our "after enhancement experiment" (using chemically or physically pre-treated fingerprints), and our "mixture experiment" (using fingerprints from three to four people on the same sheet of paper) help to define the limitations of the low copy number PCR technique in forensic casework.