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Mail 618 April 12 - 28, 2010

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Re: Colcrys  (See View: FDA grants monopoly)

You write: "What happened is that the FDA has given URL Pharma Inc. a monopoly on a folk remedy..."

No, what *happened* is that the FDA forced URL Pharma to spend dozens of millions of dollars on a study to verify the safety of a drug that's been used for hundreds of years, and the company now has to price the drug appropriately to recover those dozens of millions before the patent expires.

Ibuprofen and acetaminophen are both "grandfathered" drugs like colchicine, and it's likely that neither would be approved by the contemporary FDA without a tremendous study and severe restrictions on usage. Aspirin (acetylsalicylic acid) probably wouldn't be approved at all due to its liver toxicity.

-- Mike T. Powers

  The FDA has decided to substitute its judgment for that of the physicians and the consumers, and the "requirement" that "forced" URL Pharma to spend heavily on "verifying" the safety of a folk remedy widely accepted by physicians is a great example of the Iron Law. There was no need for this 'verification'. Since the FDA didn't have the authority to regulate colchicine, it found a way to grant a monopoly to someone who would do the FDA's bidding.

Note that we still have "homeopathic" remedies available in the drug stores. Since they contain essentially nothing -- the homeopathic theory requires enormous dilutions -- they are certainly safe. Their effectiveness is complicated since there is certainly a psychological effect -- mind over matter -- whatever the truth of the homeopathic theory that a drug that causes the symptoms of a disease but diluted to the vanishing point is the proper cure for that disease. I don't find homeopathy appealing -- I first heard of it in Martin Gardener's book Fads and Fallacies in the Name of Science and I have seen nothing to convince me that he was wrong -- but I also believe in freedom.

My notion of the "rights" of the FDA would be to let them enforce truth in advertising. I don't mind if they can require makers to label a product "This is not approved by the FDA, and the FDA finds no evidence that this product will do you any good at all." As to truth in advertising, if the bottle proclaims that it is snake oil, then it must actually have in it oil squeezed out of snake.

I don't think Congress intended the FDA to be able to grant monopolies over folk remedies. I don't think it should be able to reward a company for "verification" of harmless folk remedies.

But then I am partial to freedom.

===============

Re: Nothing will ever go out of print

You write: "Soon enough nothing will ever go out of print..."

You need to add "...as long as you consider unauthorized copyright-violating reprints". See, here's where Orphan Works really comes into play; there are many authors whose work cannot be reprinted because the rights status is unclear. There are authors who can't get THEIR OWN WORK reprinted because of this problem.

As I said before, people like to yell about the Google Grab, but maybe this is a good thing--if the US Copyright Office can't keep records well enough to allow people to identify and contact rightsholders, then maybe we just need to set everything back to zero.

-- Mike T. Powers

Come now. I can't repeat everything I ever said about a subject every time I mention it. I have written extensively about the problem of orphan works, and the idiocy of extending copyrights to ridiculous lengths many times. I suppose "soon enough" isn't quite the right phrase; but eventually all copyrights expire. At that point nothing will be out of print since anything can be scanned and distributed either as e-Book or Print on Demand. That, of course, assumes that orphan works survive. Thousands vanish every year, which was the spark that made Google decide to go scanning everything in several libraries, then spend millions on adjudication and arbitration.

I didn't like the Google Grab when I first heard of it, but over time my views have changes. I have said many times that I don't share the SFWA view of the Google Grab, and over time I have come to believe that the Authors Guild negotiation came up with about as good a settlement as we can hope for. It allows authors to opt out of the settlement and those who feel really strongly about the insult of having their work scanned without permission can do so. Obviously there is no way to make it opt in because orphan works would automatically be excluded. As I've made clear here in previous essays, I think doing nothing has worse consequences than the Google Grab. The Guild has done about as well as we're likely to get. Now if the judge will just approve it we can get on with our lives.

==========

The US and Viet Nam are likely allies if reality prevails...

Dear Dr Pournelle,

You might be surprised. US Navy ships have been making regular port calls for years. Last year for about two weeks the house was constantly shaking because of low flying Migs. The US Air Force was doing an evaluation of Vietnamese Fighter Pilot Training. Note, the house is about 50 miles from the Phan Rang Air Base and once a month for a couple of days there will be an occasional low flying Mig on a training mission.

Sam

I'd heard something of the sort, and probably should have mentioned it. Thanks.

============

Firing Public Servants

You said:

I wonder if there will be any effort to find the civil servants who approved these, or if, having identified them, there is any possible remedy to be applied. Remember: whoever approved this will be able to retire with a large pension which you will get to pay for, probably for the rest of your life. Now the government that approves an Energy Star Certificate for a gasoline powered alarm clock will now in essence take over administering the Health Care System in the United States. Good luck, America.

 --They would in Canada. Back during the Flu ‘crisis’, an official approved that the Calgary Flames could jump the que. They made a point of finding who it was and publicly firing him. Also all our public officials federally have had hiring freezes and wage freezes since the federal budget was announced. They remember how back in the 90’s the service was cut by over 60 percent. The service knows that our PM and the Conservatives would gut them if they had a majority.

<http://www.nationalpost.com/
sports/story.html?id=2184594

DM

David March

==========

Letter from Vacaville

Spent Easter with family in San Diego. Easter Monday, drove to Yosemite, stopping off in Mariposa to look at houses. One of my brothers has commented that when he sees us shopping for houses, he knows the recession is at an end. Spent three days in Yosemite and am currently headed towards SFO for departure.

Californians appear to be markedly wealthier than the British at all social levels. Medical care in the UK is cheaper, and for the most part, better. The difference is for rare and end-of-life conditions--the British are much less vulnerable to cost, but less treatments are available.

The UK election continues to evolve...

Kenneth Clarke criticises Labour jobs programmes <http://tinyurl.com/y76thp2

Currently in the UK it costs more in taxes to be married than to live together. The Tories propose to change this <http://tinyurl.com/y294xkj>  <http://tinyurl.com/y2xm9g5

UK election news <http://tinyurl.com/yaro3yl> <http://tinyurl.com/y4aoh7o>  <http://tinyurl.com/y7ceqrw>  <http://tinyurl.com/y3jryv5>  <http://tinyurl.com/y2yae6l

Forensic DNA in the UK (I teach this stuff) <http://tinyurl.com/y3onync

Bright students unable to find university places <http://tinyurl.com/y4dfvpu

-- Harry Erwin, PhD, Senior Lecturer of Computing, University of Sunderland. Computational neuroethologist: http://crowan-scat.sunderland.ac.uk/~harryerw/mediawiki/index.php

I'd be interested in the definition of "better".

============

Maestrogenic

Jerry,

I had never seen the word "maestrogenic" before reading your replies in the mail from April 10th, [subject dyslexis] and so I looked it up. Google seemed to think I was looking for "estrogenic," but I found one likely link for maestrogenic and followed it:

http://3e.org/nota/archives/2001/01/vocabulary_corn.html 

As it turned out, the usage example they cite is a quote by you--from over nine years ago, on the same subject as what you wrote on the 10th that sent me looking for the definition in the first place! I'm not sure what to call that, but I thought you'd appreciate it.

They also suggested that you might have coined the word, as it does not appear in dictionaries. Did you?

-Philip

I doubt it is original with me but that's possible. It just seems obvious once you find out about iatrogenic disorders, and I heard that word [iatrogenic] used in my undergraduate abnormal psychology class. I have been using maestrogenic for decades, but I don't know if I head someone else say it or I came up with it myself. I even had a lecture on "maestrogenic disorders" back when I was on the lecture circuit.

I am fairly certain that a majority of 'dyslexia' is maestrogenic.

===============

 

 

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Tuesday,  April 13, 2010

FDA

"I don't think [the FDA] should be able to reward a company for "verification" of harmless folk remedies." (See View) (See also Mail)

Your quotes around verification show that you missed the point. It's not a scam where the company "verified" a medicine which was already known safe, but I think the company WAS required by the FDA to do the usual multimillions in studies required for any new medicine. The only scam here is by the FDA.

I wholeheartedly agree that truth in advertising is the solution. If the medicine is going to kill you it must say so right on the label, and let any adult decide if he wants to take it.

R

If it's in the law that FDA can require a company to verify a medicine not only already known safe but exempted from FDA jurisdiction in the black letter law, then that's just plain wrong. Why should the Feds be able to require verification of folk remedies? At most they should be able to require a label warning "This product has not been validated as safe or effective by the FDA." That's consistent with freedom.

What the FDA did was encourage this company to spend money to "verify" a known safe product prescribed by many physicians and known safe for a hundred years, then give that company a monopoly on the product as a reward. It's the Iron Law of Bureaucracy in action, as the FDA seeks to expand its power so that it can hire more people and thus promote the ones it has.

It was an FDA scam, and I thought that was the point of my bringing it up; apparently I didn't make that clear enough.

=========================

Microsoft outsources IT to Indian firm.

<http://www.techflash.com/seattle/
2010/04/microsoft_outsources_its_own_it.html>

---- Roland Dobbins

=================

Subject: Unpaid Internships (See view)

I think there is another dynamic at work too. Face it schools don't have incentive to promote unpaid teaching and can't stop kids from taking paid jobs. But schools do have a huge desire to turn those unpaid internships into tuition paid learning experiences. My Son has had to pay for 2 such events in College and I think there will be more of them. It may be likely that schools in their greed will only promote student paid internships in their desire to suck every last penny from the parents.

Jeff Mulzer

The higher education system in this nation is seriously broken, and the Federal Government helps them continue this madness. Credentialism is strangling our dynamism as well as clipping the wings of freedom. But we've been sowing that wind for many years.

============

  Obama calls for Thoughts

the Obama administration wants to draw on the collective wisdom of scientists everywhere in deciding which scientific and technological challenges should be the focus of policy initiatives in the coming years.

In 2009 President Obama provided some examples of what these challenges might be:

* Complete DNA sequencing of every type of cancer. * A universal vaccine for influenza that will protect against all future strains. * Solar cells as cheap as paint, and green buildings that produce all of the energy they consume. * A light-weight vest for soldiers and police officers that can stop an armor-piercing bullet. * Educational software that is as compelling as the best video game and as effective as a personal tutor. * Biological systems that can turn sunlight into carbon-neutral fuel, reduce the costs of producing antimalarial drugs by a factor of 10, and quickly and inexpensively dispose of radioactive wastes and toxic chemicals.

Now, the White House wants your help in shaping the federal government’s current and future scientific priorities. As scientists and concerned citizens, we have a great responsibility and a unique opportunity to be the voices that are helping to define the White House’s scientific agenda. Make your voice heard. Submit your ideas today <http://www.info-aaas.org/l.jsp?d=
4297.491302.654.2aqNKEyfk9g..A>  .

http://promo.aaas.org/expertlabs/grandchallenges.html  (via WattsUpWithThat)

Strikes me that space industrialization is the elephant in the room not mentioned & an X-Prize Foundation the answer. Ageing research may be another elephant. Surely both are of greater value to humanity than a better bullet proof vest? On the other hand silly as some of these are at least he is asking.

Neil C

Perhaps we ought all to suggest Prizes; it's not what the Administration wants, but perhaps enough such suggestions would at least get some attention.

And of course if they'd all just read A Step Farther Out...

 

For a PDF copy of A Step Farther Out:

================

"Even our great leaders Mao Zedong and Deng Xiaoping needed help writing."

<http://news.yahoo.com/s/ap/20100411/ap_on_re_as/as_china_academic_cheating>

-- Roland Dobbins

=================

Yesterday's Letter from England contained the statement that the English health care system was 'better' than the US. I asked what that meant

The average life expectancy at birth in the UK is 79.01 years, while that in the USA is 78.11 years. <http://tinyurl.com/yrq7l8>  (CIA) Wikipedia has slightly different numbers, but the rank ordering is similar. <http://en.wikipedia.org/wiki/
List_of_countries_by_life_expectancy>  Per capita expenditure in the UK was $2784 in 2006, while that in America was $6714 (WHO <http://www.who.int/nha/country/en/> ). The UK simply doesn't spend the money Americans do on end of life care and rare conditions, and the greater emphasis in the UK on preventative and primary care results in better life expectancy for much less cost. YMMV.

-- Harry Erwin, PhD, Senior Lecturer of Computing, University of Sunderland. Computational neuroscientist modeling bat bioacoustics and behavior. http://osiris.sunderland.ac.uk/~cs0her

I am not sure this is "better" but it's certainly arguable. I don't necessarily accept the argument, of course.  "Better" requires consideration of waiting list times, facilities -- it is my understanding that many British hospital facilities have problems -- and other such factors such as how long it takes to get an appointment. Statistically I suppose the point is made, but I would not put 1 year of life expectancy differential as the first crucial criterion I would select for choosing a "better" system.

The expense in US health care is in large part due to the separation of consumer from payer. Of course that happens with the British system, but the British system is far more heavily regulated.

As it happens, this morning I sent email to my Kaiser providers, both the primary physician and the dermitologist; as of half an hour ago I have appointments with both. There will be a small co-payment of course, and I'm happy to make that. I have no experience with the British health care system, but I am told that getting appointments is far more difficult there and the waiting times are longer, particularly for specialists. My Kaiser dues are paid by Medicare Advantage, and that may change under the new Act, but I don't know the details.

===========

Annotated Labour Policy Guide  

Your readers may find this Guardian (liberal) article interesting <http://tinyurl.com/ybv92ts>.  It takes the Labour election manifesto apart.

-- Harry Erwin, PhD, Senior Lecturer of Computing, University of Sunderland. Computational neuroethologist: http://crowan-scat.sunderland.ac.uk/~harryerw/mediawiki/index.php

=============

Alice for iPad.

Be sure and turn down your volume before watching; definitely interesting, IMHO:

<http://www.youtube.com/watch?v=gew68Qj5kxw>

--- Roland Dobbins

============

In re: Kzin cub discovered in France?

Dear Dr. Pournelle

In re: "Kzin cub discovered in France?" in yesterday's mail, I guess "annoying music" is in the ear of the listener. Many anime fans like Yoko Kanno's <http://en.wikipedia.org/wiki/Yoko_Kanno>  music. I regularly listen to several of the the classic Kanno "Cowboy Bebop" <http://en.wikipedia.org/wiki/Cowboy_Bebop>  tracks on my mp3 player, and "Cats on Mars" for the clip seemed appropriate to me. But then, I've always been considered more than a little weird. On an unrelated note, the panel discussion was interesting. Keep well.

Stephen Bragg MSGT USAF Retired

===========

Implications of cheap e-book reader

Does a new $149 e-reader presage enabling of particularism? When every school board, every school create it's own texts, does that bring us closer to students being taught that pi=3, there's no such thing as 'objective reality' or that global warming has an unqualified consensus?

I just stumbled across a $149 e-reader shipping next month, and posted the details at my technical blog, http://kiloseven.blogspot.com  - then thought of the divisive effect that non-standardized curricula could bring.

Could professional societies step forth and certify Open Sourced textfiles as worthy of merit? i know I'd be much more trusting of a chemistry text approved by the ACS, the RCS or the Christian Brothers than a snake-handlin' denomination.

-- John Bartley

It's an interesting concept.

==============

Best show or patriotism 

Dr. Pournelle,

In an era where nobody seems to understand what our government is really doing, it is refreshing to find true patriotism in a form that is far more mature than most of the partisan bickering passed along as patriotism in Washington these days.

http://www.youtube.com/watch?v=eXeIxtI--uc&NR=1 

The rest of this studio's videos are worth watching as well.

Sean

Great Heavens! This is -- odd.

=================

For a PDF copy of A Step Farther Out:

 

 

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Wednesday, April 14, 2010

Canada's Health Care

Brian H. wrote: "...Can't have "2-tier" services, you see, the theory being that all the doctors and services will migrate to the private carriage trade. That even includes no running the existing MRI machines outside official 9-5 hours, so they sit idle most of the time, with 6-month waiting lists."

It's worse than that sets out. The MRI's (and we have waaay less per capita than the US) are not used because the govt/hospitals cannot fund the technicians for 24/7 service. The MRI's themselves are never turned off: too long to re-boot!. So at night, they sit there, unused, except of course, if your vet want's an MRI done on your dog. He can get in there any night at midnight or so, at most hospitals with an MRI, and for $300 (reported by the National Post as the 'going rate'), you get an MRI. Of COURSE, the tech is not "credentialed" to do MRI's on HUMANS, so he won't do your back, but gee, it's only a dog, so no-one is likely to get sued if something goes wrong. So what's wrong with this picture?

meanwhile, my longtime GP retired a year ago, after two years of attempting to sell his practice. No luck. Why *buy* a practice, when you can just put up a shingle and a 'take-a-number' machine. New doc, same location, over her head with applications. Luckily for me, she took on old patients first so I now have a GP, who I have not yet met for my now three-year delayed 'annual'. For which she will get I don't know, $100???

Geoff

Ouch. I have an appointment for my more or less annual this afternoon. Made it yesterday. But that's Kaiser in  California.

==========

Subject: Flight plan closed after 44 years

Dr. Pournelle,

I thought you would find this worth posting.

http://www.omaha.com/article/20100409/NEWS01/704109784 

"Their helicopter vanished into dense jungle on Dec. 28, 1965.

With no conclusive information about what happened, their flight plan remained “open” for decades.

The crash site was officially located a few years ago and finally excavated last year."

Matt Kirchner

Closure...

==============

It appears that there is more to the Colchicine story than first appeared. 

: Colchicine

Hi Jerry,

I am an academic Internist and Clinical Pharmacologist with 28 years experience as a practicing physician and with a long-standing research interest in adverse drug events. I have used colchicine many times in my career but each time I have done so, it has been with trepidation. In recent years, I have rarely used this drug due to concern about the quality of the available products and the toxicity of the drug even when administered properly. I thought I might share with you my perspective on the FDA's recent approval of a new colchicine product and impending removal of competing "grandfather" colchicine products.

The safety of the previously available colchicine products was *not* well-established prior to the recent approval by the FDA of a new product. In fact, there have been deaths related to improperly compounded colchicine and deaths from properly compounded colchicine. In the absence of FDA oversight, one manufacturer managed to formulate a colchicine product with 10X the labeled dose. For many patients, that would be a fatal dose. This was rather a big problem for the average patient, who would go to his pharmacist with a prescription for colchicine in hand and be dispensed something which might have the right dose of colchicine in it, might have 10X too much colchicine and might have no colchicine at all! (e.g., http:// www.portlandtribune.com/news/story.php?story_id=117762600839413400

An abstract from the recent literature: Schlesinger N. Reassessing the safety of intravenous and compounded injectable colchicine in acute gout treatment. Expert Opin Drug Saf. 2007 Nov;6(6):625-9.Division of Rheumatology, UMDNJ/Robert Wood Johnson Medical School, New Brunswick, NJ 08901-1977, USA. schlesna@umdnj.edu 

<begin abstract/> "Colchicine has been used for over 2000 years. Intravenous (i.v.) colchicine has been used for the treatment of acute gout since the 1950s. I.v. and oral colchicine were 'grandfathered' before the 1969 FDA Phase III trials for drug toxicity became law. Data on toxic reactions are, therefore, based only on passive surveillance. The risk of toxicity with i.v. use depends on the total dose over a period of time, the presence of comorbid conditions and the size of individual dose. Colchicine toxicity has been compared to arsenic poisoning. Symptoms start 2-5 h after the toxic dose has been ingested and not uncommonly lead to death. Injections of compounded colchicine have been implicated in the deaths of several patients, several of which received off-label i.v. colchicine for back pain. Given that colchicine has the smallest benefit to toxicity ratio of the drugs that are used in the management of acute gout and the fact that acute gout is not life- threatening, one could make a strong case for eliminating the use of i.v. colchicine the treatment of acute gout."</end abstract>

The availability of an FDA-approved colchicine product is a genuine improvement over the past situation. There were numerous hoops that required jumps in order to get this product approved. Hoop jumping is expensive. At least some of these hoops also have merit: it is nice to have a drug that is manufactured according to GMP, that has been shown to be safe and effective in clinical trials, and that is properly labeled. The company likely got some period of exclusivity (probably about 3 years) after which generic competitors will come into the market. The price of colchicine will then drop to a low value due to competition. This seems quite reasonable to me.

Of course, one might imagine an alternate universe where the safety of medications was assured via free market mechanisms. However, that is not the system we currently have. The conservative approach is to limit regulatory actions by the FDA to those where the public health is endangered. That is what happened here. There are thousands of unapproved pharmaceutical products on the market. Generally, the FDA does not act to remove these drugs from the market unless there is a threat to the public health. If we decide as a society to "reform" the FDA to better comply with libertarian principles, that reform ought to be done in a thoughtful, prudent, conservative manner. I would certainly support some cautious movement in a libertarian direction. But the FDA acted appropriately here.

My 2¢…

-Steve

I questioned that and got

Jerry-

There seems to be a general ignorance of what happened here. If one accepts the idea that the government should create monopolies by establishing protection for intellectual property, then what happened here is very reasonable. There is a libertarian position that patents, copyrights, and market exclusivity should not be allowed. That would be an interesting experiment, although I am not at all sure the results would be good or bad or neutral.

It is important to consider the IP issues separately. The FDA granted three years of exclusivity for colcrys for gout and 7 years of exclusivity for familial mediterranean fever. This limits marketing by competitors between year 3 and year 7 but competitors will be able to enter the market with a package label indication for acute gout during this time. See, for example, http://www.mdconsult.com/das/
news/body/195089773-2/mnfp/0/216043/1.html?
nid=216043&date=all&general=true&mine=true   

The longer patent (2016) that USPTO granted was actually for a *novel* combination of colchicine and a macrolide antibiotic. Colchicine is metabolized by the liver enzyme CYP3A4. The metabolic clearance of colchicine is thus slowed by coadministration of a macrolide as macrolides inhibit CYP3A4. This is actually a clever approach for decreasing total dose and thereby increasing safety. See http://www.drugpatentwatch.com/ultimate/
preview/patent/index.php?query=7601758   

The AGREE study results show that the lower 0.3 mg dose of colchicine is as effective as the old higher dose. This strongly implies greater safety, as the toxicity risk increases with dose.

http://www.prnewswire.com/news-releases/
colcrysr-colchicine-usp-shows-superior-safety
-with-comparable-efficacy-compared-to-high-dose
-colchicine-in-treatment-of-early-acute-
gout-flares-89610352.html    

-Steve

 

Now I believe in copyrights, and I have no objection to a patent on new formulations of this stuff, but that isn't what happened as far as I can see. The FDA commissioned one company to invest in a study -- I have not been able to determine if that was done by competitive bids or just how the study was let -- and rather than pay for the study, the FDA issued a monopoly not on the new formulation, which would have been fine, but on the whole kit and kaboodle folk remedy and all. That's presumably because the new product wouldn't compete if priced at $5 bucks a pill as opposed to a dime; lots of people including doctors would decided that if grandma was happy enough with the dime stuff (more likely grandpa, of course) then I will be. To hell with five bucks a pop to big pharma.

Now we are at the edge of the real question: provided you know the truth, whose final decision is it? Yours, a doctor's, or the FDA's?  I tend to think the Nanny State is already too big. I can live with the FDA requiring label warnings, but no on granting monopolies to generics and folk remedies.

The real question is, who decides what is "dangerous" and "not properly prepared" and thus must be forbidden from sales? How much authority do we give the federal government? I see nothing in the Constitution that gives them any at all but we have over a century of precedents; that doesn't mean that we automatically expand the Federal authority. We know the FDA grows by the Iron Law. Not only to all such organizations grow that way, but this one certainly has stuck its nose into things. I used to have to smuggle SAMe into the US from Italy because the FDA forbade its sale in the US. I could tell other such stories. I start with the presumption that Nanny wants more control. I see no reason to believe that this is anything else.

The proper remedy to a folk remedy being dangerous is free speech. Publicity. If the folk product is inferior to a better crafted one, get that word out: but forbidding something because it isn't approved is a dangerous practice. I seem to recall going through all this in the 1970's when a Glendale Dentist tried to tell people that aspirin would be useful in preventing heart attacks. Then there was SAMe. And the Folic Acid disaster in which the FDA caused a bunch of retarded children. Nanny knows best except when she doesn't.

I have no quarrel with granting monopolies over something one has developed. I remain unconvinced at the value of letting the FDA take over folk remedies.

============

UK vs US Health Care

Dear Dr. Pournelle,

Harry Erwin made the argument that the UK health care system is “better” and based that on the life expectancy statistics. This is flawed as life expectancy statistics do not draw a direct correlation between money spent on health care and level of service. I would suspect that the higher number of murders is pulling the US statistic down, rather than any supposed benefit from preventative measures. According to the CIA Factbook he links to, there are 35 countries that have “better” health care systems, including Canada at #7 with a life expectancy of 81.23.

It sounds as though you made your appointment with your dermatologist directly. That would be impossible in Canada, and I would suspect in the UK, as well. One must request such an appointment from your General Practitioner, who receives a $54 referral fee from the government. There have been stories of GP who can make upwards of 15 referrals per hour.

Stay well,

Bill Grigg

At Kaiser you need a referral for your first appointment with a specialist, but after that he's not involved any longer. I've been seeing the dermatologist for barnacles -- well, precancerous conditions taken care of with a can of liquid air -- for some years. Same with the cancer chap and the heart specialist. One reason I like the Kaiser system. Incidentally they claim that no one will lose Kaiser membership as a result of the health care bill. I rejoice at that.

==

"Better" Part 2 

I agree with you that expected survival at birth is a rather blunt tool for differentiating health care systems, but what about maternal mortality, which is twice as high in the USA as in Albania or the UK? Waiting times are a poor measure, too--if you remember your queueing theory, they're non-linear in the system load, so that they typically double as you go from 90 to 95% load. My recent experience with a non-critical (low priority) eye condition is that I had to wait a week to see my primary physician and 24 days to see a specialist, but that was acceptable. There are also issues with treatment facilities and the availability of treatments--UK doctors differentiate between hard and soft results in the medical literature and tend to ignore the latter. However the dramatic difference in the level of expenditure is important. The median household income in the UK is about 78% of the same figure for the USA <http://en.wikipedia.org/wiki/Median_household_income>,  but the mean medical expenditure per person in the UK is about 40% of the level in the USA with very comparable outcomes. The UK doesn't have copayments (except for dentistry), so that mechanism to discourage moral hazard is weaker here, yet expenditure levels are much lower than in the USA. Given our experience here that most of the increase in the NHS budget over the last 13 years of Labour Government has benefited the medical practitioners rather than the medical consumers, I suspect there's a *lot* of air in the American system.

You have seen me complain about problems in UK health system, but they're in the skin. The problems in the US system are in the bones.

-- Harry Erwin, PhD, Senior Lecturer of Computing, University of Sunderland. Computational neuroethologist: http://crowan-scat.sunderland.ac.uk/~harryerw/mediawiki/index.php

Well the stories of facilities I have heard are anecdotal but I believe my sources, who tell me they shopped in stores for mops and cleaning equipment and scrubbed floors and walls around their father's are in the ward, the rest of the place being unsanitary: this in a standard hospital, not a long term care facility, the ward being for recovery from surgery. I have also read the same stories in published accounts. I have never been in an English hospital. I do think the stories about waiting times must have some foundation.

As to the terrible problems in the US systems, my experiences have been good and that's true of most of the people I know. Until I turned 65 I paid $350 a month for my Kaiser dues -- I paid it all, since I am self-employed -- and that covered me, my wife, and the kids until they left, forget whether 18 or 21. I suppose that was expensive but it wasn't excessively so, and in those times it covered essentially everything. I suppose there was a nominal copayment. Today's visit cost $5 for my checkup interview and another $15 for a chest x-ray. Enough to keep me from going out daily for a chat, but hardly crippling.

I keep hearing how awful the US system is, but my experiences don't match those stories, most of which seem fairly unusual.

==============

LEO Price

Just checked out the price of LEO for Space-X's vehicles

4905.491 dollars a pound

  <http://www.spacex.com/falcon1.php

Far better than NASA's cost of 15000 dollars a pound in 1988 dollars. The maximum payload of 1010 KG's. And the latest version of their ship promisses cheaper flights.

And I just did the numbers on their next vehicle

The Falcon 9 http://www.spacex.com/falcon9.php  

1632.80 dollars per pound!

 

David March

Hurrah

==

Astounding Mars video from JPL

Jerry,

I still recall my excitement, and then crushing disappointment, as a 10 year old when Mariner 4 returned the first flyby pictures of Mars in 1965, and we saw that it was "As dead as the moon."

We've been some decades correcting that misperception, but now we see that it is a very interesting world with LOTS of water ice. This short video from JPL is well worth the viewing. Note especially that if Viking had dug down 6 more INCHES, we would have known of subsurface water ice on Mars 35 years ago.

Would this have changed space policy? Probably not; it came at least six years after we had already decided to dismantle the infrastructure that could have taken us to Mars in just a few years, and other events determined the course of space policy.

I was at the Udvar-Hazy branch of the Air and Space museum last week (also well worth it for anyone who reads these pages), and saw one of those magnificent F-1 engines from the Saturn V. Oh, what might have been...

Anyway, this is a nice video on MRO science results:

http://marsprogram.jpl.nasa.gov/
mro/videos/mro/movies/200909
24a/mro20090924-480cc.mov

Chuck

 

 

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Thursday, April 15, 2010

Kyrgyzstan Revolution about Energy Costs

This take on the Kyrgyzstan revilution may be of interest. It says it was simply because the government was artificially putting up power prices. Also it seems the mobs here are rather better armed than those facing Napoleon - being undecided myself on gun control I don't find this example definitive either way.

http://eureferendum.blogspot.com/
2010/04/energy-riots-in-kyrgyzstan.html 

However it seems to me that if the American or British public ever appreciated how much power costs are increased by Luddism & government parasitism (I think at least 50% probably 75% taking in all factors) they would not be happy bunnies.

Neil C

==========

The greatest play in baseball 

Dr Pournelle

http://www.youtube.com/watch?v=IrV8QPQAhxo 

Live long and prosper h lynn keith

============

 the wait

http://www.usatoday.com/news/
washington/2010-04-13-nuke-plans_N.htm

J

==========

UK News 

ClimateGate (Telegraph) <http://tinyurl.com/y6lol24>  Politics (Times) <http://tinyurl.com/y63bhpg>  Lib-Dem manifesto (Guardian) <http://tinyurl.com/yyf63e7

-- Harry Erwin, PhD, Senior Lecturer of Computing, University of Sunderland. Computational neuroethologist: http://crowan-scat.sunderland.ac.uk/~harryerw/mediawiki/index.php

==========

24-72 hours for Fed response to Nuclear Detonation

Dr. Pournelle:

This is a little reported story that I noticed yesterday, http://www.usatoday.com/news/washington/2010-04-13-nuke-plans_N.htm which indicates that Local Authorities should not expect significant Federal response to a Nuclear Detonation for 24 to 72 hours.

This guidance seems to stem from a Planning Guide (linked in the article) that I believe to be from the end of the Bush era (it was issued in January of 2009). Since the White House is now citing it authoritatively, I assume that the current Administration has adopted its recommendations. The 24-72 hours is cited on page 10 where it goes on to say that "Emergency response is principally a local function."

I have not read the entire document, but I find these statements to be curious at the very least. The Feds have the National Laboratories, the Military, and an array of other resources designed to deal with Nuclear matters especially Nuclear Detonations. I don't expect that states have much expertise in this area at all especially since we have allowed our Civil Defense competence to lapse over the decades. I imagine that a local response would be inept and would make matters worse as local authorities try to figure out what dose level is prohibitive and what dose level can be tolerated for rescue. I would expect mistakes that let viable victims die for fear of radiation while in other cases rescue workers would be needlessly sacrificed for victims with no hope of surviving. Moreover, what local government has significant stores of even the simplest equipment such as working, calibrated radiation detectors? While the cited document purports to provide guidance for local authorities in the case of a Nuclear Detonation, does anyone expect states or municipalities to actually read the thing and prepare? It seems to me that if a Nuclear Detonation on American soil is more likely now, the Feds should prepare for it recognizing that local authorities will not and cannot do so. Certainly, a response team made up of people from the National Labs and the Military could be put together now and could be able to deploy in much less than 24 hours to provide Command and Control for the local authorities along with the required knowhow.

Perhaps the current administration has no fear of being pilloried for a poor response to a disaster as in Hurricane Katrina even though a Nuclear Detonation would be far worse and vastly more terrifying.

--

Clay Booker

We need Civil Defense. FEMA is the problem, not the solution.

==========

Alice for IPad

I'm beginning to wonder if we can maintain our civilization when our attention span and ability to process written information atrophies to the point where our brains are all reduced to the equivalent of a fast-twitch muscle fiber.

Will we need to develop printed book holders with blinking colored lights on them so children don't discard the book immediately in favor of whatever shiny object has attracted their attention?

Tom Brosz

===========

Surprise, surprise - Big Aerospace are leery of a true commercial spaceflight market.

Of course, they're "happy" to continue with cost-plus:

<http://www.nytimes.com/2010/04/12/science/space/12rocket.html?pagewanted=all

-- Roland Dobbins

Of course Big Aerospace wants to continue cost plus.

 

 

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Friday,  April 16, 2010

'It turns out that watching Goldman Sachs, the United Auto Workers, public employee unions and a raft of other vampires drain the treasury at America's weakest moment in a generation will make a person pretty hacked off.'

<http://www.washingtonexaminer.com/politics/
Hating-the-government-finally-goes-
mainstream-90852389.html>

--- Roland Dobbins

Imagine that. They used to call that "smearing" in McCarthy's day, but times they are a changing

=============

"The discipline problem is much better than it's been in years."

<http://www.washingtonpost.com/wp-dyn/content/article/2010/04/15/AR2010041505964_pf.html>

- Roland Dobbins

Taking a swat at it...

===========

Re: attention span 

Contra Tom Brosz's email about children's attention spans, I've noticed that the popular children's TV shows (at least for the pre-school set) have largely discarded the quick-clip format that was the norm when I was a child in the 1970's. The usual format is two stories of 10 or 15 minutes each, with a short "intermission" segment in between. Even "Sesame Street", which I think is considered the originator of the short-segment format, has gone to longer segments for its most popular muppet character, "Elmo". The children's computer games associated with the TV shows also seem to require a fairly lengthy attention span. The educational establishment seems to have backed away from the idea that children have short attention spans.

And, of course, children's books haven't gotten any shorter.

Neil Tice

===========

: More Police Brutality

It is a good thing that Americans are all carrying cameras now. The police charges are complete lies when one views the video. This is not an isolated incident. I see videos like this on an almost daily basis. This is one of the worst I've seen, as the victim clearly did nothing wrong other than get into close proximity with a mounted officer. Then, police lied and said the victim assaulted them and the horse. This is common, however. When the police attack someone, they tend to charge the victim with assaulting a police officer. At least, that was the pattern in more than 20 incidents that I looked into over the past year. Now it is clear why local and state governments are trying to make it illegal to video tape police--if it wasn't clear already.

Here is the video report by the Associated Press:

http://www.youtube.com/watch?v=
TAPwyodTkYA&feature=player_embedded 

-- BDAB,

Josh

=============

Health care in England

Dr. Pournelle:

"The UK simply doesn't spend the money Americans do on end of life care and rare conditions, and the greater emphasis in the UK on preventative and primary care results in better life expectancy for much less cost." - Harry Irwin

If you discuss nationalized health care with any proponent, you will eventually carve the discussion down to some version of this one point. That's a lot of ideology to balance on two statistics, particularly in light of two things:

First, life expectancy has an awful lot of variables. When you go to the link Harry Erwin provides, and look at the lists, the question immediately occurs to me: How many of the countries above the U.S. on this list do not have state-provided health care? How many countries below us do? Hong Kong is number two on the list. Do they have single-payer health care?

Second, to my knowledge nobody has ever itemized the commonly-used term "per capita health expenditures." Does this include research? Money spent to qualify drugs for market? Development and manufacturing costs of new technologies? What exactly is included in this number? Does it take into account the level to which other countries rely on us for the medical technology they simply have to pull off a shelf?

Tom Brosz

I believe but do not know that the per capita figures do include research costs, including the cost of getting FDA approvals. Those can be extremely expensive, and our FDA costs are much higher than those of other countries. Another cost involves litigation and insurance, not just costs and damage but 'punitive damage' and jury interpretations of pain and suffering. Admittedly that's a tough nut to crack, but surely litigation reforms would reduce the US per capita costs by quite a lot. Don't see how that works with the new Act.

==============

 

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Saturday, April 17, 2010

I took the day off.

 

 

 

 

 

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Sunday, April 18, 2010      

Volcano 

Jerry,

Any thoughts on the ash cloud over Europe? I happen to be one of the thousands grounded and hence stuck in London for what is now four extra days. It is looking as though this will last at least through mid-week. Meanwhile, the Dutch and Germans are flying their planes with no ill effects...

http://news.yahoo.com/s/ap/
20100418/ap_on_re_eu/eu_iceland_volcano 

-dave

Roland found this, but I have no other information. It's a bit out of my specialty...

'The airlines say officials have over-reacted to a single computer simulation of the cloud.'

<http://www.dailymail.co.uk/news/article
-1267116/Operation-volcano-Navy-armada
-ready-pick-thousands-stranded-Britons-
France-scuppers-DIY-rescue-mission.html

- Roland Dobbins

I have no qualifications for any opinions on the matter.

==

Iceland Video

http://www.youtube.com/watch?v=Cp4n6zeVzII

Julie

============

Warmest month falsified

Some investigating has found the reason for "warmest month on record" and warmer winters and poles reported despite peoples personal experiences in those winters. It appears that minus signs are being dropped regularly from temperature reports, and in winter or poles, the colder it is the greater the error this gives (going from -20 to 20 is a bigger area than from -5 to 5). The world temperature measuring bodies only care about monthly temepratures, they do not look at daily temeratures and thus never see these problems. meanwhile 41% of "official" world temeprature measurements are now at airports, a wopping 92% in the USA, and airports report for aircraft, who generally don't care much about temerature anyway, not for central climate organizations, who do. Furthermore, those climate organizations expect and stand to benifite from "global warming", thus if they see rising temepratures in winter or at the poles, that is what they expect to see and want to see, and what all their associates tell them they should see (peer pressure rienforced by blackballing any peer who does not tow the line), thus they do not bother to check too closly (which would take them out of their cozy offices anyway). Of course, if they see lower temeratues than they expect and want, they check very closly.

As Upton Sinclair once said:

“It is difficult to get a man to understand something when his job depends on not understanding it.”

You can read about the investigation here http://wattsupwiththat.com/
2010/04/17/giss-metar-dial-m-for-
missing-minus-signs-its-worse-than-we-t
hought/#more-18590  and you can see it actually happening here, look down the list and see the minus signs dropped http://www.sailwx.info/shiptrack/
shipposition.phtml?call=48534 

Meanwhile, they have taken to rounding any fractions only up, so that 1.5C becomes 2C and -1.5C becomes -1C. In addition, the buoy measurement errors from the site above would result in a 3C error when averaged. This does not even take into account that all those airports surround the station with hot tarmac, air conditioning outlets, and increasing urbanization, that the great drop-off (actually culling by the climate organizations) of temperature measuring stations dropped mostly rural and higher altitudes and latitudes stations more likely to report lower temperatures, substituting "estimates" made from "the nearest station" to cover uncovered areas, which can mean areas hundreds of miles away are estimated from an essentially urban, heat island effected, and generally warmer area sited station.

Also, satellite measurements show no unusual warming, NASA at least has responded by quietly dropping the use of satellite temperatures.

So they next time you see "global temperature" reported (n 3 decimal places) you might want to think about this, and muse on these words

D

The weaker the data available upon which to base one's conclusion, the greater the precision which should be quoted in order to give the data authenticity.--Norman Ralph Augustine

I have not heard nor do I have another source for the marked statement. I do not have two decimal place confidence in the measurements as reported, but I remain doubtful, not certain that the "warmest March: statement is falsified. I have heard stories about the missing minus signs on some reports, but again I have no way to confirm that.

I would think that publication of primary data and the formulas used to calculate the large averages would be important before we spend a great deal of money.

My hypothesis about warming is that El Nino has a very great deal more to do with it than anything else we can see just now.

==

The Temperatures Continue to Rise.

Jerry,

I am not so sure that is correct to say that "Temperatures continue to rise."

I believe that a more appropriate statement would be to say "We are told that temperatures continue to rise."

Bob Holmes

I would prefer to see the primary data and the averaging formulae. It should not be that difficult to post that stuff on line.

==

: The ice age returns! 

Dear Dr. Pournelle,

Scientists tells us that not only was last year freakin' cold, but we may very well see more of it due to decreased sunspot activity.

http://www.newscientist.com/article/
mg20627564.800-quiet-sun-puts-europe-on-ice.html 

Respectfully,

Brian P.

So Europe was cold but it was the warmest year on record, and ---  Does anyone have the primary data?

===========

Mikrokopter

In case you haven't seen it...

This “mikrokopter” has a central hub with six arms sticking out. At the end of each arm is a two-bladed propeller oriented horizontally. You will be amazed at how well this can fly. When you get to the GPS section, you will be further amazed. If you have an interest in aviation or love things that fly and make noise, you will want to see...

 <http://mikrokopter.de/ucwiki/VideoAbspielen?id=188

Charles Brumbelow

=============

: Nassim Taleb interview

Jerry,

As a fellow fan of the insightful thinking in "The Black Swan", I thought you'd enjoy this interview with Nassim Taleb from April 14th http://www.businessinsider.com/interview-with-nassim-taleb-2010-4 

All the best,

Jim Woodinville, WA

=========

Subject: The Iron Law Restated

Someone hasn't read the Iron Law, but has observed it in practice. http://techdirt.com/articles/20100404/2112388868.shtml 

"Institutions will try to preserve the problem to which they are the solution." They are calling this the Shirky Principle.

And this relates to Upton Sinclair's famous line:

"It is difficult to get a man to understand something, when his salary depends upon his not understanding it!"

-- Dwayne Phillips

==============

 

 

 

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