Wednesday, December 24, 2014

Capitalism, pharmaceutical companies, and morality


Gilead, the Pharmaceutical company selling the Hepatitis C cure Sovaldi, is tiering prices for the 3 month course of the drug: $84,000 in the U.S. $55,000 in Canada, $66,000 in Germany, and reportedly around $2,000 for a generic version that may be licensed to several Indian companies. Sovaldi costs about $130 to manufacture, reinforcing how outrageous its pricing is.

Gilead justifies its pricing by suggesting that it reflects the value of Sovaldi to the overall health care system because of downstream health savings. If you accept that logic, then you should be paying $10,000 for a penicillin prescription for a strep infection instead of $8. Or one step further in that logic - Should the charge for an appendectomy reflect the value of the patient's life earnings from that point onward?

The pricing of Sovaldi is the perfect illustration of how pure unfettered capitalism has no morality or ethic. It looks like any effective new drug treatment is going to be priced at what the market will bear, even if it bankrupts individuals and government programs. Yes, you need a profit incentive for the companies to develop these drugs, but allowing such wanton extortion from seriously sick people makes me feel ill also.

Thursday, December 18, 2014

The Military in a Democracy

12/17/2004  - First, let me set the stage.  Oklahoma Senator Tom Coburn has placed a hold on the Clay Hunt Suicide Prevention for American Veterans Act, claiming that the legislation is too costly and doesn't accomplish much, a claim which is widely disputed by veterans groups and despite the fact that it had nearly unanimous support on both houses of Congress, which is all but unheard of these days.  In the United States Senate, a hold is a parliamentary procedure permitted by the Standing Rules of the United States Senate which allows one or more Senators to prevent a motion from reaching a vote on the Senate floor.  In other words, this one senator prevented this bill from consideration.

Mr. Coburn, a medical doctor says this portion of the bill is duplicative since the VA already has the authority to offer incentives to understaffed specialties.  Alex Nicholson, legislative director for Iraq and Afghanistan Veterans of America, said Mr. Coburn’s staff are confusing psychologists, whom the VA already has authority to recruit with incentives, and psychiatrists.
Let me point out here that Tom Coburn has never served in the armed services, never worn a military uniform, and has no first-hand experience of living or fighting at any level.  This is not to attack Mr Coburn personally for his circumstances . . . he is among the more than 80% of the 113th Congress that has no primary experience, officer or enlisted, in the army, air force, navy, marines, coast guard, etc.  

The percentage of congressmen/women has been falling, and will continue to fall, because the younger one is, the less likely is a personal history of military service, and as the older members leave congress the newly elected members will less likely be veterans . . .

Why is this?  It is partially a result of the aging of the WW II veterans, but as time goes on it is more because of the elimination of the selective service draft in 1973.  As the chart below demonstrates, the percent of the US population on active duty is now less than 1%.  ( . . . and the number actually having live combat experience is a small fraction of that.)

Back to Mr Coburn; I disagree with his fiscal conservatism, targeting depressed veterans for his budget cuts rather than the oil and pharmaceutical elites.  (I will have to give him credit for voting "nay" on invading Iraq and later voting "nay" on funding Iraq.  I think he had good foresight in that matter, but on almost every other point of politics we totally disagree.)

Many of the hawks in Washington talk a good game because their sons and daughters are not and will not be serving. I’m certain if one of Mitt Romey’s five sons was serving, he wouldn't have been so aggressive on sending troops into Syria, Iran, North Korea and where ever else he felt we should be waging a ground war.  (Neither her nor his 5 sons are veterans).

American are quick to support our military but most are not quick to serve or have their son and daughters serve. That’s the disconnect. If you haven’t served or are not willing to serve, and your children or spouse have never served, I'm not sure your vote should count when it comes to the lives of those that do serve or have served.

Many western societies have adopted a universal service requirement for all citizens.  That does not mean they all have to be trained in the military as such, but have to be in some basic service for the good of their country at some point during or after their education.  I don't think I will ever see it, but I think it would make us a better country.

Saturday, August 16, 2014

Just for the Joy of it

Barbara and I have seen this man, making giant bubbles, on several occasions, but I have only talked to him on one occasion when he was at the large, Downtown Farmer's Market one Saturday.  He was standing on an elevated section of the entrance to the Art Museum with a loop of rope strung between two long handles, dipping it into a vat of soapy water and producing these giant, shimmering bubbles that would drift over the crowd to everyone's delight until finally some child with giggles and a smile would burst the bubble as it floated into reach.

The gentleman has a full time job, but on his own time and schedule, when the mood moves him, will appear at various places around town that he has found suitable for this process.  I told him that it was very nice that he would do this for people and he did acknowledge that it pleased him to see people, especially children react positively to the giant bubbles, but he did it mostly for his own pleasure.  He likened it to flying a kite: "you fly it mostly because you like to fly it, not so other people can see you fly it."

We talked only briefly of the chemistry of bubbles, but I seem to recall it as quite interesting; click here for a nice link.

Barbara was first to observe him a couple of months ago, early one morning on the bridge below our apartment, releasing his bubbles over the river.  This morning as I was perusing the paper with my first cup of coffee I saw a shimmering, shape-changing bubble drifting slowly upriver a few feet above the water.  It was early and the bridge was empty of pedestrians, with just some commuting drivers oblivious of things beyond their dashboard, and in this relative solitude there he was for the joy of the chemistry, for the joy of the creative activity,  just for his own joy; creating his bubbles and watching their short, but beautiful life.

(The pictures are first - of the early morning as I looked from the window, next - the bridge with the bubble-maker on the projection of the walk of the bridge that is the tip of May's Island with his head obscured by part of the "tree" sculpture, and last - a picture of a bubble floating up the river.)

Tuesday, July 22, 2014

Chrome OS and the Chromebook; a commentary

I have had more computers, tablets, and smart phones than I can recall, and it keeps evolving.

I have moved largely to my iPhone and iPad Mini for the majority of my searching and communication, but neither of those are reasonable when it comes to inputting more than a sentence or two of text or other data rather than simply downloading information.  I bought a keyboard for my Mini, which works sort of OK, but there is still no good way to upload data or media from an external source such as a USB “thumb” drive.  Also, I am attracted to the idea of having my documents and media securely stored and universally available “in the cloud” on a reliable 3rd party data farm rather than my hard drive next to my coffee cup.

Enter Google and the Chromebook with its Chrome OS.  If you are not familiar with this device, then it is a little hard to describe. It is in a very limited way what was marketed a few years ago as a "NetBook", but what makes all the difference is the integration with the Google world. They do look like small, thin notebooks, but the OS works without resident programing.  For example, I cannot load MS Office as a program  into the system (though I can access my MS account and work on Word and Excel documents via the MS Office web app). What Google prefers for you to do is to use Google drive to store your documents in the Google cloud, and to use their versions of document, spreadsheet, presentation, etc applications instead.  Google documents can also be sent or saved as OpenOffice and MS Office formats, and group collaboration over the web is facilitated.

One significant downside for me personally in the use of this device would be the inability to use Dragon/Nuance voice recognition (requires loading a program on the device, which can’t be done), with no adequate substitute available currently from Google.  Also, I am an apple fan, and was less than happy with the Android OS phone I had a few years ago.  Nevertheless, I could give this a try with a small investment, since most Chromebooks sell for ~$200, occasionally less.  

I found a Dell Chromebook on the internet for a discount price, with 4GB (vs the standard 2GB) of memory and the standard 16GB (SSD).  The lack of a large internal drive is the concept that you don’t need a lot of internal drive storage because you will be keeping your data on Google Drive or some other cloud storage server.  

After 3 or 4 weeks with the Chromebook, I will have to admit that I tend to use it 70-80% of the time for checking email and perusing FaceBook, and 98% of the time for working on documents or entering email or FaceBook comments longer than  2 or three sentences.  This has not been by any conscious plan or because of availability, but because the Chromebook seems to work quite well for most purposes other than true mobile uses.

The Dell Chromebook 11 Specs:  4th gen Intel 2955U processor (more efficient and faster than the Celeron 847 in many other Chromebooks), Chrome OS, 4GB DDR3L memory, 16GB SSD drive, WiFi, bluetooth, 1366 X 768 11.6” LCD screen, 4W stereo speakers, audio/mike, USB 3.0 X2, HDMI, SD Card reader.  Battery life >10 hours according to specs (and also some published reviews.)

Though I have only 3 weeks or so of experience with my Chromebook, I will try to share from this experience some of the advantages and disadvantages of the Chromebook compared to iPad/iPhone and my windows notebook computer.Data input is a big advantage over an iPad.  First, the hard keyboard is far superior to the soft keyboard on a phone or tablet.  Siri works pretty well, but not well enough to replace my fingers, and the Dell Chromebook keyboard has an almost perfect tactile response.  The Chrome keyboard is missing a few things that are not important (the windows logo key) and a few more important keys (Caps Lock, Delete), though there are preset keys and key remapping that you can use to get around this issue.  My Dell has two USB 3.0 connections and a SD card reader that makes data/media uploading and sneaker-net transfers easy.

The Chrome OS is not quite as intuitive as Apple’s OS 7.x.x, but it is close.  Anything is better than Windows 8.  What a disaster.  It came with my last notebook purchase and after almost a year I hate it as much as at the start.  MS seems to me to have tried to combine a tablet and desktop OS and failled miserably.  That is a big reason my Windows machine is rarely opened any more.

You can use any of the apps available in the google store, but I have found that I use few of these; why use a limited app designed for a limited mobile device when interacting with a site, when you can have the full functionality of the standard browser interaction.  For example, the popular Yelp dining site has a much richer user interaction on its “Full” internet browser site than on its mobile phone or tablet app. The same applies to Zillow, Chase Bank, Wells Fargo, and others.  Another reason I don’t use apps: security . . .Without question, a Chromebook is safer than Windows, OS X, Linux, iOS or Android. "Security is baked into the design."  Is it totally secure?  Of course not; it is connected to the web.  However, it’s still quite secure without my buying/using an antivirus program or other security software.  Read the link for a Computerworld article all about Chromebook security.

Upkeep is another big advantage.  I have no security software that constantly needs new definitions downloaded.  I have no programs to update or to upgrade.  I have no external hard drive to backup my documents (I suppose if Google has a storage farm disaster my data could disappear, but that is much less likely than my own backup burning up in a house fire, etc.

The need to have internet connectivity is not a problem, but could be an issue when traveling, especially in Europe.   If you usually have WiFi at your home /work/etc. then it’s unlikely to be a problem. Chromebooks with internal 4G LTE are now available.  And you could use a mobile WiFi device or your phone as a hot spot.  It has not been a problem for me (I’m typing in a McDonald's at this moment.)

Since the Chromebooks generally have a larger battery than a tablet, most of them have an external transformer for charging, and this might be an issue if you are a heavy mobile user.  My Dell has a longer battery life than most, and I suspect that is why it’s a bit heavier than some of them, but I can work all day from a Starbucks without running out of juice.

Chromebooks are relatively cheap compared to a standard notebook and even many tablets, yet for many people have the potential to replace most or all of what they use a computer for. If it breaks, just buy another one for not much more than a warranty would cost for a notebook or desktop computer. If you use a good password, you don't even have to worry about theft, as your data does not reside on the Chromebook.

One final thing; you cannot plug a printer into your Chromebook, because as a locked, secure OS it will not download a printer driver.  If you want to print directly from a Chromebook, your printer has to be compatible with Google cloud print  There are dozens of printers that are so compatible, but there are dozens that are not.  There are other options including setting up one of your other computers with the Chrome printing system, or delivering your document with email or a memory key to open and print from that computer.  I am in the market for a wireless printer, and will need to make sure it it Google cloud print capable.

If you have been considering a Chromebook, I hope you find this useful.

What do I know, not know, and believe?

Book Review:  How we do harm by Otis Brawley

Everyone, and I mean everyone, should read this book that is largely concerned with the medical-industrial complex in the USA. Dr. Otis Brawley is qualified in so many ways to write this book as you will discover in the preface/introductions.

"What do I know, what do I not know, and what do I believe?" This is the recurring theme through the book.

We as physicians have a responsibility to act with information, integrity, and awareness of what might be influencing us unconsciously, and to then act ethically with nothing but the patient's best interest as our goal. Because, disturbingly, this often is not what happens, you and I as patients have a responsibility to be informed about our health, and not afraid to respectfully question our care plans. It is NOT as some sensationalists suggest that there is a conscious effort to keep magical treatments from the public, but the subtle and not-so-subtle reasons things are done due to misguided opinion, because someone is lazy and recommending over and over the traditional treatment when science has moved on, or simply to make money. 

The book will also turn your concept that all health screening test are good on its head.

This is one of those rare books that I will strongly endorse to family and friends.

Friday, June 13, 2014

"A very Fortunate Life"

Although we have paid considerable tribute to the veterans of World War II in recent years, I think we still fall short of appreciating, much less "venerating" the elder members of society in this country.Two years ago when I was waiting for my car to be serviced at a garage in Estes Park, Colorado, an elderly man wandered in, dressed in somewhat shabby clothes, and after checking his car in for service looked for a place to sit. There were only a few chairs around and I cleared some newspapers from the chair next to mine to give him a place to sit. Instead of letting me read my book in peace, he was interested in chatting, so I closed my book and we had a very nice talk. It turns out he was a widely published physician who had established the neurology training program at UCLA many years ago. It was truly one of those "you can't tell a book by its cover" moments.

More recently, I was returning from work at the hospital in Vinton, Iowa, and saw a small sign for "railroad depot" which directed me a couple of blocks off the main road to a very nicely preserved/restored railroad depot sitting on the tracks. I stopped to take a quick picture before continuing back to Cedar Rapids, and as I was about to get back in my car, a gentleman pictured below pulled up in his car and rolled down the window and inquired of my interest in that particular building.

Keith Elwick

It turns out that this gentlemen, who is 96 years old (born in 1918 and about to celebrate his 75th wedding anniversary), was a significant part of the history of this old railroad depot. He was  not boastful, but neither was he reticent to answer my questions regarding his life, and I wish I could have taken more time to benefit from his stories over a long cup of coffee as he had suggested. As we talked, it became apparent that not only had this man been part of a successful farm family, but was quite an inventor and had built an agricultural machinery manufacturing business from scratch. He had been personally presented from Queen Elizabeth two awards for innovation and excellence in agricultural machinery manufacture, but he never mentioned this significant fact; I only learned it later by some internet research.

In 1964, Queen Elizabeth and Prince Philip presented Keith Elwick (right) and the Howard Rotovator company, which manufactured his side-delivery manure spreader in England, with an award for British implement of the year.
 Keith's original manufacturing company was located in an old canning factory next to the railroad tracks in Vinton, but some years later they required some new administrative offices and it turned to the old railroad depot across the street which had been closed and was being offered by the railroad to a suitable caretaker. Keith's company purchased the depot for a nominal sum and then spent over $100,000, a considerable amount at the time, in complete restoration and renovation, preserving not only the exterior, but also all of the original benches, counters, and instruments in their original state. His company then donated the entire depot to the local historical society on a leaseback for his company use, thereby ensuring that it would remain in its state of historical preservation into the future.

Mr. Elwick a couple of times noted "I have had a very fortunate life" and during our discussion never mentioned his meeting with the Queen of England or many of his accomplishments I only read about online after our meeting.  Not everyone will have a story such as his, but I wonder how many equally fascinating lives we fail to share by not taking the time for conversation with those who have lived longer and may have seen far more than we can imagine.

Click here for a link that has some commentary about Keith's life from the award ceremony when he received a "Silos and Smokestacks" award.

Vinton RR Depot
Built in 1900

Passage way to the tracks
Opposite view
Old Motor Car Garage containing preserved
old hobo signs


Sunday, May 25, 2014

A Sunday Walk

Early this Sunday morning I set out to take a walk around our new neighborhood for a light exercise and to see what's there. (click on any picture to enlarge it.)

Started my walk on the river walk below our window, and crossed the bridge.

Not much traffic on a Sunday morning.  Our Apt building on the left; Veterans' Auditorium (link) on the right. 

The river walk was uipgraded in the 90's, and survived the 2008 flood reasonably intact.

The footings for the current bridge were originally laid about 100 years ago.
The city was founded here because the riverbed was rocky, and could be crossed
on foot or wagon during times of low-normal flow.

The Vets Memorial reopened only recently (link), after extensive renovation after the flood (link)
Note the bridges that I walked this morning and the entire island
were totally underwater during the flood!
The old bank (the original part in the foreground) (link) was designed by Louis Sullivan
and is now an Italian Restaurant.  New Condos east of the bank and across from the
 new river amphitheater are almost finished.

The trees have just about finished their blossoming, but new flowers are appearing elsewhere.

This trail through Cedar Rapids connects with the Cedar Valley Trail (link)
Improvements in the landscaping are underway.

An old warehouse under conversion to urban lofts.

Doors for exiting to the side street after the performance at the Paramount Theater

In addition to some mid-century ugly, there are some really nice preserved old buildings in the downtown.
Not that old, but attractive.

The Blue Strawberry - my favorite downtown coffee shop
- and only 1  1/2 blocks from our apartment building!

The Blue Strawberry