Saturday, April 21, 2018

The Politicization Of Science And Gun Control: The CDC's Hidden Data

I was involved some time ago in a conversation with a friend regarding the longstanding ban on the CDC engaging in research on gun control, with my friend taking the position that there was no reason for them not to do so, as it is a legitimate area of inquiry. My objections were two:
  1. The CDC stands for the Centers for Disease Control (and Prevention). That is, it is about the control of infectious or other kinds of disease, and thus research into guns represents mission creep.
  2. The CDC would immediately be used as a friendly home for gun control advocates to produce shoddy, biased work that would be used to cloak their activities in the white lab coat of science while ignoring anything that contradicted the party line.
 The second was particularly important as a factor in 1994, when CDC Director for Injury Prevention and Control Mark Rosenberg said "We need to revolutionize the way we look at guns, like what we did with cigarettes ... It used to be that smoking was a glamour symbol—cool, sexy, macho. Now it is dirty, deadly—and banned." In 1996,
Congress passed an amendment to a spending bill that forbade the Centers for Disease Control and Prevention from using money to “advocate or promote gun control.”

The National Rifle Association had pushed for the amendment, after public-health researchers produced a spate of studies suggesting that, for example, having a gun in the house increased risk of homicide and suicide. It deemed the research politically motivated. ...

The actual amendment sponsored by Jay Dickey, a congressman from Arkansas, did not explicitly forbid research into gun-related deaths, just advocacy. But the Congress also lowered the CDC’s budget by the exact amount it spent on such research.
(Dickey later expressed regret for his part in introducing the bill.) So it was no small surprise to me when Reason published a piece yesterday indicating that the CDC had actually performed research on the defensive use of guns after that legislation passed, in 1996, 1996, and 1998. What they found was that guns were used literally millions of times annually for self-defense, the vast majority of which did not involve firing a single shot. (Emboldening in the passages below are mine, as ever.)
Florida State University criminologist Gary Kleck conducted the most thorough previously known survey data on the question in the 1990s. His study, which has been harshly disputed in pro-gun-control quarters, indicated that there were more than 2.2 million such defensive uses of guns (DGUs) in America a year.

Now Kleck has unearthed some lost CDC survey data on the question. The CDC essentially confirmed Kleck's results. But Kleck didn't know about that until now, because the CDC never reported what it found.
The CDC survey turned up numbers very similar to (but not identical with) Kleck's more recently (2001) published figures, a discrepancy Kleck attributes to a generally declining crime rate since then. (Gun control advocates are more wont to use National Crime Victimization Survey figures of about 100,000, an order of magnitude smaller.) The essay makes no effort to determine CDC's the motives for burying these results, but the obvious ones are
  1. CDC honchos were gunshy, as it were, about publishing anything on the subject after a significant maelstrom that resulted in funding cuts.
  2. They did not like the results they got, and hid them.
  3. Some other reason.
If the first, why did the CDC pursue this study in 1997 and 1998? Funding is finite, so why bother when there are other areas of research that need money as well? This alone suggests that the latter two are in play, and the optics surely argue for the second (particularly given Rosenberg's remarks). If gun control advocates wish to develop some credibility on the subject of state-sponsored gun injury research, they need to stop acting in ways that are visibly dishonest.

Wednesday, April 18, 2018

Sarah Kliff, Promoter Of Democratic Healthcare Fantasies

Vox's Sarah Kliff, last seen before 2016 election whistling past the Obamacare graveyard, now chirps about the number of Democratic health care proposals! Yay, team!
It’s notable to me that Democrats seem really keen on having another health care debate. They’re preparing for it by putting all these different options on the table, to sort through where a consensus might exist.
And the "options" really boil down to a Hobson's choice: how do you want your government-controlled health care delivered? All from the government right now (single-payer, a consistent loser at the polls)? Pretending that single-payer isn't the endgame right away (Medicare/Medicaid buy-in, i.e. the public option)? However you cut it, the belief in magical government intervention as an elixir is central to all of them. None of these will fix the physician shortage, nor will it fix the patent system, nor the regulatory moats around pharmaceuticals. Kliff doesn't concern herself with those kinds of details; her job is that of cheerleader. We know this because the second half of her article goes on to explain the wonders of the Murphy-Merkley plan, during which she writes the following:
The Choose Medicare Act envisions that individuals and companies would cover their costs for buying into Medicare, meaning actuaries would need to determine what those premiums would look like. There is some reason to expect these premiums would be lower than premiums for private insurance, because Medicare typically pays lower prices.
There are a lot of things to say about that, not least the shifting terrain that a large influx of new "insureds" would look like; recall that the Obamacare cohort was sicker than the general population, i.e. the incentives are for such people to seek out such care. There's hardly a reason to think a "public option" would save material costs, and considerable reasons to think it would do worse (i.e. the Democrats would be sure to goose the actuarial realities by way of further subsidies).

Another problem is the quip sometimes attributed to Stalin, that quantity has a quality all its own. Kliff is right that private payers pay more for their services than Medicare. But assuming Medicare expansion will fix costs also assumes that physicians will continue to accept Medicare patients. While data is hard to come by, Texas Medical Association figures showed a dramatic drop in the acceptance of new Medicare patients from 2000 (when 67% of physicians accepted all comers) to 2010 (only 31%). Moreover, given that Medicare represents a relatively small fraction of physician income (as of 2011, around 40% in Texas, see PDF page 5), expanding it would demand physicians take a substantial pay cut. That they might opt out of accepting new patients or stop seeing Medicare patients altogether. Second-order effects: we can haz them!

Sunday, April 15, 2018

Contra Randall Munroe On Free Speech

Bar none, the best explainer of why that XKCD comic on free speech is both correct and woefully inadequate: while it is true that advertiser boycotts are a legitimate means to get TV programs one dislikes off the air, it also gives air to the deplatforming assholes who also are wont to exercise the heckler's veto.

Tuesday, April 10, 2018

How An Idiotic Patent Turned $20 Worth Of Generic Drugs Into $5,430

So I went to see the surgeon today for a followup appointment following my knee surgery, a routine arthroscopy. He recommended I take an anti-inflammatory, 800 mg of ibuprofen, three times a day. Doses that large are not always well-tolerated; they have been known to cause gastric upset. Consequently, we get this:

Meet Duexis, a product of Horizon Pharma. Duexis consists of 800 mg of ibuprofen, and 26.6 mg of famotidine. Ibuprofen was patented in the UK in 1961, and expired in 1984; the US patent (3769425A) was granted in 1970, and would have expired in 1987. Originally sold under the trade name of Pepcid, famotidine has been off patent for 20 years, with generics appearing in 2001.

I checked at Sam's Club, and 200 count 20mg famotidine is currently $8.76, and 1,200 200 mg ibuprofen is available for $10.88. Assuming I take three 800 mg ibuprofen doses daily and three of the 20 mg famotidine, that would mean the latter is the limiting factor, and I could go about two months (66 days, plus two doses the next) on that. (The 1,200 ibuprofen would take me 100 days, a little over three months.)

A one month prescription of Duexis (30 days @ 3x/day) is $2,715 (per the Sam's Club pharmacy). Two months is $5,430.

Duexis is covered by US patent 8,501,228, which I assume is the reason for this insane pricing. (Horizon also granted Par Pharmaceutical a license to make a generic starting in 2023 as a result of a patent suit settlement.) This kind of apparently frivolous patent grant is disturbingly common:
When the patent reaches its expiry date, the comfortable monopoly evaporates, replaced by cut-throat competition. Incumbents have three ways of defending themselves. Marketing can create brand-specific demand, dulling the temptation to switch to low-price products. Ibuprofen illustrates this. Developed by the chemists at Boots itself in the 1960s, the patent expired in 1984. But a year earlier Boots had created Nurofen, branded ibuprofen. The clever mix of packaging and advertising protected its profits. The lucrative Nurofen brand was sold in 2006; Boots still stocks the product, which costs five times more than its generic equivalent.

A second strategy nudges customers towards newer drugs that are still protected by patent. Omeprazole, a drug to reduce stomach acid developed by AstraZeneca in the 1980s, shows how it works. Branded as Losec in Britain and Prilosec in America, it became one of the world’s bestselling drugs in the mid-1990s. With the patent set to expire in 2001 AstraZeneca faced a drop in profits. So the company took its drug and adapted it, creating a closely related compound, esomeprazole, which it sold as Nexium. Though a clear offshoot of the original medicine, this counted as a new drug and was given a patent. A big marketing campaign and attractive pricing helped shift demand away from Losec and towards Nexium. With the help of this strategy, sales between 2006 and 2013 amounted to almost $40 billion.
A third approach is to "pay the makers of generics not to compete". None of these are in the customer's interest.

Ironically, the surgeon pointed me at a manufacturer program that was going to cut me a break if I used their particular pharmacy — oh, joy! — I only have to pay a $10 copay! But this made me wonder if my insurance was going to pay it or some part of it. In which case, am I not indirectly paying for this usuriousness?

Saturday, April 7, 2018

Jill Filipovic, Political Medium, Speaks To Conservative Ghosts

Jill Filipovic once described herself as a "recovering attorney", which is about right, because she doesn't actually do a terribly good job of encapsulating the arguments of her opponents. I came across an essay of hers in NBC News' Think blog, in which she attempts to extirpate the stain of Chappaquiddick from the Democratic brand while bagging on conservatives for their support of someone as vile as Donald Trump. Leaving that aside for the moment (and she does have a valid point that support for Trump precludes conservative moral dudgeon on a vast array of Democratic transgressions), she seriously stumbles at her misapprehension of what the conservative argument actually might be:
The conservative worldview has always been animated by the idea of men as sexual predators who need reining-in by the morally temperate, sexually mild and inherently alluring female of the species. Women, in this view, are a family’s moral beacon, while men are its public face. That ideology conveniently requires women to stay behind the scenes; if women do subvert their traditional roles, it removes responsibility from men to still behave well.
 This is a curious charge to level at Republicans, who offered up a famously incompetent but still female vice presidential candidate in 2008. Republican women form a majority of women governors and lieutenant governors, as well as notching 706 elected state-level representatives. Not only does Filipovic's explanation appear not to come from someone within the movement, it doesn't even square with known facts. It's like she's having a conversation with the ghost of Phyllis Schlafly.

Saturday, March 24, 2018

Second Amendment For All, Shot And Chaser Edition


Martin Luther King Jr. carried guns for self-protection, applied for a conceal-carry permit (denied by racist white authorities), and once declared, "the principle of self-defense, even involving weapons and bloodshed, has never been condemned, even by Gandhi."

The War On Objective Competence

Campus Reform brings to us a masterpiece of feminist criticism of engineering and the hard sciences. And by "masterpiece", I mean a perfect example:
The professors are especially concerned with how engineering courses tend to be “depoliticized” compared to classes in other fields, which they contend is due in part to engineering culture’s emphasis on meritocracy and individualism.

“Socialization into the ideologies of meritocracy and individualism, coupled with a valorization of ‘technical’ prowess at the expense of ‘socially focused’ work processes, depoliticizes the gendered structure of the profession,” they write.

The professors add that this can be problematic because “students learn that raising concerns about marginalization—of themselves or others—is tangential or even distracting to what counts as the ‘real’ practical and objective work of engineering.”
The authors' credentials are all impeccable: none of them teach engineering classes, and only one drifted away from that discipline:
  • Carroll Seron has a post at the Criminology, Law and Society department of UC Irvine's School of Social Ecology.
  • Susan S. Silbey works at MIT's Sloan School of Management as a Professor of Behavioral and Policy Sciences.
  • Erin A. Cech is an assistant professor in the sociology department at U. Michigan after obtaining an engineering degree at Montana State.
  • Brian Rubineau teaches at McGill University as an Associate Professor of Organizational Behaviour.
As usual, none of these people have anything directly to do with their institutions' engineering or science schools. But it does qualify as yet another salvo in the ongoing war by idiot mandarins who do nothing upon objective measures of competence in fields where its exercise is of obvious import to society.