Cautious drug approval

Wednesday, November 26th, 2003

None of this is news to me, but I think Steven Den Beste’s Cautious drug approval piece gives a decent summary of why prescription drugs seem so expensive:

After the Thalidomide catastrophe, the FDA became notoriously cautious about approving new drugs. Thalidomide wasn’t approved in the US (it was still in process at the time) and Thalidomide caused no deformed babies in the US. This reinforced the bureaucratic culture of caution at the FDA.

But the FDA is also inherently cautious, simply because of the situation they’re in. If they approve a drug which ends up being dangerous, they will get roasted for it. But if they refuse to approve a safe drug, or if the approval process is extremely slow, they don’t get roasted for all the people who suffer and die who could have been helped if the drug had been approved sooner. It’s inherent in their situation that they will err on the side of caution because it’s much riskier for the FDA bureaucrats to be too eager to approve a drug than to be too cautious about doing so. Whether that’s good or bad for the rest of us is less clear.

The approval process is so long and so involved and requires such a mountain of data to be collected, that it is massively expensive. The total cost for development and approval can exceed $100 million per drug. And a lot of money can be consumed during the testing and approval for drugs which are ultimately rejected.

Pharmaceutical companies have to recoup that cost, and the money can only come from sales of drugs after approval. That’s why drugs which are still under patent are so expensive compared to generics after patent expiration. Generics are priced based on a markup over manufacturing and distribution costs, whereas drugs under patent are priced to amortize the cost of development and regulatory approval, as well as to amortize the money spent on other drugs which were rejected.

The amortization premium paid by Americans is all the greater because most other nations in the world “free ride” on American drug development.

Love in the Time of No Time

Wednesday, November 26th, 2003

In The Economics of On-Line Dating, Tyler Cowen cites a New York Times Magazine article, Love in the Time of No Time, that “is not full of economic reasoning though the interesting and salacious content may keep you reading.” It does mention one bit of economic data though:

In the first half of 2003, Americans spent $214.3 million on personals and dating sites — almost triple what they spent in all of 2001. Online dating is the most lucrative form of legal paid online content.

I knew I should’ve started an on-line dating site…

After working through eight or nine pages of salacious details I reached this bit that amused me:

Online dates that lead to love — and they are legion — are a little like Tolstoy’s happy families: for all their quirky particularity, they end up sounding strangely alike. There’s Kellie Smith, 33, from outside Boston, an occupational therapist who whimsically clicked ”Love on AOL” during her lunch break and found herself on Match.com, where she dashed off e-mail messages to several men who interested her. Michael DuGally, 35, a partner in a Massachusetts furniture manufacturing company, was her first online date; they met for lunch and never really parted. Last summer, the couple asked Match.com for a logo banner so they could be photographed with it on their wedding day.

I enjoyed Cowen’s analysis:

The bottom line, however, is simple. On-line dating seems to serve (at least) two major constituencies. First, many people use it to marry or otherwise find a monogamous relationship. Match.com claims to have lost 140,000 members, by enabling those people to find partners. Second, many people use internet dating to find casual sex or serial partners. The article quotes a “Greg,” who enjoys a first date with quickie sex at the end, and then offers the following remark: “I liked her, but not enough to merit fireworks. Given the seemingly endless selectoin, I get to be a little less forgiving.”

Since I suspect that on-line dating is more effective than not, people will increasingly choose one category or the other. Those people who are willing and able to marry, will find their partners and marry. After some period of time, the stock of marriageable people will be smaller. (Note: I believe that some decent chunk of the unmarried are simply emotionally incapable of marrying, for whatever reason.) The remaining unmarried will then find relatively higher returns from the serial dating and casual sex routes. So the distribution of the number of sexual partners will become more bimodal over time.

Furthermore, the last two years have been an especially good time to marry through on-line dating. The new technology is being applied to a large stock of unmarried people who could marry and be happy, but who otherwise could not find the right partner. Yes, an ongoing flow will replenish the stock but arguably the stock has been at a peak in recent times, given that on-line dating has just taken off. So if you want to marry, hurry up and get on-line. If you are just looking for casual sex, well, you have a greater luxury of waiting and in fact your options will likely improve with time.

Get Your Flu Shot!

Wednesday, November 26th, 2003

Even after reading Get Your Flu Shot!, I doubt I will — proving its point:

We do not respond to risks rationally. We are scared of Ebola, pesticides, nuclear radiation and terrorists but the flu? Who cares about the flu? You should. In an average year, the flu kills almost as many people as die in auto accidents (36,000 for the flu, 42, 815 for highway accidents in 2002) and this year experts expect some 50-70 thousand flu deaths. True, those over 65 years of age and older are most at risk but thousands of younger people die from the flu every year. A flu shot reduces your chances of death by 50 percent. (Here is more flu info from the CDC.)

The Burden of Carrying a Lethal Weapon

Tuesday, November 25th, 2003

I stumbled across this story, by a guy named Jess Lebow, about his trip to Thailand when he was 13, and what he bought with the money burning a hole in his pocket there (since the exchange rate was so favorable):

That’s when I saw it: the samurai sword that I had always wanted. Actually, there were thousands of them. This merchant had two different sizes — long and short. The longer ones (which I now know were katana) were black and the shorter ones (wakizashi) were red. The blades were made of polished, sharpened metal, but the sheathes were made of wood. Colored straw had been wrapped around the handle and glued to various parts of the sheath to add a little ornamentation.

Not exactly quality construction.

Still, it didn’t matter. I had to have one. So I began my haggling routine, purchased a black-sheathed katana with the last of my money, and returned to find my mother.

And she was livid.

How were we going to get a full-sized samurai sword (she used this term, too) through the airport and back home? They were going to stop us, she said, and maybe even put us in jail. Airport security wasn’t exactly what it is today, but hijackings and bombings were prominent in the public eye.

Taking a martial weapon on a plane was frowned upon.

Still, I somehow convinced her that everything would be fine, but as a compromise I had to agree to surrender the sword if we were hassled. She was skeptical, but we were running behind, and she didn’t want to argue. She shoved the tape recorder she’d bought as a gift for my brother into my open suitcase as I repacked.

To make matters worse, the sword in its sheath was too long to fit. I had to pull it out of its sheath to get it packed, but I did get it in. Pushing the underwear and sweatpants down as I closed the zipper, I heard a tremendous rip.

The tip had punched through the side of the suitcase.

Now my mother was even more pissed, and we were late for our flight. Nothing will push my mother over the edge faster than being late for an airplane. In a fit of what I can only call simple brilliant ingenuity, my mother came up with an engineering feat that rivals the likes of MacGyver or even the A-Team. Diving into a restaurant across the street, she came out with a wine bottle cork. Jamming it on the tip of my sword, she shoved the blade deep within the same suitcase and smashed it closed. No rip, no pop, no protruding weapon tip, and we were off.

So, of course, we got stopped at the airport. The gate agent X-rayed our bags and stopped us before we finished checking in. Back then they had to ask your permission to open your bags (ah, the good old days), and we told them they could.

They went right for the bag with the sword in it. A pair of armed guards appeared from out of nowhere, standing behind the gate agent who was searching the bag. They carried machine guns on straps over their shoulders. One actually held the handle of his gun — ready to lift and shoot at hijackers or thirteen-year-old samurai wannabes — with one hand as he casually ate an apple with the other.

My mother glared down at me, and I withered. Her words of warning rang through head. “. . . maybe even go to jail.” Then a more sickening thought pushed that one aside.

These guys might take my sword.

Not that. Anything but that.

The gate agent began piling my stuff on the stand next to him. Out came my swimming suit, my running shoes, the miniature pirate ship, a pair of stop watches, and the samurai sword with its exposed blade and wine cork on the tip.

Time seemed to slow down for me then. The gate agent lifted the sword into the air — a warrior about to strike me down. He was going to take it. I knew it. We were going to go to jail. And when we got out, I was going to be grounded for a least a month.

Probably more.

The gate agent plunged his hand deeper into the suitcase and pulled out the tape recorder. Plopping the naked blade down on top of my clothing he held out his other hand.

What’s this?”

“A-a gift,” my mother stammered. “A tape recorder.”

“Make it play.”

She took it and pressed the button, but nothing happened. It had worked when she bought it. I’d heard it myself. But now either the batteries were dead or the cheap-o cassette player was simply broken. Whatever the case, they confiscated the tape recorder, thinking it could be a bomb.

Then they let us go — after they neatly packed my sword back inside the suitcase.

I got on the plane with a smug look on my face. My mother was quite embarrassed that it had been her purchase and not mine that had gotten us stopped, and she was probably at least a little unnerved that the gate agent seemed to sense no danger from a 3-foot-long samurai sword.

I guess the cork put him at ease.

Deadly Ebola Virus Kills 18 in Northwest Congo

Tuesday, November 25th, 2003

The black magic is working. Deadly Ebola Virus Kills 18 in Northwest Congo:

An outbreak of the deadly Ebola virus has killed 18 people in northwestern Congo Republic, where the disease killed 120 earlier this year, state television said.
[...]
Officials believe the latest outbreak, first reported earlier this month, started after a group of hunters ate a dead boar they found in the forest.

Scientists think the previous Ebola outbreak in the region, known as Cuvette-Ouest, was caused by the consumption of infected monkey meat. Bushmeat is a staple among forest communities and a delicacy in many cities.

Many locals, however, believe occult forces are behind the spread of the disease. They have recently blamed Red Cross workers for conjuring up the virus through black magic.

During the previous outbreak, villagers stoned and beat to death four teachers accused of casting a spell to cause the disease.

Root from Peru Holds Hope for Dieters, Diabetics

Tuesday, November 25th, 2003

Peru is home to quite a few interesting crops. Root from Peru Holds Hope for Dieters, Diabetics:

Peru, the land that gave the world potatoes, is home to yacon, a tasty root that scientists say is good for the gut, potentially safeguards against cancer, helps absorption of calcium and vitamins and can lessen the blood sugar peaks from eating sweet food that are a problem for diabetics.
[...]
Yacon, which is native to an Andean region stretching from Venezuela to northern Argentina, has a crunchy texture like a water chestnut and is refreshingly sweet and juicy. Left in the sun, its sweetness intensifies, and it can be eaten as a fruit, consumed in drinks, syrups, cakes or pickles or in stir-fries.

Though packed with sugar, its principal appeal to the health conscious lies in the fact that the sugar in question is mainly oligofructose, which cannot be absorbed by the body.
[...]
In addition, oligofructose promotes beneficial bacteria in the colon.
[...]
Yacon — the root of a tall, leafy plant with tiny yellow sunflowers that Inca “chasquis,” or messengers, pulled from the pathside to slake their thirst — is thought to have originated in a region stretching from central Peru to northern Bolivia.
[...]
It was in Japan, Hermann said, that yacon’s oligofructose qualities were discovered. “The Japanese also found out that if the leaves are used in tea, it has the effect of avoiding the peaks that you have when eating sugary or starchy food, when your blood sugar level goes up violently,” he said.

Perhaps I could sweeten my yerba mate tea with a bit of yacon.

Brazil Seeks to Show Coffee’s Health Benefits

Monday, November 24th, 2003

Brazil Seeks to Show Coffee’s Health Benefits:

Brazil, the world’s No. 1 coffee producer, hopes to convince people to drink up — and ease a global crisis caused by oversupply — by proving that coffee is good for you.

The country that offers school children “coffee breaks,” plans to try to show that coffee can help reduce heart disease, countering the conventional wisdom that coffee causes health problems including anxiety and hypertension.

In other news, Columbia is studying the health benefits of cocaine. (OK, I made that one up.)

World’s Only Known Albino Gorilla Dies

Monday, November 24th, 2003

Albinism is such a simple change, but people go crazy over it. From World’s Only Known Albino Gorilla Dies:

The world’s only known albino gorilla, Copito de Nieve (Snowflake), died early Monday at the Barcelona zoo, leaving this city without a beloved mascot and the scientific world without one of its most unique creatures.

Now we just need a talking albino ape.

Stressful and Insecure Jobs Take a Toll on Health

Thursday, November 20th, 2003

This should surprise no one. Stressful and Insecure Jobs Take a Toll on Health:

Australian researchers found that managers and other professionals who were under a strong threat of being laid off were more than three times as likely to report depression, anxiety or being in poor health than people in more secure positions.

And people who said they worked in highly stressful jobs with little control over how and when they work were also more likely than others to have depression or anxiety.

Scan Painlessly Pinpoints Muscle Stiffness

Thursday, November 20th, 2003

I didn’t know that we needed a way to scan for muscle stiffness — I can usually tell where I’m sore — but Scan Painlessly Pinpoints Muscle Stiffness reports on the new use for MRI machines:

An experimental technique that uses widely available imaging technology is a painless way to measure muscle stiffness, researchers report.
[...]
The technique, known as magnetic resonance elastography (MRE), involves the same scanner used to perform magnetic resonance imaging (MRI), a technique that provides a good view of the internal structures of the body, particularly soft tissue, the brain, spinal cord and joints.
[...]
Within an MRI scanner, the skin is vibrated, which causes waves to penetrate tissue and to multiply in muscle. Doctors take an image of these waves and then measure them to evaluate muscle stiffness.

I foresee the following exchange with an orthopedist in the future:

“You see these black dots?”
“Yeah.”
“That’s where you’re not stiff and sore.”
“Hmm…looks about right.”

Man Dies After Winning Vodka-Drinking Contest

Wednesday, November 19th, 2003

The “winner” died after downing 1.5 liters of vodka — more than half a liter of pure alcohol (assuming the vodka was 80 proof). Man Dies After Winning Vodka-Drinking Contest:

A vodka-drinking competition in a southern Russian town ended in tragedy with the winner dead and several runners-up in intensive care.

‘The competition lasted 30, perhaps 40 minutes and the winner downed three half-liter bottles. He was taken home by taxi but died within 20 minutes,’ said Roman Popov, a prosecutor pursuing the case in the town of Volgodonsk.

‘Five contestants ended up in intensive care. Those not in hospital turned up the next day, ostensibly for another drink.’

Popov said the director of the shop organizing this month’s contest had been charged with manslaughter. He had offered 10 liters of vodka to the competitor drinking the most in the shortest time.

Russians drink the equivalent of 15 liters of pure alcohol per head annually, one of the highest rates in the world. Some experts estimate one in seven Russians is an alcoholic.

Face Transplants Possible But More Research Needed

Wednesday, November 19th, 2003

You could replace “face transplants” with just about anything and this headline would be valid — Face Transplants Possible But More Research Needed:

Face transplants are technically possible and could arguably be less difficult than reattaching a severed finger, surgeons said on Wednesday, but they called for more research into the risks involved before they are attempted.

Truly a creepy image — face-transplant rejection:

The microsurgical skills needed for a face transplant are already well established, according to a report by the Royal College of Surgeons of England.

But too little is known about the psychological impact it would have on the recipient or the donor family, the ethical issues or the long-term risks of immunosuppressive drugs that would have to be taken for life to prevent the immune system from rejecting the new face.

This might surprise some people — and ruin a number of movie plots:

“We need to get across the complexities of this medical advance and dismiss the myths that have been reported — for example the first face transplant recipients will not necessarily look like the donor,” he said.

Transplanting the skin and underlying soft tissue from one individual to the facial structure of another would give an appearance that would be different from the donor and the recipient, he added in a statement.

So much for Face Off

Man Armed With Knife Kills Hungry Bear

Tuesday, November 18th, 2003

Whoa. Man Armed With Knife Kills Hungry Bear:

Hirsch had only a 3 1/2-inch knife blade when he came across the bear in his backyard in Williams Lake, about 190 miles northeast of Vancouver.
[...]
As the bear began to circle him, Hirsch faced it like a wrestler in a ring.

“It was like a knife fight that you’d see in an old-time Western,” he said. The bear swatted out at him, but each time it lunged, he managed to stab it.

“I couldn’t tell you if the fight lasted three seconds or three minutes,” Hirsch said.

Three stabs to the bear’s chest and one to its neck finally did the bruin in.

It stood about 5 foot 7 inches to Hirsch’s 5 feet 9 inches and weighed 200 pounds, according to conservation officers who inspected it.

“I can say it sure looked smaller the next morning than it did during the fight,” said Hirsch.

The bear was in poor shape, suffering from a severed tongue and broken jaw, the conservation officer said. Its stomach was empty and the bear had little fat on it.

Hirsch, a retired electrical foreman at B.C. Hydro, suffered a scratch to the top of his head and scratches to his back — and a shredded T-shirt.

Fat Cells May Be the Obesity-Hypertension Link

Friday, November 14th, 2003

Fat Cells May Be the Obesity-Hypertension Link reports on a recent PNAS paper:

Fat cells produce factors that directly stimulate the adrenal gland to release the hormone aldosterone, new findings show. Because aldosterone regulates blood pressure, these factors may at least partly explain the link between obesity and high blood pressure.
[...]
Other hormones produced by the cells also increased: cortisol was nearly tripled, and dehydroepiandrosterone (DHEA) levels increased 1.5-fold.

Milestones

Thursday, November 13th, 2003

Milestones quotes an interesting passage from Inventing Japan. Compare post-war Japan to present-day Iraq:

Tokyo endured [the] winter [of 1945-1946] on the workings of an illegal economy. The black market encompassed thousands of sellers and millions of buyers dealing in every commodity of daily life. It was also a vast jungle of lawlessness that began with thefts and led to gang killings, turf wars, and casual murders, becoming at last a criminal demimonde of immense proportions. It embraced all classes and kinds of people. When the war ended, sake, bread, clothing, shoes, sugar and blankets had disappeared from military depots all over the country, pilfered wholesale by officers and enlisted men alike. Small thefts were the routine of daily existence. A bicycle snatched at Ueno’s railway station turned up repainted and for sale two hours later at the station in Shimbashi. Koreans and Chinese, forced-labor immigrants during the war, prospered with goods smuggled from Hong Kong and Taiwan, and by the Occupation’s ruling, they could not be arrested by Japanese police.

It was the beginning for many mobster organizations, some of whose descendants still operate today. In Tokyo there were eight major syndicates, each with its own piece of turf around the major train stations…They fought amongst themselves and against other gangs, the Japanese mobs battling constantly for territory against the Koreans and Chinese. Guns were plentiful, another result of looted army depots. Unable or unwilling to intervene, police let gangs have at one another, and the shootouts continued for several years into the Occupation. One day in April 1948, two gangs — one Japanese, one Korean — fought it out with pistols in the Hamamatsu district. The next day, about one hundred Japanese returned to the attack on the Koreans’ black market there and killed or wounded more than 15 men.