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.
As the public’s fear and loathing surge, the frontrunner’s durable candidacy has taken a dark turn.
MYRTLE BEACH, South Carolina—All politicians, if they are any good at their craft, know the truth about human nature.
Donald Trump is very good, and he knows it better than most.
Trump stands alone on a long platform, surrounded by a rapturous throng. Below and behind him—sitting on bleachers and standing on the floor—they fill this city’s cavernous, yellow-beige convention center by the thousands. As Trump will shortly point out, there are a lot of other Republican presidential candidates, but none of them get crowds anything like this.
Trump raises an orange-pink hand like a waiter holding a tray. “They are not coming in from Syria,” he says. “We’re sending them back!” The crowd surges, whistles, cheers. “So many bad things are happening—they have sections of Paris where the police are afraid to go,” he continues. “Look at Belgium, the whole place is closed down! We can’t let it happen here, folks.”
The Islamic State is no mere collection of psychopaths. It is a religious group with carefully considered beliefs, among them that it is a key agent of the coming apocalypse. Here’s what that means for its strategy—and for how to stop it.
What is the Islamic State?
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.
Mary Beard’s sweeping history is a new read of citizenship in the ancient empire.
A british college student named Megan Beech recently published a poetry collection called When I Grow Up I Want to Be Mary Beard. Beech is not alone in her admiration for Beard, who was for a time the only female classics lecturer at Cambridge University and has since become the most prominent representative of a field once associated with dusty male privilege. In 2013, Beard was appointed to the Order of the British Empire for “services to Classical Scholarship.” A prolific authority on Roman culture, she construes those services broadly. Her academic work ranges from studies of Roman religion and Roman victory practices to reflections on Roman laughter, and she has written lively books about Pompeii and the Colosseum. As the erudite docent on a BBC series three years ago titled Meet the Romans, Beard introduced a bigger audience to a bigger Rome: a citizenry far beyond the handful of Latin-speaking men who populated the Senate, served as emperors, or wrote (often dictating to their slaves) the books that we call “Roman literature.” Whatever the context (she also writes a blog, “A Don’s Life,” for the Times Literary Supplement), Beard does precisely what few popularizers dare to try and plenty of dons can’t pull off: She conveys the thrill of puzzling over texts and events that are bound to be ambiguous, and she complicates received wisdom in the process.
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.
Why are so many kids with bright prospects killing themselves in Palo Alto?
The air shrieks, and life stops. First, from far away, comes a high whine like angry insects swarming, and then a trampling, like a herd moving through. The kids on their bikes who pass by the Caltrain crossing are eager to get home from school, but they know the drill. Brake. Wait for the train to pass. Five cars, double-decker, tearing past at 50 miles an hour. Too fast to see the faces of the Silicon Valley commuters on board, only a long silver thing with black teeth. A Caltrain coming into a station slows, invites you in. But a Caltrain at a crossing registers more like an ambulance, warning you fiercely out of its way.
The kids wait until the passing train forces a gust you can feel on your skin. The alarms ring and the red lights flash for a few seconds more, just in case. Then the gate lifts up, signaling that it’s safe to cross. All at once life revives: a rush of bikes, skateboards, helmets, backpacks, basketball shorts, boisterous conversation. “Ew, how old is that gum?” “The quiz is next week, dipshit.” On the road, a minivan makes a left a little too fast—nothing ominous, just a mom late for pickup. The air is again still, like it usually is in spring in Palo Alto. A woodpecker does its work nearby. A bee goes in search of jasmine, stinging no one.
An entire industry has been built on the premise that creating gourmet meals at home is simple and effortless. But it isn’t true.
I write about food for a living. Because of this, I spend more time than the average American surrounded by cooking advice and recipes. I’m also a mother, which means more often than not, when I return from work 15 minutes before bedtime, I end up feeding my 1-year-old son squares of peanut-butter toast because there was nothing in the fridge capable of being transformed into a wholesome, homemade toddler meal in a matter of minutes. Every day, when I head to my office after a nourishing breakfast of smashed blueberries or oatmeal I found stuck to the pan, and open a glossy new cookbook, check my RSS feed, or page through a stack of magazines, I’m confronted by an impenetrable wall of unimaginable cooking projects, just sitting there pretending to be totally reasonable meals. Homemade beef barbacoa tacos. Short-rib potpie. “Weekday” French toast. Make-ahead coconut cake. They might as well be skyscraper blueprints, so improbable is the possibility that I will begin making my own nut butters, baking my own sandwich bread, or turning that fall farmer’s market bounty into jars of homemade applesauce.
A yearlong investigation of Greek houses reveals their endemic, lurid, and sometimes tragic problems—and a sophisticated system for shifting the blame.
One warm spring night in 2011, a young man named Travis Hughes stood on the back deck of the Alpha Tau Omega fraternity house at Marshall University, in West Virginia, and was struck by what seemed to him—under the influence of powerful inebriants, not least among them the clear ether of youth itself—to be an excellent idea: he would shove a bottle rocket up his ass and blast it into the sweet night air. And perhaps it was an excellent idea. What was not an excellent idea, however, was to misjudge the relative tightness of a 20-year-old sphincter and the propulsive reliability of a 20-cent bottle rocket. What followed ignition was not the bright report of a successful blastoff, but the muffled thud of fire in the hole.
Retailers are experimenting with a bold new strategy for the commercial high holiday: boycotting themselves.
It starts with a scene of touch football in the yard. Next, a woman and a girl, cooking together in the kitchen. “Imagine a world,” a soothing voice intones, “where the only thing you have to wrestle for on Thanksgiving is the last piece of pumpkin pie, and the only place we camped out was in front of a fire, and not the parking lot of a store.” And, then, more scenes: a man, cuddling with kids on a couch. An older woman, rolling pie dough on the counter. A fire, crackling in the fireplace. Warmth. Wine. Togetherness. Laughter.
It’s an ad, unsurprisingly, but it’s an ad with a strange objective: to tell you not to buy stuff. Or, at least, to spend a day not buying stuff. “At T.J. Maxx, Marshall’s, and HomeGoods, we’re closed on Thanksgiving,” the spot’s velvet-voiced narrator informs us, “because family time comes first.” And then: more music. More scenes of familiar/familial delights. More laughter. More pie. The whole thing concludes: “Let’s put more value on what really matters. This season, bring back the holidays—with T.J. Maxx, Marshall’s, and HomeGoods.”
How a con-artist father and treason in MI6 created the bard of the Cold War
Every writer is a kind of spy, ghosting through life in the service of an alien power. He lurks, he snoops, he eavesdrops, he jots his jottings, he thinks his treacherous thoughts. But not every spy is a writer. Kim Philby, for example, the Soviet double agent who spent a perfidiously productive decade in the highest echelons of Cold War British intelligence, was also responsible for some appalling prose. “Her political views are Socialistic, but like the majority of the wealthy class, she has an almost ineradicable tendency towards a definite form of philistinism.” This is Philby, secret totalitarian, summarizing for his Moscow controllers the ideological impurities of his (at this point) unsuspecting wife, Aileen. “She believes in upbringing, the British navy, personal freedom, democracy, the constitutional system, honor, etc.” The single literary touch here is an accident: that supremely horrible and languid etc., following the word honor and trailing off into an abyss of contempt.