Yup - Lipitor is definitely an extreme example. I'd rather see a system that rewards success but which isn't so much like the lottery.
As far as not spending so much on failure goes - you basically summed up the speeches that have been given in every quarterly R&D meeting in every Pharma for the last ten years. Quite a bit of R&D goes into trying to figure out which drugs won't pan out earlier. Companies have developed all kinds of crazy in-vitro tests to try to predict toxicity, and they also have done a lot to try to delay investing in development until absolutely necessary. All of that lowers the cost of failure. However, it still seems like many drugs have problems in late clinical trials.
That isn't actually all that surprising considering that clinical trials are themselves very poor at determining whether a drug is either safe or effective. Look at all the high-profile recalls in the last 15 years with products that passed their initial trials. The difference between a placebo and a drug might be a 25% success rate vs a 35% success rate, and a 10% dangerous side effect rate and an 11% one. There is so much noise in the data that I suspect dumb luck has more to do with drugs working out or not than merit. However, for all its problems clinical trials are all we have right now - anything else is just anecdotal and much worse. I suspect that more regulation of trials or even having them run by the government would help fix some of these issues. Some of the problem is undoubtedly bias and a more neutral party would probably cut down on the noise. Another big problem is hypothesis mining xkcd M&M style - which again would be addressed by having a third party run the trials (they would be given an endpoint, would design and run the trial, and would report success/failure and ensure the data is never used for anything else without another trial). Yet another big problem is that doctors have incentives to improperly enroll patients - if the doctors were just employed by a national healthcare system at a flat salary and not given any incentive to participate in trials beyond keeping their jobs I suspect that this source of noise would go away. For all the FDA investigations into misconduct at big pharma the FDA investigations into doctors participating in trials make the pharma companies look like saints.
The whole situation is a big mess that needs a big cleanup, not another bandaid. That pretty-much sums up all of healthcare. I was just doing the math on buying some medical equipment from various suppliers, and I realized that my insurance company will penalize me $700 and a ton of paperwork if I save them $2k - now there's a perverse incentive (gee, Alex, I'll take the option that saves me a fair bit and costs the insurance company a fortune)!
I didn't forget compulsory licensing, I just realize how unlikely it is in much of the Western world as long as the drug companies are anything like reasonable
Suppose the price that works out for everybody is twice what the typical European pays (and 1/4th what an American pays). Do you think that every nation in Europe and Canada would be willing to pay twice as much for all their branded pills, just so that American consumers aren't ripped off?
The simple fact is that for an increasing number of Americans, these innovative drugs might as well not exist.
There is not a single innovative drug you can get in America that can't be bought cheaply - you just have to wait about 10 years. You can get Lipitor today for a song, and you wouldn't be able to get it at all if it weren't so profitable a decade ago (granted, it didn't have to be QUITE so profitable).
In any case, I'm all for reform. However, simply controlling prices is unlikely to work. You might be able to lower overall costs by 20% or something if you really tried to contain things, but that isn't much of a change. The costs of developing the drugs still need to be paid. What is more likely to work in the long-term is some kind of government-funded development. The total cost won't be much lower, but it won't be paid by anybody but those who can afford to via income taxes. Costs aren't really the issue with drugs so much as how those costs are distributed (though I'd love to see the costs come down some).
If we do what 95% of the western world does, the drug companies will push back everywhere. Net result would be higher prices in 95% of the west, lower prices here and balance restored.
You're forgetting about compulsory licensing. If a drug manufacturer doesn't accept the prices asked for by a local government, the local government will simply buy the drug from a generic manufacturer in violation of the patent. So, any country can effectively dictate the cost of a drug, down to marginal cost, and if you allow trade in that drug then everybody gets it at that price.
Considering that the drug companies sell at much lower prices in the 3rd world than they do in Canada, I don't see how their sales in Canada would be just barely profitable. It's notable that they even sell some of the same prescription drugs dirt cheap in the U.S. for veterinary use.
Again, once you develop the drug and pay for the R&D, any price above a few cents per pill is profitable. Airlines sell the same seat for $100, $300, and $1000. They don't need to sell them all at $1k, but just because they can sell some at $100 doesn't mean that they could sell them all at $300.
Veterinary use usually isn't as heavily regulated, and I doubt much development money is spent beyond what is spent on people. Plus, you don't have to bribe vets as much to get them to participate in clinical trials - a doctor requires a substantial payoff before they'll let one of their patients know that there is an experimental drug that might help them, and if there are two of them they'll refer their patient to whoever is paying them more. Disgusting practice, but there is a reason that most of the clinical trials happen in places like Eastern Europe and Asia - you don't have to bribe the doctors as much and local regulators are less demanding, plus there is less liability overall. Government-run clinical trials combined with government-employed doctors would reform this practice as well, and those are things I completely support.
Yup - pretty-much the whole reason management consultants exist is that there are incompetent people running companies that for whatever reason can convince people to give them the job. They then spend their companies money to hire somebody else to do their job for them. If the shareholders had any brains or power they'd just hire the consultants instead.
From what I've seen I'd say the unity among Bible translators is probably similar to that among scientists. There aren't a lot of people who are qualified to do a first-rate job of it, and they're very intelligent, and thus they tend to realize that they don't always have all the answers.
Now, unity among denominations and churches is an entirely different matter. It takes a far different skillset to get people to pay to listen to you go on for an hour about whatever you're feeling concerned about. The people in power here tend to be much more political and ideological, and they tend not to be so humble about the limits of their knowledge (if they were humble they wouldn't sound so convincing behind a pulplit and people wouldn't pay to listen to them).
Of course, some of this depends on what you call a Bible translation. Anybody can grab their denomination's favorite existing English translation and modernize the words or do a literal translation into another language they happen to know, and thus the general sense of academic liberalism doesn't apply. By translation I am referring more to creating a rendition of the text of the Bible that conveys in the best way possible the intended meaning of the original authors. That requires strong knowledge of the original languages, good historical context, good language skills in the target language, and strong skills in textual criticism (trying to figure out what the original authors wrote in the first place, translations aside).
I see no reason why Americans should bankrupt themselves to subsidize other western countries governments buying pills for less. If our government pushes a little, the prices will balance better.
If the government wants to do what 95% of the other countries do out there, everything could be as expensive as aspirin. Of course, you'd never see another new medication unless the government footed the bill 100% up-front. Companies would still sell approved medications at the lower rates, since they would make a marginal profit, even if the most recent ones would show a net loss (not selling them would just result in a bigger loss).
If it won't, the least it could do is get out of the way so we can level the prices ourselves by re-importing. Either full regulation or full de-regulation would be principled stands, letting the corporations charge what they like AND blocking consumers from going to a market with more favorable prices is indefensible.
Allowing free re-importation would simply result in pills being priced at the lowest price supported by a country that allows for compulsory licensing. If this were allowed the first thing that would happen is that branded drug companies (US and otherwise) would curtail all supplies worldwide outside the US to delay the change as long as possible - resulting in shortages worldwide (they probably wouldn't cut nations off entirely - just limit them so much that various governments would restrict exports to limit shortages). US prices wouldn't change much initially as a result. Then most non-US nations would institute compulsory licensing, bringing costs way down, and then prices in the US would fall dramatically as a result of re-importation. Branded drug manufacturers would stop R&D and become generic manufacturers except where governments pay for it up-front so that there is no risk (that could take many forms, but basically it would mean that the company potentially makes lots of money regardless of prices).
Note, I'm not talking about 3rd world pricing, I'm talking about Canada.
We do need to review how the bills are paid though, so we can get more antibiotics, antivirals, and chemo agents and less hair pills that cause prostate cancer and birth defects.
Canada's pricing is only marginally profitable - if everybody charged that rate then creating a new medication would be a net loss. Now, selling pills at that rate once your costs are covered makes perfect economic sense. Again, it is the same kind of logic that makes it profitable to sell $100 airline tickets even though selling them all at that price would bankrupt the airline.
As far as more important meds vs hair pills go - think about what you're saying. I doubt most countries strongly regulate prices or allow compulsory licensing on hair pills, because they aren't medically necessary. That means that companies can sell at high prices without competition, making these medications very profitable. On the other hand, antibiotics and chemo agents are life-saving medicines, and countries are far more likely to regulate prices to increase access to them. That means that they are less profitable, and thus companies are less likely to research them. This is a perverse incentive at work - if you want companies to supply more of product A than product B, then you have to make product A more profitable. Shouldn't the cure for cancer be more profitable than a hair pill? And yet, the incentives with healthcare price controls make the opposite true. We shouldn't be surprised when nobody wants to cure cancer as a result.
The problem with medications isn't that companies make money off of live-saving medicines. The problem seems to be one of access and socialism - pill prices are a pretty regressive way to pay for healthcare. You can't solve that problem merely by regulating the pricing - you need to find some other way to pay people to do discovery.
That is kind of like saying that because an airline sells last-minute tickets for $99, that it must be profitable to charge that price for every seat on the plane. In fact, it is not profitable to sell all your seats at that rate. However, it is profitable to fill up the plane as much as you can as long as you exceed the marginal cost per seat, which is less than $99. You could look at it as if the first seat costs $100k, and then every seat after that costs $25. Since nobody pays $100k for a ticket, you try to get what you can from everybody and spread out that initial cost.
The same issue applies with pills. The first pill costs maybe $350M on average, and every pill after that costs a dime. Since nobody pays $350M for a pill, you make as much money as you can off of each market. However, as long as you can make at least a dime on a pill it is still in your interests to sell it. However, if you sold every pill for a dime you'd lose money.
I'm all for reform here, but it isn't as black-and-white as people make it out to be. There are significant fixed costs and they cannot be recovered at the kinds of prices pills sell for in the third world. Now, if taxpayers just funded the full cost of development then everything could be sold just fine for ten cents per pill. However, that isn't how the current system works. The problem is that no matter how you slice it somebody has to pay the $350M development bill, or it won't happen.
I'm sure that in at least some cases the counterfeits are made on the same line as the genuine pill. I suspect that doesn't happen quite as often as it does in other industries - the pharma industry has really only just started to really outsource their production. Most pills sold in the US are made at plants directly managed by the company whose logo is on the bottle (not necessarily in the US). That will likely change over time.
Most people can't afford private schools. The kids aren't in public schools because their parents don't care, they're there because they can't afford private schools. Since you were poor when you raised your kids you certainly should know that.
Sometimes I wonder if the solution to a bunch of problems is to require a license to have kids. Setting aside the major ethical issues around this consider the possibilities:
1. No accidental births. Kids are only there because somebody cared to bring them into the world. 2. Possibly no financial issues - you might require pre-payment of educational and medical expenses before granting a license. 3. Interested parents. If a parent took out a $500k loan to pay to have a kid, chances are they will take the time to make sure the kid is learning something in school, and they'll care about how schools are spending their money as well.
I'm not saying you have to limit parenting only to people able to spend huge sums of money - you could have "scholarships" or whatever based on any number of criteria. However, as it stands right now it is a lot harder to buy a house than to have a kid. People take care of their houses because they had to invest to acquire it. If people had to do the same for kids then chances are kids would be a lot better off.
Many counterfeit drugs are in face substandard in quality, but due to price pressure they can work their way into first-world markets. As you say, many are also perfectly safe generics that simply haven't been licensed.
Both actually create problems with our current system of R&D. Since the way 95% of drug safety trials are funded is from private investment, any threat to private investment is a threat to the development of new drugs. Now, I'm not convinced that this is necessarily the best way to fund drug safety trials, and I'm all for coming up with a better way. However, if we're going to stick with the current model where nothing gets on the market without some private company spending $50M on trials (only about 10% of which work out) then you need to have a lot of money going back to those companies for them to take on the risk.
Please also note that I'm about "drug safety trials" or clinical trials. I realize the government spends plenty of money on blue sky R&D. For whatever reason it doesn't spend money on clinical trials - probably because they're boring and not really cutting-edge research. However, these are one of the biggest expenses in drug development and they're necessary to ensure drugs are safe. If government would just fund drugs end-to-end and keep the patent rights this whole debate would become moot...
If you just want 5GB of offsite storage accessible from a somewhat dedicated platform that would be pretty usable.
If you want a place you can dump your documents and access from any browser/phone/etc, that would be almost impossible without some kind of API and software front-end. Key management alone would be a mess.
The service providers have no incentive to provide either the API or the encryption. They benefit from being able to mine your data (even just for ads), and encryption tends to ruin de-duplication which becomes a big cost for them.
There's a reason that a GPS unit in a plane generally does less than a typical $150 motorist unit and yet costs $2. A big factor is obviously liability, but another factor is the concept of "required navigational performance." The GPS has to not only be accurate, but it has to know if it is accurate or not and warn the pilot if this is not the case. For general navigation around the sky the required accuracy isn't super-high, but when you're on a landing approach it has to be very good both horizontally and vertically. If you can't see the runway then you don't know for sure where you are, and there could be a hill, tree, or tower anywhere in your vicinity. Being off by a few hundred feet on a landing approach simply isn't acceptable, and as soon as this happens you have to abort the landing.
In a car a GPS unit is a helpful tool. In a plane making a GPS instrument approach it is a vital piece of safety equipment and is as carefully regulated as an altimeter or the flight controls.
I doubt the auto GPS unit is going to care about this stuff - it will just report whatever it thinks and some algorithm will decide what to bill you.
Disclaimer - I'm not an expert on GPS requirements in aviation - I'm casually aware of this stuff as an enthusiast, but I haven't studied up. Exact requirements/procedures are likely to vary somewhat from what I described, although I believe the gist of my description is accurate.
No, if your insurer starts a program like this and you opt out, then you'll get penalized in your rates by default. Oh, they won't itemize this as a penalty - they'll just raise their rates across the board and you won't get the itemized benefit that offsets this.
Uh, I'm sure the average price will rise with inflation. Those who are good drivers might initially rise a little slower than inflation, and those who are bad drivers will rise faster than inflation.
Rates are set to what the market will bear, and a market where people are required by law to hold insurance and where barriers to entry are high will bear quite a bit...
It certainly should be, and it would be if speed limits were remotely sane. Right now speeding is just travelling at the same speed as 90% of the other cars on the road. Speed limits should be set at a speed that most drivers would not be comfortable driving at.
They already do that. If you have gone 6 years without any accidents, 6 years without any tickets, and 6 years without any insurance claims, your rate will be significantly lower than if you wrote off a car last year, and had a careless driving charge the year before.
While as a whole your statement is generally true, parts of it are misleading, depending on where you live. In at least some states you aren't allowed to charge differently based on whether you have filed claims, which is a pretty sane way to regulate. Now, they can charge you for being at-fault in an accident regardless of whether you file a claim, but filing claims (at least in some states) has no impact on your rates.
Of course, the insurance company likes to keep people thinking that you get a better rate if you don't file claims, that way they can collect their premiums and not even have to pay out when they're supposed to.
Check the laws of your state. If your's is like mine then you should file a claim any time it exceeds the deductible.
I think a key thing to look at is the number of times an experiment has been run. If you run 1000 experiments getting a result that you'd only expect at random 1/1000th of the time isn't terribly impressive. I'm not sure what counts as a trial in a particle accellerator, but I suspect those things churn through collisions about as fast as a CPU goes through instructions...
ICS works great on the G2 with only 512MB - I'd say it is peppier than Gingerbread was. Now if only they either had a stable driver API or actually kept their drivers up-to-date or open-source...
The issue is liability. If you build a technology that saves 1000 lives per year, but fails to save 10, then you get sued into non-existence. If you don't put it on the market then 990 more people die per year, but you get off scott-free.
Our legal system makes the perfect the enemy of the good.
It isn't supposed to be a test of the author's abilities - just of the accuracy of the paper. The author could be an idiot but if the paper accurately describes the experimental results and their validity then the paper should be published.
Personally I don't see any harm in having both options. If people want Ubuntu they can use it, and if they want Debian/Gentoo/whatever they can use that.
If anything upstream doing this stuff makes it harder for others to offer choice. Gnome is moving in a direction where if you want to use their DE you have to also use their sysvinit replacement,/dev manager, and I'm sure lots of other stuff. At the rate they're moving they'll basically become a distro. It will likely lead to much tighter integration, but also less choice, and will make it harder for better components to evolve since they'll lose the integration. Would we have systemd or wayland if you couldn't use Gnome or KDE with anything but sysvinit or xorg?
Sometimes choice IS the focus. I do agree that it is hard to achieve both choice and vertical integration - this is largely why Gentoo tends to be a bit rougher on the edges compared to most distros. However, it is a great distro to use if you want to do something a little out of the mainstream as it doesn't fight you every step of the way.
I suppose it is ironic then on Gentoo that I've found KDE to be one of the things that "just works?":)
It certainly has its share of sharp edges, but when you run into them they tend to be reasonably fixable. The only time KDE on Gentoo was problematic reflected upstream more than the distro - during the 3.5 to 4.0 "transition." I stuck with 3.5 for quite a while, then went to xfce until it got sorted out. Now I just USE=-semantic-desktop and KDE is blazing fast (no nepomuk).
Or, if you'd rather I'm sure Sabayon will round off some of the sharp edges and since it includes binary versions of just about everything you can install it quickly.
Gentoo in general is desktop-environment-neutral (indeed, it is X-vs-no-X neutral as well).
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Yup - Lipitor is definitely an extreme example. I'd rather see a system that rewards success but which isn't so much like the lottery.
As far as not spending so much on failure goes - you basically summed up the speeches that have been given in every quarterly R&D meeting in every Pharma for the last ten years. Quite a bit of R&D goes into trying to figure out which drugs won't pan out earlier. Companies have developed all kinds of crazy in-vitro tests to try to predict toxicity, and they also have done a lot to try to delay investing in development until absolutely necessary. All of that lowers the cost of failure. However, it still seems like many drugs have problems in late clinical trials.
That isn't actually all that surprising considering that clinical trials are themselves very poor at determining whether a drug is either safe or effective. Look at all the high-profile recalls in the last 15 years with products that passed their initial trials. The difference between a placebo and a drug might be a 25% success rate vs a 35% success rate, and a 10% dangerous side effect rate and an 11% one. There is so much noise in the data that I suspect dumb luck has more to do with drugs working out or not than merit. However, for all its problems clinical trials are all we have right now - anything else is just anecdotal and much worse. I suspect that more regulation of trials or even having them run by the government would help fix some of these issues. Some of the problem is undoubtedly bias and a more neutral party would probably cut down on the noise. Another big problem is hypothesis mining xkcd M&M style - which again would be addressed by having a third party run the trials (they would be given an endpoint, would design and run the trial, and would report success/failure and ensure the data is never used for anything else without another trial). Yet another big problem is that doctors have incentives to improperly enroll patients - if the doctors were just employed by a national healthcare system at a flat salary and not given any incentive to participate in trials beyond keeping their jobs I suspect that this source of noise would go away. For all the FDA investigations into misconduct at big pharma the FDA investigations into doctors participating in trials make the pharma companies look like saints.
The whole situation is a big mess that needs a big cleanup, not another bandaid. That pretty-much sums up all of healthcare. I was just doing the math on buying some medical equipment from various suppliers, and I realized that my insurance company will penalize me $700 and a ton of paperwork if I save them $2k - now there's a perverse incentive (gee, Alex, I'll take the option that saves me a fair bit and costs the insurance company a fortune)!
I didn't forget compulsory licensing, I just realize how unlikely it is in much of the Western world as long as the drug companies are anything like reasonable
Suppose the price that works out for everybody is twice what the typical European pays (and 1/4th what an American pays). Do you think that every nation in Europe and Canada would be willing to pay twice as much for all their branded pills, just so that American consumers aren't ripped off?
The simple fact is that for an increasing number of Americans, these innovative drugs might as well not exist.
There is not a single innovative drug you can get in America that can't be bought cheaply - you just have to wait about 10 years. You can get Lipitor today for a song, and you wouldn't be able to get it at all if it weren't so profitable a decade ago (granted, it didn't have to be QUITE so profitable).
In any case, I'm all for reform. However, simply controlling prices is unlikely to work. You might be able to lower overall costs by 20% or something if you really tried to contain things, but that isn't much of a change. The costs of developing the drugs still need to be paid. What is more likely to work in the long-term is some kind of government-funded development. The total cost won't be much lower, but it won't be paid by anybody but those who can afford to via income taxes. Costs aren't really the issue with drugs so much as how those costs are distributed (though I'd love to see the costs come down some).
If we do what 95% of the western world does, the drug companies will push back everywhere. Net result would be higher prices in 95% of the west, lower prices here and balance restored.
You're forgetting about compulsory licensing. If a drug manufacturer doesn't accept the prices asked for by a local government, the local government will simply buy the drug from a generic manufacturer in violation of the patent. So, any country can effectively dictate the cost of a drug, down to marginal cost, and if you allow trade in that drug then everybody gets it at that price.
Considering that the drug companies sell at much lower prices in the 3rd world than they do in Canada, I don't see how their sales in Canada would be just barely profitable. It's notable that they even sell some of the same prescription drugs dirt cheap in the U.S. for veterinary use.
Again, once you develop the drug and pay for the R&D, any price above a few cents per pill is profitable. Airlines sell the same seat for $100, $300, and $1000. They don't need to sell them all at $1k, but just because they can sell some at $100 doesn't mean that they could sell them all at $300.
Veterinary use usually isn't as heavily regulated, and I doubt much development money is spent beyond what is spent on people. Plus, you don't have to bribe vets as much to get them to participate in clinical trials - a doctor requires a substantial payoff before they'll let one of their patients know that there is an experimental drug that might help them, and if there are two of them they'll refer their patient to whoever is paying them more. Disgusting practice, but there is a reason that most of the clinical trials happen in places like Eastern Europe and Asia - you don't have to bribe the doctors as much and local regulators are less demanding, plus there is less liability overall. Government-run clinical trials combined with government-employed doctors would reform this practice as well, and those are things I completely support.
Yup - pretty-much the whole reason management consultants exist is that there are incompetent people running companies that for whatever reason can convince people to give them the job. They then spend their companies money to hire somebody else to do their job for them. If the shareholders had any brains or power they'd just hire the consultants instead.
From what I've seen I'd say the unity among Bible translators is probably similar to that among scientists. There aren't a lot of people who are qualified to do a first-rate job of it, and they're very intelligent, and thus they tend to realize that they don't always have all the answers.
Now, unity among denominations and churches is an entirely different matter. It takes a far different skillset to get people to pay to listen to you go on for an hour about whatever you're feeling concerned about. The people in power here tend to be much more political and ideological, and they tend not to be so humble about the limits of their knowledge (if they were humble they wouldn't sound so convincing behind a pulplit and people wouldn't pay to listen to them).
Of course, some of this depends on what you call a Bible translation. Anybody can grab their denomination's favorite existing English translation and modernize the words or do a literal translation into another language they happen to know, and thus the general sense of academic liberalism doesn't apply. By translation I am referring more to creating a rendition of the text of the Bible that conveys in the best way possible the intended meaning of the original authors. That requires strong knowledge of the original languages, good historical context, good language skills in the target language, and strong skills in textual criticism (trying to figure out what the original authors wrote in the first place, translations aside).
I see no reason why Americans should bankrupt themselves to subsidize other western countries governments buying pills for less. If our government pushes a little, the prices will balance better.
If the government wants to do what 95% of the other countries do out there, everything could be as expensive as aspirin. Of course, you'd never see another new medication unless the government footed the bill 100% up-front. Companies would still sell approved medications at the lower rates, since they would make a marginal profit, even if the most recent ones would show a net loss (not selling them would just result in a bigger loss).
If it won't, the least it could do is get out of the way so we can level the prices ourselves by re-importing. Either full regulation or full de-regulation would be principled stands, letting the corporations charge what they like AND blocking consumers from going to a market with more favorable prices is indefensible.
Allowing free re-importation would simply result in pills being priced at the lowest price supported by a country that allows for compulsory licensing. If this were allowed the first thing that would happen is that branded drug companies (US and otherwise) would curtail all supplies worldwide outside the US to delay the change as long as possible - resulting in shortages worldwide (they probably wouldn't cut nations off entirely - just limit them so much that various governments would restrict exports to limit shortages). US prices wouldn't change much initially as a result. Then most non-US nations would institute compulsory licensing, bringing costs way down, and then prices in the US would fall dramatically as a result of re-importation. Branded drug manufacturers would stop R&D and become generic manufacturers except where governments pay for it up-front so that there is no risk (that could take many forms, but basically it would mean that the company potentially makes lots of money regardless of prices).
Note, I'm not talking about 3rd world pricing, I'm talking about Canada.
We do need to review how the bills are paid though, so we can get more antibiotics, antivirals, and chemo agents and less hair pills that cause prostate cancer and birth defects.
Canada's pricing is only marginally profitable - if everybody charged that rate then creating a new medication would be a net loss. Now, selling pills at that rate once your costs are covered makes perfect economic sense. Again, it is the same kind of logic that makes it profitable to sell $100 airline tickets even though selling them all at that price would bankrupt the airline.
As far as more important meds vs hair pills go - think about what you're saying. I doubt most countries strongly regulate prices or allow compulsory licensing on hair pills, because they aren't medically necessary. That means that companies can sell at high prices without competition, making these medications very profitable. On the other hand, antibiotics and chemo agents are life-saving medicines, and countries are far more likely to regulate prices to increase access to them. That means that they are less profitable, and thus companies are less likely to research them. This is a perverse incentive at work - if you want companies to supply more of product A than product B, then you have to make product A more profitable. Shouldn't the cure for cancer be more profitable than a hair pill? And yet, the incentives with healthcare price controls make the opposite true. We shouldn't be surprised when nobody wants to cure cancer as a result.
The problem with medications isn't that companies make money off of live-saving medicines. The problem seems to be one of access and socialism - pill prices are a pretty regressive way to pay for healthcare. You can't solve that problem merely by regulating the pricing - you need to find some other way to pay people to do discovery.
If you want a regulatory solut
That is kind of like saying that because an airline sells last-minute tickets for $99, that it must be profitable to charge that price for every seat on the plane. In fact, it is not profitable to sell all your seats at that rate. However, it is profitable to fill up the plane as much as you can as long as you exceed the marginal cost per seat, which is less than $99. You could look at it as if the first seat costs $100k, and then every seat after that costs $25. Since nobody pays $100k for a ticket, you try to get what you can from everybody and spread out that initial cost.
The same issue applies with pills. The first pill costs maybe $350M on average, and every pill after that costs a dime. Since nobody pays $350M for a pill, you make as much money as you can off of each market. However, as long as you can make at least a dime on a pill it is still in your interests to sell it. However, if you sold every pill for a dime you'd lose money.
I'm all for reform here, but it isn't as black-and-white as people make it out to be. There are significant fixed costs and they cannot be recovered at the kinds of prices pills sell for in the third world. Now, if taxpayers just funded the full cost of development then everything could be sold just fine for ten cents per pill. However, that isn't how the current system works. The problem is that no matter how you slice it somebody has to pay the $350M development bill, or it won't happen.
I'm sure that in at least some cases the counterfeits are made on the same line as the genuine pill. I suspect that doesn't happen quite as often as it does in other industries - the pharma industry has really only just started to really outsource their production. Most pills sold in the US are made at plants directly managed by the company whose logo is on the bottle (not necessarily in the US). That will likely change over time.
Perhaps, but when was the last time you drove down a highway that didn't have a posted speed limit where this experiment was being done?
Most people can't afford private schools. The kids aren't in public schools because their parents don't care, they're there because they can't afford private schools. Since you were poor when you raised your kids you certainly should know that.
Sometimes I wonder if the solution to a bunch of problems is to require a license to have kids. Setting aside the major ethical issues around this consider the possibilities:
1. No accidental births. Kids are only there because somebody cared to bring them into the world.
2. Possibly no financial issues - you might require pre-payment of educational and medical expenses before granting a license.
3. Interested parents. If a parent took out a $500k loan to pay to have a kid, chances are they will take the time to make sure the kid is learning something in school, and they'll care about how schools are spending their money as well.
I'm not saying you have to limit parenting only to people able to spend huge sums of money - you could have "scholarships" or whatever based on any number of criteria. However, as it stands right now it is a lot harder to buy a house than to have a kid. People take care of their houses because they had to invest to acquire it. If people had to do the same for kids then chances are kids would be a lot better off.
The situation is a bit complex with drugs.
Many counterfeit drugs are in face substandard in quality, but due to price pressure they can work their way into first-world markets. As you say, many are also perfectly safe generics that simply haven't been licensed.
Both actually create problems with our current system of R&D. Since the way 95% of drug safety trials are funded is from private investment, any threat to private investment is a threat to the development of new drugs. Now, I'm not convinced that this is necessarily the best way to fund drug safety trials, and I'm all for coming up with a better way. However, if we're going to stick with the current model where nothing gets on the market without some private company spending $50M on trials (only about 10% of which work out) then you need to have a lot of money going back to those companies for them to take on the risk.
Please also note that I'm about "drug safety trials" or clinical trials. I realize the government spends plenty of money on blue sky R&D. For whatever reason it doesn't spend money on clinical trials - probably because they're boring and not really cutting-edge research. However, these are one of the biggest expenses in drug development and they're necessary to ensure drugs are safe. If government would just fund drugs end-to-end and keep the patent rights this whole debate would become moot...
Think about your use case here.
If you just want 5GB of offsite storage accessible from a somewhat dedicated platform that would be pretty usable.
If you want a place you can dump your documents and access from any browser/phone/etc, that would be almost impossible without some kind of API and software front-end. Key management alone would be a mess.
The service providers have no incentive to provide either the API or the encryption. They benefit from being able to mine your data (even just for ads), and encryption tends to ruin de-duplication which becomes a big cost for them.
There's a reason that a GPS unit in a plane generally does less than a typical $150 motorist unit and yet costs $2. A big factor is obviously liability, but another factor is the concept of "required navigational performance." The GPS has to not only be accurate, but it has to know if it is accurate or not and warn the pilot if this is not the case. For general navigation around the sky the required accuracy isn't super-high, but when you're on a landing approach it has to be very good both horizontally and vertically. If you can't see the runway then you don't know for sure where you are, and there could be a hill, tree, or tower anywhere in your vicinity. Being off by a few hundred feet on a landing approach simply isn't acceptable, and as soon as this happens you have to abort the landing.
In a car a GPS unit is a helpful tool. In a plane making a GPS instrument approach it is a vital piece of safety equipment and is as carefully regulated as an altimeter or the flight controls.
I doubt the auto GPS unit is going to care about this stuff - it will just report whatever it thinks and some algorithm will decide what to bill you.
Disclaimer - I'm not an expert on GPS requirements in aviation - I'm casually aware of this stuff as an enthusiast, but I haven't studied up. Exact requirements/procedures are likely to vary somewhat from what I described, although I believe the gist of my description is accurate.
No, if your insurer starts a program like this and you opt out, then you'll get penalized in your rates by default. Oh, they won't itemize this as a penalty - they'll just raise their rates across the board and you won't get the itemized benefit that offsets this.
Uh, I'm sure the average price will rise with inflation. Those who are good drivers might initially rise a little slower than inflation, and those who are bad drivers will rise faster than inflation.
Rates are set to what the market will bear, and a market where people are required by law to hold insurance and where barriers to entry are high will bear quite a bit...
Speeding should be a dangerous risk.
It certainly should be, and it would be if speed limits were remotely sane. Right now speeding is just travelling at the same speed as 90% of the other cars on the road. Speed limits should be set at a speed that most drivers would not be comfortable driving at.
They already do that. If you have gone 6 years without any accidents, 6 years without any tickets, and 6 years without any insurance claims, your rate will be significantly lower than if you wrote off a car last year, and had a careless driving charge the year before.
While as a whole your statement is generally true, parts of it are misleading, depending on where you live. In at least some states you aren't allowed to charge differently based on whether you have filed claims, which is a pretty sane way to regulate. Now, they can charge you for being at-fault in an accident regardless of whether you file a claim, but filing claims (at least in some states) has no impact on your rates.
Of course, the insurance company likes to keep people thinking that you get a better rate if you don't file claims, that way they can collect their premiums and not even have to pay out when they're supposed to.
Check the laws of your state. If your's is like mine then you should file a claim any time it exceeds the deductible.
I think a key thing to look at is the number of times an experiment has been run. If you run 1000 experiments getting a result that you'd only expect at random 1/1000th of the time isn't terribly impressive. I'm not sure what counts as a trial in a particle accellerator, but I suspect those things churn through collisions about as fast as a CPU goes through instructions...
Yup, and once they do they'll switch regardless of how the court sides..
Obviously it isn't consistent, but it works fine on my G2 running Andromadus.
ICS works great on the G2 with only 512MB - I'd say it is peppier than Gingerbread was. Now if only they either had a stable driver API or actually kept their drivers up-to-date or open-source...
The issue is liability. If you build a technology that saves 1000 lives per year, but fails to save 10, then you get sued into non-existence. If you don't put it on the market then 990 more people die per year, but you get off scott-free.
Our legal system makes the perfect the enemy of the good.
It isn't supposed to be a test of the author's abilities - just of the accuracy of the paper. The author could be an idiot but if the paper accurately describes the experimental results and their validity then the paper should be published.
Personally I don't see any harm in having both options. If people want Ubuntu they can use it, and if they want Debian/Gentoo/whatever they can use that.
If anything upstream doing this stuff makes it harder for others to offer choice. Gnome is moving in a direction where if you want to use their DE you have to also use their sysvinit replacement, /dev manager, and I'm sure lots of other stuff. At the rate they're moving they'll basically become a distro. It will likely lead to much tighter integration, but also less choice, and will make it harder for better components to evolve since they'll lose the integration. Would we have systemd or wayland if you couldn't use Gnome or KDE with anything but sysvinit or xorg?
"Gentoo is about choice." :)
Sometimes choice IS the focus. I do agree that it is hard to achieve both choice and vertical integration - this is largely why Gentoo tends to be a bit rougher on the edges compared to most distros. However, it is a great distro to use if you want to do something a little out of the mainstream as it doesn't fight you every step of the way.
I suppose it is ironic then on Gentoo that I've found KDE to be one of the things that "just works?" :)
It certainly has its share of sharp edges, but when you run into them they tend to be reasonably fixable. The only time KDE on Gentoo was problematic reflected upstream more than the distro - during the 3.5 to 4.0 "transition." I stuck with 3.5 for quite a while, then went to xfce until it got sorted out. Now I just USE=-semantic-desktop and KDE is blazing fast (no nepomuk).
Or, if you'd rather I'm sure Sabayon will round off some of the sharp edges and since it includes binary versions of just about everything you can install it quickly.
Gentoo in general is desktop-environment-neutral (indeed, it is X-vs-no-X neutral as well).