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.
People look to Amy Schumer and her fellow jokers not just to make fun of the world, but to make sense of it. And maybe even to help fix it.
This week, in a much-anticipated sketch on her Comedy Central show, Amy Schumer staged a trial of Bill Cosby in “the court of public opinion.” Schumer—her character, at any rate—played the role of the defense. “Let’s remind ourselves what’s at stake here,” she argued to the jury. “If convicted, the next time you put on a rerun of The Cosby Show you may wince a little. Might feel a little pang. And none of us deserve that. We don’t deserve to feel that pang.”
Her conclusion? “We deserve to dance like no one’s watching, and watch like no one’s raping.”
Ooof. This is the kind of thing that gets Inside Amy Schumer referred to as “the most feminist show on television,” and her act in general called, in a phrase that reveals as much about her craft as about Schumer herself, “comedy with a message.” But while Schumer’s work is operating at the vanguard of popular comedy, it’s also in line with the work being done by her fellow performers: jokes that tend to treat humor not just as an end in itself, but as a vehicle for making a point. Watch like no one’s raping.
For those who didn't go to prestigious schools, don't come from money, and aren't interested in sports and booze—it's near impossible to gain access to the best paying jobs.
As income inequality in the U.S. strikes historic highs, many people are starting to feel that the American dream is either dead or out of reach. Only 64 percent of Americans still believe that it’s possible to go from rags to riches, and, in another poll, 63 percent said they did not believe their children would be better off than they were. These days, the idea that anyone who works hard can become wealthy is at best a tough sell.
What it’s like to watch a komodo dragon get dissected
Try to imagine how hard it would be to skin a Komodo dragon.
It is harder than that.
The problem is that the giant lizard’s hide is not just tough and leathery, but also reinforced. Many of the scales contain a small nugget of bone, called an osteoderm, which together form a kind of pointillist body armor. Sawing through these is tough on both arms and blades.
I’m at the Royal Veterinary College, about 20 kilometers outside of central London, watching four biologists put their shoulders into the task. A Komodo dragon, which recently died in London Zoo for unexplained reasons, lies on a steel gurney in front of them. Their task, over the next three days, is to dissect it and measure all of its muscles. So, first, the skin must come off.
There are two types of people in the world: those with hundreds of unread messages, and those who can’t relax until their inboxes are cleared out.
For some, it’s a spider. For others, it’s an unexpected run-in with an ex. But for me, discomfort is a dot with a number in it: 1,328 unread-message notifications? I just can’t fathom how anyone lives like that.
How is it that some people remain calm as unread messages trickle into their inboxes and then roost there unattended, while others can’t sit still knowing that there are bolded-black emails and red-dotted Slack messages? I may operate toward the extreme end of compulsive notification-eliminators, but surveys suggest I’m not alone: One 2012 study found that 70 percent of work emails were attended to within six seconds of their arrival.
This has led me to a theory that there are two types of emailers in the world: Those who can comfortably ignore unread notifications, and those who feel the need to take action immediately.
Caves and tunnels have always been part of human life.
Caves and tunnels have always been part of human life. We've grown more adept at shaping these underground shelters and passages over the millennia, and today we dig for hundreds of reasons. We excavate to find both literal and cultural treasures, digging mines and unearthing archaeological discoveries. We use caverns for stable storage, for entertainment, and for an effective shelter from natural and man-made disasters. And as the planet's surface becomes ever more crowded, and national borders are closed, tunnels provide pathways for our vehicles and for smugglers of every kind. Collected below are more recent subterranean scenes from around the world.
The danger of uploading one’s consciousness to a computer without a suicide switch
Imagine a supercomputer so advanced that it could hold the contents of a human brain. The Google engineer Ray Kurzweil famously believes that this will be possible by 2045. Organized technologists are seeking to transfer human personalities to non-biological carriers, “extending life, including to the point of immortality.” My gut says that they’ll never get there. But say I’m wrong. Were it possible, would you upload the contents of your brain to a computer before death, extending your conscious moments on this earth indefinitely? Or would you die as your ancestors did, passing into nothingness or an unknown beyond human comprehension?
The promise of a radically extended lifespan, or even immortality, would tempt many. But it seems to me that they’d be risking something very much like hell on earth.
New research confirms what they say about nice guys.
Smile at the customer. Bake cookies for your colleagues. Sing your subordinates’ praises. Share credit. Listen. Empathize. Don’t drive the last dollar out of a deal. Leave the last doughnut for someone else.
Sneer at the customer. Keep your colleagues on edge. Claim credit. Speak first. Put your feet on the table. Withhold approval. Instill fear. Interrupt. Ask for more. And by all means, take that last doughnut. You deserve it.
Follow one of those paths, the success literature tells us, and you’ll go far. Follow the other, and you’ll die powerless and broke. The only question is, which is which?
Of all the issues that preoccupy the modern mind—Nature or nurture? Is there life in outer space? Why can’t America field a decent soccer team?—it’s hard to think of one that has attracted so much water-cooler philosophizing yet so little scientific inquiry. Does it pay to be nice? Or is there an advantage to being a jerk?
A song from 2011 is causing controversy now, proving how slowly the genre’s attitudes about women are evolving.
The rapper Action Bronson, whose major-label debut came out recently, is mostly known for his love of food, his large frame, and the fact that he sounds so much like Ghostface Killah that even Ghostface Killah gets confused sometimes. He will likely now be known by more people for one particular lyric of his, due to a headline-making petition asking Toronto’s NXNE music festival to kick the artist off the bill because, in its words, he “glorifies gang-raping and murdering women.”
The lyrics in question come from the 2011 song, “Consensual Rape,” which has a verse that mentions giving a girl MDMA and then having very rough sex with her. The petition also calls out a 2011 music video that portrays Bronson happily disposing of a woman’s corpse.
We're all going to die and we all know it. This can be both a burden and a blessing.
In the heart of every parent lives the tightly coiled nightmare that his child will die. It might spring at logical times—when a toddler runs into the street, say—or it might sneak up in quieter moments. The fear is a helpful evolutionary motivation for parents to protect their children, but it's haunting nonetheless.
The ancient Stoic philosopher Epictetus advised parents to indulge that fear. “What harm is it, just when you are kissing your little child, to say: Tomorrow you will die?”he wrote in his Discourses.
Some might say Epictetus was an asshole. William Irvine thinks he was on to something.
“The Stoics had the insight that the prospect of death can actually make our lives much happier than they would otherwise be,” he says. “You’re supposed to allow yourself to have a flickering thought that someday you’re going to die, and someday the people you love are going to die. I’ve tried it, and it’s incredibly powerful. Well, I am a 21st-century practicing Stoic.”
Reforms were slow to take hold in Cincinnati, but when they did, they drove down crime while also reducing arrests.
CINCINNATI—Citizens were throwing stones and beer bottles at police officers in front of City Hall, and Maris Herold didn’t understand what they wanted.
She was a police officer herself, and knew that her department had made some missteps. Most recently, an officer gunned down a 19-year-old unarmed black man, Timothy Thomas—the fifteenth black man to die at the hands of police in five years.
But, Herold knew, the police were investigating the incident. They were listening to the community. They were working 12-hour shifts to protect the city from looting and fires, though the disturbance would soon turn into the worst riots in the U.S. in a decade.
“I was like, ‘We’re doing everything right, obviously the police officers made mistakes and we’re trying to get to the bottom of it,’” she told me recently. Herold, who joined the police force after a career in social work, couldn’t understand what more the police could do to make amends with the community.