Turing and the Trans-Pacific Partnership: Intellectual Property, Public Health, and Access to Essential Medicines

A recent controversy in the United States over drug pricing by Turing Pharmaceuticals AG has raised larger issues in respect of intellectual property, access to medicines, and the Trans-Pacific Partnership (TPP). In August 2015, Turing Pharmaceuticals AG – a private biopharmaceutical company with offices in New York, the United States, and Zug, Switzerland - acquired the exclusive marketing rights to Daraprim in the United States from Impax Laboratories Incorporated. Martin Shkreli, Turing’s Founder and Chief Executive Officer, maintained: “The acquisition of Daraprim and our toxoplasmosis research program are significant steps along Turing’s path of bringing novel medications to patients with serious disorders, some of whom often go undiagnosed and untreated.” He emphasised: “We intend to invest in the development of new drug candidates that we hope will yield an even better clinical profile, and also plan to launch an educational effort to help raise awareness and improve diagnosis for patients with toxoplasmosis.” In September 2015, there was much public controversy over the decision of Martin Shkreli to raise the price of a 62 year old drug, Daraprim, from $US13.50 to $US750 a pill. The drug is particularly useful in respect to the treatment and prevention of malaria, and in the treatment of infections in individuals with HIV/AIDS. Daraprim is listed on the World Health Organization’s (WHO) List of Essential Medicines. In the face of much criticism, Martin Shkreli has said that he will reduce the price of Daraprim. He observed: “We've agreed to lower the price on Daraprim to a point that is more affordable and is able to allow the company to make a profit, but a very small profit.” He maintained: “We think these changes will be welcomed.” However, he has been vague and ambiguous about the nature of the commitment. Notably, the lobby group, Pharmaceutical Research and Manufacturers of America (PhARMA), disassociated itself from the claims of Turing Pharmaceuticals. The group said: “PhRMA members have a long history of drug discovery and innovation that has led to increased longevity and improved lives for millions of patients.” The group noted: “Turing Pharmaceutical is not a member of PhRMA and we do not embrace either their recent actions or the conduct of their CEO.” The biotechnology peak body Biotechnology Industry Organization also sought to distance itself from Turing Pharmaceuticals. A hot topic: United States political debate about access to affordable medicines This controversy over Daraprim is unusual – given the age of drug concerned. Daraprim is not subject to patent protection. Nonetheless, there remains a monopoly in respect of the marketplace. Drug pricing is not an isolated problem. There have been many concerns about drug pricing – particularly in respect of essential medicines for HIV/AIDS, tuberculosis, and malaria. This recent controversy is part of a larger debate about access to affordable medicines. The dispute raises larger issues about healthcare, consumer rights, competition policy, and trade. The Daraprim controversy has provided impetus for law reform in the US. US Presidential Candidate Hillary Clinton commented: “Price gouging like this in this specialty drug market is outrageous.” In response to her comments, the Nasdaq Biotechnology Index fell sharply. Hillary Clinton has announced a prescription drug reform plan to protect consumers and promote innovation – while putting an end to profiteering. On her campaign site, she has emphasised that “affordable healthcare is a basic human right.” Her rival progressive candidate, Bernie Sanders, was also concerned about the price hike. He wrote a letter to Martin Shkreli, complaining about the price increase for the drug Daraprim. Sanders said: “The enormous, overnight price increase for Daraprim is just the latest in a long list of skyrocketing price increases for certain critical medications.” He has pushed for reforms to intellectual property to make medicines affordable. The TPP and intellectual property The Daraprim controversy and political debate raises further issues about the design of the TPP. The dispute highlights the dangers of extending the rights of pharmaceutical drug companies under intellectual property, investor-state dispute settlement, and drug administration. Recently, the civil society group Knowledge Ecology International published a leaked draft of the Intellectual Property Chapter of the TPP. Knowledge Ecology International Director, James Love, was concerned the text revealed that the US “continues to be the most aggressive supporter of expanded intellectual property rights for drug companies.” He was concerned that “the proposals contained in the TPP will harm consumers and in some cases block innovation.” James Love feared: “In countless ways, the Obama Administration has sought to expand and extend drug monopolies and raise drug prices.” He maintained: “The astonishing collection of proposals pandering to big drug companies make more difficult the task of ensuring access to drugs for the treatment of cancer and other diseases and conditions.” Love called for a different approach to intellectual property and trade: “Rather than focusing on more intellectual property rights for drug companies, and a death-inducing spiral of higher prices and access barriers, the trade agreement could seek new norms to expand the funding of medical research and development (R&D) as a public good, an area where the US has an admirable track record, such as the public funding of research at the National Institutes of Health (NIH) and other federal agencies.” In addition, there has been much concern about the Investment Chapter of the TPP. The investor-state dispute settlement regime would enable foreign investors to challenge government policy making, which affected their investments. In the context of healthcare, there is a worry that pharmaceutical drug companies will deploy their investor rights to challenge public health measures – such as, for instance, initiatives to curb drug pricing and profiteering. Such concerns are not merely theoretical. Eli Lilly has brought an investor action against the Canadian Government over the rejection of its drug patents under the investor-state dispute settlement regime of the North American Free Trade Agreement (NAFTA). The Health Annex to the TPP also raises worries that pharmaceutical drug companies will able to object to regulatory procedures in respect of healthcare. It is disappointing that the TPP – in the leaks that we have seen – has only limited recognition of the importance of access to essential medicines. There is a need to ensure that there are proper safeguards to provide access to essential medicines – particularly in respect of HIV/AIDs, malaria, and tuberculosis. Moreover, there must be protection against drug profiteering and price gouging in any trade agreement. There should be strong measures against the abuse of intellectual property rights. The dispute over Turing Pharmaceuticals AG and Daraprim is an important cautionary warning in respect of some of the dangers present in the secret negotiations in respect of the TPP. There is a need to preserve consumer rights, competition policy, and public health in trade negotiations over an agreement covering the Pacific Rim.

Sustainable building envelope design by considering energy cost and occupant satisfaction

The built environment is a major contributor to the world’s carbon dioxide emissions, with a considerable amount of energy being consumed in buildings due to heating, ventilation and air-conditioning, space illumination, use of electrical appliances, etc., to facilitate various anthropogenic activities. The development of sustainable buildings seeks to ameliorate this situation mainly by reducing energy consumption. Sustainable building design, however, is a complicated process involving a large number of design variables, each with a range of feasible values. There are also multiple, often conflicting, objectives involved such as the life cycle costs and occupant satisfaction. One approach to dealing with this is through the use of optimization models. In this paper, a new multi-objective optimization model is developed for sustainable building design by considering the design objectives of cost and energy consumption minimization and occupant comfort level maximization. In a case study demonstration, it is shown that the model can derive a set of suitable design solutions in terms of life cycle cost, energy consumption and indoor environmental quality so as to help the client and design team gain a better understanding of the design space and trade-off patterns between different design objectives. The model can very useful in the conceptual design stages to determine appropriate operational settings to achieve the optimal building performance in terms of minimizing energy consumption and maximizing occupant comfort level.

Career Adapt-Abilities Scale—Iran Form: Psychometric properties and relationships with career satisfaction and entrepreneurial intentions

This study examined the psychometric properties of a Persian translation of the Career Adapt-Abilities Scale (CAAS—Iran Form) and its relationships with career satisfaction, business opportunity identification, and entrepreneurial intentions. It was hypothesized that career adaptability relates positively to these three outcomes, even when controlling for demographic and employment characteristics. Data were provided by 204 workers from Iran. Results showed that the overall CAAS score and sub-dimension scores (concern, control, curiosity, and confidence) were highly reliable. Moreover, confirmatory factor analyses indicated that the CAAS—Iran Form measures four distinct dimensions that can be combined into a higher-order career adaptability factor. Findings also demonstrated criterion-related validity of the scale with regard to career satisfaction and entrepreneurial intentions. In contrast, overall career adaptability was not significantly related to opportunity identification, while concern related positively, and control related negatively to opportunity identification. Overall, the CAAS—Iran Form has very good psychometric properties and predicts important career outcomes, suggesting that it can be used for career counseling and future research with Persian-speaking workers.

A new multi-objective model to optimise rail transport scheduler

The sugarcane transport system plays a critical role in the overall performance of Australia’s sugarcane industry. An inefficient sugarcane transport system interrupts the raw sugarcane harvesting process, delays the delivery of sugarcane to the mill, deteriorates the sugar quality, increases the usage of empty bins, and leads to the additional sugarcane production costs. Due to these negative effects, there is an urgent need for an efficient sugarcane transport schedule that should be developed by the rail schedulers. In this study, a multi-objective model using mixed integer programming (MIP) is developed to produce an industry-oriented scheduling optimiser for sugarcane rail transport system. The exact MIP solver (IBM ILOG-CPLEX) is applied to minimise the makespan and the total operating time as multi-objective functions. Moreover, the so-called Siding neighbourhood search (SNS) algorithm is developed and integrated with Sidings Satisfaction Priorities (SSP) and Rail Conflict Elimination (RCE) algorithms to solve the problem in a more efficient way. In implementation, the sugarcane transport system of Kalamia Sugar Mill that is a coastal locality about 1050 km northwest of Brisbane city is investigated as a real case study. Computational experiments indicate that high-quality solutions are obtainable in industry-scale applications.

Developing nations need more than words from G20 tax reform

Tax reform is squarely on the agenda for the G20 Brisbane summit in November. The current international tax regime is broken and it’s going to take significant effort on a global scale to fix it. In a recently released CEDA Report on securing the G20’s future, I recommended the role Australia could play in ensuring real and substantive progress is made in international tax reform. There’s a very real need to ensure the Brisbane summit is not just a “talkfest”. One group that stands to significantly win or lose from reform, or lack of it, is developing nations.

Hot corrosion of γ-Y2Si2O7 in strongly basic Na2CO3 molten salt environment

γ-Y2Si2O7 is a promising candidate both for high temperature structural applications and as thermal barrier coatings due to its unique combination of properties, such as high melting point, good machinability, high thermal stability, low linear thermal expansion coefficient (3.9 × 10-6 K-1, 25-1400 °C) and low thermal conductivity (<3 W/m K above 300 °C). In this work, the hot corrosion behavior of γ-Y2Si2O7 in strongly basic Na2CO3 molten salt at 850-1000 °C for 20 h in flowing air was investigated. In the employed conditions, multi-layer corrosion scales with total thickness less than 90 μm were formed. At 850-900 °C, the outmost layer of the scale was composed of the reprecipitation of Y2O3, the bottom of a Si-rich Na2O·xSiO2 (x > 3.65) melt layer, and the middle of a NaYSiO4 layer. At 1000 °C, the corrosion products turned out to be a mixture of NaY9Si6O26 and Si-rich Na2O·xSiO2 (x > 3.65). In all cases, a thin layer of protective SiO2 formed under the Na2O·xSiO2 melt and protected the bulk material from further corrosion.

Decision fusion for reliable flood mapping using remote sensing images

Flood extent mapping is a basic tool for flood damage assessment, which can be done by digital classification techniques using satellite imageries, including the data recorded by radar and optical sensors. However, converting the data into the information we need is not a straightforward task. One of the great challenges involved in the data interpretation is to separate the permanent water bodies and flooding regions, including both the fully inundated areas and the wet areas where trees and houses are partly covered with water. This paper adopts the decision fusion technique to combine the mapping results from radar data and the NDVI data derived from optical data. An improved capacity in terms of identifying the permanent or semi-permanent water bodies from flood inundated areas has been achieved. Computer software tools Multispec and Matlab were used.

The impact of communication technologies on life and relationship satisfaction

Previous studies have shown a relationship between the use of communications technology and well-being, particularly mediated through its effect on personal relationships. However, there is some debate over whether this effect is positive or negative. The present study explored this issue further, examining whether the effect varies depending on the type of communications technology, and the nature of the personal relationship. An online survey was conducted with 3,421 participants in three countries (Australia, UK and US). It examined the use of ten communication methods, overall satisfaction with life and satisfaction with four different kinds of relationships (close and extended family, and close and distant friends). Results indicate that richer communication methods, which include non-verbal cues, were positively associated with both overall satisfaction with life and satisfaction with relationships. These methods included face-to-face communication, and phone and video calls. Conversely, more restricted methods, such as text messaging and instant messaging, were negatively associated with both variables. Social networking was negatively associated with overall satisfaction, but not with satisfaction with relationships. The strength of the association between a communications method and satisfaction with a relationship varied depending on the type of relationship, but whether it was positive or negative did not change.

Reengaging, reenacting and reenvisaging discourses of disaster through public space performance: Austerity, art, and the art of protest

This paper offers a mediation on disaster, recovery, resilience, and restoration of balance, in both a material and a metaphorical sense, when ‘disaster’ befalls not the body politic of the nation but the body personal. In the past few decades, of course, artists, activists and scholars have deliberately tried to avoid describing personal, physical and phenomenological experiences of the disabled body in terms of difficulty and disaster. This has been part of a political move, from a medical model, in which disability, disease and illness are positioned as personal catastrophes, to a social model, in which disability is positioned as a social construct that comes from systems, institutions and infrastructure designed to exclude different bodies. It is a move that is responsible for a certain discomfort people with disabilities, and artists with disabilities, today feel towards performances that deploy disability as a metaphor for disaster, from Hijikata, to Theatre Hora. In the past five years, though, this particular discourse has begun rising again, particularly as people with disabilities fact their own anything but natural disasters as a result of the austerity measures now widespread across the US, UK, Europe and elsewhere. Measures that threaten people’s ability to live, and take part in social and institutional life, in any meaningful way. Measures that, as artist Katherine Araniello notes, also bring additional difficulty, danger, and potential for disaster as they ripple outwards across the tides of familial ties, threatening family, friends, and careers who become bound up in the struggle to do more with less. In this paper, I consider how people with disabilities use performance, particularly public space interventionalist performance, to reengage, renact and reenvisage the discourse of national, economic, environmental or other forms of disaster, the need for austerity, the need to avoid providing people with support for desires and interests as well as basic daily needs, particularly when fraud and corruption is so right, and other such ideas that have become an all too unpleasant reality for many people. Performances, for instance, like Liz Crow’s Bedding Out, where she invited people into her bed – for people with disabilities a symbolic space, which necessarily becomes more a public living room restaurant, office and so forth than a private space when poor mobility means they spend much time it in – to talk about their lives, their difficulties, and dealing with austerity. Or, for instance, like the Bolshy Divas, who mimic public and political policy, reports and advertising paranoia to undermine their discourses about austerity. I examine the effects, politics and ethics of such interventions, including examination of the comparative effect of highly bodied interventions (like Crow’s) and highly disembodied interventions (like the Bolshy Diva’s) in discourses of difficulty, disaster and austerity on a range of target spectator communities.

Stimulating immune responses to fight cancer: Basic biology and mechanisms

Chronic inflammation is now recognized as a major cause of malignant disease. In concert with various mechanisms (including DNA instability), hypoxia and activation of inflammatory bioactive lipid pathways and pro-inflammatory cytokines open the doorway to malignant transformation and proliferation, angiogenesis, and metastasis in many cancers. A balance between stimulatory and inhibitory signals regulates the immune response to cancer. These include inhibitory checkpoints that modulate the extent and duration of the immune response and may be activated by tumor cells. This contributes to immune resistance, especially against tumor antigen-specific T-cells. Targeting these checkpoints is an evolving approach to cancer immunotherapy, designed to foster an immune response. The current focus of these trials is on the programmed cell death protein 1 (PD-1) receptor and its ligands (PD-L1, PD-L2) and cytotoxic T-lymphocyte-associated protein 4 (CTLA-4). Researchers have developed anti-PD-1 and anti-PDL-1 antibodies that interfere with the ligands and receptor and allow the tumor cell to be recognized and attacked by tumor-infiltrating T-cells. These are currently being studied in lung cancer. Likewise, CTLA-4 inhibitors, which have had success treating advanced melanoma, are being studied in lung cancer with encouraging results.

Older Australians: Structural barriers to learning in later life

Learning in older age is associated with a wide range of benefits including increases in skills, social interactions, self-satisfaction, coping ability, enjoyment, and resilience to age-related changes in the brain. It is also recognized as being a fundamental component of active ageing and if active ageing objectives are to be met for the growing ageing population, barriers to learning for this group need to be fully understood so that they can be properly addressed. This paper reports on findings from a study aimed at determining the degree that structural factors deter older people aged 55 years and older from engaging in learning activities relative to other factors, based on survey (n=421) and interview (n=40) data. Quantitative and qualitative analyses revealed that factors related to educational institutions as well as infrastructure were commonly cited as barriers to participation in learning. The implications of these and other findings are discussed.

The selection, optimization, and compensation model in the work context: A systematic review and meta-analysis of two decades of research

Over the past two decades, the selection, optimization, and compensation (SOC) model has been applied in the work context to investigate antecedents and outcomes of employees' use of action regulation strategies. We systematically review, meta-analyze, and critically discuss the literature on SOC strategy use at work and outline directions for future research and practice. The systematic review illustrates the breadth of constructs that have been studied in relation to SOC strategy use, and that SOC strategy use can mediate and moderate relationships of person and contextual antecedents with work outcomes. Results of the meta-analysis show that SOC strategy use is positively related to age (rc = .04), job autonomy (rc = .17), self-reported job performance (rc = .23), non-self-reported job performance (rc = .21), job satisfaction (rc = .25), and job engagement (rc = .38), whereas SOC strategy use is not significantly related to job tenure, job demands, and job strain. Overall, our findings underline the importance of the SOC model for the work context, and they also suggest that its measurement and reporting standards need to be improved to become a reliable guide for future research and organizational practice.

Student satisfaction with models of field placement supervision

Field placements provide social work students with the opportunity to integrate their classroom learning with the knowledge and skills used in various human service programs. The supervision structure that has most commonly been used is the intensive one-to-one, clinical teaching model. However, this model is being challenged by significant changes in educational and industry sectors, which have led to an increased use of alternative fieldwork structures and supervision arrangements, including task supervision, group supervision, external supervision, and shared supervisory arrangements. This study focuses on identifying models of supervision and student satisfaction with their learning experiences and the supervision received on placement. The study analysed responses to a questionnaire administered to 263 undergraduate social work students enrolled in three different campuses in Australia after they had completed their first or final field placement. The study identified that just over half of the placements used the traditional one student to one social work supervisor model. A number of “emerging” models were also identified, where two or more social workers were involved in the professional supervision of the student. High levels of dissatisfaction were reported by those students who received external social work supervision. Results suggest that students are more satisfied across all aspects of the placement where there is a strong on-site social work presence.

Student satisfaction with models of field placement supervision

Field placements provide social work students with the opportunity to integrate their classroom learning with the knowledge and skills used in various human service programs. The supervision structure that has most commonly been used is the intensive one-to-one, clinical teaching model. However, this model is being challenged by significant changes in educational and industry sectors, which have led to an increased use of alternative fieldwork structures and supervision arrangements, including task supervision, group supervision, external supervision, and shared supervisory arrangements. This study focuses on identifying models of supervision and student satisfaction with their learning experiences and the supervision received on placement. The study analysed responses to a questionnaire administered to 263 undergraduate social work students enrolled in three different campuses in Australia after they had completed their first or final field placement. The study identified that just over half of the placements used the traditional one student to one social work supervisor model. A number of “emerging” models were also identified, where two or more social workers were involved in the professional supervision of the student. High levels of dissatisfaction were reported by those students who received external social work supervision. Results suggest that students are more satisfied across all aspects of the placement where there is a strong on-site social work presence.