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.
Many point to unromantic 20-somethings and women’s entry into the workforce, but an overlooked factor is the trouble young men have in finding steady, well-paid jobs.
TOKYO—Japan’s population is shrinking. For the first time since the government started keeping track more than a century ago, there were fewer than 1 million births last year, as the country’s population fell by more than 300,000 people. The blame has long been put on Japan’s young people, who are accused of not having enough sex, and on women, who, the narrative goes, put their careers before thoughts of getting married and having a family.
But there’s another, simpler explanation for the country’s low birth rate, one that has implications for the U.S.: Japan’s birth rate may be falling because there are fewer good opportunities for young people, and especially men, in the country’s economy. In a country where men are still widely expected to be breadwinners and support families, a lack of good jobs may be creating a class of men who don’t marry and have children because they—and their potential partners—know they can’t afford to.
Biology textbooks tell us that lichens are alliances between two organisms—a fungus and an alga. They are wrong.
In 1995, if you had told Toby Spribille that he’d eventually overthrow a scientific idea that’s been the stuff of textbooks for 150 years, he would have laughed at you. Back then, his life seemed constrained to a very different path. He was raised in a Montana trailer park, and home-schooled by what he now describes as a “fundamentalist cult.” At a young age, he fell in love with science, but had no way of feeding that love. He longed to break away from his roots and get a proper education.
At 19, he got a job at a local forestry service. Within a few years, he had earned enough to leave home. His meager savings and non-existent grades meant that no American university would take him, so Spribille looked to Europe.
The transcript of the president’s conversation with The New York Times throws his shortcomings into greater relief than ever before.
“Now Donald Trump has finally done it” is a sentence many people have said or written, but which has never yet proven true. As Trump gained momentum during the campaign season, errors that on their own would have stopped or badly damaged previous candidates bounced right off.
These ranged from mocking John McCain as a loser (because “I like people who weren’t captured”), to being stumped by the term “nuclear triad” (the weapons of mass destruction that he as U.S. president now controls), to “when you’re a star ... you can grab ‘em by the pussy” (my onetime employer Jimmy Carter had to spend days in the 1976 campaign explaining away his admission to Playboy that he had sometimes felt “lust in the heart”), to being labelled by an in-party opponent a “pathological liar,” “utterly amoral,” and “a narcissist at a level I don't think this country's ever seen” (the words of his now-supporter Ted Cruz). I kept my list of 152 such moments in the Time Capsule series as the campaign went on.
Amidst the no-shampoo revolution, a look at global hygiene habits
Cleanliness, it turns out, has been one dirty trick. One reason early-20th-century Americans ramped up their weekly baths to daily showers is that marketing companies capitalized on the insecurities of a new class of office drones working in close quarters. As Gizmodo wrote last week, to sell products like "toilet soap" and Listerine to Americans, "the advertising industry had to create pseudoscientific maladies like 'bad breath' and 'body odor.'"
Take, for instance, Gizmodo's description of the philosophy of the Cleanliness Institute, which was founded by the Association of American Soap and Glycerine Producers:
The trade association wanted Americans to wash quite unwittingly after toilet, to wash without thought before eating, to jump into the tub as automatically as one might awake each new day.
The president also angrily lashed out at the media and his critics.
President Trump lashed out at the media in a Saturday morning tweetstorm, insisting his authority to issue pardons is “complete” and expressing frustration over stories that revealed Attorney General Jeff Sessions may have lied about his contacts with Russian officials during the 2016 campaign.
“A new INTELLIGENCE LEAK from the Amazon Washington Post, this time against A.G. Jeff Sessions. These illegal leaks, like Comey’s, must stop!” the president tweeted, following up by stating that “While all agree the U. S. President has the complete power to pardon, why think of that when only crime so far is LEAKS against us. FAKE NEWS.”
The tacit acknowledgement the president has been thinking about his pardon power in relation to the Russia investigation, and the qualification that no crimes but leaks had been revealed “so far” raised eyebrows among media observers.
On Flower Boy the rapper suggests he’s not straight—and struggles with a stigma he helped propagate.
Tyler, the Creator became famous, in part, for being hateful. When his rap collective Odd Future Wolf Gang Kill Them All (“Odd Future” is fine) caught buzz around 2010, it was because of their delirious energy and Eminem-like love of mayhem. But it was their threats against women and “faggots,” delivered in song and on social media, that elevated them from subculture phenomenon to become essay prompt and political flashpoint. The likes of GLAAD and the band Tegan and Sara declared Tyler poisonous and asked the music industry to stop supporting him. Theresa May, back when she was home secretary of the U.K., took the extraordinary step of banning him from her country because his lyrics “encourage violence and intolerance of homosexuality.”
One story that should not slip underneath the radar, however, is a report that the Trump administration has apparently entrusted a small group at the White House to undermine the Iran nuclear accords over the objections of the Departments of State and Defense.
The news says a lot about two very narrow ways in which the administration sees not only Iran but the greater world. First, some members of the administration have failed to see the admittedly very real challenges presented by Iran outside the binary U.S.-Iranian contest for influence in the Middle East. Second, and most importantly, some members of the administration still do not understand that much of what the United States has been able to accomplish over the past two decades has been achieved through coalitions that could actively resist U.S. efforts to roll back those accomplishments.
The Senate parliamentarian’s rejection of important provisions of the GOP’s Obamacare repeal bill puts its status in further jeopardy.
On Friday, Senate Democrats released a list of provisions in the Republican health-care bill that the Senate parliamentarian holds can pass via a simple, filibuster-proof majority vote. Among those provisions that didn’t meet her scrutiny are the bill’s plans to defund Planned Parenthood, restrict tax-credit funding for insurance plans that provide abortions, and a six-month “lockout” period from purchasing insurance for people who don’t maintain continuous coverage.
If this preliminary guidance holds, the Better Care Reconciliation Act—which is already in dire straits—seems likely to fail.
The final assessment of the parliamentarian, Elizabeth MacDonough, is a critical step in the GOP’s strategy for passing their bill to repeal and replace Obamacare. Republicans have opted to pass their health-care legislation via the special reconciliation process, under which they can cut debate short in the Senate and thus eliminate indefinite filibusters, which Democrats would certainly use in order to block any attempt to repeal Obamacare. But bills have to follow a certain procedure—called the Byrd Rule—in order to pass by reconciliation.
Epic yet intimate, the director's new war film is boldly experimental and visually stunning.
What is Dunkirk?
The answer is more complicated than one might imagine. Director Christopher Nolan’s latest is a war film, of course, yet one in which the enemy scarcely makes an appearance. It is a $150 million epic, yet also as lean and spare as a haiku, three brief, almost wordless strands of narrative woven together in a mere 106 minutes of running time. It is classic in its themes—honor, duty, the horror of war—yet simultaneously Nolan’s most radical experiment since Memento. And for all these reasons, it is a masterpiece.
The historical moment captured by the film ascended long ago to the level of martial lore: In May 1940, in the early days of World War II, some 400,000 British and Allied troops were flanked and entrapped by Germany on the beaches of Dunkirk in northern France. Although the Channel was narrow enough that the men could almost see across to England, the waters were too shallow for warships to approach the beaches. So a flotilla of some 700 civilian craft—the “Little Ships of Dunkirk”—made their way from Ramsgate in England to assist in the rescue.
A new study explores why the latter are far more likely to opt for an elite college where they'd struggle than a so-so one where they'd excel.
There’s a saying in China that it’s better to be the head of a chicken than the tail of a phoenix. The premise of the aphorism—it’s better to be over-qualified than under-qualified relative to one’s surroundings—is so widely accepted that similar versions of it exist across cultures. In Japan, they tend to say that it’s better to be the head of a sardine than the tail of a whale. Americans and Brits often declare that it’s better to be a big frog (or fish) in a small pond than a little frog in a big pond.
Extensive research supports these axioms, particularly in the realm of education. Longitudinal studies have consistently shown that high-performing students at less-selective schools feel more competent, have higher GPAs, and have more ambitious career aspirations than low-performing students at more-selective schools.