Houdini wins the rapid tournament !! That's not really a surprise, right? A solid 6 points out of the last 7 was more than it needed to keep first place. Very few engines managed to slow Houdini down. Fizbo and Nirvana are the only ones that held Houdini to two draws, other than the top 3 engines. Well done Houdini !
Komodo kept its small lead over Stockfish and finished second. Both remained unbeaten in the tournament, and it was their worse performance against weak engines that made them lose the race to the top. I think this says more about the tournament than it does on the relative strength of the top engines.
In the second trio of engines Fire finished fourth comfortably, finishing the second RR without loss. Jonny overtook Ginkgo and finished fifth.
My opinion of the rapid tournament has not changed. There were too many games and many of them too one-sided. The games went by too fast, it was impossible to follow them or to get excited by them. There was some entertainment value in the race but Houdini opened up a gap and was hardly in danger most of the time.
And what about the superfinal? Remember that? A 100-game match between Stockfish and Houdini, long games like we used to have in TCEC? So far there have been no news as to when this should start. Anton from chessdom has not posted anything in the chat or on the facebook page for a while and it was said he had health issues. I hope he gets well soon. I also hope we will not have to wait too much for the superfinal. Note also that the world chess championship match between Carlsen and Karjakin starts in a few weeks, will we have both matches at the same time? Worlds colliding.
Gull - Jonny: Jonny was sure it had an advantage with eval over 1, but after a series of exchanges its eval came back down. When only opposite colored bishops remained the engines agreed on a draw.
Houdini - Rybka: Rybka held its position against Houdini for over 30 moves. Rybka's center was strong and Houdini attacked on the queen side, quickly opening files and creating an advanced passer. Rybka managed to stop the passer for the price of a deadly pawn-bishop pair in the corner. The only blocking piece was the black queen, leading to an easy win for Houdini. Another obstacle cleared by Houdini.
Stockfish - Komodo: Komodo had an effective pawn line that stopped any attack attempts by Stockfish. Stockfish tried to open the position by giving a rook for a bishop, both evals then fell to 0 and a draw was just a matter of time. Houdini's lead is 3 points with 6 games remaining.
Naum - Ginkgo: There were may early exchanges, Naum was a pawn up but it was a doubled pawn. On move 32 only B vs N remained, the engines continued to shuffle for more than 90 moves before declaring a draw.
Ginkgo - Stockfish: Stockfish came out of the opening in a better position, with rooks controling the center and a queen side passer. After a pair of rooks was exchanged only RB vs RB remained, Stockfish was able to get a two pawn lead and exchange down to a winning 6-man rook ending. That was the last serious opponent for Stockfish in the RR, it has a chance to get second place.
Komodo - Houdini: Komodo had an eval advantage for a short while but Houdini was never in any danger. Evals came back to 0 and the engines shuffled and exchanged until adjudication. Komodo's last chance of geting closer to Houdini is gone, and it is tied with Stockfish in second.
Jonny - Andscacs: Jonny was very happy with the opening, getting an eval advantage of over 1. Andscacs remained calm with low eval, and when the shuffling began it proved it was right. It took more than 150 more moves of mostly nothing for a draw to be declared. Jonny is tied with Ginkgo in fifth place.
Chiron - Jonny: Chiron was outplayed by Jonny in a closed position. Chiron started with an eval advantage but after less than 20 moves Jonny took the initiative on the king side. While Chiron's pieces defended Jonny captured two pawns on the queen side, and eventually after many exchanges the queen side passers were enough to win. Surprising how easily Jonny won here.
Fire - Protector: Fire had an eval advantage for over 60 moves when the game reached a BN vs R position. Protector could have perhaps held on with better play, it came down to which engine had the better passers. Fire had an extra piece to block the black pawns' advance, and the white pawns won the game.
Nirvana - Komodo: Nirvana had the opening advantage and it took Komodo 30 moves to turn things around and get the initiative. Komodo took over the center and won a pawn with eval getting over 1. Nirvana held its position for another 40 moves or so but after queens were exchanged Komodo's eval started to climb again. With a nice combination Komodo reduced the board to a rook ending with two pawns advantage. It took Nirvana a while to see it was losing.
Houdini - Ginkgo: Houdini had an eval advantage of almost 1 when Ginkgo started an effective blockade. The engines shuffled for 40 moves, then Houdini exchanged rooks and in an QRB vs QRN position the evals started to rise gradually. With evals over 2 suddenly Ginkgo crashed for no apparent reason. Houdini got the win but from its PV it was aiming for a R vs N ending with king side pawns, is that a sure win? Jonny is now 1 point ahead of Ginkgo in fifth place.
Stockfish - Gaviota: Stockfish couldn't get anything going in this game, even though it played white. By move 23 only minor pieces remained and the rest of the game was shuffling and further exchanges. With this draw Stockfish is third again, 0.5 points behind Komodo.
Fizbo - Stockfish: The engines started to shuffle on move 19, Fizbo thought it had some advantage while Stockfish's eval was 0. After a series of exchanges Fizbo's eval came down, with only QBN vs QNN left. The game was close to adjudication when Stockfish's eval jumped close to over 0.5 where it stayed for 15 moves. Fizbo managed to exchange down to a drawn knight ending. The third draw in 4 games for Stockfish, quite a bad result for such a strong engine.
Ginkgo - Nirvana: Ginkgo thought it had a small advantage from the opening. After the rooks were exchanged the engines started to shuffle, and after queens were exchanged the game was a dead draw, though Ginkgo had to lower its eval first for adjudication.
Hannibal - Fire: A series of exchanges removed almost all pieces with only QB vs QN remaining. Fire forced a repetition draw a few moves after that.
Jonny - Critter: After the opening the engines fought for control of the center. Critter had an advantage with a rook for a bishop and pawns and an eval of 1. After several exchanges the center struggle was resolved and only RB vs RR remained. Despite the material advantage Critter was stuck and after a long rook shuffle the engines agreed on a draw. Jonny keeps a 1 point lead over Ginkgo.
Laser - Jonny: By move 26 only QRB vs QRB remained, and the engines settled for a repetition draw not long after that.
Fire - Rybka: Evals stayed close to 0 the whole game, Rybka ended the game with a bishop sacrifice and perpetual check.
Houdini - Fizbo: Houdini had an eval advantage from the opening, Fizbo defended and exchanged pieces until only QRR vs QRR remained on move 23. Houdini's eval came down and then it was Fizbo's turn to be optimistic. However, with a pair of rooks exchanged the engines started to shuffle, and with the queens gone the draw came quickly. Despite the draw Houdini is now officially the winner of the rapid tournament. With only two games left Houdini leads Komodo by 2.5 points.
Komodo - Fire: Komodo had an eval advantage that grew to about 1 when Fire started to exchange pieces. By move 28 only QN vs QN remained and evals were on the way down. Fire created a passer that forced Komodo to draw with perpetual check. Komodo is only 0.5 points ahead of Stockfish.
Jonny - Raptor: Jonny got its queen into a tight spot in the corner, and the only way out allowed Raptor to exchange all pieces and reach a drawn rook ending. Ginkgo has a chance to catch up with Jonny in its last game if it wins against Fire.
The Baron - Komodo: The Baron held out for 25 moves against Komodo but it was all downhill from there. Komodo created a passer and opened up the position a little, its evals started to jump. The Baron had to give a bishop to get rid of the dangerous passer giving Komodo a decisive lead. After this win Komodo guarantees second place.
Fire - Ginkgo: Both engines had strong pawn lines and they began to shuffle on move 26. After another 40 moves a draw was agreed. Jonny keeps fifth place.


text:
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import { Ng2InputFormsConfig } from '../ng2-input-forms-config';

import {
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} from '@angular/forms';

@Component({
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export class InputTextareaComponent extends ElementBase<string> {
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  ) {
    super(validators, asyncValidators, config);
  }
}

let identifier = 0;

redpajama_set_name: RedPajamaGithub


1. INTERPRETATION: In these terms and conditions (Terms), the following words and phases shall have the following meanings. "The Buyer" means the person, firm or company who purchases the Goods and Services from the Company. "The Company" means Opt4mobility Limited. "Contract" means the contract or agreement between the Company and the Buyer, which shall be deemed to incorporate all the Terms. "Goods" means any goods and services agreed in the Contract to be supplied by the Company to the Buyer. "Place of Delivery," means the place to which the Goods are to be delivered or collected. In these Terms, reference to any statute or statutory provision shall be construed as a reference to such statute or statutory provision as amended, modified, re-enacted or replaced from time-to-time.
2. THE CONTRACT: The Contract shall be these Terms to the exclusion of all other terms and conditions, including any such terms and conditions that are purported to be included or applied by the Buyer. No terms and conditions contained in the confirmation of order, purchase order or any other document of the Buyer will form part of the Contract.
4. RISK IN AND OWNERSHIP OF THE GOODS: Risk in the Goods shall pass to the Buyer on delivery or collection of the Goods. Ownership in the Goods shall not pass to the Buyer until the Company has received in full in cleared funds all sums due to the Company in respect of the Goods and all other sums which are or may become due to the Company from the Buyer on any account. Until ownership of the Goods has passed to the Buyer, the Buyer shall hold the Goods on a fiduciary basis as the Company's bailee; store the Goods separately from all other goods of the Buyer or any third party in such a way that they remain identifiable as the Company's property; not destroy or deface any identifying mark on the Goods or their packaging; maintain the Goods in satisfactory condition insured with the Company's interest noted on the policy and hold any proceeds of such insurance on trust for the Company and not mix them with any other money.
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Located on 28 acres in downtown Buffalo, between the shores of Lake Erie and Lake Ontario, Roswell Park Comprehensive Cancer Center is a 10-minute drive from the Canadian border.
It is served by the new Buffalo-Niagara International Airport, which offers 110 daily non-stop flights, and the Niagara Falls International airport, which accommodates international charter and cargo flights.
Please note that the above address is NOT Roswell Park's mailing address.
Exit Route 33 West at Locust St.
Cross the Peace Bridge into the U.S.
Roswell Park's parking garage is on the southeast corner of Carlton and Elm Streets, across from the hospital's main entrance. Clearance in the parking garage is 6'5". Valet parking is also available.
Buffalo/Niagara International Airport is approximately six miles from Roswell Park. Many area hotels offer shuttle bus transportation from the airport. Alternately, there is taxi service. Rental cars are also available.
Buffalo is served by a number of bus lines. Buses arrive at the main bus station, which is approximately two miles from Roswell Park. Learn more at the Niagara Frontier Transportation Authority (NFTA) website which includes routes, schedules and fare information, or call 716-855-7211.
Roswell Park is easily accessed by the city's Metro rail. The Allen/Medical Campus Station is located within one city block of Roswell Park at Main and Allen streets. For schedules and fare information, visit call the NFTA website or call 716-855-7211.
Rail service to Buffalo is provided by Amtrak. There is taxi service available from the train station.


text:
Newsroom > Aira Announcement > MBTA Launches AccessAI Pilot Connecting Blind and Low Vision Users with Aira's Human Artificial Intelligence Technology
MBTA Launches AccessAI Pilot Connecting Blind and Low Vision Users with Aira's Human Artificial Intelligence Technology
An Aira Explorer holding their smartphone with the Aira app open. The smartphone camera is pointed toward a map of the T.
Aira's technology, services will be free to users throughout the MBTA bus, subway, Commuter Rail, and ferry system during the six-month pilot that began May 1.
BOSTON – The MBTA announced the launch of a free six-month accessibility technology pilot called "AccessAI" featuring Aira's human artificial intelligence (human AI) technology at a kick-off event and live demonstration held today at Government Center Station with General Manager Steve Poftak, Assistant General Manager of System-wide Accessibility Laura Brelsford, Aira Co-Founder and CEO Suman Kanuganti, Massachusetts Association for the Blind and Visually Impaired Executive Director Sassy Outwater-Wright, and AT&T External Affairs Assistant Vice President Brooke Thomson. Local elected officials and members of the blind and low vision community were also in attendance.
Aira connects blind or low vision users with highly trained sighted agents who provide visual information about the user's surrounding environment—live and on-demand through smartphone video technology. During the six-month pilot that began on May 1, the Aira smartphone app, powered by AT&T, will be free to users throughout the MBTA system at all bus stops, subway stations, Commuter Rail stations, and ferry routes.
"Aira is passionate about transforming daily life for people who are blind or low vision, as better mobility leads to a better economy, which impacts everyone positively," said Aira Co-Founder and CEO Suman Kanuganti. "We are proud to be collaborating with the MBTA on this unprecedented public private partnership. Together, we will increase accessibility on public transit, for communities in Massachusetts, and the world."
"Technology is enhancing transit infrastructure. This pilot program gives us the opportunity to unite people, technology, and mobility in ways that have never been tried before. I want to see how far we can go with this," said Massachusetts Association for the Blind and Visually Impaired Executive Director and Aira Explorer Sassy Outwater-Wright.
The MBTA is committed to continuous accessibility improvements that allow customers to use the system as independently as possible. Aira's visual interpreter service will be available to users for free throughout the MBTA's subway, bus, ferry, and commuter rail systems during the six-month pilot through October 31, 2019. The MBTA will also educate the public about the availability of this service through targeted marketing to the MBTA's Blind Access CharlieCard users and The RIDE's blind or low vision users as well as through community engagement with local blind and low vision advocate groups. This pilot comes at no cost to the MBTA.
During the six-month pilot, users will be regularly surveyed on the app's impacts with data that is gathered available to both the MBTA and Aira, and analyzed upon completion of the pilot. Next steps following the pilot will be determined after this data is gathered and analyzed following the pilot's conclusion.
Used previously at places including the Perkins School for the Blind and Massachusetts Association for the Blind and Visually Impaired (MABVI), free access to Aira is also available at Massport's Boston Logan International Airport and Worcester Regional Airport. Additional Aira Access locations can be found here.
MBTA customers interested in accessing Aira while within the MBTA system are encouraged to visit the MBTA website and AccessAI.today for more information, downloading the Aira smartphone app, and signing up for training sessions offered by the Massachusetts Association for the Blind and Visually Impaired. More information can also be found by connecting with the T on Twitter @MBTA or Aira @airaio.
Access AI MBTA The T Transit Transportation
Improvements Made to Horizon and Aira Service
Beyond Vision to Support Aira Free Trial Campaign Effort

redpajama_set_name: RedPajamaCommonCrawl


text:
Blues History: The Seventies
Peter Miles
Peter Miles gives us a history of Southend United Football Club. Part Four:
Arthur Rowley's first full season in charge at Roots Hall proved to be a spectacular disappointment. His three year contract with the club came with one of the highest salaries in the lower divisions. What was expected to be a promotion contending season faltered early on, the Blues winning just three of their opening thirteen encounters. Strangely for a record goalscorer like Rowley, his charges mustered only seven goals in that run. While his own signings took time to settle, it was Ernie Shepherd's final signing that caught the eye. Young winger, Peter Taylor, a £100 signing from Canvey Island, gained some rave reviews when he broke into the team towards the end of the campaign. Prolific front man Billy Best top scored for the third successive campaign.
In the build up to the 1971/72 season the Blues undertook a historic tour to Russia. Although all four matches played ended in narrow defeats, the tour was a resounding success and gained the club positive headlines.
Blues take on Shinnik Yarosavi
Rowley had rebuilt his team for the new season, notably in defence with Ray Ternent and Brian Albeson joining the club. After another slow start the side picked up substantial momentum in the League and also enjoyed an FA Cup success against eventual Third Division champions, Aston Villa. The club had a super run of seventeen unbeaten matches in March and April and looked strong bets for the title. However, a vital home game against Cambridge United was lost when goalkeeper Derek Bellotti was injured early on in the game. A further three draws handed the title to Grimsby Town but second place ensured a return to the Third Division. Long serving defender, Tony Bentley, was rewarded with a second testimonial match against Stoke City.
The new season saw an excellent signing arriving at the club, Alan Moody signed from Middlesbrough and would go on to set the club's all time appearance record of 507 games. However, after a League Cup tie with Chelsea in September, the Shrimpers accepted a club record bid of £80,000 for Bill Garner from the Stamford Bridge club. Goals proved hard to come by without Garner and Gary Moore went a dozen matches with out a goal. In November Rowley bought in Chris Guthrie from Newcastle to help Best with the burden of goalscoring. He obliged with 15 goals in 25 games and steered the Blues to mid-table safety.
The next two seasons under Rowley proved to be a disappointment with the club failing to progress up the table, indeed an 18th placing in 1974/75 saw the Blues avoid relegation by a mere four points. Prodigious talent Peter Taylor had been sold to Crystal Palace for a record fee of £120,000 and would eventually win full England caps. Rowley had secured some very decent signings, Stuart Brace top scored in the 73/74 season and Tony Hadley and Ronnie Pountney would enjoy lengthy careers at Roots Hall.
If those seasons were disappointing the 1975/76 campaign was an unmitigated disaster and would prove to be Rowley's last at the helm. While the FA Cup proved to be a welcome distraction, Swansea, Dover, Brighton and Cardiff were beaten in a run to the fifth round, League form slid alarming during the season. A run of just two wins in the final thirteen games of the campaign ensured the Blues finished second bottom and dropped back to Division Four.
The 1975/76 Squad
Scotsman Dave Smith was the man charged with reviving Southend's fortunes. He cleared out a number of Rowley's men and signed the likes of Neil Freeman, Ken Price and Micky Laverick. While a tenth place finish in the League was viewed as a disappointment, the club reached the third round of the FA Cup for the fourth successive campaign.
Manager Dave Smith
Smith pruned his squad further, preferring to work with a smaller tightly knitted team. The fulcrum of the team, Alan Moody, Derrick Parker and Colin Morris would play every game while Laverick and Frankie Banks would only miss five games between them. While the Blues finished some distance behind champions Watford, excellent home form ensured promotion was always on the cards for the Shrimpers.
The 1978/79 Squad that took on the European Champions
Smith reinforced his defence for the challenges of the third tier by recruiting Micky Stead, Dave Cusack and Mervyn Cawston. All three would make a significant impact on the club. The team were marooned in mid-table for the whole campaign, with goalscoring problems hampering any hopes a good finish to the season. The previously reliable Derrick Parker, mustered only a dozen goals, yet this would be five strikes more than his nearest team mate.
Blues ran Liverpool close at Roots Hall
The undoubted highlight of the campaign would be the FA Cup which saw the Blues drawn at home to European champions Liverpool at home in the third round. On an icy pitch, the original date having been frozen off, the Blues gave their famous guest a hell of a fright and held them to a goalless draw in front of a record Roots Hall gate of 31,033. While the replay at Anfield was lost, legendary Liverpool manager Bob Paisley was full of praise for Dave Smith's men.
Mervyn Cawston
The last season of the decade would prove to be a real shock for Smith's men and would result in relegation. Pre-season was difficult after the whole squad went down with food poisoning following a game at Dover. When the season proper started it appeared to start well, a League Cup run had seen the club defeat First Division opposition away from home for the first time ever when Bolton Wanderers fell to two goals from Colin Morris. The third round saw a three game epic against West Ham United with a crowd of 22,429 watching the first replay at Roots Hall. The FA Cup though would prove the antithesis this however, the Blues suffering the ignominy of a defeat to Isthmian Leaguers Harlow Town.
Smith altered his strike force mid season, trading Colin Morris for Derek Spence from Blackpool and buying Keith Mercer for £80,000 from Watford. The new strike partnership could not halt the slide and a run of one win in the last five matches of the season meant the Blues finished two points short of safety. The new decade would start in the basement division once again.
Derek Spence
By Peter Miles


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text:
Health Rights Litigation and Access to Medicines: Priority Classification of Successful Cases from Costa Rica's Constitutional Chamber of the Supreme Court
Ole Frithjof Norheim and Bruce M. Wilson
Health and Human Rights 2014, 16/2
Although Costa Rica has no explicit constitutional right to health, its constitutional chamber of the Supreme Court (Sala IV) has become increasingly central to the resolution of many health care decisions. Some argue that courts' decisions about individuals' access to very expensive medications could upset the country's medical priorities and harm the state's general health care provision capacity. This article assesses whether health rights litigation concerning the right to medications leads to more fairness in access to medications in Costa Rica. We review randomly selected access to medicines cases successfully claimed at the Sala IV in 2008 and classify them into four priority groups using standard priority-setting criteria. We find that 2.7% of the successful cases fall into priority group I (highest priority), 27% in group II, 48.6% in group III, and 21.6% in group IV (experimental treatment). Our analysis reveals a majority of successful health rights litigation for medications results in court-mandated provision of new, expensive drugs, many with only marginal benefits. More than 70% of the successful cases evaluated concerned medications judged to be of low priority. Based on these cases, we cannot conclude that litigation leads to more fairness in access to medications.
In recent years, court cases litigating a right to health have grown rapidly in many countries, which has sparked a major debate concerning whether this litigation leads to more fairness in access to medicines and distribution of health benefits. While a major study led by Varun Gauri and Daniel Brinks draws relatively positive, if nuanced, conclusions concerning the impact of litigation on social rights, including health rights, a subsequent multi-country study led by Alicia Yamin and Siri Gloppen that focuses exclusively on health rights litigation is more agnostic in its conclusions and finds "that health rights litigation is neither a dangerously infectious trend to be urgently contained nor a panacea for health inequity."1 Here, we investigate the effects of litigation on priority setting and social justice through a case study of Costa Rica, which has experienced an explosion in health rights litigation since the late-1990s. The many court cases gave rise to a vocal debate between the leaders of the health care system and constitutional magistrates. The debate has been played out in court decisions and scholarly publications as well as in the national media. To assess the health impacts of the court decisions, we need to know who benefits from them, in terms of patient groups, as well as the distribution of benefits: how much are these persons helped, compared to other patients in need?2 A starting point is to look at the forms of treatment that are successfully litigated, and then use medical evidence regarding the individual burden of disease and the effectiveness of treatment for the condition in question to assess the distributional consequences of the court decisions.
We know that some of the earliest successful health rights litigation cases, in Costa Rica and many other countries in the early 1990s, concerned people living with HIV/AIDS.3 Since then, there have been many other medical cases litigated ranging from essential medicines to high-cost cancer treatments, multiple sclerosis, and kidney failure, as well as cases concerning waiting times for surgeries and in vitro fertilization (IVF). What we don't know is whether according these successfully litigated treatments higher priority makes the health system fairer. The answer, in part, depends on the prior situation of different patient groups: do other patients have unmet needs for which they could have been helped more with the same resources? These questions are examined through an in-depth study of the nature and impact of successful litigation for medications in Costa Rica.
Costa Rica is a small Central American country with a population of 4.8 million and is one of the oldest, most democratic countries in the Americas.4 Costa Ricans enjoy an extensive, government-provided social welfare system covering insurance, health care, pensions, and education, among other services.5 The success of this generous welfare system and virtually universal health care system is reflected in the country's relatively high Human Development Index (HDI) rank of 54th in the world.6 Despite a GNI per capita (PPP) of US$10,863 and per capita government expenditure on health at (PPP) is $932 (in 2012), key health indicators are very good, especially in comparison with the country's Central American neighbors.7 For example, life expectancy at birth is 78.7 years (77.4 years for males and 81.3 for females), and the under-five mortality rate is 10 per 1,000 live births; these are among the best rates in the Americas.8
Courts and health rights
Historically, Costa Rica's Supreme Court was, like most Latin American Supreme Courts, a moribund institution that was unable and unwilling to protect people's individual or collective constitutional rights. A 1989 constitutional reform created a Constitutional Chamber of the Supreme Court (Sala Constitucional or Sala IV) with far-reaching judicial review powers: the Sala IV has become one of the most assertive and politically significant courts in the Americas. Apart from exercising an emphatic accountability function, the court has been willing and able to support and enforce an expansive range of individual rights.9 The court effectively opened a significant new legal opportunity structure that political parties, individuals, and groups from virtually every sector of society have used. These range from the weakest, most marginalized individuals, including prisoners and people living with HIV/AIDS, to the most powerful, including multinational businesses and former presidents.10 The superior court abandoned its previous legal formalism and instead allows any individual to file a case directly with the Sala IV with no charge and no need to hire legal representation. The court is open 365 days a year, 24 hours a day. Thus, the court leveled the judicial playing field for all claimants and has had a profound impact on the balance of political power in the country. It has brought the constitution to life, placing it at the center of all political and rights questions in the country. According to one Sala IV magistrate, Eduardo Sancho, the role of the constitutional court from its inception has been to "protect the rights of people."11
The right to health in Costa Rica
Figure 1 shows a rapid increase in litigation following the inauguration of the Sala IV, but it was not until the early 1990s that the first health rights cases were filed. This is in part because Costa Rica's current (1949) Constitution contains no explicit, fundamental right to health. Rather, the Constitutional Chamber of the Supreme Court after its creation in 1989 constructed a constitutional right to health. According to the court, this right to health is derived from the Constitution's protection of human life (Article 21), the right to social security protection (Article 73), and many international Human Rights conventions to which Costa Rica is a signatory.12 These international human rights treaties are treated by the Sala IV as having an "almost supra constitutional value," which has helped facilitate a gradual expansion of a justiciable right to health that the court has been willing and able to respond to positively and quickly.13
One of the earliest health rights cases the Sala IV examined, in 1992, involved a person living with HIV/AIDS who filed a claim with the court to demand that the state-funded health care system (the Costa Rican Social Security Fund, Caja Costarricense de Seguro Social, CCSS) provide and pay for the anti-retroviral (ARV) medication azidothymidine. The CCSS had denied the patient's access to the medication. In response to the litigation, the CCSS argued that the drugs were not on the country's list of essential medicines because they were too expensive and were not a cure for HIV/AIDS. The Sala IV accepted the CCSS's argument, noting that an individual's right to health were necessarily limited by scarce financial resources, and ruled against the claimant, denying him state-funded access to the medication.14 The Court's restricted notion of a right to health was maintained over the following five years, during which time only 25 more medication cases were filed with the Sala IV; these resulted in only nine successful claims. Of those nine, seven were merely patients requesting permission to take their current medications at home instead of at a medical facility.15
The Sala IV's health rights jurisprudence began to change in 1997, when three HIV/AIDS patients filed a similar case to the failed 1992 ARV case. In 1997, highly effective triple combination ARV therapy had been developed and was in use in the US and other countries. In response to the new litigation, however, the CCSS made the same cost-based argument it had successfully employed in the 1992 case. This time, though, the Sala IV's health rights jurisprudence had developed to the point where the right to health was considered to be a justiciable constitutional right. The Sala IV's 1997 decision reversed its 1992 ruling, deciding in favor of the plaintiffs and ordering the CCSS to supply and pay for the necessary medications. The court argued, "What good are the rest of the rights and guarantees . . . [or] the advantages and benefits of our system of liberties, if a person cannot count on the right to life and health assured?"16 The justification for the court's ruling in this case became the foundation stone of all health rights jurisprudence and has been expanded and clarified in subsequent rulings. In 2003, for example, the Sala IV deliberated for just one hour before ruling against the CCSS's medical experts and forcing it to pay for Cerezyme, at an annual cost of $175,000, for a young girl with Gaucher disease.17 The court's jurisprudence relating to the provision of high-cost medications is clearly stated in a 2007 decision when the court argued that the CCSS cannot decline to fill prescriptions prescribed by a patient's treating physician for "eminently economic reasons."18 Instead, the court argued, the CCSS is "under the undeniable obligation" to supply them, even if they are not on the CCSS's official list. This increasingly expansive definition of the right to health has been frequently cited in many subsequent cases and, as seen in Figure 1, lit a slow-burning jurisprudential fuse that eventually resulted in an explosion of health rights cases.19
Although the ruling was originally inter partes (applying only to the people involved in this particular case), the subsequent deluge of cases filed by HIV/AIDS patients were decided by the Sala IV in the same manner and with the same reasoning, effectively making it erga omnes (a court decision that applies to all similar situations). Consequently, the CCSS provides ARV medications to all patients with a valid prescription from a CCSS doctor, resulting in the highest coverage of HIV/AIDS patients in Latin America. The impact of this decision was remarkable and fast; morbidity rates for people living with HIV and AIDS declined significantly after the 1997 decision, reversing the trend of the 1980s and 1990s.20
The lessons of the Sala IV's HIV/AIDS medication decision were recognized not just by other people living with HIV/AIDS, but by patients suffering from other chronic illnesses who subsequently used the legal opportunity provided by the Sala IV to claim and win access to expensive medications, even if the CCSS had previously denied their claims.21 According to Carlos Zamora—a medical doctor who works in the actuarial division of the CCSS—the 1997 decision was "perhaps the most relevant case in the rights to medication arena…the arguments put forth and the Sala IV's interpretation has served as a model that has shaped the field of health rights."22
Since the success of the 1997 decision, the number of amparo (a writ to protect or reestablish constitutional rights or human rights contained in international instruments to which Costa Rica is a signatory) cases claiming a right to medications increased gradually with some fluctuations before it exploded from 2002 onwards. While this rapidly increasing quantity of cases might discourage claimants from filing claims, the court has made great effort to reduce the length of time it takes to reach a decision on amparo cases. In the court's early years of operation, the average time to resolve an amparo case was 12 weeks, then, as a result of the rapid growth in caseload, it increased to five months by 2003. From 2003 onward, that time fell, reaching an average of seven weeks in 2011.23 While the vast majority of health rights claims are amparo cases, the court treats these cases as a special category and requires letrados (clerks to the court) to give them priority above all other cases except habeas corpus cases, dedicating one day per week to resolving health cases as quickly as possible. Also, while the vast majority of amparo cases are unsuccessful (approximately 75 percent), medical amparo cases tend to succeed more often. In the period under discussion here, medical amparo claims against the CCSS succeeded in over 60 percent of the cases.24 In most cases, the court has argued that "the specialist doctor who treats a patient knows better than anyone else their reality and needs" and that a prescription from that doctor outweighs the technical medical criteria used by the CCSS's Comité Central de Farmacoterapia (Central Committee of Pharmacotherapy) to determine which medicines should be on the essential drugs list.25
While it is clear that the number of cases has been increasing since 1997, little is known about the scope, outcome, and impact of those cases. Hogerzeil et al. report that in 2006, seven cases related to essential medicines won in Costa Rica. Their impact on the health system and its allocation of scarce health care resources is not known. As noted by Hogerzeil et al.: most public budgets are not infinite and at a certain moment choices have to be made. Progressive implementation of the right to health requires a State to choose which components should be implemented first. Under such circumstances, should courts of justice or national committees of experts decide how public funds are spent in the most equitable and cost-effective manner?26
Although several types of health-related cases are brought to the constitutional court, such as cases related to non-discrimination, surgeries, waitlists, quality of care, and others, a particularly interesting class of cases concerns access to medications. These cases are also the source of much of the criticism against the Sala IV from members of the CCSS who argue that these health rights medication decisions lead to the misallocation of scarce resources, corruption by unscrupulous lawyers and doctors acting on behalf of pharmacy companies, and by foreigners accessing court-mandated free medicines. Does the court secure individuals' access to high-priority medicines that the publicly funded health care system in Costa Rica should have provided or, arguably, should have put them on the essential drugs list? Or does the court decide with claims that from a public health or social justice perspective would be seen as a low priority? In short: does health rights litigation concerning the right to medications lead to more fairness in access to treatment and distribution of health benefits?
In this paper, we review 37 successful cases from Costa Rica concerning access to medicines brought to the Sala IV in 2008. We classify them according to standard fairness criteria from the public health and priority-setting literature.
The bars in Figure 1 show the rapid increase in the total number of cases filed with the Sala IV since its inception in 1989; the solid line reflects the number of amparo cases filed, which have historically accounted for almost 80% of the total caseload. Figure 2 illustrates the growth in the total number of cases based on the right to health. Figure 3 shows the development of a litigation strategy used by patients to file cases at the Sala IV against the CCSS to make a claim for a specific medication. The solid line in Figure 3 shows the increasing number of successful cases claiming a right to medications that the CCSS had previously denied. Taken together, these figures clearly demonstrate a delayed learning effect where claimants appear to have slowly recognized the creation of an effective legal opportunity that would allow them to approach the court to obtain medications that the CCSS had previously denied.
Figure 1: Sala IV total caseload and amparo cases, 1989-2013
Source: Sala IV, 2014
Figure 2: Health rights claims filed against CCSS, 1989-2008
Source: Zamora Zamora, 2010
Figure 3: Medication claims filed against CCSS, 1989-2011
Source: Zamora Zamora, Amparos contra la Caja Costarricense de Seguro Social, 2009 to 2011. Preliminary report. February 2014
To investigate the impact of this health rights litigation, we created a database of all the right to health cases filed with the Sala IV against the CCSS in Costa Rica for the year 2008. This database allows us to look deeper into these cases and conduct an evaluation of their impact on the equitability of the health system. In total, there were almost 18,000 cases filed, the vast majority (16,345) writs of amparo, of which approximately 500 were right to health cases.27 Of those cases, 192 were claims for medications, with approximately 50% of those cases winning their litigation. We then randomly selected 37 successful cases and extracted a brief description of the case, the medication involved, and the judicial basis of the court's decision. Second, we searched for published cost-effectiveness studies and reports where these medicines have been evaluated according to the methods of health technology assessment (HTA).28 We used PubMed to identify published academic studies, and the website of the National Institute for Health and Clinical Excellence (NICE) in the UK as a starting point for relevant and up-to-date publicly available HTA reports. Third, we extracted priority-relevant medical evidence concerning health outcomes and costs from the identified studies and reports. "Priority-relevant evidence" was defined as information necessary to evaluate the effectiveness of a given medication, its overall costs, and the severity of condition for a typical patient in need of medication. In addition, we extracted information about the quality of evidence concerning health outcomes and costs. After extracting priority-relevant evidence for the medications in question, we explicitly evaluated each medicine according to predefined criteria for priority classification. Finally, we summarized all evidence for each criterion, combined it into an overall assessment, and classified each medicine into one of four priority groups with declining rank of importance from a standard public health priority-setting perspective.
Analytical framework
Most scholars agree that the two main goals for health systems are: efficiency and fairness in the distribution of health and health care.29 While people disagree on the relative weight accorded to the different concerns, almost all theories of resource allocation in health care would recognize the following as criteria for assessing the priority of a given condition and its intervention:30
The severity of disease without the new medicine
The effectiveness of the new medicine
The cost-effectiveness of the new medicine
The quality of evidence on 1-3
In concrete cases, this information can be formulated in terms of the patient's characteristics, the nature of the condition, and the health intervention in question. We developed a framework for priority classification based on such standard fairness criteria from the public health and priority-setting literature:
Priority group I = High priority
Priority group II = Medium priority
Priority group III = Low priority
Priority group IV = Experimental interventions
By experimental interventions, we mean interventions judged as experimental according to evidence by a trustworthy health technology assessment agency. An intervention for a given condition is assigned high priority if it addresses a severe condition (where the prognosis is poor in terms of lost life years or reduced quality of life), if it is highly effective (improves the prognosis with regard to life years or quality of life), and if it is reasonably cost-effective. The measure of effectiveness used in most HTA reports and cost-effectiveness studies is the quality-adjusted life year (QALY). We grade clinical effectiveness in terms of QALYs. We use a threshold of > 1 QALY for very effective (grade I). For studies where severity of disease was not reported, we extracted relevant information and indirectly estimated the health gap by using QALY gain with standard treatment with the help of life tables for the relevant country. For example, if a 40-year-old patient from Costa Rica with terminal breast cancer had a prognosis of 1 QALY, her health gap was calculated as life expectancy at age 40 (= 42.2) minus 1 QALY (= 41.2). We use this as an indicator of her severity of disease. We classified a condition as very severe (grade I) if the loss is more than 5 QALYs; severe (grade II) if the loss is between 1 and 5 QALYs; and not severe (grade III) if the loss is less than 1 QALY (for further discussion of this framework and its application, see Norheim and Gloppen).31 Ideally, these thresholds should be discussed and determined in health-policy deliberations, but in the absence of agreement on thresholds, we believe that these are not unreasonable. In addition, we assessed whether effectiveness and cost-effectiveness had been documented in high-quality studies (preferably from randomized controlled trials). For the detailed framework, see Table 1.
Table 1: Criteria for priority classification
Criterion Information needed Measure* Grading
Effectiveness Mortality
Morbidity QALY gain** I > 1 QALY
II < 1 & > 0.5 QALY
III < 0.5 QALY
Severity of disease Mortality
Morbidity QALY loss*** I > 5 QALY loss
II > 1 QALY loss < 5 QALY loss
III < 1 QALY loss
Cost-effectiveness Total and incremental costs
Effectiveness Cost per QALY gained I Cost-effective: < GDP per capita
II Intermediate: > GDP per capita < 3 x GDP per capita
III Not cost-effective: > 3 x GDP per capita
Quality of evidence Type of studies documenting treatment effects Evidence grading systems**** I Meta-analysis or randomized clinical trial
II Observational, non-comparative studies
III Single case reports
* = Quality-Adjusted Life Years = QALYs
** = Compared to standard intervention
*** = Compared to normal healthy life expectancy
**** = Such as the AGREE instrument or others
In our material of 37 randomly selected cases which concerned access to medicines and were brought to the Constitutional Chamber of the Supreme Court, we found that 2.7% fell into priority group 1 (highest priority), 27% in group II, 48.6% in group III, and 21.6% in group IV (see Table 2). Only three of the drugs are already on the official WHO essential drugs list.
Table 2 provides more detail and summarizes all evidence for each criterion and combines it into an overall assessment of each medicine. Each medicine is classified into one of four priority groups with declining rank. In order to qualify for priority group I, the condition and medication in question must be evaluated as grade I for each criterion. The kind of conditions and number of cases are also listed.
A summary of priority-relevant evidence is listed in Table 3. Although there is uncertainty concerning evidence for effectiveness, severity, and cost-effectiveness for many cases, the evidence available from studies and HTA reports enabled us to evaluate each medicine according to predefined criteria for priority classification. For comparison, we have also included an evaluation of ARV therapy for HIV/AIDS that was introduced in 1997 in Costa Rica. Only one of the successful medications from 2008 is as effective or addresses such a severe condition as antiretroviral therapy for HIV/AIDS. Table 4 shows evaluation and grading of each medication according to the predefined priority criteria. We see from Tables 3 and 4 that some medications provide a QALY gain (effectiveness) of less than 1 QALY (grade II and III), while several have higher gains in terms of quality-adjusted life years.
Table 2: Priority classification of cases
Medicine Condition Cases I II III
Bevacizumab
Colon cancer 3 3
Carvedilol Heart disease 1 1
Cyclofosfamid Breast cancer 1 1
Erlotinib Lung cancer 1 1
Imatinib (Glivec) Leukemia 2 2
Lactulosa Portosystemic encephalopathy 1 1
Escitalopram (Lexapro/Cipralex) Depression 1 1
Medication for dialysis (serum) Kidney insufficiency 1 1
Nilotinib (Tasigna) Leukemia 1 1
Octreotidelar Pituitary adenoma 1 1
Omeprazol Stomach ailments 1 1
Pamidronato de sodio Osteogenesis imperfecta 1 1
Clopidogrel (Plavix) Heart disease 2 2
Clopidogrel (Plavix) Cerebral insult 2 2
Potassium gloconate Hypothyroidism 1 1
Risperdal Autism 1 1
Risperidona Vascular dementia 1 1
Alendronate Osteoporosis 2 2
Rituximab Lymphoma Hodgkin's desease 1 1
Sunitinib Kidney cancer with metastasis 2 2
Ralidomid Spinal cord cancer 1 1
Trastuzumab Breast cancer 6 6
Zometa Breast cancer with bone metastasis 1 1
Sildenafil (Viagra) Pulmonary hypertension 1 1
Capecitabine (Xeloda) Bilateral lung metastasis 1 1
Sum (%) 1
(27.0) 18
(48.6) 8 (21.6)
Table 3: Evidence for grading and priority classification
Effectiveness (individual QALY gain)
Severity of disease (QALY loss) Cost ($) per QALY Quality of evidence References
Bevacizumab Colon cancer 0.85 18 51,120 2 RCT# 69
Carvedilol Heart disease 2,309 RCT 70
Ciclofosfamida Breast cancer
Erlotinib Lung cancer
Imatinib (Glivec) Leukemia 1.00 >10 74,315 4 RCT 7172
Lactulose Portosystemic encephalopathy 1.4 28.4 57,000 Decision model + metanalysis of 10 RCT (low quality, weak evidence) 73
Escitalopram (Lexapro/Cipralex) Depression 3 >5 28,167 74
Medication for dialysis Kidney insufficiency 10 20 100,000 Standardly used in high-income countries 75
Nilotinib (Tasigna) Leukemia Not found Not found Not found Experimental. Rejected by NICE UK 2009 76
Octreotidelar Pituitary adenoma Not found Not found Not found Experimental? No HTA§/CEA study found
Omeprazol Stomach ailments/hiatus hernia 1 2 3.000 Standardly used in high-income countries No HTA/CEA study found
Pamidronatode sodio Osteogenesis imperfecta Not found Not found Not found Experimental? Approved by Atnea (US) No HTA/CEA study found
Clopidogrel (Plavix) Heart disease 0.1 9.19 15.400 RCT + CEA$ 77
Clopidogrel (Plavix)Carvedilol (Coreg) Cerebral insult Search RCT 7870
Potassium gloconate Hypothyroidism Not found Not found Not found – No HTA/CEA study found
Risperdal Autism Not found Not found Not found Experimental. Not approved in 2005 by US Food and Drug Administration (FDA) No HTA/CEA study found
Risperidona Vascular dementia NE NE Not found No HTA/CEA study found
Alendronate Osteoporosis 0.15 2 11,600 RCT 79
Rituximab Lymphoma
Hodgkin's disease 0.82 >5 17,271 1 RCT 80
Sunitinib Kidney cancer with metastasis 0.20 19,5 74,000 1 RCT + CEA 81
Talidomida Spinal cord cancer Not found Not found Not found Experimental? No HTA/CEA study found
Trastuzumab Breast cancer 1.54 10,45 18,970 RCT + CEA 82
Medical treatment with zometa Breast cancer with bone metastasis
Sildenafil (Viagra) Pulmonary
hypertension 0.2 >5 Not found Only one small open label trial of Sildenafil 50 mg orally 83
Capecitabine (Xeloda) Bilateral lung metastasis 0.2 >5 Uncertain 1 RCT for combination therapy, weak evidence 84
Comparison case: Antiretroviral therapy HIV eligible for treatment > 3.5 > 20 1180 * RCT + CEA
* = cost in recent analysis, not at the point of introduction (1997)
# RCT = Randomized clinical trial
§ HTA Health technology assessment
$ CEA = Cost-effectiveness analysis
Table 4: Evaluation and grading of each medication according to the priority criteria
Condition Number of cases WHO Essential drug list Effectiveness Severity Cost-effectiveness Strength of evidence
Priority group
Bevacizumab Colon cancer 3 0 II I III II III
Carvedilol Heart disease 1 0 I I I
Ciclofosfamida Breast cancer 1 0 II
Erlotinib Lung cancer 1 0 III
Imatinib (Glivec) Leukemia 2 0 I I III I III
Lactulosa Portosystemic encephalopathy 1 0 I I III III III
Escitalopram (Lexapro/Cipralex) Depression 1 0 I I II II II
Medication for dialysis (serum) Kidney insufficiency 1 0 I I III I III
Nilotinib (Tasigna) Leukemia 1 0 NE* NE NE Experimental IV
Octreotidelar Pituitary adenoma 1 0 NE NE NE Experimental IV
Omeprazol Stomach ailments 1 YES I II I I II
Pamidronato de sodio Osteogenesis imperfecta 1 0 NE NE NE Experimental IV
Clopidogrel (Plavix) Heart disease 2 0 III I II I III
Clopidogrel (Plavix) Cerebral insult 2 0 III
Potassium gloconate Hypothyroidism 1 0 NE NE NE Experimental IV
Risperdal Autism 1 0 NE NE NE Experimental IV
Risperidona Vascular dementia 1 0 NE NE NE Experimental IV
Medication alendronato sodico Osteoporosis 2 0 III II II I III
Rituximab Lymphoma Hodgkin's desease 1 0 II I II II II
Sunitinib Kidney cancer with metastasis 2 0 III I III II III
Talidomida Spinal cord cancer 1 0 NE NE NE Experimental IV
Trastuzumab Breast cancer 6 0 I I II I II
Medical treatment with zometa Breast cancer with bone metastasis 1 0 III
Sildenafil (viagra) Pulmonary hypertension 1 0 NE I NE Experimental
Capecitabine (xeloda)
Bilateral lung metastasis 1 0 III I III III
* NE = no evidence
Most conditions, however, are severe. We see from Table 3 that many conditions imply a QALY loss of five or more. Some groups can expect 1-5 QALYs lost, while there are no non-severe cases with conditions in category III, that is, with expected losses of less than 1 QALY.
In terms of cost-effectiveness, few interventions are evaluated as highly cost-effective; many are evaluated as not cost-effective; some as intermediate; and for 10 cases, there were no cost-effectiveness analyses available.
Eight of the medications are evaluated as experimental, according to evidence by an HTA agency deemed trustworthy as of 2008; all the others are proven effective in large randomized clinical trials.
In this study, we review 37 cases from Costa Rica concerning access to medicines brought to the court and won in 2008. After considering available evidence, we classified them according to standard fairness criteria from the public health and priority setting literature. Of the 37 cases evaluated, 73% can be classified as either low priority or experimental. These medications can be described as providing 'marginal' health benefits for very severe conditions at a high cost for the health care system. For the remaining 27% of the cases falling into priority class I or II, it is not unreasonable—according to our evaluation—that those were successful. Trastuzumab (herceptin) for breast cancer is the largest group in this category.
How robust is our system for priority classification? There is some agreement on priority criteria, but reasonable people may disagree on classification. Every system of priority classification is bound to be controversial. Our method is based on all available evidence, and we use explicit criteria grounded in theories of fair priority setting in health.
Priority setting according to cost-effectiveness is particularly controversial. WHO and others have suggested that interventions be classified as highly cost-effective if cost per QALY is less than one GDP per capita; intermediate if cost per QALY is more than 1 x GDP per capita and less than 3 x GDP per capita; and not cost-effective if cost per QALY is above 3 x GDP per capita.32 For example, if treatment for advanced breast cancer would cost less than $10,800 per QALY gained, it would be considered highly cost-effective. According to this rule of thumb, all interventions costing more than approximately $32,400 per QALY gained would be judged as not cost-effective. The underlying ethical rationale for considering cost-effectiveness is that there may be unmet needs in the system for which there exist more cost-effective interventions, and that population health is more efficiently improved if priority is given to the most cost-effective interventions first.
Moreover, our framework requires that all criteria be satisfied cumulatively, that is, each condition must be severe enough, and the treatment effective and cost-effective enough to qualify for a priority group. An alternative would be to balance the criteria against each other so that, for example, since HER2+ breast cancer is very severe (grade I) and the treatment (Trastuzumab) effective (grade I) in terms of effectiveness but only grade II in cost-effectiveness, a judgment could be made to adjust the cost-effectiveness threshold so that overall the case is classified as priority group I. This accords with commonly held notions of fair distribution of health benefits. However, there is no agreement on how much the cost-effectiveness threshold should be adjusted when the intervention targets a very severe condition where the QALY loss is particularly great.33 We therefore used the cumulative grading system instead of a weighted grading system.
It is important to note that this method does not capture all aspects relevant for evaluation of equity. Classification in priority groups is only one part of the evaluation. The method focuses on fair and efficient distribution of health outcomes, but is not assessing fair access to medicines in terms of the socioeconomic status of patients or other issues related to non-discrimination. For an overall assessment, we also need to know more about whether there are many other unmet medical needs that would have fallen into priority group I or II. It is worth noting that invariably, all cases concerned claimants with high severity of disease that would have a large impact on health inequality if not treated. This fact is probably given high weight in the court's deliberation on individual cases. One may question whether our classification has assigned enough weight to this criterion. This issue can be seen as an aspect of the familiar trade-off between efficiency and equity.34 Moreover, we evaluate the conditions and medicines for the typical patient, and are aware that particular characteristics of individual patients may vary.
By taking a random sample of cases from our database, we attempted to create a representative set of medical cases. We know from follow-up studies conducted by the Sala IV that the CCSS's compliance with the court's decisions is almost universal, and patients regularly receive the medications claimed in successful health rights cases.35 However, while the original database is the most comprehensive representation of all health rights cases filed and decided by the court, it is possible that some cases have been overlooked due to the difficulties of searching through the 18,000 cases filed in 2008. Adding to the difficulties understanding the success or failure of medication claims is the court's tendency to combine similar individual cases together with a single decision number. Our sample, even if randomly selected, is quite small.
More importantly, as Figures 2 and 3 show, our database of cases concerning medicine is not representative of all health rights cases brought to the court. We have not assessed cases concerning non-discrimination, waiting lists, quality of care, infrastructure, or surgery. Nor have we examined the cases in which the court's decision was followed by the CCSS's inclusion of the claimed medication into the official medications list, as happened with the AIDS medications in 1997, and more recently, the multiple sclerosis cases.36 Finally, we have not examined the recent health rights decisions decided in favor of entire classes of people. Further analysis of a larger and more comprehensive sample, using the same methods, is clearly warranted.
A 2009 decision ruled that everyone aged over 65 years should be granted access to vaccinations for pneumococcus, which was previously provided only to children under 2 years (a high-risk category).37 A group of senior citizens filed the case, arguing that they, too, were a high-risk group for pneumococcal infection, and that the CCSS was denying their right to health. Their claim was successful, and the CCSS was forced to vaccinate them (and all other people over 65) against pneumococcus and rotavirus at a total cost of $8 million per year.38 This confirmed the fears of the health rights litigation critics that the Sala IV's decisions were diverting scarce resources from the higher priorities set by the CCSS's experts. In the pneumococcus case, though, the Sala IV invited the Minister of Health to present her medical experts' views to the court before it made its decision. According to one senior letrado, this evidence "probably tilted the case in favor of the seniors' demand to have access to the vaccine."39 That is, the actions of the court were more dialogic than previous decisions and were more of a class settlement than the previous inter partes health rights decisions (i.e. binding only on the parties involved in the case).40
Does health rights litigation that seeks access to medications not covered by an official medications list lead to more fairness in access to medicines and distribution of health benefits? For the case of Costa Rica, we have shown that of the 37 cases evaluated, about 70% could be classified as either low priority or experimental and can be described as providing 'marginal' health benefits for very severe conditions at a high cost to the health care system. For the remaining 30% of the cases falling into priority class I or II, it is not unreasonable—according to our evaluation—that these were successful.
The priority classification system applied here makes it possible to distinguish medications that could be assigned high, medium, low or no priority, according to available evidence and relatively standard fairness criteria from the public health and priority-setting literature. Further studies of a representative set of cases are needed to evaluate whether health litigation contributes to a more or less fair distribution of health in Costa Rica. Like the current analysis, it could be based on a framework specifying widely agreed principles of fair distribution, and assigning high priority to health services that have a large impact on life expectancy (improves average health), and targeting those with least lifetime health measured in terms of quality of life and premature mortality (reducing overall health inequality). If a majority of the successful litigated medication cases results in access to new expensive medications with only marginal benefits, we cannot conclude that litigation led to more fairness in access to medications in Costa Rica. More than 70% of the successful cases analyzed concerned medications judged to be of low priority.
While consistently pushing back against criticism that it is making poorly informed medical decisions and placing an untenable financial burden on the CCSS, the court actively sought partners and input to create a process that would allow the magistrates to make more informed decisions on health rights cases. The court recently signed a Technical Cooperation Plan (Plan de cooperación técnica) with the Cochrane Collaboration that involved all major stakeholders in the health care system. This new collaboration, signed in May 2014, will facilitate an ongoing dialogue between interested health specialists on important questions of "equity, efficiency, design and implementation of public policies concerned with prioritization, law, and the judicialization of health."41 It will also provide the Sala IV with access to the Cochrane Collaboration's extensive medical databases and provide training to relevant court personnel to better understand specialized medical information.42 As a consequence of the collaboration, the Sala IV should be able to make better-informed health rights decisions that benefit from previously unavailable technical medical information and input from relevant stakeholders.
To include all stakeholders in mechanisms for systematic and impartial consideration of the medical evidence, the costs, and the distributional impact of introducing new medications is an important first step toward making the priority-setting process fairer.
Ole Frithjof Norheim, MD, PhD, is a Professor in the Department of Global Public Health and Primary Care, University of Bergen, Norway.
Bruce M. Wilson, PhD, is a Professor in the Department of Political Science at the University of Central Florida, Orlando, FL, USA, and Associated Senior Researcher at the Chr. Michelsen Institute, Bergen, Norway.
Please address correspondence to Ole Frithjof Norheim. Email: ole.norheim@igs.uib.no.
See generally, V. Gauri and D. Brinks (eds), Courting social justice: Judicial enforcement of social and economic rights in the developing world. (New York: Cambridge University Press, 2008); A. Yamin and S. Gloppen (eds), Litigating health rights: Can courts bring more justice to health? (Cambridge, MA: Harvard University Press, 2011).
A. Yamin and O. Norheim, "Taking equality seriously: Applying human rights frameworks to priority setting in health." Human Rights Quarterly 36, (2014), pp. 296-324.
A. Yamin, "Power, suffering, and courts: Reflections on promoting health rights through judicialization," in A. Yamin S. Gloppen (eds) (see note 1).
World Health Organization, Global health observatory: Costa Rica statistics summary (2002-present). Available at http://apps.who.int/gho/data/view.country.6800; Freedom House, Freedom in the world. Available at http://www.freedomhouse.org/report-types/freedom-world.
B. Wilson, "The causes and consequences of health rights litigation in Costa Rica," in A. Yamin S. Gloppen (eds) (see note 1), pp. 132-154.
United Nations Development Programme, Human Development Report 2009. "Overcoming barriers: Human mobility and development."Available at http://hdr.undp.org/sites/default/files/reports/269/hdr_2009_en_complete.pdf. (New York: Palgrave Macmillan, 2009).
UNDP. "Statistical Tables from the 2013 Human Development Report." (2014). Available at https://data.undp.org/dataset/GNI-per-capita-in-PPP-terms-constant-2005-internat/u2dx-y6wx.
UNDP (2009), see note 6.
S. Gloppen et al, Courts and power in Latin America and Africa (New York: Palgrave Macmillan, 2010); B. Wilson, (see note 1); B. Wilson and O. Rodríguez, "Costa Rica: Understanding variations in compliance," in Langford et al (eds), Making it stick: Compliance with socio-economic rights judgments in comparative perspective (New York: Cambridge University Press, forthcoming 2015).
B. Wilson and J. Rodríguez, "Legal opportunity structures and social movements: The effects of institutional change on Costa Rican politics," Comparative Political Studies 39/3 (2006), pp. 325-351.
Sala IV. Corte suprema de justicia-Sala Constitucional, reseña histórica (1999). Document on file with authors.
K. Vargas López, El desarrollo del derecho a la salud por parte de la Sala Constitucional y su influencia en el sistema público de salud en Costa Rica, MA thesis (2010). Available at http://portal.ccss.sa.cr/portal/page/portal/Gerencia_Administrativa/dJuridica/Contextos/EL_DESARROLLO_DEL_DERECHO_SALUD%20_POR_PARTE_SALA_CONSTITU.pdf.
F. Cruz Castro, "Costa Rica's constitutional jurisprudence, its political importance, and international human rights law: Examination of some decisions." Duquesne Law Review 45/3 (2007), pp. 557-576.
Resolution number: 1992-00280.
C. Zamora Zamora, "Los recursos de amparo y los recursos de constitucionalidad con la Caja de 1989 a 2008," Caja Costarricense de Seguridad Social Dirección Actuarial (2010), Working paper.
S. Heuser, "One girl's hope, a nation's dilemma," Boston Globe (June 14, 2009). Available at http://www.boston.com/news/health/articles/2009/06/14/one_girls_hope_a_nations_dilemma.
Resolution number: 2007-00043; Resolution numbers 2002-7384, 2005-13408, and 2008-0907, among many others; Resolution number 2005-7379.
R. Navarro Fallas and R. Piza Rocafort. "Protección constitucional del Derecho a la Salud en Costa Rica." Unpublished manuscript on file with authors, (2013).
B. Wilson, see note 1.
B. Wilson, "Claiming individual rights through a constitutional court: The example of gays in Costa Rica," International Journal of Constitutional Law 5 (2007), pp. 242-257.
C. Zamora Zamora, see note 15.
Poder Judicial, "Sección de estadísticas, departamento de planificación. Promedio de duración de los votos de la Sala IV." Available at http://sitios.poder-judicial.go.cr/salaconstitucional/estadisticas/promedios%20de%20duraci%C3%B3n%20de%20los%20votos.pdf.
Resolution number 13408-05 among others. Vargas López, (2010), see note 12; Resolution numbers 2003-5246, 2004-11302, among many others.
H. Hogerzeil et al, "Is access to essential medicines as part of the fulfilment of the right to health enforceable through the courts?" Lancet 368/9532 (2006), pp. 305-311.
Poder Judicial, see note 23.
M. Drummond et al., "Key principles for the improved conduct of health technology assessments for resource allocation decisions," International Journal of Technology Assessment in Health Care 24/3 (2008), pp. 244-258.
D. Brock and D. Wikler, "Ethical issues in resource allocation, research, and new product development," in D. Jamison et al (eds), Disease control priorities in developing countries, 2nd ed. (New York, Oxford University Press and The World Bank: 259-270, 2006); N. Daniels, Just health (New York, Cambridge University Press, 2008).
C. Ham, "Synthesis: What can we learn from international experience?" British Medical Bulletin 51/4 (1995), pp. 819-830; C. Ham and A. Coulter "Where are we now?" in A. Coulter and C. Ham (eds), The global challenge of health care rationing (London, Open University Press, 2000); O. Norheim, "Increasing demand for accountability: Is there a professional response?" in A. Coulter and C. Ham (eds), see note 30.
O. Norheim and S. Gloppen, "Litigating for medicines. How can we assess impact on health outcomes?" pp. 304-332, in A. Yamin and S. Gloppen (eds), see note 1.
R. Hutubessy et al, "Generalised cost-effectiveness analysis: An aid to decision making in health." Applied Health Economics Health Policy 1/2 (2002), pp 89-95; D. Jamison et al, see note 29.
M. Rawlins and A. Culyer, "National Institute for Clinical Excellence and its value judgements. " BMJ 329 (2004), pp. 224-226.
O. Norheim, "A note on Brock: Prioritarianism, egalitarianism and the distribution of life years." Journal of Medical Ethics 35/9 (2009), pp 565-569.
B. Wilson and O. Rodríguez, see note 9.
E. Ramírez Flores, "Ratifican condena contra la CCSS por caso de vacunas." Seminario Universitario (June 6, 2010). Available at: http://www.semanariouniversidad.ucr.cr/component/content/article/757-Pa%C3%ADs/2392-ratifican-condena-contra-la-ccss-por-caso-de-vacunas-.html
Resolution number: 2009-8339.
Á. Ávalos, "Sala IV ordena vacunar contra neumococo y rotavirus." La Nación (October 22, 2008). Available at http://wvw.nacion.com/ln_ee/2008/octubre/22/pais1746428.html.
Personal correspondence on file with the author, April 2010.
R. Gargarella, "Dialogic justice in the enforcement of social rights: Some initial arguments." In A. Yamin and S. Gloppen (eds), see note 1.
"Sala Constitucional y médicos forenses se capacitan." Available at http://sitios.poder-judicial.go.cr/salaconstitucional/documentos%20varios/02-05-14%20Nota%20capacitacion.pdf.
"Cooperación Técnica entre la Sala Constitucional de Costa Rica y la Colaboración Cochrane." (2014). Available at http://youtu.be/-FTUHIunv8?list=UU5pGw_JyZ1daGCnXMlCtDvg.
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text:
Love Rain...
I fancy myself a pop-culture pundit of sorts and so am not ashamed to admit that this includes my succumbing to the Reality TV/Celebreality machine. Likewise, I also try to stay abreast of social media buzz and peep what blogs, cyber-mags, and social networking forums are on about. The two mediums seem to go hand-in-hand, particularly when the "Black Twitter" collective is concerned. Black tweeters bring the LOLz and they come, guns blazing, when skewering Black celebrities for some foolish infraction. Black politicians, especially of the Conservative-Republican variety, aren't above Twitter reproach either... (Herman Cain-kabob anyone?).
Perhaps the best, below-the-belt barbs and Twitter hash-tags come during the hours reality shows such as Real Housewives of Atlanta, The Braxtons, Basketbell Wives, Love & Hip Hop and shows of that ilk are on. Some of the more snarky Black tweeters hit their mark with their quips during some of the more ridiculous, off-the-cuff scenes. Then there're those who incite the rest of us to chorus and ask "Huh?" after they've tweeted something... well... dumb or misguided.
Per usual, folks did not disappoint during Love & Hip Hop, which was followed up by the premiere of T.I. and Tiny: The Family Hustle, VH-1's latest reality offering, which documents the lives of rapper T.I. (fresh from a second prison stint) and his long suffering girlfriend-turned-wife Tiny, of Xscape and BET's Tiny & Toya fame.
Surprisingly, Black women on Twitter seemed to saturate their chonies with crème-de-la-lady leche and began espousing the virtues of true love during some of the more pivotal scenes on Love & Hip Hop (when rapper Jim Jones finally implored his mother to stop antagonizing his embattled and always battling lady-in-waiting, Chrissy Lampkin. Jones later pledged his undying affection for Chrissy by placating her o'er top of a roof for a Moroccan inspired dinner with all the decorative fixings). T.I's - (who makes it known under no uncertain terms, that he wears the pants and bankrolls day-to-day operations in his relationship with Tiny) - obvious loyalty to his blended family and wife is undeniable. In fact, seeing it played out on TV caused a collective genital quake across Twitter however; the relationship has been fraught with well-documented legal troubles and alleged cheating. But this did not stop some women from christening Jim and T.I.'s dysfunctional relationships with their women as the blueprint for Black love. I'd be willing to wager that some of these admirers of dysfunctional love, were some of the same detractors of single-motherhood who suggested single moms should aspire to be like Beyonce and Jay Z, shortly after her pregnancy announcement. They lashed out, calling all Snarky McSnarksteins jealous haters who can't get a man or sustain a relationship ... ... ... OK.
One writer for the popular online publication, Clutch Magazine, posted a whole article citing these two televised relationships as heartfelt and wrote:
"Say what you will about Tiny and T.I.'s hoodrich love, but theirs is the type of relationship many long for: Loving, affectionate, fun, respectful, and supportive. Just like Jim and Chrissy, watching T.I. and Tiny interact on screen made it clear that they are genuinely in love and they want the world to know."
Much to the chagrin of some commenters, who cyber side-eyed the piece...
"T.I and Jim Jones… you have to be kidding! What I don't understand is this constant need to look to celelbrities [sic] as role models. I mean I really don't understand it. I would like to hope these old a$$ men would want to settle down. T.I with all those d@mn kids! Jim jones and Dipset with the way the [sic] talk about women…"
Listen, while no one deserves to be crucified for their past and everyone has the right to err, love, and be loved; Why is it that some in our community put these dysfunctional "ride or die" relationships on a pedestal (especially when a man of questionable character is at the helm, trying to overcompensate for having put his paramour or wife through years of hell), yet will belittle others (usually when a woman *read unwed baby mama* is the crux of the conversation)? While it's undoubtedly love that they're feeling, it just isn't the standard for Black Love like some people are trying to suggest. Relationships riddled with drama may work for some, but doesn't for everyone else, and if that makes me sound like a bitter, single, jealous hag then... that's the ignoramus, narrow view of a naysayer.
This comment from the aforementioned online magazine sums it up: "You can't turn a hoe into a housewife, but you can turn a drug dealer into a husband?" Well, I guess you should ask Beyonce and Tiny. Apparently thugs can grow into men, probably an exception and not a rule though. While it's cute, sweet, and seems genuine, don't get wrapped up in the love and hip-hop thinking it could be you."
Posted by TiffJ at Tuesday, December 06, 2011
Labels: Black Women Brain Matters Celebreality Dating Just a thought love my petition neuroses OK Cupid popculture Tiny and T.I. tv VH1
Brother OMi 11:20 PM
dope analogy as usual.
yes i confess i do watch
Coffey 9:44 AM
Thanks! I watch too. As much as folks like to pretend they don't, I know they watch. Reality shows are foolish, but reading how people interpret the lives of celebreality stars is telling.
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In the literature of pre-Mujaddidi Naqshibandis the topic of Laṭāʾif seems not to be of great importance. So it is Aḥmad Sirhindī (d. 1034/1624) who is the first to introduce a systematic approach to the Laṭāʾif in this Ṭarīqah, and one of the Successors of Sirhindī, Mīr Muḥammad Nuʿmān (d. 1060/1650 ?) adds to the system of his Shaykh a certain location for every Laṭīfah in the body of man and the way of making dhikr with these certain areas and with focus on them has become the first step in the Mujaddidī way of spiritual education and its important element. In the Pre-Mujaddidī Naqshibandi literature we can't find a systematic approach to the Laṭāʾif, but we see discussions about them based on spiritual experiences and upon the books of the Kubrawī Shaykhs, which were mentioned before.
Bahā al-Dīn Shāh al-Naqshibands (d. 791/1389) saying: "All mirrors of the Masters have two sides, but our mirror has six sides" , was interpreted by Ahmad Sirhindī as: "with mirror the heart of the ʿĀrif is meant. The two-sided mirror is 'nafs' and 'rūḥ', but the six-sided are the six Laṭāʾif." He was indicating with this, that the Laṭāʾif are known since those times.
Bāqībillāh (d. 1012/1603) said like ʿAlā al-Dawla Simnānī and Muḥammad Pārsā that men have seven Laṭāʾif and listed their names, but didn't give any details about them.  Murīdī Tāj al-Dīn Naqshbandī (d. 1050/1640) is giving more details about them. According to him, in the dhikr of the heart the one remembering has in his heart The Real One and also the Creation, while in the dhikr of the soul the thought about being in the presence of the Lord overcomes the thought about the creation. In the dhikr of the sirr he only feels himself being in the Presence of his Lord and can't perceive the creation – and in the dhikr of the khāfī he can't even feel himself and only the One Remembered exists.  Muḥammad Akram b. Muḥammad ʿAlī Barāsawī speaks about Tāj al-Dīn Naqshibandī's method of dhikr and says the Dhikr of "Allah Allah" has to be placed on every Laṭīfah so that the whole body is brought to the dhikr itself and gives after that details about the places of the Laṭāʾif: (The name of the first Laṭīfah is not mentioned, but it is assumed that nafs is meant) it is a bit above the stomach and its light is yellow; the heart Laṭīfah is beneath the left breast and its light is red; the place of the rūḥ is beneath the right breast and its light is white; the sirr Laṭīfah is between heart and rūḥ and its light is green; the khāfī is on his forehead beneath the hairline and its light is black; the place of the akhfāʾ is on the head, and its light is also black.  But because Tāj al-Dīn himself is not giving any information about the places of the Laṭāʾif in his own works, we have to be careful regarding what Barasāwī is saying. In the era of the Mujaddidiyyah different places of the Laṭāʾif were given and also different colours and it is very reasonable that this was based upon their own spiritual experience […].
 From: Necdet Tosun, Bahâeddîn Nakşbend, Hayatı Görüşleri Tarîkatı, Istanbul 2012.
 Qushayri, ar-Risālat al-Qushayriyya, I, p. 92-93.
 Ḥakīm Tirmidhī, Bayān al-Farq bayna al-ṣadr wa al-qalb wa al-fuʾād wa al-lub (pub. Nicholas Heer), Cairo 1958, p. 35 – 38, 80.
 Najm al-Dīn, Mirsād al-ʿIbād, p. 306.
 ʿAlā al-Dawla Simnānī, al-ʿurwa li ahl al-ḫalwa wa al-jalwa, (ed. Najīb Māyil Harawī), Teheran 1362/1983, p. 229 – 230, 326 – 328.
 ʿAlā al-Dawla Simnānī, Jihil Majlis, (ed. Amīr Iqbāl Shāh, pub. Najīb Māyil Harawī), Teheran 1366/1987, p. 120.
 Mīr Nuʿmān, Risāla-i Sulūk (pub. Ghulām Muṣtafā Khān), Karachi 1969, p. 7, 10-11.
 Yūsuf Hamdānī, Rutbat al-Ḥayāt, p. 56.
 Bukhārī, Anīs al-Ṭālibīn, p. 149; Muḥammad Bȧqir, Maqāmāt, p. 69.
 Aḥmad Sirhindī, Mabdaʾ wa Maʿād, p. 18 – 20.
 Pārsā, Tuḥfat al-Sālikīn, p. 362 – 363.
 Ibid., p. 377 – 381. The same words were repeated by Aḥmad b. Muḥammad Khazīnī,Jawāhir al-Abrār min Anwāj al-bihār, p. 67a – 68b.
 Pārsā, Qudsiyya, p. 37. See for the Ikhtilaf regarding the Ḥusayn b. Ibn al-Yamīn, Mirʾāt al-Badāyī, p. 47a.
 Jarhi, Tafsīr-i Yaʿqūb al-Jarhī, p. 189.
 Ibn al-Yamīn in the Naqshibandi Order is from the Kāsāniyya and his name is Mawlana Aka Shibirgānī (d. 1004/1595 – 96) and this person could be his son.
 Ḥusayn b. Ibn al-Yamīn, Mirʾāt al-Badāyī, p. 45b – 46b.
 Bāqībillāh, Kulliyāt-i Bāqībillāh, p. 111.; Dihlawī, Kalimāt al-Ṣādiqān, p. 169.
 Tāj al-Dīn Naqshibandī, Jāmiʿ al-Fuʾād, p. 19a.
 Muḥammad Akram b. Muḥammad ʿAlī Barāsawī, Manāḥij al-Sālikīn, p. 81-82.
1) sufi tariqas r structured as master-to-disciple lineages. So if MM Numan introduced it, it should be only among the descendents of him. BuIts possible his lineage is still active and living, not extant, but all the lineages of Naqshbandi I know of dont have Numan in their lineage. So how can he influence them?


The European Union and its Member States are the biggest global donor of official development aid, contributing 58.2 billion euros in 2014.
• Europeans' awareness of the "European Year for Development – 2015" and their level of information about development aid in general.
The results of the survey highlight that attitudes towards development aid have generally become increasingly positive over the past year. There is growing awareness about development and development aid across Europe. Almost one out of five respondents were aware that 2015 was the European Year for Development, while 36% have heard of the Sustainable Development Goals from the 2030 Agenda for Development.
Continuing the trend first observed in 2014, respondents are increasingly of the opinion that it is important to help people in developing countries. In fact, in 12 Member States at least nine out of ten agree tackling poverty in developing countries should be one of the main priorities of the EU, and almost all respondents agree in Sweden (98%) and Luxembourg (96%). Respondents are also more likely to agree this should be one of the main priorities of the EU and of national governments than they were in 2014. Most also agree helping developing countries would benefit Europeans and that providing aid is in the EU's own interest.
Despite, or perhaps because of the current refugee and migration crisis, the very high support for continuous and even growing engagement in and assistance to developing countries is increasing, with almost three quarters of respondents agreeing that development aid is an effective way to tackle irregular migration. In a related issue, the continuing and escalating unrest in the Middle East may well have influenced views on the priority areas for development: peace and security is now more likely to be considered as a pressing challenge for developing countries than health.
Just over half of all respondents agree that individuals can play a role in tackling poverty, and one third of respondents are personally involved in helping developing countries, usually by donating to organisations that help these countries (although young people are less likely to be engaged in this way than older age groups). Respondents are also positive about the efficacy of official development aid as an effective means to tackle poverty, as well as about the impact of volunteering or donating to organisations. Half are willing to pay more for products from developing countries to support people there.
In general, opinions about development aid do not vary by clear geographic clusters, with the most positive respondents about development issues scattered across the EU in countries including Sweden, Cyprus, Malta, Portugal and Spain. In addition, those in Italy and France have become more positive about many aspects of development aid since the last survey in 2014.


Nations will march together under 'unified Korean flag' at 2018 Winter Olympics.
North Korean Flag -- (stephan)/Flickr.
To the surprise of many around the world, North Korea and South Korea have been working together over the past three days to discuss matters in regards to possible reconciliation efforts involving the 2018 Winter Olympic Games (beginning Friday, February 9th). Today, North and South Korea have confirmed that after much discussion they have agreed to not only field a Joint Women's Ice Hockey Team together, but to also march together under a single unified Korean flag at the 2018 Winter Olympics next month, taking place in South Korea.
While tensions between the two countries have been high for quite a while now, this new development suggests that tensions may be easing slightly, with improved relations between them.
The two nations are expected to present their plan to the International Olympics Committee this weekend, with high hopes for approval. Both nations have offered comments in regards to their sudden talks, via The Guardian, with South Korea adding that the two nations have also discussed joint cultural events, the use of a ski resort in North Korea, and the size of the North Korean team.
In addition, North Korea has also apparently shown a willingness to send a large number of its cheer team to the 2018 Winter Olympics. These developments have been made rapidly and to the surprise of many since the beginning of the year when North Korean leader Kim Jong-un offered to send a delegation to the games.
Reportedly, the plans are for the delegation to walk across the border separating North and South Korea, a border which is typically extremely heavily armed, in an extremely symbolic move for the relations between the two nations.
Three officials from each nation participated in the discussions between the North and South, and the decision will be discussed by the IOC on Saturday to evaluate the potential positive outcomes as well as potential consequences of such a shocking turn of events.
Relations between North Korea and South Korea have been strained for nearly an entire decade, according to North Korea's Chief Delegate, Jon Jong-su. According to The Guardian, Jong-su added that through this meeting and the (hopefully) pleasing results that follow, he hopes that ties can resume.
North and South Korea have not sent a joint team to the Olympics since 1991, so if this happens, make sure to tune in because you will be witnessing history.


From I-275 travel north to Bearss Avenue exit . Travel east to Bruce B. Downs Boulevard. Turn north & travel to Cross Creek Boulevard. Turn right , go 2 miles and Andover Place is on the corner of Kinnan and Cross Creek Boulevard. From I-75, follow north to exit . Travel north on Bruce B. Downs & turn right on Cross Creek Boulevard.


text:
Philip Glass (born January 31, 1937) is an American composer whose music is frequently described as minimalist. He was born in Baltimore, Maryland and studied the flute as a child at the Peabody Conservatory of Music. He then went on to the Julliard School of Music where he switched to mostly play the keyboard.
After studying with Nadia Boulanger and working with Ravi Shankar in France, Glass traveled, mainly for religious reasons, to North India in 1966, where he came in contact with Tibetan refugees. He became a Buddhist, and met the Dalai Lama in 1972. He is a strong supporter of the Tibetan cause. It was his work with Ravi Shankar, and his perception of rhythm in Indian music as being entirely additive, that led to his distinctive style. When he returned home he renounced all his earlier Milhaud and Copland-like compositions and began writing austere pieces based on additive rhythms and a sense of time influenced by Samuel Beckett whose work he encountered writing for experimental theater. Finding little sympathy from traditional performers and performance spaces Glass formed his own ensemble and began performing mainly in art galleries, this being the only real connection between musical minimalism and minimalist visual art. His works grew increasingly less austere and more complex, and in his consideration, not minimalist at all, culminating in Music in Twelve Parts. He then collaborated on the first opera of his trilogy Einstein on the Beach with Robert Wilson.
Glass orchestrated some of David Bowie's instrumentals from the albums Low and Heroes in his Low Symphony and Heroes Symphony. Glass has been prolific throughout his career, and has scored many films, including Godfrey Reggio's experimental documentary film Koyaanisqatsi, Errol Morris' biopic A Brief History of Time (based on Stephen Hawking's popular physics book), and Martin Scorsese's Kundun.
Notable works:
Einstein on the Beach (opera, 1976)
Satyagraha (opera, 1980)
Glassworks (1982)
The Photographer (1982)
Akhnaten (opera, 1983)
Koyaanisqatsi (film score, 1983)
Mishima (film score, 1984)
The making of the representative for Planet 8 (opera, 1985-88)
Anima Mundi (film score, 1992)
Orph�e (opera, 1993)
La belle et la b�te (opera, 1994)
The marriages between zones three, four, and five (opera, 1997)
Heroes Symphony (1997)
Kundun (film score, 1997)
Music with Changing Parts
Music in Twelve Parts
Hydrogen Jukebox (libretto by Allen Ginsberg)
Solo Piano (1989)
See also: John Adams, Steve Reich, Terry Riley, Louis Andriessen
http://www.glasspages.org/
http://www.philipglass.com/
Audio (.ram files) of a 1986 interview for the BBC