I've seen many studies of fatalities in the U.S., and in other countries, like Bohlin's studies in Sweden, that report higher fatalities with higher speed. If I saw good data to the contrary, my belief would be shaken.
Bohlin had a graph of fatalities vs. speed, and it wasn't linear. It went up very quickly and it looked like a power function to me. Fatalities are caused by many mechanisms, and you have to sum them all. If you have a curve with a better fit, I'd be happy to use it.
As for the autobahn, you have to compare equal roads, and equal cars. I'm not convinced that Germany vs. the U.S. is a good comparison, and I'm not convinced that the autobahn is just as safe with unlimited speed as it would be with limited speed. And it looks like German traffic engineers aren't convinced either.
A 2009 report in the American Journal of Public Health found that higher speed limits adopted by states in the wake of the 1995 repeal of federal speed-limit controls had led to a 3.2% increase in road fatalities, or an estimated 12,500 more deaths from 1995 to 2005. "When you increase speed limits, you have an increase in the severity of injuries," said Lee Friedman, a professor at the University of Illinois at Chicago and one of the authors of the report.
German authorities already have used speed caps to make the autobahn safer. Last year, after an 80-mph limit was imposed on the busy stretch between Hamburg and Berlin, traffic-related deaths fell from eight to zero, according to a government study.
This has been documented repeatedly in the Stapp Car Crash Conference Proceedings over the past 50 years. You could also look in the Engineering Index.
Nils Bohlin demonstrated that if you stay below the magical 55mph limit, and wear a 3-point seat belt, you will survive in accidents like the 28,000 accidents they studied in Sweden.
This was confirmed in the entire auto safety literature.
I don't know of any peer-reviewed studies that found fewer fatalities over 55mph. There were some studies of single states that didn't control for variables like the weather, and/or didn't have the statistical power to prove their conclusions, but they weren't published in peer-reviewed journals where people who understood auto safety engineering could check them over.
I've read about a hundred papers on auto collisions and talked to a couple of dozen auto safety engineers to make sure I understood what I was reading. The fatality rates of automobile collisions increase by about a square function of the speed. When you have a collision, you have a lot of energy to dissipate, and KE = 1/2 mv^2.
I don't have my files around to cite, and I've forgotten most of my college physics, but here's the bottom line (Fermi exercise; the numbers may not be right, but if you have better numbers you can recalculate it for me):
1. According to a presentation on front-end collisions I read in Automotive News by a Mercedes-Benz engineer, it's impossible to make a car that will keep you alive in a front-end collision into a rigid barrier at more than about 50 or 55mph.
A car crashes into a barrier. The occupants are restrained by their seat belts. The front end of the car crushes until the car comes to a stop. The front end, from bumper to firewall, is about 50 inches. The maximum deceleration the occupant can survive is 50g. When you run the numbers, the initial speed is about 50mph. With those parameters, the front end of the car is completely crushed, up to the firewall, and the passenger compartment is intact. Above that speed, the engine goes into the passenger compartment, the passenger compartment crushes and collapses, and the collision usually isn't survivable.
The engineer said that you can't raise the survivable speed significantly, because the front end would have to be impractically long (that 50 inches would increase as the square of the speed).
There might be somebody out there who drove into a brick wall at 65mph and lived. This is an idealized model, and specific circumstances can affect it.
But that's the physics of most head-on collisions, and it's been confirmed in collision labs and in accident investigations on the road.
2. OK, so not all collisions are head-on into a barrier. Let's assume that Texas road is designed well enough to avoid that. Let's assume it's lined on the sides with breakaway signs, popcorn-filled barriers and right-of-ways filled with sand.
You've got people driving along at 85mph. For a certain number of those cars, something will go wrong. Maybe a tire will blow. Maybe one car will bump another. Maybe a wheel won't be aligned right. (I've seen wheels fall off.) There will be a lot of human failures, like drivers falling asleep, or failing to pay attention,
Once you have the initial disruption, a car at 85mph (vs. 55mph) (a) is much less stable, and much harder to get back under control and (b) has a lot more energy to dissipate before it comes to a stop.
Maybe you'll be lucky and slide to a stop along the pavement, but the physics is against it. If you don't crash against a barrier, that energy tends to convert to rolling energy.
The tendency is to roll, along a couple of axes. First you roll across the horizontal plane, until the car is perpendicular to the direction of travel. Then the car flips over, and usually rolls until it stops. Rollover accidents are the most fatal. Racing cars are built with reinforced tops and rollover bars that can take a rollover, but when I was studying this stuff, the roofs of passenger cars usually collapsed after one or two rollovers, and even if they didn't collapse, the occupants got a lot of damage.
So you're going to roll over a lot more violently, and a lot farther, at 85mph than you would at 60mph.
Whether a driver should risk his life and brain by driving >85mph is a question that physics can't answer. But the death rate goes up pretty fast above 55mph.
As my physics professor used to say, I don't care if you kill yourself, as long as you get the physics right.
Yes, most people are too dumb to look at a drug and understand what the risk is. How many people could pass the finals for an introductory college statistics course? That's what it would take, for starters.
The FDA doesn't use force. They just tell the manufacturers that they can't sell a drug for a purpose that has no evidence behind it. The manufacturers won' t sell it if the FDA doesn't approve it. Doctors won't prescribe it if they might be sued for malpractice. If you really want it, you can get around those barriers. Buy it from India or China.
The FDA isn't ultra-conservative. For some life-threatening diseases, all the drugs have harmful effects. For some cancers, you have a choice between a drug with a 20% chance of killing you, and a cancer with an 80% chance of killing you. The FDA knows that.
The FDA is required by law to weigh the risks against the benefits. They can accept a cancer drug with a 20% chance of killing you, but they won't accept a headache drug with a 20% chance of killing you.
I've read transcripts of FDA hearings where their expert panels weigh the risks and benefits of a new drug. You can go to the FDA web site and read them yourself. The panels are made up of doctors who treat patients. They want to give their patients the best chance of surviving. They often have desperate cases where their patients are likely to die. They want to have every effective drug available. They're trying unproven drugs -- in clinical trials. They're constantly debating about how much proof is enough. When they get a groundbreaking drug, they approve it right away. Most of the debates come when it's not clear whether it's killing more people than it saves. And that happens quite a bit. The line is, "The oversight committee terminated the study early."
I don't think you realize how complicated and (mathematically) difficult these decisions are. When there's a controversy it's because the studies aren't clear. They usually have a dozen studies, of different quality, and depending on what statistical methods you use, you can get different answers. I've read thousands of these studies, and I can't always figure them out.
It's simply not possible for a patient with a disease like cancer to do their own risk analysis and get it right. Even doctors who get life-threatening diseases usually let their own doctors make their decisions. Most of them don't want to. They want to go to the best experts, and let the experts decide.
You don't sound like you've read many of these studies where doctors actually weigh these decisions. If you want to understand it, that's what you have to do. I'd recommend going to NEJM.org and trying to find some studies that don't require a subscription.
In 1964, the racists who were trying to stop blacks from voting were Democrats.
In 2012, the racists who are trying to stop blacks from voting are Republicans.
That was the Republican "Southern strategy." As soon as the Democrats started distancing themselves from the southern racists, the Republicans were happy to move in.
It's still around but it's harder to get than Oxycontin -- and for good reason.
Accutane was a godsend to editorial writers at the Wall Street Journal, who made a good living arguing that personal responsibility and the free market should prevail over an incompetent, bureaucratic government agency.
They earned their living because (1) acne is a cosmetic problem (although the social consequences of severe acne can significantly affect peoples' lives) and (2) the people who suffered the worst side effects were not the irresponsible bimbos who got pregnant, but their children who had to go through life with flippers (and worse).
The issue here is personal responsibility. Should an individual bimbo be able to make any decision about medical treatment she wants, or are there some decisions that are just so dangerous that the government should step in and decide for people?
Should the drug company be able to say, "Don't sue me. I warned her of the dangers. If she ignores me and makes a foolish decision, that's her personal responsibility"?
The answer is no. Even for libertarians, you shouldn't be free to harm somebody else. A woman has an unconditional right to abortion, but doing things that will result in severe birth defects of a child that she decides to have is something else again. In our society, you can't punish a woman for doing things that harm her fetus (except in some Republicans states).
Then come the lawyers. If a drug company sells a drug that causes birth defects, and a woman takes it and becomes pregnant, it's going to cost another $3 million to bring that child up with the accommodations it needs to live a reasonably normal life. Where does that $3 million come from? Does the child go on welfare, and have the government pay for it?
When somebody gets injured in an accident, like a car accident, you usually have a combination of circumstances. The first driver was tired. The second driver had a beer. It was raining. The tires were bald. The seat belt had a manufacturing defect. The brake in this car had a record of failures. It's called an "accident chain." So who's responsible?
The answer is, a lot of people are responsible.
Same with Accutane. The bimbo who got pregnant was responsible. Her doctor was responsible. The manufacturer of Accutane was responsible.
The FDA and a lot of doctors said that Accutane was too dangerous, and acne was too frivolous. Roche swore on their mothers' graves that they could set up a system in which women who were of childbearing age wouldn't get Accutane and get pregnant. They would have counseling, personal responsibility contracts, toll-free numbers, 2 kinds of contraception, belts and suspenders.
It didn't work. So who pays?
When you ask the juries, they decided that Roche pays.
One of the problems with these drugs is that they start out being used for the most severe cases of acne or whatever. Maybe there are 1,000 cases in the U.S. like that. But if the drug company can convince doctors to use it for less severe cases, they can make 10 times as much money. So maybe that's what happened with Accutane.
This goes back to the idea of central planning, which is what we started out talking about. If you have individual patients and doctors making their own decisions about taking Accutane, then Roche can market the hell out of it, to patients and doctors, and make 10 times as much money. But if you have a central authority, like the FDA, or the big insurance companies, or the national health service in other countries, they can restrict the sales just to people who really need it. They save money, which is part of their motivation, but they also avoid flipper babies.
Some things are so dangerous that you just need central authority.
The Greeks had an idea of a golden age in which everybody followed the law voluntarily.
Then you find some doctors or drug company promoting a drug that does a lot of damage, like phen-fen, the diet drug. Patients are desperate to lose weight, doctors assure them it's safe. The drug companies hear about patients getting heart failure, but they convince themselves that their drug wasn't responsible.
Then the patients wind up with heart failure and 3 to 5 years to live. Those patients don't say, "I'm glad the government let me make my own decision and didn't coerce me." They don't say, "Well, by my values and decisions, heart failure isn't too bad." They say, "The government should have stopped them from selling this dangerous drug." They even say, "The government should have stopped me from buying this dangerous drug."
The reason the FDA started regulating drugs is that drug companies used to sell dangerous, ineffective drugs, without even identifying the ingredients, and people used to die as a result. Most people don't want to make individual decisions with those kinds of risks.
And you can't say that times have changed and we don't need the FDA any more. Whenever the Republicans or the moderate Democrats loosen up the FDA regulations, people start dying from unsafe drugs and devices again. So they tighten the regulations up again.
A free market assumes that consumers have adequate information and the ability to make decisions. When they don't, the free market doesn't work. When people see the free market not working, and harming them, they demand that the government regulate it.
Many black parents are interested in their kids, but can't spend the time with them they would like, because they're overwhelmed with making a living, or just surviving.
That's because they started out in slavery, and even for 100 years after slavery ended, they had discrimination that was almost as bad as slavery. Not being allowed to vote is pretty serious discrimination. The Republicans are still trying to stop blacks from voting.
The reason you're a racist is that you don't understand that.
Let's take your drug idea. Here are a list of questions no central authority can answer: Is the rigor that is applied today is too strict or not strict enough? What is the optimal amount of rigor to benefit the most people? What conditions can be permitted to try riskier drugs with possible benefits? Is it more beneficial to have a long life or shorter more active one?
The problem is all of the answer to these questions depend on the individual.
If you read the New England Journal of Medicine (which you could call a central authority), you'd see lots of articles answering those very questions. Some of the authors that you can find with a Google search are Marcia Angell and Jeffrey Avorn. For many years, the FDA was under a lot of pressure to approve medical devices. Then they wound up with a few well-publicized disasters, like heart pacemakers where the electric leads got damaged and patients died. Now they're making specific changes in the standards they use for premarket testing. They approved drugs that produced improvements in secondary outcomes (like raising hemoglobin levels), but didn't improve primary outcomes (like death). They found out that more people died with the drug than without it, so the FDA went back to approving drugs based on primary outcomes like death.
Science can only find out how a treatment works on a population level, not on an individual level. If they randomize 100 people to a drug, and 30 of them die, and 100 people to a placebo, and 10 of them die, I wouldn't want to take that drug under those circumstances.
You may have a doctor who thinks he's smarter than everybody else in the world, and he believes that he can tell that the drug will work for you. You may have a gypsy fortune teller who believes that the drug will work for you. Go ahead and use it if you insist. The FDA won't stop you.
Most people would play by the numbers. And the only place to get those numbers is from a central authority.
If you compare black families and white families who have the same good jobs, in organizations that make an effort to eliminate discrimination (like IBM or the military), they have equally successful kids.
The main difference between black families and white families is that more black families are poor.
Do you think slavery had anything to do with that?
I once researched some of the literature on science teaching. Science teachers have to know both the subject and the methods of teaching. (There are a lot of articles in Science magazine about this.)
You may know a lot about the subject, but if you don't know how to teach it to students at different levels, you'll fail. For example, I was surprised to see in the science teaching guidelines that middle-school students can't usually understand the concept of molecules. You can teach them to memorize facts and answers, but they don't understand what they're answering. I saw that when I took my niece to a museum, and they had an exhibit for young children about DNA. My niece saw the exhibit. She played DNA games. I asked her what DNA was. She didn't know. It makes sense when you think about it. Science is about learning things through the experimental method, not from books or videos. It's difficult or impossible to show middle school students an experiment that demonstrates the existence of molecules.
In contrast, there was an article in Science about a teaching module in which kids had to figure out whether vision was something that comes into your eyes or something that comes out of your eyes. That may seem obvious today, but until the 17th century, some of the world's greatest scientists got it wrong.
Science teaching is a science itself, based on the experimental method and published studies, and many things that seem obvious turn out to be wrong. If you don't realize that obvious things turn out to be wrong when you test them experimentally, then you're not too familiar with the scientific method.
If you have a PhD, but don't know how to teach, you'll fail. You won't teach the kids science, and at best you'll teach them to memorize a lot of facts they don't understand. You'll be boring and teach them to hate science.
I think unions do a lot of things that are wrong, but I don't accept this theory that there is a problem with unions protecting incompetent teachers, and the solution is to fire them. Unions make it more difficult to fire teachers who have been employed for years -- and it should be difficult to fire people who have been there for years. (Your first recourse should be to train them. If you're a principal, and you can't teach a teacher how to improve, you're not a very good teacher.) Before we had unions, we had the spoils system, and the Democrats would win and fire all the Republican civil servants, then the Republicans would win and fire all the Democratic civil servants. Try to fire an incompetent teacher whose brother-in-law is a city councilman. That's what we'll get without unions.
But the final word about unions is to look around the world, especially at the school systems that are doing much better in STEM than we are, like Finland, Germany, etc. In all the European countries, the teachers are unionized and well-paid. They study their subject and also teaching methods. They do have lifetime employment. "Weeding out the incompetents" is a problem that doesn't come up much.
Sometimes central planning works, sometimes it doesn't.
In medicine, doctors use a lot of drugs, but don't know whether they work, or whether they're actually harmful. The best way to find out is with a randomized, controlled trial. For the most part, these trials are funded by government agencies. They collect the best experts in the country (or the world), figure out how to design and run the trial, and do it. In other words, they create a central authority to collect all the evidence and report their recommendations. They found out that a lot of drugs were actually killing more people than they were helping. http://en.wikipedia.org/wiki/Epoetin_alfa
Then after they find out that the drug is killing people, there are still a lot of doctors who just want to continue using it, either out of habit, or because they make a lot of money out of it, or because they really believe in it. If you want to stop doctors from prescribing drugs that kill people, the first thing to do is to have a central authority, like a medical association or government agency, recommend against it. When you leave it to doctors to decide by themselves, you're more likely to die. When you leave it to patients to choose for themselves, they really don't know what they're doing. There have been good studies of this. Most patients can't make good medical decisions. Those who do know how to make decisions follow the recommendations of the central authority.
I'm using medicine as an example because I know more about medicine than education, and because in medicine, where peoples' lives are at stake and they have lots of money, they do very rigorous studies.
There are good central authorities and bad central authorities. If you have a central authority that makes their decisions on the basis of the scientific evidence, they can do a good job. If you have a central authority that ignores the scientific evidence and follows the politics, as the Obama and GWB administration did with Race to the Top, No Child Left Behind, and firing teachers on the basis of test results, they're going to do a bad job (as they did).
There's no simple way to make policy. You can't just say, "Central authorities are good" or "Central authorities are bad." It depends on whether the central authority is independent enough from politics to collect the best-informed experts and follow their advice.
A lot of big science came from central authorities and probably wouldn't have been possible without a central authority. The Manhattan Project and NASA were highly centralized.
Under capitalism, people who can afford it pay about $10,000 per capita per year to insurance companies for health care (depending on the year you measure).
This is Obama's economy, his policies, his executive orders, his parties control of the senate and house - for two years a supermajority.
You mean his supermajority for four months?
http://washingtonindependent.com/74033/the-four-month-supermajority The Four-Month Supermajority By David Weigel Friday, January 15, 2010 at 9:03 am In the final stretch of the Massachusetts special election for Senate, Republican candidate Scott Brown has focused on “restoring balance” to Washington. He’ll be the “41st vote” to filibuster legislation; the Democrats’ hold on 60 votes has let liberals run the country into the ground. “That’s not what the founders intended,” he said Monday during the final debate. The irony is that if Democrats lose the seat, they will have had a working 60-seat majority for all of four months — much of which was spent with the Senate in recess. They opened the Congress in January with 58 votes, counting the ailing Sen. Ted Kennedy (D-Mass.), not counting Sen. Al Franken (D-Minn.), whose razor-thin victory was held up by lawsuits from former Sen. Norm Coleman (R-Minn.). On April 28, 2009, Sen. Arlen Specter (D-Pa.) switched to the Democratic Party, bringing the Democrats to 59 votes without Franken. When Franken was finally sworn in on into the Senate on July 7, 2009, the badly ailing Kennedy was unable to vote and break filibusters
Teachers' ability is correlated with student results. The tests that they use to measure teachers' ability is not correlated with student results. The same teachers rank in the top 10% one year, and the bottom 10% the next year. Obviously the tests aren't measuring the teachers' ability.
The effect of student poverty is far greater than the effect of teachers' ability. The test scores are primarily measuring student poverty, according to Ravitch.
Teachers' ability is correlated with experience. Teachers who have been teaching for 20 years can get better results than charter-school teachers who are on the job for 3 years and quit, as many of them do. If you want teachers to stay on the job for 20 or 30 years, you have to pay them enough to raise a family and send their own kids to college.
Give me one bad thing about capitalism without going into some political rant. Pick a point, lets discuss.
The capitalist health care system, as implemented in the U.S., costs twice as much per captia as the socialist health care system in any other developed country. And their results are just as good as ours, sometimes better.
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I've seen many studies of fatalities in the U.S., and in other countries, like Bohlin's studies in Sweden, that report higher fatalities with higher speed. If I saw good data to the contrary, my belief would be shaken.
Bohlin had a graph of fatalities vs. speed, and it wasn't linear. It went up very quickly and it looked like a power function to me. Fatalities are caused by many mechanisms, and you have to sum them all. If you have a curve with a better fit, I'd be happy to use it.
As for the autobahn, you have to compare equal roads, and equal cars. I'm not convinced that Germany vs. the U.S. is a good comparison, and I'm not convinced that the autobahn is just as safe with unlimited speed as it would be with limited speed. And it looks like German traffic engineers aren't convinced either.
http://online.wsj.com/article/SB10000872396390443589304577637773840176082.html
September 7, 2012, 6:24 p.m. ET
Toll Road Offers Fast Cash to Texas
By NATHAN KOPPEL
A 2009 report in the American Journal of Public Health found that higher speed limits adopted by states in the wake of the 1995 repeal of federal speed-limit controls had led to a 3.2% increase in road fatalities, or an estimated 12,500 more deaths from 1995 to 2005. "When you increase speed limits, you have an increase in the severity of injuries," said Lee Friedman, a professor at the University of Illinois at Chicago and one of the authors of the report.
http://www.chron.com/news/nation-world/article/Green-light-may-light-up-to-cap-autobahn-s-speed-1475147.php
German authorities already have used speed caps to make the autobahn safer. Last year, after an 80-mph limit was imposed on the busy stretch between Hamburg and Berlin, traffic-related deaths fell from eight to zero, according to a government study.
Citation needed.
This has been documented repeatedly in the Stapp Car Crash Conference Proceedings over the past 50 years. You could also look in the Engineering Index.
Nils Bohlin demonstrated that if you stay below the magical 55mph limit, and wear a 3-point seat belt, you will survive in accidents like the 28,000 accidents they studied in Sweden.
This was confirmed in the entire auto safety literature.
I don't know of any peer-reviewed studies that found fewer fatalities over 55mph. There were some studies of single states that didn't control for variables like the weather, and/or didn't have the statistical power to prove their conclusions, but they weren't published in peer-reviewed journals where people who understood auto safety engineering could check them over.
The big factor that is responsible for variation in fatal accidents is the weather. A snowy winter would do it.
I've read about a hundred papers on auto collisions and talked to a couple of dozen auto safety engineers to make sure I understood what I was reading. The fatality rates of automobile collisions increase by about a square function of the speed. When you have a collision, you have a lot of energy to dissipate, and KE = 1/2 mv^2.
I don't have my files around to cite, and I've forgotten most of my college physics, but here's the bottom line (Fermi exercise; the numbers may not be right, but if you have better numbers you can recalculate it for me):
1. According to a presentation on front-end collisions I read in Automotive News by a Mercedes-Benz engineer, it's impossible to make a car that will keep you alive in a front-end collision into a rigid barrier at more than about 50 or 55mph.
A car crashes into a barrier. The occupants are restrained by their seat belts. The front end of the car crushes until the car comes to a stop. The front end, from bumper to firewall, is about 50 inches. The maximum deceleration the occupant can survive is 50g. When you run the numbers, the initial speed is about 50mph. With those parameters, the front end of the car is completely crushed, up to the firewall, and the passenger compartment is intact. Above that speed, the engine goes into the passenger compartment, the passenger compartment crushes and collapses, and the collision usually isn't survivable.
The engineer said that you can't raise the survivable speed significantly, because the front end would have to be impractically long (that 50 inches would increase as the square of the speed).
There might be somebody out there who drove into a brick wall at 65mph and lived. This is an idealized model, and specific circumstances can affect it.
But that's the physics of most head-on collisions, and it's been confirmed in collision labs and in accident investigations on the road.
In fact, most people don't survive a head-on collision at >55mph, as this classic study http://papers.sae.org/670925/ by Nils Bohlin http://en.wikipedia.org/wiki/Nils_Bohlin found out. Great read, BTW (if you're a physics/engineering nerd).
2. OK, so not all collisions are head-on into a barrier. Let's assume that Texas road is designed well enough to avoid that. Let's assume it's lined on the sides with breakaway signs, popcorn-filled barriers and right-of-ways filled with sand.
You've got people driving along at 85mph. For a certain number of those cars, something will go wrong. Maybe a tire will blow. Maybe one car will bump another. Maybe a wheel won't be aligned right. (I've seen wheels fall off.) There will be a lot of human failures, like drivers falling asleep, or failing to pay attention,
Once you have the initial disruption, a car at 85mph (vs. 55mph) (a) is much less stable, and much harder to get back under control and (b) has a lot more energy to dissipate before it comes to a stop.
Maybe you'll be lucky and slide to a stop along the pavement, but the physics is against it. If you don't crash against a barrier, that energy tends to convert to rolling energy.
The tendency is to roll, along a couple of axes. First you roll across the horizontal plane, until the car is perpendicular to the direction of travel. Then the car flips over, and usually rolls until it stops. Rollover accidents are the most fatal. Racing cars are built with reinforced tops and rollover bars that can take a rollover, but when I was studying this stuff, the roofs of passenger cars usually collapsed after one or two rollovers, and even if they didn't collapse, the occupants got a lot of damage.
So you're going to roll over a lot more violently, and a lot farther, at 85mph than you would at 60mph.
Whether a driver should risk his life and brain by driving >85mph is a question that physics can't answer. But the death rate goes up pretty fast above 55mph.
As my physics professor used to say, I don't care if you kill yourself, as long as you get the physics right.
I think they refer to themselves as "centerist" Democrats.
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I wanted an FDR and all I got was this lousy Obama.
Yes, most people are too dumb to look at a drug and understand what the risk is. How many people could pass the finals for an introductory college statistics course? That's what it would take, for starters.
The FDA doesn't use force. They just tell the manufacturers that they can't sell a drug for a purpose that has no evidence behind it. The manufacturers won' t sell it if the FDA doesn't approve it. Doctors won't prescribe it if they might be sued for malpractice. If you really want it, you can get around those barriers. Buy it from India or China.
The FDA isn't ultra-conservative. For some life-threatening diseases, all the drugs have harmful effects. For some cancers, you have a choice between a drug with a 20% chance of killing you, and a cancer with an 80% chance of killing you. The FDA knows that.
The FDA is required by law to weigh the risks against the benefits. They can accept a cancer drug with a 20% chance of killing you, but they won't accept a headache drug with a 20% chance of killing you.
I've read transcripts of FDA hearings where their expert panels weigh the risks and benefits of a new drug. You can go to the FDA web site and read them yourself. The panels are made up of doctors who treat patients. They want to give their patients the best chance of surviving. They often have desperate cases where their patients are likely to die. They want to have every effective drug available. They're trying unproven drugs -- in clinical trials. They're constantly debating about how much proof is enough. When they get a groundbreaking drug, they approve it right away. Most of the debates come when it's not clear whether it's killing more people than it saves. And that happens quite a bit. The line is, "The oversight committee terminated the study early."
I don't think you realize how complicated and (mathematically) difficult these decisions are. When there's a controversy it's because the studies aren't clear. They usually have a dozen studies, of different quality, and depending on what statistical methods you use, you can get different answers. I've read thousands of these studies, and I can't always figure them out.
It's simply not possible for a patient with a disease like cancer to do their own risk analysis and get it right. Even doctors who get life-threatening diseases usually let their own doctors make their decisions. Most of them don't want to. They want to go to the best experts, and let the experts decide.
You don't sound like you've read many of these studies where doctors actually weigh these decisions. If you want to understand it, that's what you have to do. I'd recommend going to NEJM.org and trying to find some studies that don't require a subscription.
In 1964, the racists who were trying to stop blacks from voting were Democrats.
In 2012, the racists who are trying to stop blacks from voting are Republicans.
That was the Republican "Southern strategy." As soon as the Democrats started distancing themselves from the southern racists, the Republicans were happy to move in.
Sounds like Accutane, which was used to treat acne. It is not correct to say that it had no side effects. http://en.wikipedia.org/wiki/Accutane http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000532/
It's still around but it's harder to get than Oxycontin -- and for good reason.
Accutane was a godsend to editorial writers at the Wall Street Journal, who made a good living arguing that personal responsibility and the free market should prevail over an incompetent, bureaucratic government agency.
They earned their living because (1) acne is a cosmetic problem (although the social consequences of severe acne can significantly affect peoples' lives) and (2) the people who suffered the worst side effects were not the irresponsible bimbos who got pregnant, but their children who had to go through life with flippers (and worse).
The issue here is personal responsibility. Should an individual bimbo be able to make any decision about medical treatment she wants, or are there some decisions that are just so dangerous that the government should step in and decide for people?
Should the drug company be able to say, "Don't sue me. I warned her of the dangers. If she ignores me and makes a foolish decision, that's her personal responsibility"?
The answer is no. Even for libertarians, you shouldn't be free to harm somebody else. A woman has an unconditional right to abortion, but doing things that will result in severe birth defects of a child that she decides to have is something else again. In our society, you can't punish a woman for doing things that harm her fetus (except in some Republicans states).
Then come the lawyers. If a drug company sells a drug that causes birth defects, and a woman takes it and becomes pregnant, it's going to cost another $3 million to bring that child up with the accommodations it needs to live a reasonably normal life. Where does that $3 million come from? Does the child go on welfare, and have the government pay for it?
When somebody gets injured in an accident, like a car accident, you usually have a combination of circumstances. The first driver was tired. The second driver had a beer. It was raining. The tires were bald. The seat belt had a manufacturing defect. The brake in this car had a record of failures. It's called an "accident chain." So who's responsible?
The answer is, a lot of people are responsible.
Same with Accutane. The bimbo who got pregnant was responsible. Her doctor was responsible. The manufacturer of Accutane was responsible.
The FDA and a lot of doctors said that Accutane was too dangerous, and acne was too frivolous. Roche swore on their mothers' graves that they could set up a system in which women who were of childbearing age wouldn't get Accutane and get pregnant. They would have counseling, personal responsibility contracts, toll-free numbers, 2 kinds of contraception, belts and suspenders.
It didn't work. So who pays?
When you ask the juries, they decided that Roche pays.
One of the problems with these drugs is that they start out being used for the most severe cases of acne or whatever. Maybe there are 1,000 cases in the U.S. like that. But if the drug company can convince doctors to use it for less severe cases, they can make 10 times as much money. So maybe that's what happened with Accutane.
This goes back to the idea of central planning, which is what we started out talking about. If you have individual patients and doctors making their own decisions about taking Accutane, then Roche can market the hell out of it, to patients and doctors, and make 10 times as much money. But if you have a central authority, like the FDA, or the big insurance companies, or the national health service in other countries, they can restrict the sales just to people who really need it. They save money, which is part of their motivation, but they also avoid flipper babies.
Some things are so dangerous that you just need central authority.
The Greeks had an idea of a golden age in which everybody followed the law voluntarily.
Then you find some doctors or drug company promoting a drug that does a lot of damage, like phen-fen, the diet drug. Patients are desperate to lose weight, doctors assure them it's safe. The drug companies hear about patients getting heart failure, but they convince themselves that their drug wasn't responsible.
Then the patients wind up with heart failure and 3 to 5 years to live. Those patients don't say, "I'm glad the government let me make my own decision and didn't coerce me." They don't say, "Well, by my values and decisions, heart failure isn't too bad." They say, "The government should have stopped them from selling this dangerous drug." They even say, "The government should have stopped me from buying this dangerous drug."
The reason the FDA started regulating drugs is that drug companies used to sell dangerous, ineffective drugs, without even identifying the ingredients, and people used to die as a result. Most people don't want to make individual decisions with those kinds of risks.
And you can't say that times have changed and we don't need the FDA any more. Whenever the Republicans or the moderate Democrats loosen up the FDA regulations, people start dying from unsafe drugs and devices again. So they tighten the regulations up again.
A free market assumes that consumers have adequate information and the ability to make decisions. When they don't, the free market doesn't work. When people see the free market not working, and harming them, they demand that the government regulate it.
There are studies that show that even the rich are better off in egalitarian societies than in unequal societies.
For example, their health is better.
That's why, in rational countries, even the rich support progressive taxes.
Just as long as they don't blow it on scotch, cocaine, escorts and ranches the way George W. Bush did.
Many black parents are interested in their kids, but can't spend the time with them they would like, because they're overwhelmed with making a living, or just surviving.
That's because they started out in slavery, and even for 100 years after slavery ended, they had discrimination that was almost as bad as slavery. Not being allowed to vote is pretty serious discrimination. The Republicans are still trying to stop blacks from voting.
The reason you're a racist is that you don't understand that.
No. You don't necessarily have to spend a lot of money. The important thing is following the scientific evidence.
Given the results of our education system, I don't think too many other countries would be interested. We're already a laughingstock for creationism.
Well, most of the Democrats are Republicans, for all practical purposes.
Except for Joe Lieberman, he's an independent.
Let's take your drug idea. Here are a list of questions no central authority can answer:
Is the rigor that is applied today is too strict or not strict enough?
What is the optimal amount of rigor to benefit the most people?
What conditions can be permitted to try riskier drugs with possible benefits?
Is it more beneficial to have a long life or shorter more active one?
The problem is all of the answer to these questions depend on the individual.
If you read the New England Journal of Medicine (which you could call a central authority), you'd see lots of articles answering those very questions. Some of the authors that you can find with a Google search are Marcia Angell and Jeffrey Avorn. For many years, the FDA was under a lot of pressure to approve medical devices. Then they wound up with a few well-publicized disasters, like heart pacemakers where the electric leads got damaged and patients died. Now they're making specific changes in the standards they use for premarket testing. They approved drugs that produced improvements in secondary outcomes (like raising hemoglobin levels), but didn't improve primary outcomes (like death). They found out that more people died with the drug than without it, so the FDA went back to approving drugs based on primary outcomes like death.
Science can only find out how a treatment works on a population level, not on an individual level. If they randomize 100 people to a drug, and 30 of them die, and 100 people to a placebo, and 10 of them die, I wouldn't want to take that drug under those circumstances.
You may have a doctor who thinks he's smarter than everybody else in the world, and he believes that he can tell that the drug will work for you. You may have a gypsy fortune teller who believes that the drug will work for you. Go ahead and use it if you insist. The FDA won't stop you.
Most people would play by the numbers. And the only place to get those numbers is from a central authority.
If you compare black families and white families who have the same good jobs, in organizations that make an effort to eliminate discrimination (like IBM or the military), they have equally successful kids.
The main difference between black families and white families is that more black families are poor.
Do you think slavery had anything to do with that?
I once researched some of the literature on science teaching. Science teachers have to know both the subject and the methods of teaching. (There are a lot of articles in Science magazine about this.)
You may know a lot about the subject, but if you don't know how to teach it to students at different levels, you'll fail. For example, I was surprised to see in the science teaching guidelines that middle-school students can't usually understand the concept of molecules. You can teach them to memorize facts and answers, but they don't understand what they're answering. I saw that when I took my niece to a museum, and they had an exhibit for young children about DNA. My niece saw the exhibit. She played DNA games. I asked her what DNA was. She didn't know. It makes sense when you think about it. Science is about learning things through the experimental method, not from books or videos. It's difficult or impossible to show middle school students an experiment that demonstrates the existence of molecules.
In contrast, there was an article in Science about a teaching module in which kids had to figure out whether vision was something that comes into your eyes or something that comes out of your eyes. That may seem obvious today, but until the 17th century, some of the world's greatest scientists got it wrong.
Science teaching is a science itself, based on the experimental method and published studies, and many things that seem obvious turn out to be wrong. If you don't realize that obvious things turn out to be wrong when you test them experimentally, then you're not too familiar with the scientific method.
If you have a PhD, but don't know how to teach, you'll fail. You won't teach the kids science, and at best you'll teach them to memorize a lot of facts they don't understand. You'll be boring and teach them to hate science.
I think unions do a lot of things that are wrong, but I don't accept this theory that there is a problem with unions protecting incompetent teachers, and the solution is to fire them. Unions make it more difficult to fire teachers who have been employed for years -- and it should be difficult to fire people who have been there for years. (Your first recourse should be to train them. If you're a principal, and you can't teach a teacher how to improve, you're not a very good teacher.) Before we had unions, we had the spoils system, and the Democrats would win and fire all the Republican civil servants, then the Republicans would win and fire all the Democratic civil servants. Try to fire an incompetent teacher whose brother-in-law is a city councilman. That's what we'll get without unions.
But the final word about unions is to look around the world, especially at the school systems that are doing much better in STEM than we are, like Finland, Germany, etc. In all the European countries, the teachers are unionized and well-paid. They study their subject and also teaching methods. They do have lifetime employment. "Weeding out the incompetents" is a problem that doesn't come up much.
Sometimes central planning works, sometimes it doesn't.
In medicine, doctors use a lot of drugs, but don't know whether they work, or whether they're actually harmful. The best way to find out is with a randomized, controlled trial. For the most part, these trials are funded by government agencies. They collect the best experts in the country (or the world), figure out how to design and run the trial, and do it. In other words, they create a central authority to collect all the evidence and report their recommendations. They found out that a lot of drugs were actually killing more people than they were helping. http://en.wikipedia.org/wiki/Epoetin_alfa
Then after they find out that the drug is killing people, there are still a lot of doctors who just want to continue using it, either out of habit, or because they make a lot of money out of it, or because they really believe in it. If you want to stop doctors from prescribing drugs that kill people, the first thing to do is to have a central authority, like a medical association or government agency, recommend against it. When you leave it to doctors to decide by themselves, you're more likely to die. When you leave it to patients to choose for themselves, they really don't know what they're doing. There have been good studies of this. Most patients can't make good medical decisions. Those who do know how to make decisions follow the recommendations of the central authority.
I'm using medicine as an example because I know more about medicine than education, and because in medicine, where peoples' lives are at stake and they have lots of money, they do very rigorous studies.
There are good central authorities and bad central authorities. If you have a central authority that makes their decisions on the basis of the scientific evidence, they can do a good job. If you have a central authority that ignores the scientific evidence and follows the politics, as the Obama and GWB administration did with Race to the Top, No Child Left Behind, and firing teachers on the basis of test results, they're going to do a bad job (as they did).
There's no simple way to make policy. You can't just say, "Central authorities are good" or "Central authorities are bad." It depends on whether the central authority is independent enough from politics to collect the best-informed experts and follow their advice.
A lot of big science came from central authorities and probably wouldn't have been possible without a central authority. The Manhattan Project and NASA were highly centralized.
You have to subtract the blue dog Democrats, who are just as bad as Republicans.
So where is the magic land that actually has a capitalistic system?
Or is capitalism just impossible?
Under capitalism, people who can afford it pay about $10,000 per capita per year to insurance companies for health care (depending on the year you measure).
Under socialism, people pay about $5,000 per capita in taxes for health care of the same (and sometimes better) quality. http://www.openmedicine.ca/article/view/8/1
This is Obama's economy, his policies, his executive orders, his parties control of the senate and house - for two years a supermajority.
You mean his supermajority for four months?
http://washingtonindependent.com/74033/the-four-month-supermajority
The Four-Month Supermajority
By David Weigel
Friday, January 15, 2010 at 9:03 am
In the final stretch of the Massachusetts special election for Senate, Republican candidate Scott Brown has focused on “restoring balance” to Washington. He’ll be the “41st vote” to filibuster legislation; the Democrats’ hold on 60 votes has let liberals run the country into the ground. “That’s not what the founders intended,” he said Monday during the final debate.
The irony is that if Democrats lose the seat, they will have had a working 60-seat majority for all of four months — much of which was spent with the Senate in recess. They opened the Congress in January with 58 votes, counting the ailing Sen. Ted Kennedy (D-Mass.), not counting Sen. Al Franken (D-Minn.), whose razor-thin victory was held up by lawsuits from former Sen. Norm Coleman (R-Minn.). On April 28, 2009, Sen. Arlen Specter (D-Pa.) switched to the Democratic Party, bringing the Democrats to 59 votes without Franken. When Franken was finally sworn in on into the Senate on July 7, 2009, the badly ailing Kennedy was unable to vote and break filibusters
Teachers' ability is correlated with student results. The tests that they use to measure teachers' ability is not correlated with student results. The same teachers rank in the top 10% one year, and the bottom 10% the next year. Obviously the tests aren't measuring the teachers' ability.
The effect of student poverty is far greater than the effect of teachers' ability. The test scores are primarily measuring student poverty, according to Ravitch.
Teachers' ability is correlated with experience. Teachers who have been teaching for 20 years can get better results than charter-school teachers who are on the job for 3 years and quit, as many of them do. If you want teachers to stay on the job for 20 or 30 years, you have to pay them enough to raise a family and send their own kids to college.
Give me one bad thing about capitalism without going into some political rant. Pick a point, lets discuss.
The capitalist health care system, as implemented in the U.S., costs twice as much per captia as the socialist health care system in any other developed country. And their results are just as good as ours, sometimes better.