A2K

 

Rough context notes for May 16th talk at conference about access to medicine in Europe

bit.ly/17uCalc

1. Affordability: High price of medicines for states and for individuals. Can we afford allowing millions of people to be sick and for many of them to die. Is it ethical that millions of persons, citizens or not, are denied treatments when the marginal costs of the medicines is minimal?

2. Health Conditionality of rescue operations: Why can´t part of rescue operations of banks or sovereign debt be set aside for keeping people alive or healthy in public health systems?

3. Transparency: Know what prices paid in procurement of hospitals, states and regions. Efficacy and safety of new and existing medicines is not known because clinical trial data is not available. How can we spend our money right if we don´t even have doctors and patients access to the essential data about how and if the drugs work? Clinical trials regulation.

4. Public risk, public return: We need social conditionality of affordability of public investments in biomedical research. 70% Cancer research public money but many drugs cost up to 100 thousand euros a month. Taxpayers are risk capitalists but if medicine is successful does not only not revert into the public good, but we have to face unaffordable prices under patent monopoly. “Affordability and accessibility” but Council against in Horizon 2020.

5. Together we stand, divided we fall: pooled procurement, Why don´t countries get together to buy medicines together? If the EC it is against the rule, we should change the rules.

6. Justice. Inclusion: Inmigrants and other vulnerable groups. Cheap labour but no health care. Where are EU basic values.

7. Public knowledge goods: Billlions in H2020 and other publicly financed biomed research results should become publicly available and shared for development of creation generic products from the first day to save lives and public health systems.

8. Tricks, bribes and pay to delay. Me Toos (over 90% little new therapeutic value), evergreening (never off patent), pay to delay to prevent generics(documented by EC), paying doctors directly to prescribe brand name drugs…

9. “Industry Myths” – We need high prices to pay for R and D. Max 16% of profits spent on R and D according to Pharma. Much more spent on on marketing. Over 12% of medicines researched by industry at any level end up authorized.

10. “De-linkage” Disassociate R and D costs from the production and  final price of medicines. New Models: Innovation inducement prizes, PDPs, Patent pooling, prizes, equitable licensing, open source, open data,

Business as usual is not an option: Health first : Like in South Africa with HIV/Aids: Health emergency: Compulsory Licenses is also an option if other strategies fail. Health is more important than patent monopolies.

 

  Expert and policy-making conference

How can we provide access to affordable medicines in Greece?

The situation on the ground and possible solutions

European Parliament office (Amalias Avenue 8) in Athens, 31 May 2013

CONCEPT

Crisis and access to medicine in Greece: situation and responses

The current financial crisis and the conditions imposed on the Greek state has had a profound impact on the ability of the Greek public health systems to adequately provide many necessary biomedical products for its citizens.

This half-day conference in Athens organized by TACD with the support of MEP Nikos Chrysogelos (Greens/EFA, EL), Médecins Sans Frontières and Médecins du Monde (MdM Greece) aims at presenting information on the situation of Access to Medicines (henceforth A2M) in Greece today and to consider some possible responses to this problem. Issues to be dealt with would be the situation on the ground with regards to accessibility and affordability of life saving medicines. Also to be reported would be the degree of state payments or out of the pocket citizen expenditure under the strain of the public debt crisis.

Experts will present possible alternatives to the high price of medicines and will also consider new models of biomedical innovation that is at once affordable and health needs-driven. These proposals will also include new forms of pooled medical procurement, new licensing systems of medicines in order to promote generic access to key medicines and changes in EU policy to facilitate access to medicine in Greece.

Objectives

To focus European and Greek attention on the state of access to medicine inside Greece today and the health impact of the present financial crisis.

To influence and initiate major policy debates in the in Greece and the EU institutions on legal, financial and scientific measures that could be employed to guarantee the right to healthcare.

The Athens conference will be a follow-up to the EU wide conference entitled “Can EU Citizens Afford Their Medicines?” which took place at the European Parliament in Brussels on 16 May 2013.

Instruments

A manifesto by experts on the topic.  The preparation of a “Athens Declaration on Access to Medicine in Greece”. 

Speakers and experts

Public health experts, academics, generic industry, NGOs, economists and policy makers

 AGENDA

How can we provide access to affordable medicines in Greece?

The situation on the ground and possible solutions

09.00-09.15: Registration and coffee

09.15-09.30: Welcome and introductory remarks

Nikos Chrysogelos, MEP, Greens/EFA Group in the European Parliament

David Hammerstein, Senior advocate,  TransAtlantic Consumer Dialogue, Brussels

09.30-10.45: First panel discussion

The situation on the ground in Greece concerning access to life-saving medicines

Nicky Voudouri, Medical Department Coordinator, PRAKSIS NGO

Giorgos Kassaras, Special Advisor, Médecins du Monde (MdM Greece)

Despina Makridaki, President, Association of Pharmacists within state hospitals (PEFNI)

Ioannis Dagres, Treasurer, Athens Pharmacists’ Association

Oliver Moldenhauer, Coordinator Access Campaign, Médecins sans Frontières (MSF Germany)

Dr. Sotiris Vandoros, Lecturer in Economics, Brunel University London

Moderator: David Hammerstein, Senior Advocate, TransAtlantic Consumer Dialogue, Brussels

10.45-11.15: Q & A

11.15-11.30: Coffee break

11:30-13.00: Second panel discussion

Looking forward: action-oriented solutions to access to medicine crisis in Greece in the short, middle and long term

Lycurgus Liaropoulos, Professor, Health Economics and Health Care Management, University of Athens

Nikos Kefalas, Vice-President, Hellenic Association of Pharmaceutical Companies (SFEE), Managing-Director, Janssen-Cilag Pharmaceuticals

Fei Kosmopoulou, Managing-Director, Panhellenic Association of Pharmaceutical Industries (PEF)

James Love, Director, Knowledge Ecology International

Aurelie Vandeputte, Task Force for Greece

Representative of the Greek Ministry of Health

Els Torreele, Director Access to Medicines initiative, Open Society Foundation

Moderator: Tasos Telloglou, Reporter, Kathimerini newspaper & Neoi Fakeloi (SKAI TV)

13.00-13.45: Q & A

13.45-14.00: Closing remarks

14.00-14.30: Lunch

Interact in Twitter using #a2mGreece

 RSVP: Please confirm your attendance before May 30 by writing to a2m.athensconference@gmail.com

The conference will be webstreamed (http://www.ustream.tv/channel/transatlantic-consumer-dialogue-tacd) and translation will be provided.

 

 

 

 

 

 

Cita de David Hammerstein del Diálogo Transatlántico de Consumidores

“La Unión Europea parece estar más preocupada por la salud de los bancos que por la salud de la ciudadanía europea. Las radicales medidas de austeridad impuestas en distintos países de la UE ha significado que millones de personas no tienen acceso a tratamientos esenciales en los centros de sanidad pública.
Debido a unas políticas totalmente pro-industria de la UE existen unos precios inasequibles para muchos medicamentos y tenemos una crisis creciente de acceso a medicamentos dentro de la Unión Europea. En cambio, una política orientada hacia las necesidades de salud de la mayoría incluiría una estrecha coordinación entre países europeos en las compras públicas de medicamentos, unas reglas más flexibles de propiedad intelectual y medidas anti-monopolio para fomentar la competencia de productos genéricos y su importación, normas para la condicionalidad social para el uso de los resultados científicos financiados con fondos públicos y  una regulación estricta de la transparencia para poder evaluar la eficacia y seguridad reales de los productos farmacéuticos.  El modelo farmacéutico actual está dominado por unos gastos masivos en marketing, unos pobres resultados en innovación y unos precios muy altos mantenidos artificialmente. La crisis ha convertido la situación en insostenible.”

http://www.a2meurope.eu/index.php?id=home

Press statement quote for Conference “Can EU citizens afford their medicnes?” on May 16th, 2013 in European Parliament, Brussels

David Hammerstein TransAtlantic Consumer Dialogue:

“Today the EU seems to be much more concerned about the health of large banks than the health of its citizens. Radical austerity measures imposed on a number of EU member states means that millions of persons are being denied life-saving medical treatment by public health systems.  Because the EU´s one-sided pro big-pharma purely market oriented policies allow unaffordable high prices for many treatments, now we have a growing access to medicine problem inside Europe. A health needs oriented EU policy would include pooled procurement of key medicines, flexible IPR rules and anti-monopoly measures to promote generic competition and imports, social conditionality norms on the results of publicly financed biomedical research and stringent transparency regulations so we could evaluate the real efficacy and safety of existing medicines. We also need a “de-linkage” of R and D costs from the price of life-saving medicines. The present  EU pharmaceutical model is dominated by massive marketing costs, poor innovation outcomes and artificially maintained high prices. The crisis has made this situation unsustainable.”

On May 10, 2013, a very revealing freedom of information request was made available from the UK Intellectual Property Office (IPO). The request had been filed on April 14, 2013 by the journalist Glyn Moody, for:

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A PDF version of our comments is available here.

People have until midnight May 10, 2013 to file comments, here:
http://www.regulations.gov/#!documentDetail;D=USTR-2013-0019-0001

This is the table of contents.

Comments on the Administration’s Intention to Enter Into Negotiations for the Transatlantic Trade and Investment Partnership (TTIP) Agreement
Response to Docket No. USTR-2013-0019

Introduction
Transparency

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Note, we are adding some video clips from the meeting here:

May 13, 2013. KEI meeting on WIPO negotiations. http://www.youtube.com/playlist?list=PLLw9jWaZPEpzafm6_61VtLb6aW-nFaINa

On May 13, 2013, KEI will host a 12:30 to 2:30 brown bag lunch for a discussion of the WIPO Treaty for the Blind negotiations. It will be possible to attend in person, or follow the meeting on the telephone.

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On April 15, 2013, the Intellectual Property Owners Association (IPO) sent a letter to Teresa Stanek Rea, the Acting Under Secretary of Commerce for Intellectual Property and the Director of the U.S. Patent and Trademark Office, setting out the IPO "concerns" about the proposed WIPO treaty for persons who are blind or visually impaired. (Copy here).

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On April 26, 2013 I attended a half day meeting on "A Human Rights Approach to Intellectual Property and Access to Medicines" organized by the Yale Law School and the Yale School of Public Health. These are notes from my interventions on behalf of KEI.

1. KEI does a lot of work on intellectual property rights that has impact on human rights. We do not always give prominence to human rights law or the language of human rights, although at times and in the right context, it can be important to do so.

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Below is the PhRMA press release on the Special 301 Report.

Key points in the PhRMA release:

* PhRMA "dismayed that USTR did not grant an out-of-cycle review for India." PhRMA claims that India decisions involving German owned Bayer and Swiss owned Novartis "disproportionately impacted U.S. biopharmaceutical companies." (Perhaps PhRMA could have said, companies that have ownership claims on the US government).

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Today USTR held a one hour "listening session" with several Washington, DC public interest groups. The topic was the Transatlantic Trade and Investment Partnership (TTIP) with the European Union.

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On 1 May 2013, USTR released its 2013 Special 301 Report. Ukraine was put on the Priority Foreign Country list this year, a designation not used by USTR for several years. USTR's 2013 report spends more than six pages discussing China and two full pages on India. Below are some comments regarding this year's report.

Least Developed Countries

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On 18 December 2012 and 20 December 2012, the World Trade Organization (WTO) undertook a trade policy review of the United States of America. All members of the WTO are subject to review under the Trade Policy Review Mechanism (TPRM). The questions raised by WTO Members during the US TPR touched upon on compulsory licensing (including cases of judicial compulsory licensing following eBay v. MercExchange), copyright (Golan v. Holder), the Special 301 report and the Medicines Patent Pool. On 30 April 2013, the WTO released the records of the meeting including WT/TPR/M/275.

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“Can EU Citizens Afford Their Medicines?

The Economic Crisis & Access to Medicines in Europe “

16th of May 2013, 9:00 – 18.00

European Parliament, Brussels

Room Jan 4Q2

A meeting hosted by Mr Alejandro Cercas MEP (Spain, S&D) and by the Socialists and Democrats in the European Parliament (S&D Group).

Members of the European Parliament (MEPs) from Greece, Romania and Portugal have agreed to meet with civil society to find solutions to the increasing challenge of access to medicines in Europe. Organised in the European Parliament, this gathering will serve to assess the impact of cost-containment policies put in place in some EU member states with patients, health professionals, civil society actors, and academics from Greece, Lithuania, Spain, Portugal, Belgium, and the UK. Participants will debate which role new innovation models and instruments could play in ensuring the affordability of medicines.

Deborah Cohen of the British Medical Journal will moderate the morning session. The founder of the Medicines Patent Pool, Ellen ‘t Hoen, will moderate an afternoon session.

The seminar will bring together actors and institutions that do not traditionally meet or exchange ideas. One of the expected outcomes of the event is to develop recommendations to be put forward to multilateral institutions, ministries of finance, research and health. It is expected a significant press coverage and a high attendance from the public health community at large, health ministries, industry, health and NGOs, academics, think tanks and key health stakeholders from across the EU.

Mr Andrzej Jan Rys, Director Health Systems and Products at DG SANCO; Hugo Hurts, Director Department of Pharmaceutical Affairs and Medical Technology of the Dutch Ministry of Health, Welfare and Sport; and Thomas Heynisch, Deputy Head of Unit for Food and Healthcare Industries, Biotechnology (DG ENT) will participate to discuss the impact of cost-containment measures on patients.

? Do you have a Twitter account? Join the discussion at hashtag #access2medicinesEU

We do hope you will be able to join us for this timely discussion.

If you would like to attend the event, please register before 5 May:

Registration link: http://my.epha.org/civicrm/event/info?reset=1&id=153

DRAFT AGENDA: https://docs.google.com/viewer?a=v&pid=gmail&attid=0.1&thid=13e18242cf6a2145&mt=application/pdf&url=https://mail.google.com/mail/u/0/?ui%3D2%26ik%3D71538a1919%26view%3Datt%26th%3D13e18242cf6a2145%26attid%3D0.1%26disp%3Dsafe%26realattid%3Df_hfmixags0%26zw&sig=AHIEtbQBH-dZg5V2z-9MDHDrTbfVKmNC3g

Dear  colleagues,

As you know the European parliament will choose next fall the new European Ombudsman. The current Ombudsman P. Nikiforos Diamandouros who has held the position since 2003, was re-appointed by an absolute majority of MEPs to serve a fresh five-year term at a plenary vote in January 2010. Nikiforos Diamandouros is widely praised for his independent position and critical reports which aim at improving governance and transparency of European institutions. After his election in 2010Diamandouros said het wanted to work “to improve the quality of the EU administration and to promote a culture of service in the EU institutions for the benefit of European citizens”. MEP and rapporteur Chrysoula Paliadeli (S&D) recognised in 2009 the Ombudsman’s efforts to improve performance of the EU institutions and underlined that “the Ombudsman has supported the rule of law with great sensitivity”. MEP Jorgo Chatzimarkakis (ALDE) said at the time that “while Diamandouros was in office the position of the Ombudsman has grown; the acceptance and the confidence towards this institution has increased noticeably”.

The candidate Ombudsman needs to collect at least 40 signatures from MEP’s, is then heard by the PETI Committee and is then elected in plenary by secret ballot at the start of each parliamentary term.
There are currently 5 candidates trying to run for the post of the new European Ombudsman. MEP´colleagues Dagmar Roth-Behrendt (S&D) and Ria Oomen-Ruiten (EPP) have both gathered more than 100 signatures of support from MEPs from their own groups (and still counting). The other outstanding candidates, the current Irish Ombudsman, Emily O’Reilly, the current Dutch Ombudsman, Alex Brenninkmeijier, and the German candidate from the Council of Europe, Marcus Jaeger, are finding it much more difficult to get the 40 signatures needed.

Not at all doubting the qualifications of the two EP-candidates and their capabilities to fulfil this job, we nevertheless think the European Ombudsman needs to have a more political neutral profile. It is important to underline that art. 6(2) of the Statute of the Ombudsman states that the candidate shall offer every guarantee of independence. An Ombudsman with clear party political affiliation and political strings attached to the European parliament, will have a more difficult job in working in full independence and live up to the crucial expectations of European citizens.

This parliament even has a young tradition in this. At the time of the 2003 Ombudsman elections Spanish MEP Enrique Barón Crespo, then leader of the Socialist group said: “At the beginning of this process we took a clear decision that the election of a new Ombudsman should not be a political contest and that our support for any particular candidate would be on the basis of competence and experience. We also agreed not to vote for any present or former MEP for the post. It is clear to any objective observer that Professor Diamandouros admirably fulfils the conditions required for the position of EU Ombudsman and I am happy to note that support for his candidature was also to be found in other political groups of the Parliament.”

Politicising the nomination process of the new European Ombudsman now, is especially not a good idea in these times of rising euro-scepticism. Therefore, in order to ensure the continued trust and respect of both the citizens (but also the other EU-institutions) in the impartiality of the Ombudsman’s office, we need a candidate that is independent to continue and develop the good work of the two previous Ombudsmen.
To give you an idea of the workload, the current Ombudsman recorded 3406 complaints in 2008. Of the 296 inquiries opened in 2008 by the Ombudsman, 36% dealt with a lack of transparency, including a refusal to provide information or documents. MEPs said to be concerned about this, since a transparent administration is crucial to building public trust in the EU. Most of the inquiries launched by the Ombudsman in 2008 concerned the European Commission (66%). Other targets were the administration of the European Parliament (10%), the European Personnel Selection Office EPSO (7%), the Council (3%) and the European Anti-Fraud Office (2%).

Therefore, to make sure that in order for the EP to have a choice between politicised and independent candidates, we should have at least two truly qualified and independent candidates in the final round. We urge you to give broad support for at least the two candidates who have an outstanding experience as Ombudsman.

Bart Staes
Margarete Auken
Bas Eickhout

Below are several links to recent Huffington Post articles about the WIPO negotiations for a treaty on copyright exceptions for blind persons.

The first is a link to my report for HuffPo on the April 2013 negotiations, which have not gone well. The blog includes a discussion of some of the changes in key provisions of the text over time, and the recent quite harmful MPAA lobbying efforts.

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Attached is the final version of the negotiating text that will be considered at the diplomatic conference in June 17 to 28, 2013 in Marrakesh, Morocco.

88 brackets in text, plus 17 "Alternative" versions of text.

8 references to: "do not conflict with the normal exploitation of the work," plus 3 additional references the "three-step test."

11 references to technological protection measures

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The WBU just issued the attached press release. (On a related note, a video of their statement Saturday morning is available here).

WORLD BLIND UNION (WBU) press release 20th April 2013

Press Release – WIPO Negotiations Treaty for Blind people A treaty for the blind or for the rights holders?

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“Troika”-Mandated Austerity and the Emerging Health Care Crisis in Greece: An Open Letter to the Greek Government

To the Prime Minister of Greece and President of New Democracy Party, Mr. Antonis Samaras

To the President of PASOK, Mr. Evangelos Venizelos

To the President of the Democratic Left, Mr. Fotis Kouvelis,

To the Minister of Health, Mr. Andreas Lykouretzos,

This letter is an attempt by Greek scholars and physicians from diverse academic areas of specialization to raise our concerns regarding the current, dire, state of Health Care services in Greece.
Our country has fallen into a dismal state, and it is constantly challenged by extrinsic and intrinsic pressures, while the economic and social climate deteriorates further each day. The Greek government, in total obedience to the irrational demands of the Troika, focuses on the obligations of the citizens towards the state, and seems to forget or ignore its own obligations towards its citizens. The Government has imposed a brutal and self-defeating fiscal austerity; in a confiscatory manner, it tries to collect extra revenue from an already impoverished and afflicted populace, while it neglects its main role, as specified by the Constitution: The Protection of the Rights and the Welfare of the Citizen Body.
In three short years, governments comprised of the current coalition parties have managed to reduce the country’s GDP by 25%, leading Greece to the deepest and longest-lasting economic depression in the history of the modern Western world. During the same period of time, the public debt expanded from 109% GDP to 170% GDP, unemployment rose from 8% to 27%, and youth unemployment now holds the world record at 58%.  Incomes have been reduced by more than 40%, leading to a record number of families and individuals living below the poverty line. It is worth noting that the famous “haircut” (PSI), presented by the Government as a notable achievement, ultimately increased the public debt, while raiding the reserves of pension funds, reserves that were gathered painstakingly by the contributions of workers and pensioners.
One of the sectors that has been most hard-hit is Health Care. The Public Health system in Greece is now collapsing at all fronts. Having signed a memorandum of understanding with the unelected and unaccountable troika to reduce public health expenditures from 9.8% GDP (pre-crisis) to 6% GDP (the shrunken post-crisis GDP), the Greek government has instituted a number of measures which seriously undermine the health of the population. Removing health coverage from thousands of unemployed is definitely guaranteed to increase mortality in this segment of the population.
This policy of subservience to the ?roika’s demands has led to the closure or downgrading of Hospital units.  For example, the hospital of the town of Kymi “Georgios Papanikolaou”, the hospital of the city of Thebes and many others in the provinces and in metropolitan centers have seen their medical personnel reduced, the staff remained unpaid for long periods of time, their medical equipment in progressive deterioration, and laboratories with increasing shortages in all kinds of consumables (syringes, bandages, reagents etc.).  Patients now have to pay for consumables, for medical tests, and for surgeries. This is all on top of what they already paid through their insurance funds. Those who suffer from chronic diseases, such as chronic obstructive pulmonary disease, are forced to pay a 25% deductible for the cost of their medication, while prior to the crisis this deductible stood at 5%. Cancer and kidney failure patients suffer not only due to the increased costs of specialized treatments, but also the general rundown of these facilities, loss of key personnel and dramatic shortages in medications; unable to receive treatment at home anymore, they have to travel far away for dear life, and wait in endless queues in the corridors of bureaucratic health-insurance offices and/or hospital clinics. Patients in mental health units, such as Dromokaitio, face every day the alienation and indifference of a state that fails to support them. The staff and the resources in most psychiatric clinics are decreasing rapidly, while the number of patients is increasing (as this crisis is taking its toll).  Psychiatric hospitals in Greece can no longer perform at the level required to provide even basic treatment to patients diagnosed with serious mental illnesses.
Furthermore, the establishment of a “standard rate” for surgeries is forcing patients to pay in advance approximately 20% of the value of materials and services.  This “standard rate” makes both emergency and elective surgeries virtually unapproachable for a broad segment of the population. For example, on the basis of the newly introduced pricing, the cost for a hip replacement surgery at a public hospital approximates €1000; this cost is further increased by the remuneration of the surgeon, the anesthesiologist and other essential staff. Thus, the cost of this common surgery is currently unaffordable by an elderly patient with a basic pension of less than €600; such retirees would be unable to secure the funds, having to prioritize purchasing of basic foodstuffs, paying for rent and utilities, securing funds for heating, acquiring their regular medication, and affording sundry living expenses (and often this small pension supports an additional family member).
Beyond these specific destructive measures, one can easily figure out the impact on public health of the consecutive decreases in pensions and the confiscatory tax measures. Many poor pensioners have no choice but to forgo basic, life-saving drugs and healthcare monitoring, in order to afford just food and heating (the Government’s devastating policies in heating fuel are duly noted here).  The pricing of basic goods has increased (not only by inflation but also by the drastic increases in VAT for even basic items), while incomes have been drastically reduced.  The imposed increase of 500% or above on deductibles for drugs and doctor visits are simply making it impossible for many pensioners to maintain their assigned treatment.  Certainly, the consequences here, especially for persons with serious and chronic diseases, are increased morbidity and mortality.
This rapid decline in the quality of care administered is complemented by the hemorrhaging of highly trained individuals; more than 4,000 highly trained Greek doctors have emigrated abroad because of their frustration with the degradation of the system and the successive cuts in wages, overtime remuneration and benefits. It is worth noting that the National Health System (ESY) in our country has operated efficiently, provided exceptional services and constituted an important achievement of our society prior to the onset of the crisis. It was the hard work of the doctors, the nurses, the pharmacists, the laboratory scientists and technicians, the administrators and the ancillary personnel of ESY that advanced the status of the public health in the country. This system is now bereft of basic resources, besieged at every level and plundered with your consent.  Its members are fleeing in increasing numbers.
In this context, we call on the Greek government to keep and defend the value of health. There should be no cuts on funds required for the normal operation of the hospitals in Greece, both for those located in major metropolitan centers and for those in the islands and other remote areas of our country. We ask that you do not downgrade regional hospitals to just health centers. Such health centers will provide limited services and result in the collapse of public health in the provinces. Do not let these regional/provincial hospitals remain understaffed, manned simply by general practitioners or pathologists, bereft of key specialized personnel; your policies will degrade terminally what has been the key strength of these regional hospitals, a strength that contributed significantly to the improvement of public health in Greece in the last few decades.  If your policies were fully enabled, key specialized personnel would only be found in large, crowded hospital conglomerates in metropolitan centers. Such a policy would force Greeks who need special attention, to travel farther and farther from home in order to secure proper care (thus further increasing the already unbearable costs), assuming that they can even afford it, a dangerous assumption  in this current economic climate.  The additional costs and the absence of timely specialized care would undoubtedly lead to increased morbidity and mortality in the provinces.  A welfare state that respects its institutions and history, and cares about its continued existence in the future, should not even contemplate such drastic cuts in public health. Such actions can be expected by foreign-installed, occupation governments, not by a government of Greeks for Greeks.
Thus, we request the following actions by the Greek government:
The proper staffing, maintenance, and modernization of existing hospitals in the country, especially in the provinces and the islands.
The restoration of proper medical coverage of population groups, the collective health of which is specifically under threat by the current economic crisis.  These groups include the long-term unemployed, the working poor, low-income pensioners, and others.  For these population groups, you must introduce a substantial rollback of the increases in the cost of health care that you have instituted.
The creation of policies and incentives that will assist in the proper geographic allocation of physicians and nursing personnel of all specialties in order to avoid needless and counterproductive concentration of qualified personnel (often unemployed) in metropolitan centers.
The proper remuneration of physicians, nurses, laboratory scientists and technicians to avoid further depletion of these key personnel through emigration.  The drastic cuts in wages, salaries and overtime pay must be rolled back.  Otherwise, the exodus of qualified personnel will turn into a stampede, with disastrous consequences for public health
The introduction of policies that will assist in the ready availability of pharmaceuticals, consumables, laboratory supplies, and devices.  The government should forgo unconvincing public releases about primary surpluses and regularly pay suppliers and pharmaceutical companies the full amount owed.
As the government of Greece, you have the responsibility for our country’s survival and the welfare of its citizens. You have no right to obtain credit by degrading the health of your compatriots and by sending to an early grave the most vulnerable among us.  You are obliged to say NO to the demands of the unelected members of the “troika”, when obedience to these demands has devastating consequences for our country. If saying NO to Troika’s destructive demands means exiting the Euro Zone, then you must do so.  Many of us believed in a united Europe, but the Euro Zone proved to be only a means of exploitation of the weaker nations by the stronger ones. The consequences of our continued participation in the common currency have become obvious by now. Along with the impoverishment of our country, you have made us forget not only the meaning of the word “pride”, but also the meaning of “dignity”.  Despite the ongoing crisis, record unemployment, the rapid decline in GDP, the dramatic increase in poverty and hunger, the deteriorating health of the population, the sharp decline in birth rates, the wave of suicides and total loss of hope, you cling tenaciously to your policies of supplication and subjugation, while continuing to sell off public property and public companies at rock bottom prices.
The disastrous policies that undermine even the basic health of the Greek population must come to an end.  As Greeks, we are able to survive the crisis and rebuild. However, to do so, having our physical health is a prerequisite.

Signatures,
Medical and support staff of the Metropolitan Social Clinic of Elliniko, GREECE.

Akritas Alkis, Professor, CS / KU, USA.

Albrecht-???????? ?????????, Ph.D., International Programs, Foy Hall 316, Auburn University, Auburn, AL 36849, USA.

Almpoura Efstratia, MSc Developmental Psychologist, IED-Paris8, Vincennes-Saint Denis, Paris, & Harvard ES, Cambridge MA, Athens, GREECE.

Anastassopoulou Ioanna, Professor, School of Chemical Engineering, Department of Material Science and Engineering, Athens, GREECE.

Andreatos Antonios, Professor, Department of Computer Science, Department of Air Science, Air Force Academy, Athens, GREECE.

Antikas Theodoros, Ph.D., GREECE.

Apostolaki Aggeliki, MSc Psychologist, A.U.TH. Faculty of Philosophy, Department of Psychology, Thessaloniki, GREECE.

Argyrokastritis Ioannis, Associate Professor, Agricultural University of Athens, GREECE.

Argyropoulos Giannis, PhD, AT&T Labs

Aroniadou-Anderjaska Vassiliki, Ph.D., Associate Professor of Neurosciences, Bethesda, Maryland, USA.

Valaskakis Kimon, Ph.D., Ambassador of Canada (Ret), Professor of Economics (Emeritus), University of Montreal, CANADA.

Vallianatos Evangelos, Ph.D., Associate Professor, Pitzer College, USA.

Vartholomaios Tasos, MD, PhD, MFHom, GMC, UK, Registered Consultant Pathologist, Member of the Faculty of Homeopathy,UK

Vartholomaiou-McLean Athina, Ph.D., Professor, Sociology, Anthropology and Social Work, Central MI University 48859, USA.

Vichas George, Cardiologist, Head of the medical team of the Greek Metropolitan Social Clinic of Elliniko, GREECE

Vigot Jacques, DNSAP, in Plastic Arts, ENSBA, Paris. Artist-Painter, Educator in Painting and Drawing, Animation Center Les Halles-Le Marais, Paris ??wnhall of the 1st Arr., Paris, FRANCE.

Vogiatzis Alexander, Former Associate Professor, University of Macedonia, GREECE.
Burriel Angela R., Professor, Veterinary Microbiology, University of Thessaly, GREECE.

Bucher Matthias, PhD, Assistant Professor, University of Crete, Chania, GREECE.

Georgopoulou Lito, Educator, GREECE.

Giannaki Efrosyni, Surgeon Dentist, Dental School of the National and Kapodistrian University of Athens, GREECE.

Spiro Yannacopoulos,  Ph.D., P.Eng., Associate Dean and Director, School of Engineering, University of British Columbia, Okanagan Kelowna, BC, C???DA.

Panagiotis Giannopoulos, Associate Professor, Department of Civil Engineering, University of Patras, GREECE.

Giannoukos Konstantinos, M.Eng., Doctoral Candidate, Faculty of Engineering, Division of Materials Mechanics and Structures, The University of Nottingham, UK.

Giannoukos Stamatios, M.Eng., Research Assistant and Doctoral candidate, Department of Electrical Engineering and Electronics, University of Liverpool, UK.

Giokaris Nikos, Professor, Department of Physics, University of Athens, GREECE.

Gatzoulis Nina, Languages, Literature and Cultures University of New Hampshire, USA.

Dascalopoulos Stella S., MD, MSc, DIC, PhD, Assistant Professor in Medicine, Director, Vascular Health Unit, Department of Medicine, Division of Internal Medicine, McGill University, CANADA.

Dokos Socrates, Ph.D., Associate Professor, Graduate School of Biomedical Engineering, University of New South Wales, Sydney 2052, AUSTRALIA.

Dritsas Margarita, Emeritus Professor of Economic History, Greek Open University (Hellenic Open University), GREECE.

Eleftheriades George Savva, PhD, OAM, GCSCG, CETr, JP.  – ExarchOSETrAu, New South Wales, AUSTRALIA.

Eleftheriades Evgenia, CLETr, CSH; – Sydney, New South Wales, AUSTRALIA.

Evangeliou Christos C., Professor of Philosophy, Honorary President of IAGP, Towson University, Towson MD, USA

Prof. Dr. Panayiotis Zavos, Dr., Professor, Director & Chief of Andrology, Andrology Institute of America, President & CEO, ZDL, Inc. USA, P.O.Box 23777, Lexington, KY 40523, USA

Zerva Evgenia, M.Eng., Doctoral Candidate, Process and Environmental Engineering Research Division, University of Nottingham, UK.

Dr. Vassiliki Zotou, Language and Linguistics in Education, University of Thessaly, Volos, GREECE.

Zografopoulos Gregorios, Dentist,Dental School of the National and Kapodistrian University of Athens, Florina, GREECE.

Ifestos Panagiotis, Professor, International Relations-Strategic Studies, University of Piraeus, Department of International European Studies, GREECE.

Theocharopoulos Anthony, Ph.D., Lecturer in Dental Technology, Cork University Dental School and Hospital, Wilton, Cork, IRELAND.

John Petros, Ph.D., Electrical Engineering, University of Southern California, Los Angeles, CA 90089-2562, USA.

Kaimara Polyxena, MSc School and Evolutionary Psychology, MSc Public Health Specialization in Counseling and Guidance, Physical Medicine and Rehabilitation Center Florina, GREECE.

Kakouli Thomae, Ph.D., Lecturer in Biosciences, Department of Science and Health, Institute of Technology Carlow, Carlow, IRELAND.

Kakoules Theophilos, Emeritus Professor, University of Athens, GREECE.

Father Lambros Kamperidis, Concordia University, Montreal Classics, Modern Languages and Linguistics, CANADA.

Anastassios Carayannis, PhD, Professor, Department of Applied Human Sciences, Concordia University, Montreal, CANADA.

Caranastassi Irini, PhD, Assistant Professor, Department of Greenhouse Crops and Floriculture, School of Agricultural Technology, TEI of Messolonghi, GREECE.

Karan Panayiotis, Professor of Parasitology and Anatomy, Medical School, University of Cologne, 50937 Cologne, GERMANY.

Katsifarakis Costas, Professor, Department of Civil Engineering, Aristotle University, Thessaloniki, GREECE.

Panagiotis Kelandrias, Associate Professor, Department of Translation and Interpreting, Ionian University, GREECE.

Keromnes Luce, (CCI) School of Nurses-Managers of Pitié -Salpêtrière, Senior Manager of Health - retired, Paris, FRANCE.

Kontos John, Professor Emeritus, NKUA, GREECE.

Kopatou Stamatina, Professor of French in the French Institute of Athens (INFA), Greece. University of Languages ??and Literature Grenoble 3. Athens, GREECE.

Constantine Koudounas, Graduate Department of Physics UoA, MSc Marketing & Communication, Gold Coast, QLD AUSTRALIA.

Koutselini Mairi, Professor, University of Cyprus, CYPRUS.

Kranidioti Maria, Associate Professor, School of Law, University of Athens, GREECE.

Kriara Fenia, MSc Cultural Informatics and Communication, Aegean University, GREECE.

Kyriakou George, Professor, Demokrition University of Thraki, GREECE.

Koletis Theophilus M., Professor of Cardiology, University of Ioannina, GREECE.

Comodromos Petros, Lecturer, Department of Civil & Environmental Engineering School of Engineering, University of Cyprus, CYPRUS.

Kostantatos Demosthenes, Ph.D., M.Sc. M.B.A., Greenwich CT, USA.

Father Konstantelos Dimitrios I., Dr F. D.TH, Emeritus Professor of Byzantine History and Theology, Stockton College of New Jersey, Galloway, New Jersey, USA

Kostas Antigone, Doctor of Psychiatry, Greenwich CT USA

Christina Lazaridis, Ph.D, retired from Dupont Company, Wilmington DE, USA (and Heraklion, Crete, GREECE)

Lazaridis Anastasios, Eng.Sc.D, Professor Emeritus, Widener University, Chester PA, USA (and Heraklion, Crete, GREECE)

Lampropoulou Venetta, Professor, Special-Deaf Education, President of the International Congress on the Education of the Deaf, Deaf Studies Unit, Department of Primary Education, University of Patras, GREECE.

Lekanidou P., Emeritus  Professor,  UoA, GREECE.

Loutridis Abraham, MSc, PhD Candidate, Antenna and High Frequency Research Centre, Dublin Institute of Technology, Dublin, IRELAND

?anios Ioannis, National and Kapodistrian University of Athens, Faculty of Dental Surgery, Surgeon Dentist, Athens, GREECE.

Melakopides Kostas, Associate Professor of International Relations (ret.), University of Cyprus, Nicosia, CYPRUS.

Michalakopoulos George, Assistant Professor, Department of Translation and Interpreting of the Ionian University, GREECE.

Costas Moulopoulos, Associate Professor, Department of Physics, University of Cyprus, Nicosia, CYPRUS.

John E. Batzakas, Lecturer, University of the Aegean, GREECE

Bacalis Naoum, PhD, Institute of Theoretical and Physical Chemistry, National Research Institute, Athens, GREECE.

Baloglou George, Associate Professor Emeritus (SUNY Oswego), Thessaloniki, GREECE.

Balopoulos Victor, Assistant Professor Department of Civil Engineering, Democritus University of Thrace, GREECE.

Blytas ?. George, Ph.D., Physical Chemistry/Chemical Engineering, Research Consultant, Royal Dutch  Shell, retired, President, GCB Separations Consulting, Founder: The Hellenic Professional Society of Texas, Author:  The First Victory, Greece in the Second World War, 2009, USA.

Bougas Ioannis, Professor of Statistics, Montreal, CANADA.

Briasouli Eleni, Professor, Department of Geography, University of the Aegean, Mytilene, Lesvos, GREECE.

Moraitis L. Nicholas, Professor of International Relations – Comparative Politics, University of California, Berkeley.

Negreponti-Delivani Maria, Ph.D., ex Rector and Professor of University of Macedonia, GREECE.

Notopoulou Julia, MSc Developmental Psychologist, IED-Paris8, Vincennes-Saint Denis, Paris. MFA Film and Film / Video, IED-Paris8, Vincennes-Saint Denis, Paris, Athens, GREECE.

Octeau Anne-Pascale, DNSAP, in Plastic Arts, ENSBA, Paris. Artist-Painter, Educator in Painting and Drawing, Paris, FRANCE.

Papavasileiou-Alexiou Joanna, Assistant Professor of Counselling and Guidance University of Macedonia, Department of Educational and Social Policy, Thessaloniki, GREECE.

Papagiannis Gregorios, Ph.D., Byzantine Philology, Demokrition University, Thraki, GREECE.

Basil P. Panoskaltsis, MS, MA, Ph.D., GREECE.

Nikos Papadopoulos T., Emeritus Professor of Medicine Aristotle University, Thessaloniki, GREECE.

Papathanasiou Maro, Professor in the Department of Mathematics, University of Athens, GREECE.

Papamarinopoulos P. Stavros, Professor, University of Patras, GREECE.

Paparodopoulos Nikolaos, former Lecturer, University of Aegean, GREECE.

Paul P. George, Associate Professor, Department of Electrical and Computer Engineering, Polytechnic School of Xanthi, University Campus Xanthi Kimmeria, Xanthi, GREECE.

Péré-Pasturel Sandrine, MSc Psychologist, IED-Paris8, Vincennes-Saint Denis, Paris, Varcheny, Nursing-Nurse Manager at Creche au Pont, Rhône-Alpes, FRANCE.

Leonidas Petrakis, PhD, Chairman and Senior Scientist (Retired), Department of Applied Science, Brookhaven National Laboratory, Now residing in California, USA.

George Pirgiotakis, ex Associate Professor, GREECE.

Retzios Anastassios, Ph.D., President, Bay Clinical R&D Services, LLC, San Ramon, California, USA.

Riga Aikaterini, Ph.D. Director of Nematology Laboratory and Senior Scientist, Verdesian Life Sciences, Pasco, WA, USA

Peter Roussos, Assistant Professor, Agricultural University of Athens, GREECE

Sakatcheff  Veronique, MSc Cognitive-Behavioral Psychologist, IED-Paris8, Vincennes-Saint Denis, Paris, Toulon, FRANCE.

Sarri Maria, Surgeon Dentist UMFT Victor Babes, Athens, GREECE

Stamboliadis Elias, Professor, Department of Mineral Resources Engineering, Technical University of Crete, GREECE.

George Stavropoulos P., Cytologist, University of Athens, Athens, GREECE.

Mika Stavropoulou, Research Faculty, UoA

Stavropoulou Georgia, MA, MPhil. Los Angeles, CA, USA.

Stylianakis Vasilis, University of Patras, GREECE.

Tzamtzis Stavros – Dionisios, Psychologist, graduated from Aristotle University, Thessaloniki, GREECE.

Dr. George Tsobanoglou, PhD Sociology, Carleton, President, International Sociological Association, Research Committee on Sociotechnics & Sociological Practice (ISA-RC26), Associate Professor, University of the Aegean, Dept. of Sociology, Mytilini, Greece

Anna Tsirka, pediatric cardiology, Assistant Professor, Tufts University School of Medicine

Tsoutsoulopoulou A.M., EEDIP I English School of Humanities, University of Thessaly, GREECE.

Flessas George P., Professor, Department of Information & Communication Systems Engineering, Department of the Aegean, Karlovassi, Samow, Greece.

Evangelia Floros, Professor, Tel & GL Larissa, Department Decorators / Graphic Designers, Maintainers art, Design Free / Linear and specificity School of Architecture University of Thessaloniki, Larissa, GREECE.

Katerina T. Franzi, Associate Professor of Informatics, Department of Mediterranean Studies, University of the Aegean

Fridas Stavros, Professor of Parasitology Immunology-AUTH, Thessaloniki, GREECE.

Halamantaris Pantelis, Ph.D., Ed.D. (HC), Professor Emeritus, Brandon University, Deputy Director, the University of Manitoba Centre for Hellenic Civilization, Brandon, Manitoba, CANADA.

Hamilos I. Apostolos, Surgeon Dentist, Dental School, Athens, GREECE.

Hamilou A. Ioannou, Surgeon Dentist, Univerzita Karlova v Praze-Charles Univeristy, Prague, Athens, GREECE.

Hatzis Aristotelis, A.U.TH. – N.K.U.A., Dentist, School of Dentistry, Aristotle University of Thessaloniki, ATHENS, GREECE.

Hatzis Labros ,MD, PhD, BPlast, Fellow, St John’s College, Cambridge University, UK. S. Lecturer Royal College of Surgeons in Ireland, Dublin, IRELAND.

Hatzopoulos N. Ioannis, Professor, University of the Aegean, Department of the Environment, Mytilene, GREECE.

Nikoletta Christodoulou, Lecturer, Curriculum and Teaching, School of Education, University Frederick, Nicosia, Cyprus

Theodore Christou, Ph.D., Assistant Professor, Queen’s University, Faculty of Education, CANADA.

As mentioned in our piece, State of Play: Treaty for the Blind negotiations at the World Intellectual Property Organization, the February 2013 special session of the WIPO Standing Committee on Copyright and Related Rights (SCCR) reached agreement on a cluster of provisions on the Treaty's treatment of the copyright three-step test that resulted in the ARTICLE(S) section contained in SCCR/25/2/Rev.

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