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 Hillary Clinton presidential victory promises to usher in a new age of public misogyny.
Get ready for the era of The Bitch.
If Hillary Clinton wins the White House in November, it will be a historic moment, the smashing of the preeminent glass ceiling in American public life. A mere 240 years after this nation’s founding, a woman will occupy its top office. America’s daughters will at last have living, breathing, pantsuit-wearing proof that they too can grow up to be president.
A Clinton victory also promises to usher in four-to-eight years of the kind of down-and-dirty public misogyny you might expect from a stag party at Roger Ailes’s house.
You know it’s coming. As hyperpartisanship, grievance politics, and garden-variety rage shift from America’s first black commander-in-chief onto its first female one, so too will the focus of political bigotry. Some of it will be driven by genuine gender grievance or discomfort among some at being led by a woman. But in plenty of other cases, slamming Hillary as a bitch, a c**t (Thanks, Scott Baio!), or a menopausal nut-job (an enduringly popular theme on Twitter) will simply be an easy-peasy shortcut for dismissing her and delegitimizing her presidency.
The talk-radio host claims that he never took Donald Trump seriously on immigration. He neglected to tell his immigration obsessed listeners.
For almost a decade, I’ve been angrily documenting the way that many right-wing talk-radio hosts betray the rank-and-file conservatives who trust them for information. My late grandmother was one of those people. She deserved better than she got. With huge platforms and massive audiences, successful hosts ought to take more care than the average person to be truthful and avoid misinforming listeners. Yet they are egregiously careless on some days and willfully misleading on others.
And that matters, as we’ll come to see.
Rush Limbaugh is easily the most consequential of these hosts. He has an audience of millions. And over the years, parts of the conservative movement that ought to know better, like the Claremont Institute, have treated him like an honorable conservative intellectual rather than an intellectually dishonest entertainer. The full cost of doing so became evident this year, when a faction of populists shaped by years of talk radio, Fox News, and Breitbart.com picked Donald Trump to lead the Republican Party, a choice that makes a Hillary Clinton victory likely and is a catastrophe for movement conservatism regardless of who wins.
Which is a different way of asking: Can a bot commit libel?
Facebook set a new land-speed record for situational irony this week, as it fired the people who kept up its “Trending Topics” feature and replaced them with an algorithm on Friday, only to find the algorithm promoting completely fake news on Sunday.
Rarely in recent tech history has a downsizing decision come back to bite the company so publicly and so quickly.
The San Francisco quarterback has been attacked for refusing to stand for the Star Spangled Banner—and for daring to criticize the system in which he thrived.
It was in early childhood when W.E.B. Du Bois––scholar, activist, and black radical––first noticed The Veil that separated him from his white classmates in the mostly white town of Great Barrington, Massachusetts. He and his classmates were exchanging “visiting cards,” invitations to visit one another’s homes, when a white girl refused his.
“Then it dawned upon me with a certain suddenness that I was different from the others; or like, mayhap, in heart and life and longing, but shut out from their world by a vast veil. I had thereafter no desire to tear down that veil, to creep through; I held all beyond it in common contempt, and lived above it in a region of blue sky and great wandering shadows,” Du Bois wrote in his acclaimed essay collection, The Souls of Black Folk. “That sky was bluest when I could beat my mates at examination-time, or beat them at a foot-race, or even beat their stringy heads.”
Practices meant to protect marginalized communities can also ostracize those who disagree with them.
Last week, the University of Chicago’s dean of students sent a welcome letter to freshmen decrying trigger warnings and safe spaces—ways for students to be warned about and opt out of exposure to potentially challenging material. While some supported the school’s actions, arguing that these practices threaten free speech and the purpose of higher education, the note also led to widespread outrage, and understandably so. Considered in isolation, trigger warnings may seem straightforwardly good. Basic human decency means professors like myself should be aware of students’ traumatic experiences, and give them a heads up about course content—photographs of dead bodies, extended accounts of abuse, disordered eating, self-harm—that might trigger an anxiety attack and foreclose intellectual engagement. Similarly, it may seem silly to object to the creation of safe spaces on campus, where members of marginalized groups can count on meeting supportive conversation partners who empathize with their life experiences, and where they feel free to be themselves without the threat of judgment or censure.
Like a little white Lazarus with red eyes, the paralyzed mouse was walking again.
A few days earlier, the mouse had been sprawled on an operating table while two Chinese graduate students peered through a microscope and operated on its spine. With a tiny pair of scissors, they removed the top half of a fingernail-thin vertebra, exposing a gleaming patch of spinal-cord tissue. It looked like a Rothko, a clean ivory rectangle bisected by a red line. Cautiously—the mouse occasionally twitched—they snipped the red line (an artery) and tied it off. Then one student reached for a $1,000 scalpel with a diamond blade so thin that it was transparent. With a quick slice of the spinal cord, the mouse’s back legs were rendered forever useless.
To become a citizen of the United States, naturalizing immigrants must take a test. Many native-born Americans would fail this test. Indeed, most of us have never really thought about what it means to be a citizen. One radical idea from the immigration debate is the repeal of birthright citizenship—guaranteed by the Fourteenth Amendment—to prevent so-called anchor babies. Odious and constitutionally dubious as this proposal may be, it does prompt a thought experiment: What if citizenship were not, in fact, guaranteed by birth? What if everyone had to earn it upon turning 18, and renew it every 10 years, by taking an exam? What might that exam look like?
In the name of emotional well-being, college students are increasingly demanding protection from words and ideas they don’t like. Here’s why that’s disastrous for education—and mental health.
Something strange is happening at America’s colleges and universities. A movement is arising, undirected and driven largely by students, to scrub campuses clean of words, ideas, and subjects that might cause discomfort or give offense. Last December, Jeannie Suk wrote in an online article for The New Yorker about law students asking her fellow professors at Harvard not to teach rape law—or, in one case, even use the word violate (as in “that violates the law”) lest it cause students distress. In February, Laura Kipnis, a professor at Northwestern University, wrote an essay in The Chronicle of Higher Education describing a new campus politics of sexual paranoia—and was then subjected to a long investigation after students who were offended by the article and by a tweet she’d sent filed Title IX complaints against her. In June, a professor protecting himself with a pseudonym wrote an essay for Vox describing how gingerly he now has to teach. “I’m a Liberal Professor, and My Liberal Students Terrify Me,” the headline said. A number of popular comedians, including Chris Rock, have stopped performing on college campuses (see Caitlin Flanagan’s article in this month’s issue). Jerry Seinfeld and Bill Maher have publicly condemned the oversensitivity of college students, saying too many of them can’t take a joke.
Former U.S. Secretary of Education Arne Duncan examines the issues at the heart of the charter-school debate.
In the field of education, success is too often an orphan while failure has many fathers. The stories of the high-performing charter-school networks featured in Richard Whitmire’s important new book, The Founders: Inside the revolution to invent (and reinvent) America’s best charter schools, provide a welcome antidote to the pernicious notion that high-performing schools for disadvantaged students are isolated flukes, dependent on a charismatic educator or the cherry-picking of bright students. Whitmire’s account reveals the secret of the sauce: What is it that schools can do at scale for children to close achievement gaps, even in the face of the real burdens of poverty?
As the CEO of the Chicago Public Schools, and later as the U.S. Secretary of Education, I had the good fortune to visit dozens of gap-closing charter schools, including many of the charter-school networks featured in Whitmire’s account. I always came away from those visits—as I do when I visit any great public school—with both a sense of hope and a profound feeling of respect and gratitude for the school's educators and school leaders.
Bernie Sanders never showed up, and former staffers at Our Revolution believe the organization's 501(c)(4) status hurt Debbie Wasserman Schultz’s primary challenger.
The political revolution has let Tim Canova down. Bernie Sanders hasn’t shown up to campaign for his chosen primary challenger to Debbie Wasserman Schultz, the former chair of the Democratic National Committee. Heading into a Florida Democratic primary on Tuesday, Canova is behind by double digits in recent polling and looks likely to lose the race.
But that’s only part of the story. Former staffers at Our Revolution, the organization created to act as a successor to the Sanders campaign, believe the group did not do as much as it should have to help Canova in his bid to defeat the veteran Florida congresswoman.
A number of staffers who resigned from Our Revolution in protest over how it has been run say the organization’s 501(c)(4) status made it impossible to coordinate strategy with the Canova campaign, leaving the campaign worse off as a result. At least some departing staffers believe the organization should be set up under a different legal structure so that it can coordinate with candidates it endorses in the future and do more to help them win.