On the danger of factions

Great little observation here about single-issue, high-powered ethno-religious lobby groups. Namely Armenian-Americans, Cuban-Americans, and the famous/infamous Israeli lobby. Fallows pulls a great quote from the Federalist papers, about 'Factions'

"By a faction, I understand a number of citizens, whether amounting to a
majority or a minority of the whole, who are united and actuated by some common
impulse of passion, or of interest, adversed to the rights of other citizens, or
to the permanent and aggregate interests of the community."

Sound familiar?

NASA withholding vital survey safety data...for no good reason

Recently, I have been very impressed with the Associated Press. They continually break new stories, provide truly balanced, unbiased fact-based reporting. Good stuff. Unlike the NY Times...

Anyway, the AP has been trying for 14 months to get access to a 4-year NASA survey of airline pilots that the agency repressed the report "fearful it would upset air travelers and hurt airline profits".

WHAT!!!
WHAT!!!

As an economist and fan of free markets, I am hardly knee-jerk anti-corporate, but the thought that a public agency run by the government, payed by taxpayers money, and tasked with public service goals could possibly cite instigating panic and protecting corporate profits is unconscionable. In fact, I can't think of a single, defensible reason to ever suppress this kind of data. In the final letter from NASA to the AP denying their FOIA request, a NASA administrator actually wrote (and should be fired for it):

Release of the requested data, which are sensitive and safety-related, could materially affect the public confidence in, and the commercial welfare of, the air carriers and general aviation companies whose pilots participated in the survey

......(blink).....(go slack-jawed)......(start feeling overwhelming blood-boiling rage).....(serenity now).

Luckily the AP then decided that if they couldn't get the actual results, they could definitely find some disgruntled employees who could summarize them off the record. Go AP! Check out the link for full detail.

Generics not the same? Oh dear me..

Any sort of even minor groundswell against generics could lead to a catastrophic disintegration of the global healthcare system. Generics are cheaper, not just a little, but A LOT cheaper, like 90% or more than the branded versions, and their existence lies at the very core of the modern capitalist-patent innovation system.

We (society) agree not to copy a pharmaceutical company's innovations for a specified period of time (the length of a patent), as long as the details of said invention are published and made openly available after the end of the patent. In the meantime, the innovator enjoys a monopoly on his/her invention and can therefore price and market it at will, thus enabling the innovator to recoup their capital, and society to enjoy the innovation's benefits during the length of the patent. Obviously a key element of generics, once the expiry of the patent, is to exactly copy the original drug. Specifications are of course provided in the original patent, in addition to the fact that most small-molecule drugs can rather easily be reverse-engineered.

Well, this smoothly running deal between society and innovators that underpins the entire innovation paradigm of modern healthcare, while providing the obvious answer to future concerns over skyrocketing drug costs, is being called into question. Apparently, generic versions of GSK's Wellbutrin (bupropion, see label here) have been called into question.

New test findings by ConsumerLab.com that were released to MSNBC.com showed that one of a few generic versions of Wellbutrin XL 300 mg, sold as Budeprion XL 300 mg, didn't perform the same as the brand-name pill in the lab...

...For the testing, ConsumerLab.com purchased both the original Wellbutrin XL
300 mg sold by GlaxoSmithKline and the generic version sold by Teva, the same
one that Douglas took and that many other readers complained about, and had six
samples of each drug analyzed. While both drugs contained the stated amount of
the active ingredient, bupropion, "dissolution testing" showed that the generic
drug, which has a different time-release mechanism, released the active
ingredient into a solution at a quicker rate. "The Teva product released
nearly half of its ingredients in the first four hours," says Cooperman. "The
original Wellbutrin released 25 percent." Within the first two hours, 8
percent of the original Wellbutrin had dissolved, compared with 34 percent of
the Teva product, according to Cooperman. By 16 hours, both drugs had released
all the medicine.

WOW. A few quick-hit thoughts:

1. Teva isn't just some fly-by-night sketchy generics operator, it's one of the world's premier generics manufacturers (in fact, it even has one or two of its own branded drugs, like the oral MS drug Copaxone).

2. The MSNBC article, and none of the other articles I've seen, make any mention of the potentially enormous economic and social ramifications of loss of patient faith in generic drugs.

3. While the article notes it briefly, the test done by consumerlabs.com is highly suspect, in that it was an in vitro test ('in glass' i.e. in a test tube) and thus is not as rigorous as FDA testing. The FDA tests 'bioequivalence' which measures the actual drug biology in healthy volunteers, and is thus far more realistic than some test tube. Nonetheless, the words of this pharmacist stick in my head:

"the combination of anecdotal evidence and the conclusions of the in vitro study
would lead one to believe that patients might receive a different therapeutic
outcome from the two medications."

Alcohol as a therapeutic?

From Australia (where else?) comes this gem of a story about alcohol being used therapeutically:

DOCTORS used a case of vodka to help save an Italian tourist being treated for poisoning in a Queensland hospital. And hospital authorities later proved very understanding about the booze bill. The 24-year-old man was brought to Mackay Base Hospital, in north Queensland, two months ago after he had ingested a large amount of the poisonous substance ethylene glycol, found in antifreeze, which can cause renal failure and is often fatal.

Well I got curious, of course, as to how exactly it was possible for alcohol to be GOOD for you (asides from red wine, but then its not the booze in red wine that's helping you, but some of the other stuff). I also got curious, however, because this story directly relates to the Chinese Poison Toothpaste Fiasco that has been leading headlines this year (you may recall, ethylene glycol is similar to glycerine and was substituted in toothpastes made in China).

Luckily, the beauty of the modern 'radiated library' known as the internet has merged with the 1980s/90s 'evidence-based medicine' movement to let average Joes like me access lots of free medical information. Here, you can find "Methanol and ethylene glycol poisoning: a case study and review of the literature" which neatly summarizes (in fairly penetratable medspeak) exactly what happens with ethylene glycol poisoning.


Essentially, ethylene glycol and alcohol go through the same metabolic pathways in the body, and thus are broken down by the same compounds. Ethylene glycol itself is not poisonous, it is its after-molecules that cause trouble. Oxalate acid in particular has a tendancy to build up in certain bodily tissues, especially the kidneys. This 'oxalate crystal deposition' is a primary mechanism of ethylene glycol's toxicity, and leads to kidney failure (and potentially death). This is ethylene glycol's metabolic pathway:

Treating ethylene glycol poisoning is really easy, you first have to block the molecule's metabolic pathways, to prevent further harm. This is usually accomplished with IV ethanol (alcohol) or fomepizole, and seeks to block the action of ADH in metabolizing the compound. Fomepizole simply inhibits the ability of ADH to do its work, while ethanol 'competes' with ethylene glycol for ADH floating around in your system. It turns out that booze is 100 TIMES more able to soak up ADH than ethylene glycol, so putting just a little bit of alcohol into your system quickly takes up all the available ADH, simply preventing ethylene glycol from breaking down while you are drunk. In the meantime, while ADH is being blocked, ethylene glycol is simply floating around, not dangerous, but not going away. Simple hemodialysis (filtering of the blood through an external machine) can accomplish the task of scrubbing your blood of the ethylene glycol.

This is why the docs gave the guy 3 drinks an hour for 3 days, because they essentially needed to keep him long-term buzzed , to prevent his kidneys from failing, while they scrubbed his blood. I guess he took so much, that it took them a while. HAH.

Also check out wikipedia.

More cool architecture

I've been seeing some pretty cool buildings lately, in a sort of 21st century modernism based on glass, steel, aluminum and totally unconventional vertical aesthetics. It's funny how much our impression of buildings is rooted in our deep reliance on the functionality of buildings, as solid structures whose stability protects us from the element. It seems that we therefore prize solid, secure aesthetics, namely the importance of 90 degree angles. Even the Bilbao Guggenheim ascribes to this innate need for secure stability. Despite its titanium sides and smoothly fluid lines, it is fundamentally squatly anchored in the ground.

Newer 21st century architecturs even seem to challenges this, I have been noticing. This new architecture seems to revel in illusions of instability through leaning, slumping, and surging at angles neither paralell, nor perpindicular to the horizon. Three examples:

Stata Center, MIT

The new crystal addition to the Royal Ontario Museum:

And my personal favorite, the new Central Chinese Television Tower (CCTV), being built, in Beijing: