Thursday, May 24, 2018

"Check Your Privilege" Meets The Royals: The Surprising Compatibility Of Modern Feminism With Monarchy

Joanna Williams in Spiked explains why "Monarchy And Feminism [Are] A Perfect Marriage". "Bold declarations of feminist intent do not show that the monarchy has changed: instead, they show how much feminism has changed."
Today, feminism ... doesn’t call for an expansion of democracy, but for democracy to be tamed. All-women shortlists and quotas for women on company boards deny people a free choice in appointing anyone they choose. They move us away from seeing gender as an irrelevance and treating people as equals. Instead, we’re told that women need to be afforded special privileges. In the past few weeks we’ve had calls for the banning of sexist adverts and the criminalisation of street harassment. Rather than calling for women to be recognised as adults, today’s feminism insists women are treated like children.

The only question campaigners and commentators have so far raised about Meghan’s feminism is whether she’ll get away with it. Is it realistic to think she can be both a feminist and a royal? Of course it is. Feminism today poses no threat to the establishment. Feminism is the establishment. Feminism is now concerned with enforcing etiquette, telling boorish men how to behave, and calling for censorship and regulations. It is elitist and condescending – a perfect match for the monarchy. Today’s younger royals reveal all about mental-health troubles and want us to know that despite wealth and privilege, they suffer too. Again, a perfect match for a feminism that allows rich celebrities to swap stories of disadvantage.
(Emboldening mine.) The advantages of being rich collide with feminist ideals:
Where Meghan differs from other women is that she has given up her own career for marriage. Today, over 70 per cent of all women and 90 per cent of female graduates are employed. Yet on the royal website, details of Meghan’s acting career – presumably earned through her own merit and tenacity – are given only a cursory nod.
The New Feminist Woman may have never materialized in the real world, but the old one — class-conscious as ever — still sets the rules.

Saturday, May 19, 2018

Burning Down The Medical Village To Save It: The Folly Of Big Data In Medicine

Rena Xu's recent piece in The Atlantic on physician burnout is mostly interesting for its between-the-lines reporting. Yes, Big Data (i.e. medical coding) is driving a lot of physician burnout:
Regulations governing the use of electronic medical records (EMRs), first introduced in the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, have gotten more and more demanding, while expanded insurance coverage from the Affordable Care Act may have contributed to an uptrend in patient volume at many health centers. These changes are taking a toll on physicians: There’s some evidence that the administrative burden of medicine—and with it, the proportion of burned-out doctors—is on the rise. A study published last year in Health Affairs reported that from 2011 to 2014, physicians spent progressively more time on “desktop medicine” and less on face-to-face patient care. Another study found that the percentage of physicians reporting burnout increased over the same period; by 2014, more than half said they were affected.
But won't we need ever-more new physicians to deal with the aging US population? Yes, we will, but —
A quarter of U.S. physicians are expected to retire over the next decade, while the number of older Americans, who tend to need more health care, is expected to double by 2040. While it might be tempting to point to the historically competitive rates of medical-school admissions as proof that the talent pipeline for physicians won’t run dry, there is no guarantee. Last year, for the first time in at least a decade, the volume of medical school applications dropped—by nearly 14,000, according to data from the Association of American Medical Colleges. By the association’s projections, we may be short 100,000 physicians or more by 2030.
And this despite modest, recent upticks in new physicians, even despite Medicare's meddling in internship slots. In addition, the article cites the "Resident Physician Shortage Reduction Act ... [which] would add 15,000 residency spots over a five-year period." That's a 1.6% increase vs. the 2014 physician population of 916,264, but nothing compared to the gaping hole implied by 100,000 missing doctors. Mandated medical coding — the raw material of Big Data in medicine — contributes to a physician burnout we can scarcely afford.

But this kind of insanity is to be expected. The people who imagine they are helping very frequently do not subject themselves to the consequences of their "help" (viz., Jonathan Gruber, who is not a doctor). The meretricious belief that big data will somehow "bend the cost curve" is deeply embedded, including, especially, in service providers with something to sell. There are costs to acquiring that data, and that cost is, more administrative overhead (emboldening mine):
...[D]octors are most valuable when doing what they were trained to do—treating patients. Likewise, non-physicians are better suited to accomplish many of the tasks that currently fall upon physicians. The use of medical scribes during clinic visits, for instance, not only frees doctors to talk with their patients but also potentially yields better documentation. A study published last month in the World Journal of Urology reported that the introduction of scribes in a urology practice significantly increased physician efficiency, work satisfaction, and revenue.
And who pays for that increased revenue? Ultimately, it's the patients, of course, or the government (taxpayers) if it's Medicare/Medicaid.

Saturday, May 5, 2018

The Supreme Court Blesses Inter Partes Review, And The Possibilities For Pharma Reform

One of my big complaints about medicine is the ongoing problems with patents (general complaints here, a more specific example here) needlessly driving the costs of pharmaceuticals higher. The Supreme Court recently delivered some good news on this front in the case of Oil States Energy Services v. Greene's Energy Group. Essentially, the 7-2 decision said that the USPTO can revoke its own granted patents in a process called Inter Partes Review.
The basic idea behind the IPR process was an admission that the USPTO is historically bad at properly reviewing patents before granting them. It grants a lot of bad patents. The IPR process allows anyone to present evidence to the PTO that it made a mistake and granted a patent that should never have been granted. If the PTAB is convinced, it can invalidate the patent. Seems pretty straightforward. Except that the usual patent lovers (mainly patent trolls and big pharma) insisted that this was some sort of unconstitutional taking of property, without the review of a court. This is wrong for a whole bunch of reasons -- starting with the incorrect view of patents as traditional "property."
 The reaction of the pharmaceutical business, which is often predicated on shabby patents, is highly negative, but it’s unclear whether there’s enough momentum behind the process, as “Pfizer, Merck, Novartis and Sanofi are among the companies to have used the IPR process” to invalidate patents. Unfortunately, because IPR is a strictly bureaucratic creature, it is also subject to regulatory capture, i.e. if Big Pharma (say) gets hold of it, it will actually result in worse outcomes than appeals before Article III judges. A study by BiologicsHQ shows that “despite widespread concerns about the PTAB operating as a patent death squad in IPRs, ‘such concern is not justified for drug patents.’” The study found that
According to the March 2017 IPR statistics issued by the PTAB, 53 percent of IPRs resolved as of March 31, 2017 were instituted; the rest were either denied institution or reached some other resolution prior to the institution decision. 35 percent of all resolved IPRs resulted in final written decisions and 23 percent led to findings of all claims unpatentable. Only 7 percent of all resolved IPRs led to final written decisions finding that no claim was unpatentable, and 5 percent led to mixed claim findings.
This suggests that only the most obscenely obvious patents will end up invalidated, and even among those patents that do go through the process, not all of them end up being instituted! But the numbers are even worse for pharmaceutical patents:
By contrast, drug patents fare better under PTAB scrutiny in terms of having claims upheld. Of the 4,563 resolved IPRs, BiologicsHQ reports that 222 petitions (5 percent) involved patents covering drugs listed in the Orange Book. Focusing on just the IPRs involving Orange Book patents, 44 percent were instituted and 38 percent reached a final written decision, but only 16 percent led to final written decisions where all claims were found unpatentable. No instituted claim was found unpatentable in 50 percent of final written decisions (19 percent of the total number of resolved Orange Book IPRs).
 (The Orange Book is the list of FDA-accepted drugs.) Far from being a salvation, IPR might prove to be an industry Trojan Horse. To be clear, there’s no immediate evidence that regulatory capture is currently running rampant at the USPTO,  but the outcomes certainly point in the same direction.