If you'll excuse me, the rest of us will be over here in the corner, freaking out a little bit.
It's tempting, of course, to blame this on Obamacare, and I certainly wouldn't rule out the possibility that this is at least part of the explanation. But there's no evidence that this is the case, other than the crude time correlation. Derek Lowe suggests that the answer is simpler: the return to R&D spending in the industry has been falling for a long time, as many therapeutic areas are crowded with generics (or soon-to-be generics) that already do a very good job. The remaining areas (cancer, central nervous system, obesity) turn out to be very tough, and there's no guarantee that we'll ever find pharmaceutical interventions that do what we want.
There's an interesting discussion to be had about whether the market outcome differs from the socially optimal outcome--whether falling returns to pharmaceutical R&D mean that we should be putting more resources into it, or fewer. But I'll leave that aside for the nonce, because I'm not sure what I think, and talk about what this means for the rest of the health care system.
You might initially think that this is good news for cost control--the expensive brand name drugs will all go generic, and we'll save a bunch of money on prescription drugs. And indeed, this is absolutely true. But this will have repercussions for other areas of health care, and those repercussions are not good. While some drugs are simply an added expense (think chemotherapy prolonging the lives of people who would otherwise have died sooner), many of the real blockbusters substitute for labor-intensive treatment. Statins instead of cardiac catheterizations or coronary bypasses. Avandia instead of amputations. Hydrochlorothiazide instead of nursing home care for your massive stroke.
We'll still have all those drugs, of course. But with less R&D, we'll presumably see fewer pharmaceutical substitutes for the expensive conditions we still spend a lot of money treating, like Alzheimer's. Which means that health care expenses might actually rise faster than we expect. Most of the rest of the health care system is subject to a phenomenon known as Baumol's Cost Disease, which I described thusly a few years ago:
. . . medical productivity doesn't improve as fast as most of the rest of the economy--basically, activities that are very labor intensive don't tend to have massive productivity gains. That's why it still takes just about as many teachers to teach 50,000 sixth graders as it did fifty years ago. Similarly, it still takes one person to give you a sponge bath and administer your pills.
There's a caveat however: antibiotic resistance. Without antibiotics, a lot of our heroic interventions become a lot more deadly, which means less likely to be performed. And someone who has died from an infection following their coronary bypass will not be around to demand an expensive knee replacement.
Unfortunately, that's not exactly ac omforting thought.
Science says lasting relationships come down to—you guessed it—kindness and generosity.
Every day in June, the most popular wedding month of the year, about 13,000 American couples will say “I do,” committing to a lifelong relationship that will be full of friendship, joy, and love that will carry them forward to their final days on this earth.
Except, of course, it doesn’t work out that way for most people. The majority of marriages fail, either ending in divorce and separation or devolving into bitterness and dysfunction. Of all the people who get married, only three in ten remain in healthy, happy marriages, as psychologist Ty Tashiro points out in his book The Science of Happily Ever After, which was published earlier this year.
Social scientists first started studying marriages by observing them in action in the 1970s in response to a crisis: Married couples were divorcing at unprecedented rates. Worried about the impact these divorces would have on the children of the broken marriages, psychologists decided to cast their scientific net on couples, bringing them into the lab to observe them and determine what the ingredients of a healthy, lasting relationship were. Was each unhappy family unhappy in its own way, as Tolstoy claimed, or did the miserable marriages all share something toxic in common?
He lives near San Francisco, makes more than $50,000 per year, and is voting for the billionaire to fight against political correctness.
For several days, I’ve been corresponding with a 22-year-old Donald Trump supporter. He is white, has a bachelor’s degree, and earns $50,000 to $60,000 per year.
He lives near San Francisco.
“I recently became engaged to my Asian fiancée who is making roughly 3 times what I make, and I am completely supportive of her and proud she is doing so well,” he wrote. “We’ve both benefitted a lot from globalization. We are young, urban, and have a happy future planned. We seem molded to be perfect young Hillary supporters,” he observed, “but we're not. In 2016, we're both going for Trump.”
At first, we discussed Bill Clinton.
Last week, I wrote an article asking why Trump supporters aren’t bothered that their candidate called Clinton a shameful abuser of women who may well be a rapist. After all, Trump used to insist that Clinton was a victim of unfair treatment during his sex scandals. Either Trump spent years defending a man that he believed to be a sexual predator, even welcoming him as a guest at his wedding, or Trump is now cynically exploiting a rape allegation that he believes to be false.
Studies have shown narcissists post more self-promoting content on social media, but it's not always so easy to tell if someone's doing it for the attention.
It’s not hard to see why the Internet would be a good cave for a narcissist to burrow into. Generally speaking, they prefer shallow relationships (preferably one-way, with the arrow pointing toward themselves), and need outside sources to maintain their inflated but delicate egos. So, a shallow cave that you can get into, but not out of. The Internet offers both a vast potential audience, and the possibility for anonymity, and if not anonymity, then a carefully curated veneer of self that you can attach your name to.
In 1987, the psychologists Hazel Markus and Paula Nurius claimed that a person has two selves: the “now self” and the “possible self.” The Internet allows a person to become her “possible self,” or at least present a version of herself that is closer to it.
Five weeks of training was not enough to prepare me for a room of 20 unruly elementary-schoolers.
I am sitting in a comfortable gold folding chair inside one of the many ballrooms at the Georgia International Convention Center. The atmosphere is festive, with a three-course dinner being served and children playing a big-band number. The kids are students at a KIPP academy in Atlanta, and they are serenading future teachers on the first night of a four-day-long series of workshops that will introduce us to the complicated language, rituals, and doctrines we will need to adopt as Teach for America "Corps Members."
The phrase closing the achievement gap is the cornerstone of TFA's general philosophy, public-relations messaging, and training sessions. As a member of the 2011 corps, I was told immediately and often that 1) the achievement gap is a pervasive example of inequality in America, and 2) it is our personal responsibility to close the achievement gap within our classrooms, which are microcosms of America's educational inequality.
A real-time chronicle of Donald Trump’s unpresidential statements.
People will look back on this era in our history, to see what was known about Donald Trump while Americans were deciding whether to choose him as president. Here’s a running chronicle from James Fallows on the ways in which Trump has been unpresidential in an unprecedented way, and of the evidence available to voters as they make their choice. (If you’d like to flag examples to include, please let us know.)
Three Atlantic staffers discuss “Blood of My Blood,” the sixth episode of the sixth season.
Every week for the sixth season of Game of Thrones, Christopher Orr, Spencer Kornhaber, and Lenika Cruz will be discussing new episodes of the HBO drama. Because no screeners are being made available to critics in advance this year, we'll be posting our thoughts in installments.
Narcissism, disagreeableness, grandiosity—a psychologist investigates how Trump’s extraordinary personality might shape his possible presidency.
In 2006, Donald Trump made plans to purchase the Menie Estate, near Aberdeen, Scotland, aiming to convert the dunes and grassland into a luxury golf resort. He and the estate’s owner, Tom Griffin, sat down to discuss the transaction at the Cock & Bull restaurant. Griffin recalls that Trump was a hard-nosed negotiator, reluctant to give in on even the tiniest details. But, as Michael D’Antonio writes in his recent biography of Trump, Never Enough, Griffin’s most vivid recollection of the evening pertains to the theatrics. It was as if the golden-haired guest sitting across the table were an actor playing a part on the London stage.
“It was Donald Trump playing Donald Trump,” Griffin observed. There was something unreal about it.
The 104-year-old organization is having trouble recruiting black and Latina kids. Why?
Hillary Clinton. Madeleine Albright. Sandra Day O’Connor. These powerful women have all shaped the course of the United States. And they have something else in common: They were all Girl Scouts.
The girls’ leadership organization has more than 2 million current scouts and 59 million living alumnae. Nearly half of all American women have been Girl Scouts at some point in their lives. Their uniforms, badges, and cookies are synonymous with what it means to be an American girl. Or at least a white, suburban American girl.
Girl Scouts has been losing members for more than a decade as it struggles to reach the new American girl, who is more likely than ever to be an ethnic minority or come from poor, immigrant families. Unlike many scouts who followed in their mother’s footsteps, these girls and their parents have few connections to the 104-year-old organization. And the Girl Scouts can’t seem to find enough volunteers to lead troops for all the girls on the waiting list.
Those who don't have sex during their teen years are in the minority, but the reasons for—and effects of—waiting differ for everyone.
Keith McDorman walks into the back room of an Austin, Texas coffee shop. With his dirty-blond hair, light eyes, week-old beard, and striped button-down shirt, he looks like a younger, shorter, bohemian version of Bradley Cooper. He tosses his scooter helmet onto the wooden table, sits across from me at a booth that barely fits us both, and talks before I ask a question.
“My mind doesn’t comprehend how much sex I have,” says McDorman, a 29-year-old carpenter from southern California.
That statement brings glances from studying college students. We opt for more privacy by heading outside, where we talk over a live rock band at a high table near a vegan food truck. McDorman continues by telling me about a conversation he had recently with his girlfriend, in which he expressed fear that his libido had dropped. She laughed, since, well, they had had sex six times that week.