In 2000, Jordan signed the Agreement on Trade-related Aspects of Intellectual Property Rights (the TRIPS Agreement) and a free trade agreement with the US (USJFTA). Both commitments have required Jordan to comply with various obligations, including full compliance with the minimum standards for the protection of intellectual property rights (IPRs) under the TRIPS Agreement and TRIPS-Plus IP standards set out under the terms of the USJFTA. Enticed by views that strong IP protection would create prosperity in the Kingdom by promoting technological innovation and inducing transfer and dissemination of technology to Jordanians, Jordan implemented the provisions of TRIPS and the USJFTA to the letter. However, Jordan focused little attention on important “TRIPS flexibilities”. In particular, Jordan has qualified parallel importation and limited the grounds of compulsory licenses. In addition, Jordan provides pharmaceutical testing data with data exclusivity. This thesis focuses on the Jordanian experience in the pharmaceutical sector. It argues that strong patent protection has not been conducive to the promotion of technological innovation and the transfer and dissemination of technology. Moreover, this protection has resulted in adverse outcomes such as increased drug prices, unavailability of essential medicines in some public hospitals for serious diseases, and a dwindling local pharmaceutical industry, in part, as a consequence of its inability to access advanced, patented technology on reasonable commercial terms. The thesis also investigates the legitimacy of establishing certain grounds of compulsory licensing by Jordan, even in light of the TRIPS-Plus obligations under the USJFTA. It advocates that such grounds contribute to the promotion of technical innovation, lead to the transfer of advanced technology, and above all improve access to affordable medicines. Finally, the thesis explores Jordan’s obligations to protect pharmaceutical testing data under TRIPS and USFTA arguing that neither of these two instruments requires data exclusivity as claimed by Pharmaceutical Research and Manufacturers of America (PhRMA) and some developed countries.

This thesis comprises an exploration of the practice of Holistic Massage, working across the sociological areas of complementary and alternative medicines (CAM), body work, emotional labour, sociological phenomenology and narrative inquiry. Holistic Massage is one of a plethora of practices encompassed by the field of CAM. While there has been steadily increasing sociological interest in CAM in recent years, much research has treated this diverse group as relatively homogeneous. This thesis looks at one practice in depth, in order to address issues specific to Holistic Massage – including what ‘holism’ adds up in to in practice, and the devaluation of knowledge based on touch(ing) – as well as those concerning CAM more broadly. Hence, whilst drawing on existing research on CAM, this research also addresses a lacuna within it. This thesis employs the conceptual tool of ‘touching work’, which brings together the concepts of ‘emotional labour’ and ‘body work’ in a way that draws out relevant aspects of each around the fulcrum of touch, thus accounting for the latter in both its sensory and emotional meanings. In so doing, it also contributes to the recently burgeoning literature on the senses in sociology, and to an embodied sociology more generally. The thesis also draws on sociological phenomenology, in particular the notion of the intersubjective ‘stock of knowledge’, and the understanding of talk as constitutive of the everyday social world. The overall methodological approach taken brings together phenomenological theory with narrative inquiry, and specifically with the analysis of the form and content of talk. The analysis presented is based around data from loosely-structured interviews with ten women who do Holistic Massage. The interviews were analysed in terms of their overall shape and distinctive features (Chapter Three) and, in subsequent chapters, with respect to both what was said and how it was said. This analysis examines the constitution of a Holistic Massage stock of knowledge (Chapter Four) and how the practice is bounded (Chapter Five), and concludes in Chapter Six by taking a step back from the detail of the data to look at what can be known from it about Holistic Massage and touching work Piecing together the constitution by practitioners of a stock of professional Holistic Massage knowledge makes a significant contribution to the sociology of CAM. Also, by uniting phenomenological sociology and narrative inquiry, it provides a novel perspective on a form of work which is part of a small but significant contemporary occupational field in the UK. In particular, it draws out the multiple aspects of touch which can in fact be known and articulated through talk and challenges ideas about the supposedly ineffable character of touch. In this regard, it points to similarities between how practitioners talk about this and the Foucauldian challenge to the ‘repressive hypothesis’, which sees people as in fact talking readily and in detail about matters where they claim silence prevails.

This work develops a means to encourage states to take advantage of the flexibilities of compulsory licensing in the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) which promotes access to medicines in a public health emergency. In pursuing this solution, the precautionary approach (PA) and the structure of risk analysis have been adopted as a means to build a workable reading of TRIPS and to help states embody the flexibilities of intellectual property (IP). This work argues for a PA reading of TRIPS and that states have the precautionary entitlements to determine an appropriate level of health protection from the perspective of “State responsibility” in international law. A philosophical review is conducted followed by the examination of existing international legal instruments including the WTO Agreement on the Application of Sanitary and Phytosanitary Measures, the WHO International Health Regulations, the Codex Alimentarius, and the Cartagena Protocol on Biosafety. The PA has been found to have a pervasive influence on risk regulation in international law, yet the application is fraught with fragmentations in different legal regimes. In order to reach a harmonious interpretation and application of the PA in the WTO, the legal status of PAs of different WTO instruments have been analysed. Further, a comparative study on PAs in terms of legal status in the exemptions of the WTO and TRIPS obligations has been proposed. The political and moral basis for compulsory licencing in a public health emergency has been bolstered through the interpretation and the creation of legal status of the PA in WTO/TRIPS law.

The purpose of this research was to understand an indigenous perspective on the development and commercialization of non-timber forest products, such as medicines and foods, in Pikangikum First Nation, Northwestern Ontario, Canada. Framed by a research agreement between Pikangikum First Nation and the University of Manitoba, this collaborative research was based on participant observation, field trips, semi-structured interviews, and community workshops. The appropriate development and commercialization of Anishinaabe mushkeekeeh (medicine) and meecheem (food) requires the guidance of community Elders, Anishinaabe knowledge, and traditional teachings. The community is cautiously interested in developing collaborative, diligent, and culturally respectful partnerships that interface knowledge systems. Benefit sharing means the joint ownership of intellectual property and financial benefits, developing employment and capacity-building opportunities for community members, and planning products for community use. This thesis offers a community perspective on how NTFPs might be researched, developed and commercialized in joint and mutually beneficial partnerships with a First Nation.

This research involved a rigorous implementation of the conceptual framework of Australia's National Strategy for Quality Use of Medicines through a planned sequence of studies across a large defined geographical region to test the hypothesis that: The National Strategy for Quality Use of Medicines can be used to design, implement and evaluate a research program to achieve sustained improvement in health care in a regional setting.

Improving the quality use of medicines (QUM) among seniors, particularly those using multiple medicines, is a national priority. The National Prescribing Service??s Seniors QUM Program was developed in collaboration with consumers to address seniors?? medicines information needs. Seniors are trained as peer educators to convey QUM messages to other seniors in a single group session. However, there is a dearth of research assessing peer education for seniors about medicines, and little understanding of what peer educators do in practice. This research investigated how peer educators empower seniors toward the quality use of their medicines. A participatory action research inquiry was undertaken nationally with organisational leaders and locally with peer educators. The design was a nested case study with multiple sites, where the Seniors Program was the overarching case containing eight disparate local sites. The participatory inquiry engaged peer educators from each local site. Qualitative data were collected through participant observation and interviews. Data were analysed using grounded theory methods and findings were triangulated with other data sources. Peer educators demonstrated five main functions in the program ?? one primary function within QUM sessions and four support functions outside of sessions. The primary function of facilitating peer learning comprised 10 elements. A model depicts these elements in the context of varying session conditions and consequences. Educators?? lived experience as seniors and lay persons was an overarching contributor to peer learning, used strategically through storytelling to assist other elements. Sharing QUM outside of sessions occurred frequently, but requires development to reach isolated seniors. Peer educators exceeded expectations in getting QUM messages to seniors, applying unique skills to the information exchange within sessions. Their status as lay persons tackling the complex topic of QUM reflected an understanding of the disempowerment seniors may feel when seeking information about medicines. Peer educators?? ability to model an active partner role by applying their lived experience through storytelling in an interactive, mutually sharing session challenged seniors to rethink their medicines management and interactions with health professionals. As the population ages and medicines use increases, understanding and using seniors effectively as educators has great potential.

Αποτελεί αδιαμφισβήτητο γεγονός ότι τις τελευταίες δεκαετίες η βιομηχανία γενόσημων φαρμάκων σημειώνει παγκοσμίως σημαντική πρόοδο και ανάπτυξη. Η εκτεταμένη διείσδυση των γενόσημων φαρμάκων στο χώρο της υγείας δεν είναι καθόλου τυχαία και οφείλεται κατά κύριο λόγο στην οικονομική και αξιόπιστη θεραπευτική λύση που προσφέρουν. Με άλλα λόγια το πλεονέκτημά τους είναι ότι επιφέρουν ισότιμο θεραπευτικό αποτέλεσμα, όπως και τα πρωτότυπα φάρμακα, σε συνδυασμό με τον περιορισμό των φαρμακευτικών δαπανών. Η ιδιαιτερότητά τους αυτή καθορίζεται και εξασφαλίζεται μέσω του ελέγχου της βιοϊσοδυναμίας τους και της χρονικής λήξης των διπλωμάτων ευρεσιτεχνίας των πρωτότυπων φαρμάκων. Από τα παραπάνω λοιπόν, σε συνδυασμό με τη δυσμενή παγκόσμια οικονομική κατάσταση και με τα διογκωμένα οικονομικά προβλήματα που ταλανίζουν το ελληνικό σύστημα υγείας και τους εθνικούς ασφαλιστικούς οργανισμούς, καταδεικνύεται η ανάγκη ευρείας αποδοχής των συγκεκριμένων φαρμάκων από το σύνολο της ελληνικής ιατρικής κοινότητας. Για το σκοπό αυτό η συγκεκριμένη διπλωματική εργασία επιδιώκει να διερευνήσει σε βάθος τις πεποιθήσεις, τα κίνητρα και τις συνταγογραφικές συνήθειες των Ελλήνων ιατρών όσον αφορά τα γενόσημα φάρμακα, τα οποία υπόσχονται τον άμεσο περιορισμό των φαρμακευτικών δαπανών χωρίς την υποβάθμιση της ωφέλειας και της ποιότητας ζωής των ασθενών. Τα ευρήματα που προέκυψαν από την έρευνα που διεξήχθη αποκλειστικά στο Νόμο Αχαΐας είναι σημαντικά και αναλύονται διεξοδικά παρακάτω. Παρολ’ αυτά σε γενικές γραμμές αξίζει να αναφερθεί: α) το υψηλό ποσοστό απόκρισης 75,7% στη συμπλήρωση του ερωτηματολογίου, β) το υψηλό ποσοστό μετεκπαίδευσης των ιατρών που ανέρχεται στο 41.6%, γ) η εξοικείωση των ιατρών με τις νέες τεχνολογίες και το διαδίκτυο που φτάνει το 55.7%, δ) ότι το σύνολο των ιατρών συνταγογραφεί γενόσημα φάρμακα ανεξαρτήτως εάν έχουν θετική γνώμη για αυτά ή όχι, ε) ότι το πρωταρχικό και βασικότερο κριτήριο συνταγογράφησης είναι η αποτελεσματικότητα του φαρμάκου, ενώ και τα οικονομικά κίνητρα συμβάλλουν σε πολύ μεγάλο βαθμό προς την κατεύθυνση αυτή, στ) ότι η απουσία κλινικών δοκιμών των γενόσημων φαρμάκων αποτελεί το σημαντικότερο παράγοντα υστέρησης συγκριτικά με τα πρωτότυπα φάρμακα, ζ) ότι υπάρχουν δευτερογενείς παράγοντες που μπορούν να συμβάλλουν στην αυξημένη συνταγογράφηση των γενόσημων φαρμάκων π.χ. κύρος-όνομα εταιρείας, η επιστημονική ενημέρωση κ.ά., η) ότι οι συνταγογραφικές συνήθειες των ιατρών επηρεάζονται σε μικρό βαθμό από τους ιατρικούς επισκέπτες και σε μεγάλο βαθμό από το όνομα και το κύρος της φαρμακευτικής εταιρείας και θ) ότι δεν εισακούγονται σε μεγάλο ποσοστό 58.5% οι ανάγκες και οι προβληματισμοί των ιατρών από τα φαρμακευτικά στελέχη. Η παρούσα εργασία με τις συγκεκριμένες εστιάσεις προσπαθεί να αποκρυπτογραφήσει τη στάση και τους πιθανούς προβληματισμούς των ελλήνων ιατρών σχετικά με τα γενόσημα φάρμακα και να προσδιορίσει τη συνταγογραφική συμπεριφορά αυτών. Απώτερος σκοπός του παραπάνω εγχειρήματος είναι να βοηθήσει από τη μεριά του στην ανάπτυξη και στη χάραξη πολιτικών και κατευθύνσεων που να είναι σε θέση να βελτιώσουν την οικονομική και κλινική εικόνα του πολύπαθου χώρου της ελληνικής δημόσιας υγείας. / Is it an undeniable fact that in the last decades the manufacture of generic medicinal products marks globally significant progress and development. The vast permeation of generic medicinal products in the health industry is not random at all and is mainly due to the economical and reliable therapeutic solution they offer. In other words, their advantage lies in the fact that they bring equivalent therapeutic results to the reference medicinal products, combined with a reduction of medicinal expenses. This specificity of theirs is determined and secured through the control of their bioequivalence and the expiration time of the letters patent of the reference medicinal products. From all the above and taking into consideration the unfavorable global economic situation and the inflated economic problems which deplore the greek health system and the national insurance organizations, rises the need for a vast acceptance of these particular medicinal products from the greek medical community in its entirety. For this reason, this particular thesis attempts to explore in depth the greek physicians’ beliefs, motives and prescription-writing practices as far as generic medicinal products are concerned – which promise the immediate reduction of medicinal expenses without downgrading the patients’ benefits and quality of living. The findings that emerged from the research which was carried out exclusively within the prefecture of Achaia are significant and are analysed in depth further below. Nevertheless, in general, it is worth mentioning: a) the high rate of responding (75.7%) to the completion of the questionnaire, b) the high rate of doctors’ further education/training which reaches 41.6% c) the doctors’ familiarization with new technologies and the internet which comes to 55.7%, d) the fact that the doctors as a body are prescribing generic medicinal products regardless of their positive or negative views on them, e) that the prime and most fundamental criterion in prescription-writing is the effectiveness of the drug, while economic motives contribute greatly towards this direction, f) that the absence of clinical tests on generic medicinal products is the most significant factor of their lacking in comparison to reference medicinal products, g) that there are secondary factors which can contribute to the increase in prescription of generic medicinal products such as the prestige/brand name of a company, scientific documentation, etc. h) that the physicians’ prescription habits are minorly affected from pharmaceutical representatives and majorly from the brand name and prestige of the pharmaceutical company and i) that in a high rate of 58.5% physicians’ needs and problems are not heard from pharmaceutical executives. This thesis with its particular focuses, attempts to decode greek physicians’ views and possible problems as far as general medicinal products are concerned and to define their attitude towards prescription. A further goal of this attempt is to help the development and tracing of political directions which can be able to improve the economic and clinical image of the much afflicted greek national health system.

Ο προσδιορισμός του προφίλ των καταναλωτών ομοιοπαθητικών φαρμάκων και φυτικών καλλυντικών. Να προσδιορίσουμε ειδικότερα τα δημογραφικά και ψυχογραφικά χαρακτηριστικά τους, όπως το φύλο τους, την ηλικία τους, την οικογενειακή τους κατάσταση, το επάγγελμά τους, την αγοραστική τους συμπεριφορά, την κουλτούρα τους, την προσωπικότητά τους, να εντοπίσουμε τις ομάδες αναφοράς τους και να διαπιστώσουμε ποιοος ο βαθμός ικανοποιήσής τους από τη χρήση αυτών των προϊόντων. / The determination of the profile of consumers of homeopathic medicines and herbal cosmetics.More particularly to identify demographic and psychographic characteristics such as gender,age, marital status, profession, their purchasing behavior, their culture, their personality, to identify the reference groups and to ascertain what is the degree of satisfaction with the use of these products.

Given the complexity of medicines use in elderly patients, structures and processes of medicines management are key to deriving best outcomes. This research was conducted in hospitals in the United Arab Emirates (UAE) and focused on the patient journey from admission to discharge. The overall aim was to explore the structures and processes of medicines management in elderly hospitalised patients in the UAE, conducted in three phases. Phase 1. Following a review of systematic reviews of aspects of medicines management (e.g. reconciliation), this phase focused on a specific, emerging tool (the Drug Burden Index (DBI)) relating to anticholinergic/sedative agents, which are problematic in the elderly. The aim was to critically appraise, synthesize and present evidence of DBI use. The review protocol was registered with the Joanna Briggs Institute and conducted according to best accepted practice. The key finding was the lack of evidence of DBI use prospectively to identify potentially inappropriate prescribing. Phase 2. Phase 2 employed a qualitative phenomenological design to explore health professionals’ views and experiences of medicines management. Semi-structured interviews were conducted with 27 professionals and analysed using Normalization Process Theory (NPT) and the Theoretical Domains Framework (TDF). Findings revealed little evidence of coherence, cognitive participation, collective action and reflexive monitoring (NPT). TDF domains dominant were: professional role, identity; beliefs about capabilities; beliefs about consequences; environmental context, resources; and knowledge. Phase 3. The Delphi technique in phase 3 aimed to determine consensus around medicines management using an expert panel of policy makers, educators and lead health professionals. Phase 1 and 2 findings were used in construction of validated statements. A high level of consensus (≥70% strongly agree/agree) was obtained for statements other than those for targeting medicines management (rather than all elderly admissions) and tasks linked to professions (rather than trained staff). Overall, this research has generated original findings focused on the entire inpatient hospital journey, particularly the need to more clearly define, refine and agree on healthcare structures and processes across the entire patient journey from admission to discharge. The use of the NPT and TDF has highlighted those individual practitioners and organisational issues which require consideration.

The World Health Organization estimates that about 10-30% of pharmaceuticals in the world are either substandard or counterfeit. The number is even higher in the developing countries. From a public health perspective, a key contributor to the development and proliferation drug resistant strains of infections, including tuberculosis (TB), malaria and other infections that are leading killers in resource limited settings is poor quality medicines. Most of the main causes are profit driven corruption in many pharmaceutical companies, the poor manufacture and quality control, and/or the inappropriate storage conditions. Poor quality drugs lead to loss of life, create morbidity, strain the financial structure of the health system and lead to long-term drug resistance that affects us all. The current technology for screening poor quality drugs can be divided into 2 categories: the high end, precise and high cost technologies (such as High Performance Liquid Chromatography) and lower cost and qualitative technologies (such as Thin-Layered Chromatography). The high-end methods can give a precise measurement of active pharmaceutical ingredient (API) concentration and the presence of impurities in the tablets, but require trained personnel, advanced machine and lab set up, not suitable for field testing where most of poor quality pharmaceuticals have been found. The lower cost techniques require little training and simple equipment to operate at a relatively inexpensive price, but only gives qualitative results. In addition, most of current methods do not look at the dissolution profile of the tablets simultaneously with the concentration of API. Therefore, we propose to develop an assay that can quantify the concentrations of multiple APIs simultaneously and measure dissolution rates. In order to address current gaps in knowledge, my research proposal has three main parts in the assay development: 1) Development of an fluorescent/luminescent assay for detection of counterfeit/substandard antimalarial using small-molecules-based methods and field testing in Ghana; 2) Development of a fluorescent assay for detection of water-soluble pharmaceuticals using SELEX; and 3) Design a detection platform using microfluidic chips for real time quantification of multiple active pharmaceutical ingredients. For proof-of-concept, an antimalarial drug (artesunate and amodiaquine) and antibacterial antibiotics (sulfamethoxazole and trimethoprim) are selected to demonstrate the probe development and test the chip performance. Overall, the assay will be rapid, robust, portable, inexpensive, multiplexed, quantitative, specific, and sensitive. At a big picture level, emphasizing drug quality and creating robust mechanisms of drug testing will improve health outcomes and enhance treatment efficacy in resource limited settings.