The Pharmaceutical Industry and Access to Medicines in India

Pharmaceutical policy in India as elsewhere is shaped by conflicting economic and social interests and opposing values and priorities. Tensions can be understood as revolving around the contradiction between use value and exchange value in the production of medicinal drugs as commodities, as per Marx’s original analysis. The use value of medicines – if safe and efficacious, of good quality, and prescribed and consumed appropriately – is the prevention, cure or alleviation of ill-health and disease. Health policy is – or should be – aimed at optimising the use value of medicines. For this purpose government agencies administer regulatory oversight of the manufacturing, marketing and distribution of medicines. Drugs made available to patients are expected to meet adequate safety, quality and efficacy standards, but regulation to ensure such standards is subject to controversy in most countries. This is a domain where definition and interpretation of scientific-technological principles and criteria is infused by partiality and bias grounded in social and material interests, as evidenced by recurrent debates about industry ‘capture’ of regulatory agencies, including the world’s most regulator, the US Food and Drug Administration (Angell 2005; Law 2006). In India, a Parliamentary Committee Report in 2012 depicted the Central Drugs Standard Control Organisation (CDSCO) as dysfunctional and influenced inappropriately by the exchange value perspective of manufacturers (Parliamentary Standing Committee on Health and Welfare 2012). The clash between use and exchange value perspectives is starkly illustrated by cases of products known to cause more harm than good, particularly common in poorly regulated markets such as India’s, as shown by Srinivasan & Phadke.

A model driven framework to address challenges in a mobile learning environment

In this paper a review of the pedagogical, technological, policy and research challenges and concepts underlying mobile learning is presented, followed by a brief description of categories of implementations. A model Mobile learning framework and dynamic criteria for mobile learning implementations are proposed, along with a casestudy of one site that is used to illustrate how the proposed model can be applied. Implementation challenges including pedagogical challenges, technological challenges, policy challenges, and research challenges are described. These align well with the themes of EduSummIT 2013 that hosted the dialogue resulting in this paper.

Challenges in translating scientific evidence into mandatory food fortification policy: an antipodean case study of the folate- neural tube defect relationship

Objective: To identify challenges in translating scientific evidence of a  nutrient and health relationship into mandatory food fortification policy.
Design: A case study approach was used in which available evidence  associated with the folate–neural tube defect relationship was reviewed against the Australia New Zealand Food Regulation Ministerial Council's Policy Guideline for mandatory food fortification. Results: Three particular challenges were identified. The first is knowing when and how to act in the face of scientific uncertainty. The second is knowing how to address the special needs of at-risk individuals without compromising the health and safety of the population as a whole. The third is to ensure that a policy is sufficiently monitored and evaluated. Conclusions: Despite the availability of compelling evidence of a relationship between a particular nutrient and a health outcome, a definitive policy response may not be apparent.  Judgement and interpretation inevitably play significant roles in influencing whether and how authorities translate scientific evidence into mandatory food fortification policy. In relation to the case study, it would be prudent to undertake a risk–benefit analysis of policy alternatives and to implement nutrition education activities to promote folic acid supplement use among the target group. Should mandatory folate fortification be implemented,  comprehensive monitoring and evaluation of this policy will be essential to know that it is implemented as planned and does more good than harm. In relation to mandatory food fortification policy-making around the world,  ongoing national nutrition surveys are required to complement national policy guidelines.

Assessing the case for mandatory folate fortification : policy-making in the face of scientific uncertainties

This paper presents the view that policymakers face scientific uncertainties in assessing the case for mandatory folate fortification as a policy response to epidemiological evidence of the relationship between folate and neural tube defects. Moreover, the resolution of these uncertainties is confounded by the under-resourced state of nutrition information systems in Australia and New Zealand. The uncertainties relate to potential risks and benefits associated with the intervention for the target group and the population in general. These risks and benefits reflect the mismatch between evidence and policy that arises when addressing a presumed genetic abnormality in at-risk individuals with an intervention that is population-wide in its scope. There is an urgent need to conduct ongoing national nutrition surveys and monitor and evaluate policy interventions to strengthen the capacity of nutrition information systems to inform decision-making for this current, and future, public health nutrition policy.

Knowing wildfire risk: scientific interactions with risk mitigation policy and practice in Victoria, Australia

Over the past decade, major landscape wildfires (or ‘bushfires’ in Australia) in fire-prone countries have illustrated the seriousness of this global environmental problem. This natural hazard presents a complex mesh of dynamic factors for those seeking to reduce or manage its costs, as ignitions, hazard behaviour, and the reactions of different human and ecological communities during and after hazard events are all extremely uncertain. But while those at risk of wildfire have been subject to significant research, the social dimensions of its management, including the role of science, have received little attention. This paper reports on a case study of the Barwon-Otway area of Victoria in Australia, a high wildfire risk area that has recently been a pilot site for a new risk mitigation strategy utilising the wildfire simulation model PHOENIX RapidFire. Against simple equations between ‘more science’ and ‘less uncertainty,’ this paper presents results from interviews and a workshop with practitioners to investigate how scientific research interacts with and informs both wildfire policy and practice. We suggest that attending to cultural and social specificities of the application of any technical innovation—such as next generation modelling—raises questions for future research about the roles of narrative, performance, and other knowledges in the sedimentation of science.

Preemptive job scheduling policy for distributively-owned workstation clusters

Cluster computing has come to prominence as a cost-effective parallel processing tool for solving many complex computational problems. In this paper, we propose a new timesharing opportunistic scheduling policy to support remote batch job executions over networked clusters to be used in conjunction with the Condor Up-Down scheduling algorithm. We show that timesharing approaches can be used in an opportunistic setting to improve both mean job slowdowns and mean response times with little or no throughput reduction. We also show that the proposed algorithm achieves significant improvement in job response time and slowdown as compared to exiting approaches and some recently proposed new approaches.

Multifactor productivity measures of construction sectors using OECD input-output database

This research develops a new productivity measurement framework for the construction sector in the light of an input-output table. Three group multifactor productivity indicators are formulated based on the multiplier concepts in the input-output analysis. This measurement framework focuses on the intro-industry flows of products and considers the direct and indirect effects of input and output. Moreover, this framework enables us to measure the multifactor productivity of a specific sector systematically. Historical analyses and international comparisons are carried out to indicate the differences of the productivity of the construction sectors in seven selected countries, using the newly published OECD input-output database. Research findings are expected to clarify how technological, organizational and political factors affect the productivity growth, enabling the policy makers, construction businesses and researchers to quantify the competitive ability of the construction sector.

Technological disadvantage of the digital age

Debates continue about the relative benefits, costs and risks of the diffusion of computer-based technologies throughout society and schooling. One area that has received considerable attention is gender equity. Early work on gender and computers focused on differences between male and female access and use (e.g. Huff, Fleming & Cooper, 1992; Kirkman, 1993; Morritt, 1997; Nelson & Cooper, 1997; Sofia, 1993), with concerns focused on the potential for girls to be disadvantaged. In some respects, it is arguable that problems of gender equity in schools with respect to computers have been overcome. For example, in a small study I conducted in two New Zealand senior primary classrooms in 2003, I found that both boys and girls were motivated to use computers and appeared to have equal opportunities to access computers in the classroom. The students in my study expressed a belief in the importance of using computers, and this belief can also be discerned from educational policy and media coverage.
In this paper I argue that, although gender by itself no longer appears to be a source of disadvantage in terms of access to and use of computers in schools, many questions about technology, schooling and power relations still remain unanswered. I present two alternative viewpoints on the new digital age. First, I explore Melanie Stewart Millar’s (1998) analysis of digital discourse as one which reproduces the power of white, middle-class, educated, well-paid males, and excludes anything else it considers ‘Other’. Second, I review arguments that the digital age has provided sites for the transcendence of traditional hierarchies and inequalities (e.g. Spender, 1995). I conclude that, despite the discrepancies between these two viewpoints, both concur that technological disadvantage will exacerbate any existing inequality that might result from intersections of identity categories, such as, gender, ethnicity, age, and socio-economic status.

Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies

A WHO expert consultation addressed the debate about interpretation of recommended body-mass index (BMI) cut-off points for determining overweight and obesity in Asian populations, and considered whether population-specific cut-off points for BMI are necessary. They reviewed scientific evidence that suggests that Asian populations have different associations between BMI, percentage of body fat, and health risks than do European populations. The consultation concluded that the proportion of Asian people with a high risk of type 2 diabetes and cardiovascular disease is substantial at BMIs lower than the existing WHO cut-off point for overweight (25 kg/m2). However, available data do not necessarily indicate a clear BMI cut-off point for all Asians for overweight or obesity. The cut-off point for observed risk varies from 22kg/m2 to 25kg/m2 in different Asian populations; for high risk it varies from 26kg/m2 to 31kg/m2. No attempt was made, therefore, to redefine cut-off points for each population separately. The consultation also agreed that the WHO BMI cut-off points should be retained as international classifications. The consultation identified further potential public health action points (23·0, 27·5, 32·5, and 37·5 kg/m2) along the continuum of BMI, and proposed methods by which countries could make decisions about the definitions of increased risk for their population.

Technological efficacy: a new identity category

Debates continue about the relative benefits, costs and risks of the diffusion of computer-based technologies throughout society and schooling. One area that has received considerable attention is gender equity. Early work on gender and computers focused on differences between male and female access and use (e.g. Huff, Fleming & Cooper, 1992; Kirkman, 1993; Morritt, 1997; Nelson & Cooper, 1997; Sofia, 1993), with concerns focused on the potential for girls to be disadvantaged. In some respects, it is arguable that problems of gender equity in schools with respect to computers have been overcome. For example, in a small study I conducted in two New Zealand senior primary classrooms in 2003, I found that both boys and girls were motivated to use computers and appeared to have equal opportunities to access computers in the classroom. The students in my study expressed a belief in the importance of using computers, and this belief can also be discerned from educational policy and media coverage. In this paper I argue that, although gender by itself no longer appears to be a source of disadvantage in terms of access to and use of computers in schools, many questions about technology, schooling and power relations still remain unanswered. I present two alternative viewpoints on the new digital age. First, I explore Melanie Stewart Millar’s (1998) analysis of digital discourse as one which reproduces the power of white, middle-class, educated, well-paid males, and excludes anything else it considers ‘Other’. Second, I review arguments that the digital age has provided sites for the transcendence of traditional hierarchies and inequalities (e.g. Spender, 1995). I conclude that, despite the discrepancies between these two viewpoints, both concur that technological disadvantage will exacerbate any existing inequality that might result from intersections of identity categories, such as, gender, ethnicity, age, and socio-economic status, and that in this digital age, technological efficacy is arguably a new identity category.

Economic reforms, cultural policy : opportunities and challenges to the arts and culture in Vietnam in the age of globalization

The author investigates social change in Vietnam in the late 1980s-2000s, a transition from a subsidized economy to a market-oriented economy. The author discusses the influences of socioeconomic changes on the operation of the performing arts sector through analyzing changes in cultural policies, opportunities, and challenges confronted by performing arts organizations. The new cultural policy allows arts organizations, arts managers, and artists more opportunities to develop a greater degree of autonomy and more freedom in performing, programming and other artistic activities. The author believes that open policies will motivate Vietnam to develop its own national identity and to participate in cultural exchange with other parts of the world. However, under the impact of global culture, global economics, cuts in state funding, and rapid technological development, the performing arts sector has faced challenges in terms of financial viability, audience development, and balance between commercialization and artistic creativity. The author suggests that privatization should be implemented depending on the art form. Consideration should be given by the Vietnamese government to implementing appropriate funding policies and schemes, as state funding still forms a significant part of public companies' incomes.

Conceptualising the policy practice and behavioural research relationship

Background
Policy is frequently identified in the behavioural nutrition and physical activity research literature as a necessary component of effective research and practice. The purpose of this commentary is to promote a dialogue to contribute towards the further development of conceptual understandings and theories of the relationship between policy practice and behavioural research and how these two activities might work synergistically to improve public health outcomes.

Methods
Drawing on policy and public health literature, this commentary presents a a conceptual model of the interaction and mediation between nutrition and physical activity-relevant policy and behavioural nutrition and physical activity research, environments, behaviours and public health implications. The selling of food in school canteens in several Australian states is discussed to illustrate components of the relationship and the interactions among its components.

Results
The model depicts a relationship that is interdependent and cyclic. Policy contributes to the relationship through its role in shaping environmental and personal-cognitive determinants of behaviours and through these determinants it can induce behaviour change. Behavioural research describes behaviours, identifies determinants of behaviour change and therefore helps inform policy development and monitor and evaluate its impact.

Conclusion
The model has implications for guiding behavioural research and policy practice priorities to promote public health outcomes. In particular, we propose that policy practice and behavioural research activities can be strengthened by applying to each other the theories from the scientific disciplines informing these respective activities. Behavioural science theories can be applied to help understand policy-making and assist with disseminating research into policy and practice. In turn, policy science theories can be applied to support the 'institutionalisation' of commitments to ongoing behavioural research.

Quality of life of Australian family carers : implications for research, policy and practice

Abstract As part of an international,multicentered project, the burden of care, health, and subjective well-being experienced by select Australian family carers supporting a relative with disability at home were investigated. Some 448 family carers residing in New South Wales and Tasmania completed a battery of instruments, including a self-report demographic survey, the Family Caregiver Burden Inventory, the General Health Questionnaire, and the Personal Wellbeing Index. Respondents were predominantly females (mean
age = 48 years), married, and supporting a son or daughter with an intellectual disability (mean age = 18 years). Although caring for their family member was not perceived to be a burden, respondents reported notable limitations on their social networks and social activities. They reported higher levels of unemployment than would be expected for the general population and were over represented in lower income groups. They reported seriously low levels of mental health and personal well-being when compared with the general population. The findings revealed that this group of family carers were at high risk of social and economic disadvantage and at high risk of mental health challenges. Social policy makers and service providers should take these factors into account, both in the interests of promoting the health and well-being of the carers and considering the long-term needs of family members with disability who rely on family carers for daily support when designing services.

Folate fortification : a case study of public health policy-making

This thesis investigates the use of scientific evidence in the process of making public health policy. A case study located within a food regulation setting is used. The aim is to test theory against this case study. The outcome is a theoretical understanding of the use of scientific evidence in the policy-making process in a food regulation setting. Food regulation can influence food composition and food labelling and thereby affect the population's dietary intake. Frequently there are contested values, beliefs, ideologies and interests among stakeholders regarding the use of food regulation as a policy instrument to effect public health outcomes. The protection of public health and safety, taking into account evidence based practice, is generally employed by food regulators as the priority objective during the policy-making process to adjudicate among the competing expectations of stakeholders. However, this policy objective has not been clearly defined and is vulnerable to interpretation and application. The process by which folate fortification policy was made in Australia, in response to epidemiological evidence of a relationship between folate intake during the periconceptional period and reduced risk of neural tube defects, was analysed as a case study of the policy-making process. The folate fortification policy created a precedent for both food fortification and subsequently health claims policy in Australia. A social constructivist method was used to analyse the case study. The method involved deconstructing the food regulatory system into three levels; decision-making process; procedural; and political environment. Data aligned with each level of analysis was collected from 22 key informant interviews, documentary sources, field notes and surveys of both a random sample of the Australian population's knowledge of folate and use of folic acid-containing supplements (n = 5422), and the implementation of folate fortified food products into stores (n = 60). The insights that emerged from each of the three levels of analysis were assessed iteratively to identify a pattern of interrelationships associated with the policy-making process within the food regulatory system. The identified pattern was interpreted against existing theory to gain a theoretical understanding of the public health policy-making process in this political setting. The central argument of this thesis extends Sabatier and Jenkins-Smith's Advocacy Coalition Framework theory to a food regulation setting. The argument is that within the contemporary political climates of neoliberalism and globalisation, a coalition between corporate interests and the values of scientists with a positivist-reductionist approach to public health research is privileged so as to invoke certain scientific evidence to, in turn, legitimise food regulation policy decisions. The theory will help to inform policy-makers about how and why the public health policy objective in a food regulation setting is interpreted and applied. This will contribute to improving policy practice intended to effect public health outcomes. It is concluded that irrespective of the quantity and quality of the scientific evidence that is being made available, scientific evidence cannot be assumed to speak for itself Policy-making is an inherently political and value-laden process and the potential for politically motivated interpretation and application of otherwise value-neutral scientific evidence can undermine the investment in its generation. From this perspective, evidence based practice, far from liberating policy-making from political influence, can itself become part of the problem rather than the solution. Nevertheless, rational evidence based practice is an ideal to strive for and a series of recommendations is proposed to help make the use of evidence in current food regulation policy processes more transparent and democratic.