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.
Where did it come from, and what are its intentions? The simplicity of these questions can be deceiving, and few Western leaders seem to know the answers. In December, The New York Times published confidential comments by Major General Michael K. Nagata, the Special Operations commander for the United States in the Middle East, admitting that he had hardly begun figuring out the Islamic State’s appeal. “We have not defeated the idea,” he said. “We do not even understand the idea.” In the past year, President Obama has referred to the Islamic State, variously, as “not Islamic” and as al-Qaeda’s “jayvee team,” statements that reflected confusion about the group, and may have contributed to significant strategic errors.
Freddie Gray's death on April 19 leaves many unanswered questions. But it is clear that when Gray was arrested in West Baltimore on the morning of April 12, he was struggling to walk. By the time he arrived at the police station a half hour later, he was unable to breathe or talk, suffering from wounds that would kill him.*
Gray died Sunday from spinal injuries. Baltimore authorities say they're investigating how the 25-year-old was hurt—a somewhat perverse notion, given that it was while he was in police custody, and hidden from public view, that he apparently suffered injury. How it happened remains unknown. It's even difficult to understand why officers arrested Gray in the first place. But with protestors taking to the streets of Baltimore since Gray's death on Sunday, the incident falls into a line of highly publicized, fatal encounters between black men and the police. Meanwhile, on Tuesday, a reserve sheriff's deputy in Tulsa, Oklahoma, pleaded not guilty to a second-degree manslaughter charge in the death of a man he shot. The deputy says the shooting happened while he was trying to tase the man. Black men dying at the hands of the police is of course nothing new, but the nation is now paying attention and getting outraged.
Orr:Wait a minute. There’s a royal wedding—and nobody dies a horrible death? A man is beheaded—and we can all agree that it was for the best? What the hell show am I watching? I came here for Game of Thrones, baby, not Wizards of Waverly Place.
I kid, of course. Given David Benioff and D.B. Weiss’s tendency to take George R. R. Martin’s material and render it even more bloody than it already was, I’m actually mildly relieved that they didn’t throw in a random homicide just to spice up the nuptials of Margaery and young Tommen, First of His Name.
Soon, thousand of police officers across the country will don body-worn cameras when they go out among the public. Those cameras will generate millions of hours of footage—intimate views of commuters receiving speeding tickets, teens getting arrested for marijuana possession, and assault victims at some of the worst moments of their lives.
As the Washington Post and the Associated Press have reported, lawmakers in at least 15 states have proposed exempting body-cam footage from local open records laws. But the flurry of lawmaking speaks to a larger crisis: Once those millions of hours of footage have been captured, no one is sure what to do with them.
I talked to several representatives from privacy, civil rights, and progressive advocacy groups working on body cameras. Even among these often allied groups, there’s little consensus about the kind of policies that should exist around releasing footage.
A magnitude 7.8 earthquake struck Nepal early on Saturday, centered 10 miles below the surface, less than 50 miles from the capital of Kathmandu. At least 2,200 are already reported to have been killed by the quake and subsequent avalanches triggered in the Himalayas. Historic buildings and temples were destroyed, leaving massive piles of debris in streets as rescue workers and neighbors work to find and help those still trapped beneath rubble. Below are images from the region of the immediate aftermath of one of the most powerful earthquakes to strike Nepal in decades. (Editor's note, some of the images are graphic in nature.)
Hours after a major earthquake wreaked havoc across his country, Nepali Information Minister Minendra Rijal appeared at a news conference on Saturday to announce that schools would be closed for the next five days. "We never imagined we'd face such devastation," he said.
But for geologists, Saturday's disaster—which has claimed over 2,400 lives—was sadly predictable.
"Physically and geologically what happened is exactly what we thought would happen," James Jackson, head of the earth-sciences department at the University of Cambridge, told the Associated Press.
Blessed with stunning natural scenery, Nepal is a popular tourist destination that attracts hundreds of thousands of travelers each year. But the source of the country's beauty is what makes it particularly vulnerable to earthquakes. Much of Nepal's population lives in a valley beneath the Himalayas, a mountain range formed by collisions between the Indian and Central Asian tectonic plates. These collisions—which occur when the Indian plate slides underneath its much larger neighbor—are what cause earthquakes. According to The Washington Post, a chunk of the earth measuring 75 by 37 miles shifted 10 feet in 30 seconds on Saturday, destroying much of what lay atop the surface.
Take a walk along West Florissant Avenue, in Ferguson, Missouri. Head south of the burned-out Quik Trip and the famous McDonalds, south of the intersection with Chambers, south almost to the city limit, to the corner of Ferguson Avenue and West Florissant. There, last August, Emerson Electric announced third-quarter sales of $6.3 billion. Just over half a mile to the northeast, four days later, Officer Darren Wilson killed Michael Brown. The 12 shots fired by Officer Wilson were probably audible in the company lunchroom.
Outwardly, at least, the City of Ferguson would appear to occupy an enviable position. It is home to a Fortune 500 firm. It has successfully revitalized a commercial corridor through its downtown. It hosts an office park filled with corporate tenants. Its coffers should be overflowing with tax dollars.
I’m not a dog person. I prefer cats. Cats make you work to have a relationship with them, and I like that. But I have adopted several dogs, caving in to pressure from my kids. The first was Teddy, a rottweiler-chow mix whose bushy hair was cut into a lion mane. Kids loved him, and he grew on me, too. Teddy was probably ten years when we adopted him. Five years later he had multiple organs failing and it was time to put him to sleep.
When I arrived at the vet, he said I could drop him off. I was aghast. No. I needed to stay with Teddy.As the vet prepped the syringe to put him to sleep, I started sobbing. The vet gave me a couple minutes to collect myself and say goodbye. I held Teddy's paw until he died. Honestly, I didn't think I was that attached.
In a few weeks, millions of college students will enter the real world with dreams of finding work that's meaningful and challenging—and preferably lucrative enough to live roommate-free in a major city. As they embark on their job searches, recent graduates are frequently given the vague advice to "go out and network."
But what exactly should this networking entail? What does one say to a perfect stranger whom one has cajoled into "grabbing coffee," while also telepathically conveying one's desire for a job?
Science has one piece of advice, which is this: Ask them for advice.
Far from inconveniencing or annoying the advice-giver, research shows that asking for advice appears to boost perceptions of intelligence.
In her new book No One Understands You and What To Do About It, Heidi Grant Halvorson tells readers a story about her friend, Tim. When Tim started a new job as a manager, one of his top priorities was communicating to his team that he valued each member’s input. So at team meetings, as each member spoke up about whatever project they were working on, Tim made sure he put on his “active-listening face” to signal that he cared about what each person was saying.
But after meeting with him a few times, Tim’s team got a very different message from the one he intended to send. “After a few weeks of meetings,” Halvorson explains, “one team member finally summoned up the courage to ask him the question that had been on everyone’s mind.” That question was: “Tim, are you angry with us right now?” When Tim explained that he wasn’t at all angry—that he was just putting on his “active-listening face”—his colleague gently explained that his active-listening face looked a lot like his angry face.