Month: April 2013

In his first video, Steve explains why US healthcare is so expensive, including a follow-up on what he found most surprising in the course of researching his excellent Time cover-story, “Bitter Pill: Why Medical Bills Are Killing Us”:

Previous Dish on “Bitter Pill” here and here. Relatedly, Trudy Lieberman recently wondered why we don’t try to reduce costs by requiring “drug makers [to] negotiate prices with the government for the drugs used by Medicare beneficiaries” – something other countries do to keep costs down:

Brill estimated that that if drug makers were paid what other countries pay them, Medicare could save some $250 billion over 10 years and, depending on whether that amount is compared with GOP and Democratic deficit reduction proposals, “that’s a third or a half of the Medicare cuts now being talked about.” Liberal economist Dean Baker, co-director of the Center for Economic and Policy Research, crunched numbers from the Organization for Economic Cooperation and Development and came up with similar savings. He found that if seniors paid the same prices as people in Canada, the federal government would save nearly $230 billion over the next decade. States would save about $31 billion and Medicare beneficiaries $48 billion. If the federal government paid the same prices as are paid in Denmark, its savings would be more than $500 billion.

But such numbers are apparently not persuasive when they’re up against the lobbying might of the drug manufacturers. According to Open Secrets.org, drug makers spent $152 million on lobbying in 2012, an amount that has steadily increased since 2002-2003, the time when Congress was debating Medicare’s prescription drug benefit, which handed drug makers the gift of no negotiations over the prices they charge.

Thomas Bollyky highlights another growing issue in international drug prices – patents in developing countries:

Why does Gleevec, a leukemia drug that costs $70,000 per year in the United States, cost just $2,500 in India? It’s seemingly simple. Gleevec is under patent in the U.S., but not in India. Accordingly, Novartis, its Swiss-based manufacturer, may prevent competitors from making and selling lower-cost versions of the drug in the U.S., but not in India.

Last week, India’s highest court rejected an application to patent Gleevec. While the legal issue in the case is important — the patentability of modifications to existing drugs under Indian law — the impact of the decision will likely be broader than just that issue, escalating a long-simmering fight over patented cancer medications in emerging markets.

Indonesia, China and the Phillipines are taking similar measures to amend pharmaceutical patent laws:

The measures that India and other countries have taken — compulsory licensing and adopting strict standards on patentability — are consistent with its international trade commitments, but will be corrosive to the way that pharmaceutical research and development (R&D) is funded internationally. More countries are likely to follow India’s lead. Cancer is not the only NCD on the rise in developing countries, with rates of diabetes, cardiovascular, and chronic respiratory illnesses likewise increasing. U.S. patients will not indefinitely pay a 20-fold increase on the price of medicines that Indian consumers pay.

Michael Cohen echoes me on the difference between America’s reactions to events like the marathon bombing and gun violence:

Londoners, who endured IRA terror for years, might be forgiven for thinking that America over-reacted just a tad to the goings-on in Boston. They’re right – and then some. What we saw was a collective freak-out like few that we’ve seen previously in the United States. It was yet another depressing reminder that more than 11 years after 9/11 Americans still allow themselves to be easily and willingly cowed by the “threat” of terrorism. …

If only Americans reacted the same way to the actual threats that exist in their country.

Which is to say that the terrorists succeeded in almost every way possible. The day after the IRA bombing of the hotel in which she was staying, injuring 31 and killing five, Margaret Thatcher gave a speech, on schedule, to her party conference. The IRA suspects were still at large and threatening to kill again:

Today we were unlucky, but remember we only have to be lucky once. You will have to be lucky always.

Norman Geras thinks these arguments miss the point:

The supposed ‘overreaction’ to terrorist attacks isn’t primarily about the extent of risk relative to accidental death, or about fear for one’s own safety. It’s about people taking quite proper exception when, finding it morally outrageous indeed that, individuals moved by some grievance or other and/or the tenets of a murderous ideology, freely choose to put the innocent in peril by random acts of violence.

I wrote about this for my Sunday column. I am second to none in finding these acts morally outrageous, which is why we need to exercise more control in not giving them more power over our psyches than we need to. I think, in many ways, we’re still living with 9/11 collective PTSD:

Last week shows how terrorism works. It terrorizes – and the trauma of that terror lies often buried in the psyche for years, and untreated and un-addressed, it can suddenly return, without perspective or rationality. In some ways, this is understandable. Before 9/11, Americans outside Pearl Harbor, had lived for centuries feeling relatively invulnerable to the terrorism that I grew up with in Britain in the 1970s, or that occurs routinely as a consequence of the US invasion of Iraq (on the day of the Boston marathon, 65 Iraqis were murdered by terrorist bombs). 9/11 was so traumatic, in fact, that it led the US to adopt the torture techniques of totalitarian regimes and to invade and occupy two countries. Americans lost it. And I cannot say I was immune. It changed Americans because we allowed it to traumatize us.

Before 9/11, terrorism didn’t have this kind of power. The first bombing of the World Trade Center did not “change everything”. Last week, the historian Rick Perlstein noted that in Christmastime, 1975, an explosion at a La Guardia baggage claim killed 24 civilians, with severed limbs and heads flying all over the place. No one was ever found responsible – and the city of New York was not under lockdown. It’s different now.

Which means bin Laden succeeded as well – in simply terrorizing Americans. Take this statistic: the National Consortium for the Study of Terrorism and Responses to Terrorism found that the number of terror attacks in the US in the decade before 9/11 was 41 a year. Since 9/11, it has been 19 a year. And yet our terror panic endures – and even grows. It seems we cannot yet simply live with and through occasional terror. We demand its complete absence, in the black-and-white way Americans often do:

We think in absolutes, in terms of avoiding all harms and dismissing potential benefits instead of debating the relative contributions of both. … “Never eat red meat”. “Never let kids watch TV or play video games”. “Never eat soft cheese while pregnant”. “Never fail to screen for disease”. And so on.

Is this a United States thing? Or am I just wired differently? I’m just not sure that the way we react to potential harms is the best approach. This includes, by the way, our response to terrorism.

Previous Dish on Americans’ response to terrorism here.

(Photo: At around 11:45 a.m., April 19, this was the view on Congress Street looking towards Post Office Square as a lockdown-in-place was in effect in Boston during the during the ongoing manhunt for a suspect in the terrorist bombing of the 117th Boston Marathon earlier this week. By Jim Davis/The Boston Globe via Getty Images.)

Montana recently made moves to legalize eating roadkill. Nicola Twilley consults the rest of the country’s laws:

Florida is the most permissive: according to Marketplace, “If you hit a deer, it’s legal to take it home and do whatever you want with it. You don’t need permission.” Most states with roadkill bills do require drivers to notify the authorities; for example, in New York state, residents can salvage deer, moose, or bear from the highway, but only if the collision is reported and deemed to be accidental. A handful of other states expressly forbid the collection and consumption of roadkill, including, somewhat counter-intuitively, that well-known home of guns, “freedom,” and feral hogs, Texas. In some rural counties in Alaska and Vermont, you can even add your name and number to roadkill phone trees: the state game warden will give you a call when there’s a fresh moose or deer “that’s not too smooshed.”

Update from a New Zealand reader, who identifies the above bird and offers advice on eating roadkill:

The bird in your post a Pukeko, a prolific New Zealand waterfowl species that gets run over often. It does not get run over in Montana though.

Roadkill is ok to eat, but it depends on where it is hit. Rabbits and hares that get run over by a wheel are too badly bruised, but those that stick their heads up and get hit by the underside of the grill are fine. Birds can be good, but preferably if they come off the windscreen obliquely, rather than getting hit by the grill. Pheasants usually hit the windscreen and are not too badly damaged.

Pukeko is not regarded as a table bird in New Zealand, as it has suffered from the adage boil it with a rock and throw the pukeko out and eat the rock. It is ok to eat but you don’t get much meat, and it is tough if it is not allowed to settle in a fridge for about two weeks to allow the proteins to break down.

(Photo by Lee Taylor)