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.
A history of the first African American White House—and of what came next
In the waning days of President Barack Obama’s administration, he and his wife, Michelle, hosted a farewell party, the full import of which no one could then grasp. It was late October, Friday the 21st, and the president had spent many of the previous weeks, as he would spend the two subsequent weeks, campaigning for the Democratic presidential nominee, Hillary Clinton. Things were looking up. Polls in the crucial states of Virginia and Pennsylvania showed Clinton with solid advantages. The formidable GOP strongholds of Georgia and Texas were said to be under threat. The moment seemed to buoy Obama. He had been light on his feet in these last few weeks, cracking jokes at the expense of Republican opponents and laughing off hecklers. At a rally in Orlando on October 28, he greeted a student who would be introducing him by dancing toward her and then noting that the song playing over the loudspeakers—the Gap Band’s “Outstanding”—was older than she was.
How the vice president spent a few of his closing days in office
When I boarded Air Force Two for Vice President Joe Biden’s final overseas mission, he had four days left in office. His leverage was diminishing by the hour, with every new question at a Trump nominee confirmation hearing, with every new @RealDonaldTrump tweet.
There was no chance of a miracle at that point, a few days away from Vice President-elect Mike Pence getting Biden’s keys to Air Force Two—to somehow rid Ukraine of its debilitating corruption, pull off a Cyprus deal, or stand between Kosovo and Serbia and neutralize the tension between them for good. It’s hard to shame Russian President Vladimir Putin or to inspire him to spiff up his behavior if the president-elect seems to accept Putin just as he is. And of course, there’s Iraq.
Curfews, sports, and understanding kids’ brain chemistry have all helped dramatically curb substance abuse in the country.
It’s a little before 3 p.m. on a sunny Friday afternoon and Laugardalur Park, near central Reykjavik, looks practically deserted. There’s an occasional adult with a stroller, but the park’s surrounded by apartment blocks and houses, and school’s out—so where are all the kids?
Walking with me are Gudberg Jónsson, a local psychologist, and Harvey Milkman, an American psychology professor who teaches for part of the year at Reykjavik University. Twenty years ago, says Gudberg, Icelandic teens were among the heaviest-drinking youths in Europe. “You couldn’t walk the streets in downtown Reykjavik on a Friday night because it felt unsafe,” adds Milkman. “There were hordes of teenagers getting in-your-face drunk.”
Without any of his key appointees confirmed by the Senate, the incoming president has turned to existing officials to help smooth the transition.
Donald Rumsfeld is not joining the Trump administration, but one of his most famous rules is: “You go to war with the Army you have—not the Army you might wish you have.” Or the secretary of the Army, as the case might be.
With the process of vetting and appointing, to say nothing of confirming, executive-branch officials well behind the optimal pace, incoming White House Press Secretary Sean Spicer said during a briefing on Thursday that “over 50” members of the Obama administration will temporarily remain in their posts to help smooth the transition to the Trump administration.
Spicer did not name all of the officials, nor did he indicate whether others had been asked and declined to stay on. A message to the Trump transition team, asking for a full list, has not been answered. Reuters reported Thursday afternoon that some individuals on a list, dated Tuesday, of appointees being asked to stay on had declined to do so, including the principal deputy director of national intelligence, an undersecretary of state, and an assistant secretary of state.
More clues that the Facebook founder is eyeing a run for office
There’s a long-running theory that Mark Zuckerberg has presidential aspirations. It makes sense to wonder. After all, if the civically engaged and ambitious billionaire leader of the most powerful media company on the planet wanted to take on a new challenge, why not try running a country? It’s not like he has many other opportunities for a promotion.
But only in recent weeks has a Zuckerberg run for the American presidency started to seem like a legitimate possibility. First there was his personal challenge for 2017: Zuckerberg’s aiming to visit and meet with people in all 50 states by the end of the year.
And not just that, but he framed the exercise in a way that sounds, well, political: “Going into this challenge, it seems we are at a turning point in history,” he wrote in a Facebook post. “For decades, technology and globalization have made us more productive and connected. This has created many benefits, but for a lot of people it has also made life more challenging. This has contributed to a greater sense of division than I have felt in my lifetime. We need to find a way to change the game so it works for everyone.”
In the age of the digital hermit, a psychologist explains what it means to avoid other people—and what to do about it.
People today might not actually be avoiding social interaction any more than they did in past decades, but they’re certainly more vocal about it. The rise of digital communication seems to be spawning a nation of indoor cats, all humble-bragging about how introverted they are and ordering their rides and groceries without ever talking to a human.
Sometimes reclusiveness can be a sign of something more serious, though. Social anxiety is one of the most common mental illnesses, but it’s still poorly understood outside of scientific circles. The good news is that it’s highly treatable, according to Stefan G. Hofmann, the director of the Social Anxiety Program at Boston University.
I recently talked with Hofmann about how social anxiety works and what people who feel socially anxious can do about it. An edited transcript of our conversation follows.
William Jennings Bryan, the populist presidential hopeful, warned of an “epidemic of fake news” in his day.
Fake news is everywhere. The power of the press is said to be waning. And because the nation’s most famous populist—the man with his sights on the presidency—can’t trust the lying media, he says, he has no option but to be a publisher himself.
Oh yeah, and the year is 1896.
The would-be president in question is William Jennings Bryan. In an era before the internet, television, or radio, the best way to reach the masses is with newsprint. So, without the option of tweeting his grievances after losing the election to William McKinley, what does Bryan do? He starts his own newspaper. And he uses it to rail against “fake news.”
I don’t need to tell you a lot of this sounds weirdly familiar.
“There seems to be an epidemic of fake news from the city of Lincoln, [Nebraska], and it all comes from Mr. Bryan’s ‘friends’—names not given,” Bryan’s newspaper, The Commoner,wrote in 1907. “It would seem unnecessary to deny reports sent out to which no name was attached, and yet it has been necessary to send a number of telegrams to notify other papers that the report was unauthorized … As Mr. Bryan has a paper—The Commoner—through which he speaks every week, and as he is speaking often and giving out interviews frequently, a newspaper ought to view with suspicion any report sent out from Lincoln or anywhere else purporting to state what Mr. Bryan thinks or intends to do.” (In this case, the issue at hand was Bryan’s stance against a third term for Teddy Roosevelt, which some papers had apparently questioned.)
A mix of patriotic balladeers and apolitical acts will take the stage on Thursday and Friday.
It is not true, as a lot of commentary would have it, that Donald Trump’s inauguration will feature “no stars.” Some of the entertainers who have signed on to play have, in fact, built their success on entertaining millions of people. But it is true that what’s considered “the A-list” will be conspicuously absent, as will be acts from other lists: The B-Street Band, a Bruce Springsteen tribute group, backed out from an unofficial inaugural party after outcry; Broadway singer Jennifer Holliday reneged from the main concert event.
The mix of entertainers lined up for Thursday’s “Make America Great Again! Welcome Celebration” on the National Mall and Friday’s swearing-in ceremony represents a hodgepodge of ideology and expediency. In a savvy MTV essay about Trump’s national-anthem singer Jackie Evancho, Doreen St. Félix argued that booking the 16-year-old America’s Got Talent runner up was “a matter of scavenging, and then gilding over the spoils”—a description that could apply across the lineup given the many headlines about Trump’s team getting turned down by celebrities then saying that not having famous people is a good thing. But in its relative lack of glitz, and in its coalition of performers well familiar to state-fair stages, this week’s bill may inadvertently achieve the stated inaugural goal of projecting an image not of Trump but of the people who elected him.
The president-elect filled out his Cabinet on Thursday by nominating former Georgia Governor Sonny Perdue for agriculture secretary.
Updated on January 19, 2017
A day before his inauguration, President-elect Donald Trump has filled out his Cabinet.
Trump on Thursday morning announced the nomination of former Georgia Governor Sonny Perdue as secretary of agriculture, completing a search that took the duration of his presidential transition.
Perdue, who served as governor from 2003 to 2011, grew up on a farm in Georgia and earned a doctorate in veterinary medicine. “Sonny Perdue is going to accomplish great things as Secretary of Agriculture,” Trump said in a statement. “From growing up on a farm to being governor of a big agriculture state, he has spent his whole life understanding and solving the challenges our farmers face, and he is going to deliver big results for all Americans who earn their living off the land.”
This lack of discussion of civil-rights issues at the hearing was glaring, but it may be in line with DeVos’s advocacy of school vouchers and other school-choice programs in her home state of Michigan. As Kimberly Quick, a policy associate at the Century Foundation, notes, “Both historically and currently, voucher programs have served as a means for wealthier and white families to flee an increasingly diverse public school system, moving into largely unaccountable private schools that can exclude students based on a number of factors.”