The Proximal Tubule

The arthritis drug Vioxx was pulled from the market today, by its maker Merck & Co., because of recently discovered high risks to users of heart attack and stroke... A report I heard on WTOP news radio in Washington, DC, featured a physician who complained that Merck took too long to remove Vioxx from the market. The news report went on to mention critics of the Food and Drug Administration -- all of whom apparently believe that the FDA's procedures result in too many drug approvals.

Nowhere in this story or in any account that I've (so far) read does anyone propose that each arthritis sufferer be given the freedom to choose which level of risk he or she endures. The unquestioned presumption is that that there is one proper level of risk and that it is up to national-government bureaucrats to discover and enforce it.

When it comes to marriage, what’s an atheist libertarian to do? What kind of ceremony is appropriate, and who ought to officiate? For an atheist, the obvious choice might appear to be a judge or justice-of-the-peace. But for a libertarian atheist, state idolatry is as objectionable as spiritual idolatry. Sure, libertarians recognize the existence of the state (while atheists do not recognize the existence of a god), but why go inviting the state into what is ultimately a personal commitment? And while many people, including libertarians, might choose to invoke the state’s contract-enforcement apparatus, that act is conceptually distinct from the act of wedding another person (as I argued here).

I was once briefly married. Since my wife-to-be was also an atheist (or agnostic), we opted for the justice-of-the-peace default. But I doubt I’d do that again. As we discovered during our first and only year of joint tax-filing, there are few if any benefits of legal marriage for couples without children. Indeed, we ended up paying a marriage penalty amounting to about $300 of our paltry incomes (yes, I filled out the “dummy” tax forms to find out what we would have paid if we’d been single). If I ever went down that path again, I’d be inclined to postpone the legal marriage unless and until children made it worthwhile. But without ministers or judges, what’s left? Ship captains?

Although natural disasters spread destruction and economic pain to a wide variety of businesses, for some, it can mean a burst in activity and revenue.

For that reason, economists tallying the numbers expect the hurricanes will be neutral in their effect on the U.S. economy, or may even give it a slight boost, particularly because of an expected reconstruction boom in the already red-hot construction industry.

Daley emphasized that most charges involving small amounts of pot are thrown out in the state court system in Chicago.

"If 99 percent of the cases are all thrown out and you have a police officer going, why? Why do we arrest the individual, seize the marijuana, [go] to court and they're all thrown out? It costs you a lot of money for police officers to go to court.

"It's decriminalized now," the mayor added. "Sometimes a fine is worse than being thrown out of court."

Fraternal Order of Police president Mark Donahue acknowledged too many cases involving small quantities of marijuana are "pitched at the initial hearing." But FOP members stand to lose thousands of dollars in court overtime if the city starts ticketing marijuana users instead of jailing them, he said.

Gov. Arnold Schwarzenegger on Monday signed into law what some advocates describe as one of the state's most important public health policies in two decades - a five-year experiment to reduce the spread of AIDS and other diseases among intravenous drug users by making needles and syringes available without a prescription.
The legislation leaves it to local governments across the state to decide whether to take part in the pilot project. Beginning next year, in cities and counties that embrace the concept, pharmacists will be permitted to sell adults up to 10 sterile needles and syringes at a time. The measure also decriminalizes possession of needles without a prescription.

Philosophical objections aside, the latter have always struck me as the wrong approach strategically, seemingly confirming the canard that what critics of the war on drugs really want is subsidized addiction (a charge that drug czar John Walters hauled out in his recent National Review exchange with the DPA's Ethan Nadelmann). In this case, by contrast, the government is removing a legal barrier to sanitary injection practices by allowing over-the-counter sales of needles and decriminalizing their possession without a prescription.

We all know now about the Bush administration's pre-9/11 $43 million gift to the Taliban -- in thanks for the regime's prohibition on opium. Still, this Robert Scheer column written in May of 2001 is simply chilling:

Enslave your girls and women, harbor anti-U.S. terrorists, destroy every vestige of civilization in your homeland, and the Bush administration will embrace you. All that matters is that you line up as an ally in the drug war, the only international cause that this nation still takes seriously.

That's the message sent with the recent gift of $43 million to the Taliban rulers of Afghanistan, the most virulent anti-American violators of human rights in the world today. The gift, announced last Thursday by Secretary of State Colin Powell, in addition to other recent aid, makes the U.S. the main sponsor of the Taliban and rewards that "rogue regime" for declaring that opium growing is against the will of God. So, too, by the Taliban's estimation, are most human activities, but it's the ban on drugs that catches this administration's attention.

Never mind that Osama bin Laden still operates the leading anti-American terror operation from his base in Afghanistan, from which, among other crimes, he launched two bloody attacks on American embassies in Africa in 1998...

...Sadly, the Bush administration is cozying up to the Taliban regime at a time when the United Nations, at U.S. insistence, imposes sanctions on Afghanistan because the Kabul government will not turn over Bin Laden.

The war on drugs has become our own fanatics' obsession and easily trumps all other concerns. How else could we come to reward the Taliban, who has subjected the female half of the Afghan population to a continual reign of terror in a country once considered enlightened in its treatment of women?

...The Taliban may suddenly be the dream regime of our own war drug war zealots, but in the end this alliance will prove a costly failure. Our long sad history of signing up dictators in the war on drugs demonstrates the futility of building a foreign policy on a domestic obsession.

The sad irony here is that the same government that signed checks to the Taliban in the name of the drug war just months before September 11 to this day accuses drug users of supporting terrorism (a charge that doesn't stick, by the way).

"It would appear effectively to be a life sentence," the judge, Paul G. Cassell of Federal District Court there, wrote in a request to the prosecution and the defense for advice about whether he has any choice but to send the man to prison forever.

Judge Cassell, a brainy, conservative former law professor, surveyed the maximum sentences for other federal crimes. Hijacking an airplane: 25 years. Terrorist bombing intending to kill a bystander: 20 years. Second-degree murder: 14 years. Kidnapping: 13 years. Rape of a 10-year-old: 11 years.

He noted that Mr. Angelos would face a far shorter sentence in the courts of any state. In Utah, prosecutors estimate that he would receive five to seven years.

The Justice Department supports mandatory minimums, said Monica Goodling, a spokeswoman.

"Tough but fair mandatory minimum sentences take habitual lawbreakers off the streets, lock up the most dangerous criminals and help ensure the safety of law-abiding Americans," Ms. Goodling said. "Since these common-sense policies were created, we've seen crime plummet to a 30-year low. The public, the Congress and presidents of both parties have supported mandatory minimums for a simple reason - they work."

In court papers, prosecutors said Mr. Angelos "trafficked in hundreds of pounds of high-grade marijuana," "distributed cocaine and synthetic narcotics" and "affiliated himself with a violent street gang." These assertions, however, were not proved to a jury.

Last year, Justice Anthony M. Kennedy of the United States Supreme Court told the American Bar Association that "in too many cases, mandatory minimum sentences are unwise and unjust." The association appointed a commission, which recently issued a report urging the abolition of such sentencing.

"There are real economic and human costs," said Douglas A. Berman, an Ohio State University expert on sentencing law, "to putting everyone away for as long as humanly possible."

Melodie Rydalch, a spokeswoman for Paul M. Warner, the United States attorney in Salt Lake City, said his office had no comment on the Angelos case. In general, Ms. Rydalch said, "we will continue to enforce mandatory minimums so long as Congress tells us to."

We get pounded on all game, and eventually this garbage team we are playing is leading 23-8 going to the bottom of the last inning, and talking trash to boot. We plate a couple runs, make a couple outs, and I come up as the potential last out of the game. Now understand, for the year I have solid numbers. However, as the potential last out of the game, I am like 1-8. Its uncanny. However, I am not going to let it happen again. Although the game is way out of reach, I am determined to not make the last out for once. I grit my teeth and bear down. I take the first pitch high for a ball. The second pitch is to my liking, and I turn my hips, turn my wrists, and snap a line drive base hit to center! Its the small victories that count.

Oh, and then seven straight batters reach safely and I come up again to line out and end the game with the tying run on deck. Boo ya.

For me, the chief lesson of 9/11 is the simultaneous power and impotence of government.

9/11 vividly demonstrated how powerless government is to protect us and make us safe. The United States government is the most powerful organisation that has ever existed in human history. It possesses untold wealth, unmatched military might, and a globe-spanning spy network.

And in a few short hours, a handful of murderous fanatics armed with nothing more impressive than boxcutters were able to inflict a series of devastating attacks against which this almighty government was helpless.

Our rulers talk blithely about preventing future attacks, but the truth is they haven’t got a clue how to do it. If some nut wants to inflict a lot of damage and is willing to sacrifice his life to do it, there’s very little that the government can do about it. The 9/11 attacks exposed the protective nation-state as the fraud it is.

But if the government lacks much power to protect, 9/11 also showed how much power it does possess to do harm:

To pursue the arrogant foreign policy that invited the attacks in the first place.

To ensure that no one on board the hijacked planes was carrying weapons that could have been used against the hijackers.

To respond to the attacks by stepping up the assault on civil liberties at home.

To respond to the attacks by raining down death and destruction on innocent civilians in Afghanistan and Iraq, thus ensuring that even more American citizens will be targets for retaliation for the next fifty years.

A form of social organization whose power to do evil is enormous while its power to do good is minuscule is a form of social organization that needs to be mothballed.

• ABC made a big deal of the inconsistency that sees tobacco completely unregulated, yet tobacco replacement products were heavily regulated. Peter Jennings tell us cigareetes should be regulated. Unfortunately they never entertain the idea that this inconsistency can be resolved in two ways: regulate cigareetes, or deregulate tobacco replacement products. If these products do work, as implied by their FDA seal of approval, then the cumbersome regulation process cost many lives before the first of these were approved and later approved for OTC sale.
• A public health scholar from Harvard School of Public Health stated something to the effect: "The tobacco industry should be given zero trust to make a safer cigarette." Within, oh, about 45 seconds, he said this about a Philip Morris effort to make a safer cigarette: "If they are successful it would a huge boon to thei company; they would become the cigarette monopoly of the United States." How can an educated person hold these two totally opposite views. One would think such a brain would implode under the weight of such cognitive dissonance. It seems obvious to me that if some cigarette company could actually design a cigareete that was truly safer, or actually caused zero death, they would see profits unrivaled in the history of capitalism. One must have a profound hatred for the industry to believe that they would eschew such profit opportunities for the sake of...for the sake of what? Becasue they enjoy killing people just for the hell of it? Please.
• They ended the special by stating ominously that "today only the tobacco company, with no imput from the federal government, has the ability to determine how what a smoker inhales." Uh, maybe I'm late to theparty, but don't smokers have even a little say in the matter?

It doesn't mention how much it cost to immunize the population during that time period. A single dose of the vaccine is $88. According to the CDC, 85% of children were vaccinated against chickenpox in 2003. According to the Census Bureau, in 2000, there were 19 million children under age 5. (I couldn't find data for 2003.) That means that 16.1 million were immunized against chickenpox, at a cost of 1.4 billion dollars. It's possible that there were fewer children under five, or that the CDC was referring to a smaller group of children. But it still appears that the vaccine costs more than it gives.

Bush and Kerry fight over giving Medicare the power to negotiate lower drug prices, and the Administration, in yet another Friday news release quietly shores up the doctors' vote for the GOP and lines the pockets of their friends in the insurance industry by announcing a 17% increase in Medicare Part B premiums (which includes reimbursement for physician visits) in 2005. This increase is the largest in Medicare's 40 year history, and comes when seniors' Social Security payments are expected to rise by about 3 percent.

When noncontenders started to shop assets for prospects and picks, I even negotiated a possible Ichiro trade waiting in line on the ESPYs' red carpet. A woman in front of me caught the Sports Gal's eye, and said sadly, "My husband does fantasy baseball, too." She may as well have been talking about a leper. Decked out in a black cocktail dress and new heels, my wife responded, "If my husband doesn't hang up in the next 30 seconds, I'm going home with LeBron James." I hung up.

It would take $3.9 trillion today to retire the visible national debt, and $72 trillion today to pay off unfunded promises to retirees. Yet only the first debt is reported to voters. That's the kind of accounting "oversight" that, in the private sector, leads straight to a cellblock.

...Why is this important? Because suddenly the $1 trillion in "transition costs" to finance the creation of the Bush-touted private retirement accounts for younger workers doesn't seem so outlandish compared to the real federal debt, visible and invisible.

First, I would outlaw direct to consumer marketing of prescription drugs. DTC puts physicians in a difficult situation. We do feel pressure to prescribe the medication that the patient requests. Some of us have the time and presence to resist that pressure, but many physicians are so harried that writing the prescription rather than arguing is the easy way - saving them 5 precious minutes.

Economic analysis of advertising dates to the thirties and forties, when critics attacked it as a monopolistic and wasteful practice. Defenders soon emerged who argued that advertising promotes competition and lowers the cost of providing information to consumers and distributing goods. Today, most economists side with the defenders most of the time.

Contrary to the monopoly explanation (and to the assertion that advertising is a wasteful expense), advertising often lowers prices. In a classic study of advertising restrictions on optometrists, Lee Benham found that prices of eyeglasses were twenty dollars higher (in 1963 dollars) in states banning advertising than in those that did not. Bans on price advertising but not on other kinds of advertising resulted in prices nearly as low as in the states without any restrictions at all. Benham argued that advertising allowed high-volume, low-cost retailers to communicate effectively with potential customers even if they could not mention price explicitly.

Advertising messages obviously can be used to mislead, but a heavily advertised brand name also limits the scope for deception and poor quality. A firm with a well-known brand suffers serious damage to an image that it has paid dearly to establish when a defective product reaches the consumer.

The advertising industry is one of the most advertising-intensive industries. Promotional expenditures often amount to 20-30 percent of sales, sometimes even exceeding expenditures on R&D. However, contrary to most other industries the vast amount of promotional spending are not targeted at the consumers, but rather at the physicians making the prescriptions. While this can be explained by the important role of the physician as the patient's agent, another important reqason lies with the regulatory restrictions on direct-to-consumer advertising (DTCA) of prescription drugs that are present in most countries.

...The role of DTCA has generated a controversial debate. Opponents claim thta DTCA causes physicians to waste valuable time during encounters with patients and encourages the use of expensive and sometimes unnecessary medications. Proponents argue that DTCA increases the consumers' awareness and knowledge about available medical treatments, and this may enable them to detect a possible disease at an earlier stage and more actively take part in the decision of which drug to prescribe.

The debate on DTCA seems to ignore that pharmaceutical companies already spend tremendous amounts of money on promotion aimed at influencing the physicians' prescription choices in ways favourable to the companies(ed: I disagree; I am not sure if anyone ingores this). In this paper, we therefore seek to contribute to the debate by investigaing the interaction between advertising directed at consumers (DTCA), on the one hand, and promotional activities targeted at physicians (detailing), on the other.

• DTCA and detailing are substitutes, meaning when DTCA goes up, detailing goes down. Consequently, if DTCA is banned, doctors will be a big beneficiary, as they will se increased competition for their prescriptions. More pens, I guess.
• A ban on DTCA is beneficial to the pharmaceuticals if there exists price competition. There is not perfect competition among pharmaceuticals with patented drugs, obviously, but me-too drugs do provide some semblence of competition.
• A ban on DTCA may be desirable if the regulated prices are too high (for the purpose of stimulating R&D). But this is not the case if the regulated price is set correctly.

Today, we are constantly being told, the United States faces a health care crisis. Medical costs are too high, and health insurance is out of reach of the poor. The cause of this crisis is never made very clear, but the cure is obvious to nearly everybody: government must step in to solve the problem.

Eighty years ago, Americans were also told that their nation was facing a health care crisis. Then, however, the complaint was that medical costs were too low, and that health insurance was too accessible. But in that era, too, government stepped forward to solve the problem. And boy, did it solve it!

• I got my ass handed to me in my first tournament. Not that I was outmatched - on the contrary, I had a late lead in every match; just couldn't turn it into gold. Classic choke-artist, I guess. There are some strange birds who play backgammon - not that this is news.
• I couldn't get it confirmed, but it's possible that there is a radio station in Indiana that plays all John Cougar Mellencamp, all the time.
• I heard some advertisement (for whom I don't know) on the radio that stated at the end of the commercial something along the lines of: "We support a drug-free environment and are commited to maintaining diversity in the workplace." Is it just me, or could not a more self-contradictory statement been made if they had tried? Obviously they don't maintain a completely diverse workplace if they discriminate against people who use drugs in their spare time. How disingenuous.
• There isn't too much about the interstate that one could describe as "beautiful," but how about this phenomenon: when you look of into the horizon where the road is straight, you can actually see clear reflections of the sky, trees, and cars on the black asphalt. I've always noticed this, but I find it truly amazing. (Any students of optics out there to explain this?)

It also means that we spend marginal dollars on health care when we should be spending on something else. But I guess they missed that day in micro-economics class when MR=MC was brought up.

The speeches in Madison Square Garden affirmed the great truths now routinely preached from the pulpits of Fox News and the Wall Street Journal--government the problem, not the solution; the social contract a dead letter; the free market the answer to every maiden's prayer.

People like me who became conservatives because of the appeal of smaller government and more domestic freedom are now marginalized in a big-government party, bent on using the power of the state to direct people's lives, give them meaning and protect them from all dangers.

...I've said it before and I'll say it again: the only difference between Republicans and Democrats now is that the Bush Republicans believe in Big Insolvent Government and the Kerry Democrats believe in Big Solvent Government. By any measure, that makes Kerry - especially as he has endorsed the critical pay-as-you-go rule on domestic spending - easily the choice for fiscal conservatives.

The bugaboo of the left (and their organ the Democrats) in the US is the "religious right," and my comments in the paragraph above are directed primarily to this bugaboo. Aside from religiously driven moral concerns, though, the major driver of real social/cultural conservatism in this country is the puritan streak that has been handed down through the ages as the antithesis of the hedonistic American thesis.

In recent decades, this puritanical impulse has been mated to the statist impulse, yielding such unholy offspring as the radical environmental movement, the anti-smoking crusade, the nascent anti-fat crusade, and of course the drug war. You will note that the puritans reside comfortably all across the political spectrum in America, and have had a much greater impact on state activities than religious devotees.

• "The administration savings argument" - Setting aside the studies for right now, the point I was making is that your whole argument rests on this; take it away, and your case crumbles. That is not even a criticism, just a fact.
• On a free lunch" - You might not have said that your idea is a free lunch, but that's sure as hell what it is. Call it whatever you want, but when you say this system will give those covered better coverage, and provide free care to the uninsured (free not as in $0, free as in at no increase in overall health insurance), that's a free lunch. Again, regardless of whether one thinks that is what will happen under single payer, your proposed consequence is a free lunch.
• "Social Security and Medicare" - I was a little sloppy with my words, but you totally ignored my argument about Social Security. Which is appropriate for you because it provides a good historical example against your free lunch argument. There is no doubt that I have characterized SS (if you care to actually look at the numbers) correctly. There is some element of truth that this does not apply to Medicare. But here's the thing: 30 years ago, SS was not in fnancial trouble, was good "insurnace" and may or may not have trapped anyone in poverty. The 30-year head start of SS over Medicare suggests that Medicare may (likely will) go down the same road. Given the massive present value deficit it faces, and the cut's in benefits and/or tax increase that would be necessary (since you would obviously take privatization off the table), the future return on Medicare and the tax burden will mean that Medicare will soon become "sunstandard insurance."

Many gas stations are beginning to close, Lay said, and future shipments will be limited since the Port of Tampa is closed.

"It's going to be a precious commodity before long," said Lay.

I've noticed that Washington seems cooler this summer than in summers past. Must be due to Bush's policy to reduce global warming.

• This one by itslef would do it: stop the gay bashing. Stop covering it up in the "family" wrapping paper and calling it "values." Stop tying on the bow of your God and calling it "moral." It's hate regifted and called love. It's The Great Conservative Shame.
• Stop giving free markets and small government a bad name. You talk about the libertarian ideal of free economies and limited government and practice the very anti-libertarian economy of privelege and growing state.
• Follow through with "The Ownership Society," mean it, and don't fuck it up. It's the foundation of the first true political revolution in my lifetime.
• End the drug war, end the drug war, end the drug war.
• Tell the Christian Right to go to hell (which I'm sure they'll oblige in good time). Your God is not my god and I won't be ruled by Him.