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.

Human error risk management methodology for rail crack incidents

The paper presents an innovative approach to modelling the causal relationships of human errors in rail crack incidents (RCI) from a managerial perspective. A Bayesian belief network is developed to model RCI by considering the human errors of designers, manufactures, operators and maintainers (DMOM) and the causal relationships involved. A set of dependent variables whose combinations express the relevant functions performed by each DMOM participant is used to model the causal relationships. A total of 14 RCI on Hong Kong’s mass transit railway (MTR) from 2008 to 2011 are used to illustrate the application of the model. Bayesian inference is used to conduct an importance analysis to assess the impact of the participants’ errors. Sensitivity analysis is then employed to gauge the effect the increased probability of occurrence of human errors on RCI. Finally, strategies for human error identification and mitigation of RCI are proposed. The identification of ability of maintainer in the case study as the most important factor influencing the probability of RCI implies the priority need to strengthen the maintenance management of the MTR system and that improving the inspection ability of the maintainer is likely to be an effective strategy for RCI risk mitigation.

Preoperative visual acuity of cataract patients. Repeatability of visual acuity and refractive error measurements in clinical settings

Visual acuities at the time of referral and on the day before surgery were compared in 124 patients operated on for cataract in Vaasa Central Hospital, Finland. Preoperative visual acuity and the occurrence of ocular and general disease were compared in samples of consecutive cataract extractions performed in 1982, 1985, 1990, 1995 and 2000 in two hospitals in the Vaasa region in Finland. The repeatability and standard deviation of random measurement error in visual acuity and refractive error determination in a clinical environment in cataractous, pseudophakic and healthy eyes were estimated by re-examining visual acuity and refractive error of patients referred to cataract surgery or consultation by ophthalmic professionals. Altogether 99 eyes of 99 persons (41 cataractous, 36 pseudophakic and 22 healthy eyes) with a visual acuity range of Snellen 0.3 to 1.3 (0.52 to -0.11 logMAR) were examined. During an average waiting time of 13 months, visual acuity in the study eye decreased from 0.68 logMAR to 0.96 logMAR (from 0.2 to 0.1 in Snellen decimal values). The average decrease in vision was 0.27 logMAR per year. In the fastest quartile, visual acuity change per year was 0.75 logMAR, and in the second fastest 0.29 logMAR, the third and fourth quartiles were virtually unaffected. From 1982 to 2000, the incidence of cataract surgery increased from 1.0 to 7.2 operations per 1000 inhabitants per year in the Vaasa region. The average preoperative visual acuity in the operated eye increased by 0.85 logMAR (in decimal values from 0.03to 0.2) and in the better eye 0.27 logMAR (in decimal values from 0.23 to 0.43) over this period. The proportion of patients profoundly visually handicapped (VA in the better eye <0.1) before the operation fell from 15% to 4%, and that of patients less profoundly visually handicapped (VA in the better eye 0.1 to <0.3) from 47% to 15%. The repeatability visual acuity measurement estimated as a coefficient of repeatability for all 99 eyes was ±0.18 logMAR, and the standard deviation of measurement error was 0.06 logMAR. Eyes with the lowest visual acuity (0.3-0.45) had the largest variability, the coefficient of repeatability values being ±0.24 logMAR and eyes with a visual acuity of 0.7 or better had the smallest, ±0.12 logMAR. The repeatability of refractive error measurement was studied in the same patient material as the repeatability of visual acuity. Differences between measurements 1 and 2 were calculated as three-dimensional vector values and spherical equivalents and expressed by coefficients of repeatability. Coefficients of repeatability for all eyes for vertical, torsional and horisontal vectors were ±0.74D, ±0.34D and ±0.93D, respectively, and for spherical equivalent for all eyes ±0.74D. Eyes with lower visual acuity (0.3-0.45) had larger variability in vector and spherical equivalent values (±1.14), but the difference between visual acuity groups was not statistically significant. The difference in the mean defocus equivalent between measurements 1 and 2 was, however, significantly greater in the lower visual acuity group. If a change of ±0.5D (measured in defocus equivalents) is accepted as a basis for change of spectacles for eyes with good vision, the basis for eyes in the visual acuity range of 0.3 - 0.65 would be ±1D. Differences in repeated visual acuity measurements are partly explained by errors in refractive error measurements.

False Error Study of On-line Soft Error Detection Mechanisms

With technology scaling, vulnerability to soft errors in random logic is increasing. There is a need for on-line error detection and protection for logic gates even at sea level. The error checker is the key element for an on-line detection mechanism. We compare three different checkers for error detection from the point of view of area, power and false error detection rates. We find that the double sampling checker (used in Razor), is the simplest and most area and power efficient, but suffers from very high false detection rates of 1.15 times the actual error rates. We also find that the alternate approaches of triple sampling and integrate and sample method (I&S) can be designed to have zero false detection rates, but at an increased area, power and implementation complexity. The triple sampling method has about 1.74 times the area and twice the power as compared to the Double Sampling method and also needs a complex clock generation scheme. The I&S method needs about 16% more power with 0.58 times the area as double sampling, but comes with more stringent implementation constraints as it requires detection of small voltage swings.

'Someone to welcome you home' : Infertility, medicines and the Sukuma-Nyamwezi

This study Someone to Welcome you home: Infertility, medicines and the Sukuma-Nyamwezi , looks into the change in the cosmological ideology of the Sukuma-Nyamwezi of Tanzania and into the consequences of this change as expressed through cultural practices connected to female infertility. This analysis is based on 15 months of fieldwork in Isaka, in the Shinyanga area. In this area the birth rate is high and at the same time infertility is a problem for individual women. The attitudes connected to fertility and the attempts to control fertility provide a window onto social and cultural changes in the area. Even though the practices connected to fertility seem to be individualized the problem of individual women - the discourse surrounding fertility is concerned with higher cosmological levels. The traditional cosmology emphasized the centrality of the chief as the source of well-being. He was responsible for rain and the fertility of the land and, thus, for the well-being of the whole society. The holistic cosmology was hierarchical and the ritual practices connected to chiefship which dealt with the whole of the society were recursively applied at the lower levels of hierarchy, in the relationships between individuals. As on consequence of changes in the political system, the chiefship was legally abolished in the early years of Independence. However, the holistic ideology, which was the basis of the chiefship, did not disappear and instead acquired new forms. It is argued that in African societies the common efflorence of diviner-healers and witchcraft can be a consequence of the change in the relationship between the social reality and the cosmological ideology. In the Africanist research the increase in the numbers of diviner-healers and witchcraft is usually seen as a consequence of individualism and modernization. In this research, however, it is seen as an altered form of holism, as a consequence of which the hierarchical relations between women and men have changed. Because of this, the present-day practices connected to reproduction pay special attention to the control of women s sexuality.

Improved switching frequency variation control of hysteresis controlled voltage source inverter-fed IM drives using current error space vector

A constant switching frequency current error space vector-based hysteresis controller for two-level voltage source inverter-fed induction motor (IM) drives is proposed in this study. The proposed controller is capable of driving the IM in the entire speed range extending to the six-step mode. The proposed controller uses the parabolic boundary, reported earlier, for vector selection in a sector, but uses simple, fast and self-adaptive sector identification logic for sector change detection in the entire modulation range. This new scheme detects the sector change using the change in direction of current error along the axes jA, jB and jC. Most of the previous schemes use an outer boundary for sector change detection. So the current error goes outside the boundary six times during sector change, in one cycle,, introducing additional fifth and seventh harmonic components in phase current. This may cause sixth harmonic torque pulsations in the motor and spread in the harmonic spectrum of phase voltage. The proposed new scheme detects the sector change fast and accurately eliminating the chance of introducing additional fifth and seventh harmonic components in phase current and provides harmonic spectrum of phase voltage, which exactly matches with that of constant switching frequency voltage-controlled space vector pulse width modulation (VC-SVPWM)-based two-level inverter-fed drives.

Error Checking Digit for Nonconventional Chemical Codes

In handling large volumes of data such as chemical notations, serial numbers for books, etc., it is always advisable to provide checking methods which would indicate the presence of errors. The entire new discipline of coding theory is devoted to the study of the construction of codes which provide such error-detecting and correcting means.l Although these codes are very powerful, they are highly sophisticated from the point of view of practical implementation

Wavelet transform based error concealment approach for image denoising

Denoising of images in compressed wavelet domain has potential application in transmission technology such as mobile communication. In this paper, we present a new image denoising scheme based on restoration of bit-planes of wavelet coefficients in compressed domain. It exploits the fundamental property of wavelet transform - its ability to analyze the image at different resolution levels and the edge information associated with each band. The proposed scheme relies on the fact that noise commonly manifests itself as a fine-grained structure in image and wavelet transform allows the restoration strategy to adapt itself according to directional features of edges. The proposed approach shows promising results when compared with conventional unrestored scheme, in context of error reduction and has capability to adapt to situations where noise level in the image varies. The applicability of the proposed approach has implications in restoration of images due to noisy channels. This scheme, in addition, to being very flexible, tries to retain all the features, including edges of the image. The proposed scheme is computationally efficient.

Switching frequency variation control in hysteresis PWM controller for IM drives using variable parabolic bands for current error space phasor

Variation of switching frequency over the entire operating speed range of an induction motor (M drive is the major problem associated with conventional two-level three-phase hysteresis controller as well as the space phasor based PWM hysteresis controller. This paper describes a simple hysteresis current controller for controlling the switching frequency variation in the two-level PWM inverter fed IM drives for various operating speeds. A novel concept of continuously variable hysteresis boundary of current error space phasor with the varying speed of the IM drive is proposed in the present work. The variable parabolic boundary for the current error space phasor is suggested for the first time in this paper for getting the switching frequency pattern with the hysteresis controller, similar to that of the constant switching frequency voltage-controlled space vector PWM (VC-SVPWM) based inverter fed IM drive. A generalized algorithm is also developed to determine parabolic boundary for controlling the switching frequency variation, for any IM load. Only the adjacent inverter voltage vectors forming a triangular sector, in which tip of the machine voltage vector ties, are switched to keep current error space vector within the parabolic boundary. The controller uses a self-adaptive sector identification logic, which provides smooth transition between the sectors and is capable of taldng the inverter up to six-step mode of operation, if demanded by drive system. The proposed scheme is simulated and experimentally verified on a 3.7 kW IM drive.

Generation of parabolic trajectories for current error space phasor similar to an SVPWM controller for control of switching frequency variation in current hysteresis PWM controlled IM drives

Switching frequency variation over a fundamental period is a major problem associated with hysteresis controller based VSI fed IM drives. This paper describes a novel concept of generating parabolic trajectories for current error space phasor for controlling the switching frequency variation in the hysteresis controller based two-level inverter fed IM drives. A generalized algorithm is developed to determine unique set of parabolic trajectories for different speeds of operation for any given IM load. Proposed hysteresis controller provides the switching frequency spectrum of inverter output voltage, similar to that of the constant switching frequency VC-SVPWM based IM drive. The scheme is extensively simulated and experimentally verified on a 3.7 kW IM drive for steady state and transient performance.

Bootstrapping the Error Correction Model Cointegration Test

This paper is concerned with using the bootstrap to obtain improved critical values for the error correction model (ECM) cointegration test in dynamic models. In the paper we investigate the effects of dynamic specification on the size and power of the ECM cointegration test with bootstrap critical values. The results from a Monte Carlo study show that the size of the bootstrap ECM cointegration test is close to the nominal significance level. We find that overspecification of the lag length results in a loss of power. Underspecification of the lag length results in size distortion. The performance of the bootstrap ECM cointegration test deteriorates if the correct lag length is not used in the ECM. The bootstrap ECM cointegration test is therefore not robust to model misspecification.

Wavelet transform based error concealment approach for image denoising

Denoising of images in compressed wavelet domain has potential application in transmission technology such as mobile communication. In this paper, we present a new image denoising scheme based on restoration of bit-planes of wavelet coefficients in compressed domain. It exploits the fundamental property of wavelet transform - its ability to analyze the image at different resolution levels and the edge information associated with each band. The proposed scheme relies on the fact that noise commonly manifests itself as a fine-grained structure in image and wavelet transform allows the restoration strategy to adapt itself according to directional features of edges. The proposed approach shows promising results when compared with conventional unrestored scheme, in context of error reduction and has capability to adapt to situations where noise level in the image varies. The applicability of the proposed approach has implications in restoration of images due to noisy channels. This scheme, in addition, to being very flexible, tries to retain all the features, including edges of the image. The proposed scheme is computationally efficient.

On-board correction of systematic error of Earth sensors

Infrared Earth sensors are used in spacecraft for attitude sensing. Their accuracy is limited by systematic and random errors. Dominant sources of systematic errors are analyzed for a typical scanning infrared Earth sensor used in a remote-sensing satellite in a 900-km sun-synchronous orbit. The errors considered arise from 1) seasonable variation of infrared radiation, 2) oblate shape of the Earth, 3) ambient temperature of sensors, 4) changes in spin/scan period, and 5) misalignment of the axis of the sensors. Simple relations are derived using least-squares curve fitting for onboard correction of these errors. With these, it is possible to improve the accuracy of attitude determination by eight fold and achieve performance comparable to ground-based post-facto attitude computation.

Quantum Error Correction via Codes over GF(2)

It is well known that n-length stabilizer quantum error correcting codes (QECCs) can be obtained via n-length classical error correction codes (CECCs) over GF(4), that are additive and self-orthogonal with respect to the trace Hermitian inner product. But, most of the CECCs have been studied with respect to the Euclidean inner product. In this paper, it is shown that n-length stabilizer QECCs can be constructed via 371 length linear CECCs over GF(2) that are self-orthogonal with respect to the Euclidean inner product. This facilitates usage of the widely studied self-orthogonal CECCs to construct stabilizer QECCs. Moreover, classical, binary, self-orthogonal cyclic codes have been used to obtain stabilizer QECCs with guaranteed quantum error correcting capability. This is facilitated by the fact that (i) self-orthogonal, binary cyclic codes are easily identified using transform approach and (ii) for such codes lower bounds on the minimum Hamming distance are known. Several explicit codes are constructed including two pure MDS QECCs.

New a posteriori error estimator and adaptive mesh refinement strategy for 2-D crack problems

A posteriori error estimation and adaptive refinement technique for fracture analysis of 2-D/3-D crack problems is the state-of-the-art. The objective of the present paper is to propose a new a posteriori error estimator based on strain energy release rate (SERR) or stress intensity factor (SIF) at the crack tip region and to use this along with the stress based error estimator available in the literature for the region away from the crack tip. The proposed a posteriori error estimator is called the K-S error estimator. Further, an adaptive mesh refinement (h-) strategy which can be used with K-S error estimator has been proposed for fracture analysis of 2-D crack problems. The performance of the proposed a posteriori error estimator and the h-adaptive refinement strategy have been demonstrated by employing the 4-noded, 8-noded and 9-noded plane stress finite elements. The proposed error estimator together with the h-adaptive refinement strategy will facilitate automation of fracture analysis process to provide reliable solutions.