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.
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.
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.
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 1,100 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.)
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.
Four hours after learning about Saturday's devastating earthquake in Nepal, I received a Facebook notification I had never seen before: Sonia, a journalist friend based in northern India, was "marked safe." An hour later, the same notification about a different friend popped up. Then another. Soon, several of my friends wrote that they, too, had learned via this strange new notification that their friends in Nepal were okay.
A few hours later, the mystery was solved. On Saturday afternoon, Facebook CEO Mark Zuckerberg announced on his timeline that the notifications came from Safety Check, a service the company launched last fall. "When disasters happen, people need to know their loved ones are safe," he wrote, "It's moments like this that being able to connect really matters."
Today was the latest installment of the never-ending Clinton scandal saga, but it won’t be the last. Yet in some ways, the specifics are a distraction. The sale of access was designed into the post-2001 Clinton family finances from the start. Probably nobody will ever prove that this quid led to that quo … but there’s about a quarter-billion-dollar of quid heaped in plain sight and an equally impressive pile of quo, and it’s all been visible for years to anyone who cared to notice. As Jonathan Chait, who is no right-wing noise-machine operator, complained: “The Clintons have been disorganized and greedy.”
“All of this amounts to diddly-squat,” pronounced long-time Clinton associate James Carville when news broke that Hillary Clinton had erased huge numbers of emails. That may not be true: If any of the conduct in question proves illegal, destroying relevant records may also have run afoul of the law.
After more than a year of rumors and speculation, Bruce Jenner publicly came out as transgender with four simple words: “I am a woman.”
“My brain is much more female than male,” he explained to Diane Sawyer, who conducted a prime-time interview with Jenner on ABC Friday night. (Jenner indicated he prefers to be addressed with male pronouns at this time.) During the two-hour program, Jenner discussed his personal struggle with gender dysphoria and personal identity, how they shaped his past and current relationships and marriages, and how he finally told his family about his gender identity.
During the interview, Sawyer made a conspicuous point of discussing broadly unfamiliar ideas about gender and sexuality to its audience. It didn't always go smoothly; her questions occasionally came off as awkward and tone-deaf. But she showed no lack of empathy.
“People skills” are almost always assumed to be a good thing. Search employment ads and you will find them listed as a qualification for a startling array of jobs, including Applebee’s host, weight-loss specialist, CEO, shoe salesperson, and (no joke) animal-care coordinator. The notion that people smarts might help you succeed got a boost a quarter century ago, when the phrase emotional intelligence, or EI, entered the mainstream. Coined in a 1990 study, the term was popularized by Daniel Goleman’s 1995 book . Since then, scores of researchers have shown how being in touch with feelings—both your own and other people’s—gives you an edge: compared with people who have average EI, those with high EI do better at work, have fewer health problems,and report greater life satisfaction.
Lots of conservatives talk a good game about how citizens should resist federal control and devolve power to local governments. Few of them are willing to put their convictions into action in quite the same way that Sheriff Joe Arpaio is.
The man who calls himself "America's toughest sheriff" was already in trouble with Uncle Sam, on trial for contempt of court in a U.S. district court. It was only once that was under way that Arpaio and his lawyer apparently had the idea to sic a private investigator on the wife of the federal judge hearing his case. That shows toughness. It shows a willingness to use unorthodox tactics to resist federal interference. It's also not especially bright.
Reporters in the courtroom describe a somewhat shocking scene. Lawyers had completed their questioning when Judge Murray Snow announced he had some questions for Arpaio. After a series of queries, Snow asked: "Are you aware that I've been investigated by anyone?"
When healthcare is at its best, hospitals are four-star hotels, and nurses, personal butlers at the ready—at least, that’s how many hospitals seem to interpret a government mandate.
When Department of Health and Human Services administrators decided to base 30 percent of hospitals’ Medicare reimbursement on patient satisfaction survey scores, they likely figured that transparency and accountability would improve healthcare. The Centers for Medicare and Medicaid Services (CMS) officials wrote, rather reasonably, “Delivery of high-quality, patient-centered care requires us to carefully consider the patient’s experience in the hospital inpatient setting.” They probably had no idea that their methods could end up indirectly harming patients.