Drug reps and their whores - the commercialization of medicine

A successful drug rep ("pharmaceutical sales representative") will commonly earn over $150,000 a year. They know which physicians prescribe what, and they adjust their targeting appropriately. The AAFP attempted to block an organization that fights the corruption of physicians from appearing at the annual scientific assembly (this brain-dead decision was reversed when the membership began to howl). The most common strategy to corruption is to start small (pens, sponsored books) and then gradually ramp up -- the slippery slope is shallow at first.

The Atlantic is doing well these days; this article on the buying of physicians and the work of the drug rep is among the best of a good lot. Carl Elliott is a U of MN professor who lectures medical students about reps; here he writes sympathetically about both the drug reps and their physician partners. He makes a convincing case that both physicians and drug reps are increasingly similar cogs in the market machine of modern medicine.

Their are some simplifications. He writes as though most physicians believe they are not influenced by drug reps. I suspect many are more realistic, and know they've sold a bit of their soul. I'd like to read a study that asked three questions: "Do you accept gifts and samples from drug reps?" "Are your colleagues influenced by drug rep gifts?", and "Are you influenced by drug rep gifts and visits?". I think the most common answer would be yes, yes, no and next would be yes, yes, yes.

Drug reps know which physicians prescribe boringly, following the Medical Letter party line. They're polite to those physicians, but they don't spend a lot of time on them. They favor those who like the fashionable trends, and they leverage direct-to-patient marketing to make being fashionable ever more appealing. Back before they had that data, when I was in practice, they already knew not to bother with me and my partners -- but we were space aliens. Most of our colleagues were more welcoming, but I think they knew they were supping with a pleasant devil.

It's a fascinating tale of how commerce works, and how good people go sort-of-bad. I work in industry now, and I don't believe I'm incorruptible either. It's a tricky world, no doubt, and sales folks are a lot of fun ....

Update 4/16/06: The study I wished for has been done.

A 2001 study of medical residents found that 84 percent thought that their colleagues were influenced by gifts from pharmaceutical companies, but only 16 percent thought that they were similarly influenced.

The above quote came from a behavioral economics paper. I'd like to see if the percentage who realize they're influenced by gifts rises with years of practice or if it's a persistent result of a fixed personality trait (ie. insight).

When government goes mad: Cheney

Emphases mine. The usual liars will continue to tell the usual lies, but basically Cheney, with Bush's support, used fraudulent data to justify the invasion of Iraq, then used the powers of government to attack a critic of his fraud (emphase mine).

A 'Concerted Effort' to Discredit Bush Critic

... Fitzgerald reported for the first time this week that "multiple officials in the White House"-- not only Libby and White House Deputy Chief of Staff Karl Rove, who have previously been identified -- discussed Plame's CIA employment with reporters before and after publication of her name on July 14, 2003, in a column by Robert D. Novak. Fitzgerald said the grand jury has collected so much testimony and so many documents that "it is hard to conceive of what evidence there could be that would disprove the existence of White House efforts to 'punish' Wilson".

The White House went off the rails some time ago.

A conspiracy for fantasy: Moussaoui

Dahlia Lithwick has the perfect summary of the Moussaoui "trial":

When You Wish Upon a Scar By Dahlia Lithwick

... This was what negotiators describe as a Pareto-optimal result: a win-win, in which Moussaoui, the government, and Americans craving vindication all got what they wanted. In the end, the verdict's only casualties are a few impossible-to-explain facts. Facts that should have added up to just this: We don't execute people for fanciful happenings that may have followed from imaginary conversations.

Nobody will dispute that Moussaoui would have happily done anything at all to help the 9/11 plot succeed. But he did nothing to help it succeed because, as everyone but Moussaoui now agrees, he was flaky, wifty, and weird. It's not a capital crime to be flaky, wifty, or weird. Nor is it a capital crime to wish you were a hero instead of a dud.

Yet because of Moussaoui's false testimony, the government's nutty conspiracy theory, and the nation's need for closure, Moussaoui's name will be in the history books and the law books for all time; inextricably linked with 9/11, just as it has always been in his dreams. And perhaps we will all sleep better for believing that if Moussaoui had come forward and told what little he knew, we could have stopped those terrible attacks, just as it happens in our own dreams.

Richard Reid, that sad retarded schizophrenic, was to have been the copilot with Moussaoui. It's the perfect note of mocking hilarity for the musical that will be written about the trial and execution.

Our national state is now passing pathetic.

Saletan takes the prayer study seriously

I've blogged previously on the recent prayer study. Turns out someone else is considering the results seriously: The Deity in the Data By William Saletan.

Saletan is not my favorite writer, but credit where credit is due. The article is uneven; he starts out as though the study showed prayer had no effect. In fact, of course, the study seemed to show that prayer was harmful. He finally touches on the theological implications of toxic prayer, so he gets full credit.

I've been wondering how the Satanists and religious fundamentalists would spin this - were they to take it seriously. I suspect neither would have any trouble. For the fundamentalists this is very biblical -- "don''t measure God" (though wouldn't they expect the scientists to suffer rather than the patients?). The Satanists would suggest another deity should have been consulted.

It's a bigger challenge for believers in a benevolent omnipotent God. I'd love to know what Ratzinger is thinking ... Probably that the results are spurious (which is also what I believe, and I'm sticking to that story ...)

The 13 most corrupt members of congress

Two democrats (Waters and Jefferson), 11 republicans including Bill Frist.

It's good to have a handy list.

The odd history of recovered artifacts: The Judas gospel

An early christian text called the 'gospel of Judas' has resurfaced. It's historically and theologically interesting, but the story of its recovery reminds me of famous novels that just barely get published. I always wonder how much is almost found, but at the last moment is lost forever.

'Gospel of Judas' Surfaces After 1,700 Years - New York Times:

... The entire 66-page codex also contains a text titled James (also known as First Apocalypse of James), a letter by Peter and a text of what scholars are provisionally calling Book of Allogenes.

Discovered in the 1970's in a cavern near El Minya, Egypt, the document circulated for years among antiquities dealers in Egypt, then Europe and finally in the United States. It moldered in a safe-deposit box at a bank in Hicksville, N. Y., for 16 years before being bought in 2000 by a Zurich dealer, Frieda Nussberger-Tchacos. The manuscript was given the name Codex Tchacos.

When attempts to resell the codex failed, Ms. Nussberger-Tchacos turned it over to the Maecenas Foundation for conservation and translation.

Mr. Robinson said that an Egyptian antiquities dealer offered to sell him the document in 1983 for $3 million, but that he could not raise the money. He criticized the scholars now associated with the project, some of whom are his former students, because he said they violated an agreement made years ago by Coptic scholars that new discoveries should be made accessible to all qualified scholars.

The manuscript will ultimately be returned to Egypt, where it was discovered, and housed in the Coptic Museum in Cairo.

The May 15th deadline for Iraq

Thus far the Dems have sat back and watched the GOP self-destruct. Now Kerry is giving Bush a little push.

Two Deadlines and an Exit - New York Times

... Iraqi politicians should be told that they have until May 15 to put together an effective unity government or we will immediately withdraw our military. If Iraqis aren't willing to build a unity government in the five months since the election, they're probably not willing to build one at all. The civil war will only get worse, and we will have no choice anyway but to leave.

If Iraq's leaders succeed in putting together a government, then we must agree on another deadline: a schedule for withdrawing American combat forces by year's end. Doing so will empower the new Iraqi leadership, put Iraqis in the position of running their own country and undermine support for the insurgency, which is fueled in large measure by the majority of Iraqis who want us to leave their country. Only troops essential to finishing the job of training Iraqi forces should remain.

For this transition to work, we must finally begin to engage in genuine diplomacy. We must immediately bring the leaders of the Iraqi factions together at a Dayton Accords-like summit meeting. In a neutral setting, Iraqis, working with our allies, the Arab League and the United Nations, would be compelled to reach a political agreement that includes security guarantees, the dismantling of the militias and shared goals for reconstruction.

To increase the pressure on Iraq's leaders, we must redeploy American forces to garrisoned status. Troops should be used for security backup, training and emergency response; we should leave routine patrols to Iraqi forces. Special operations against Al Qaeda and other foreign terrorists in Iraq should be initiated only on hard intelligence leads.

We will defeat Al Qaeda faster when we stop serving as its best recruitment tool. Iraqis ultimately will not tolerate foreign jihadists on their soil, and the United States will be able to maintain an over-the-horizon troop presence with rapid response capacity. An exit from Iraq will also strengthen our hand in dealing with the Iranian nuclear threat and allow us to repair the damage of repeated deployments, which flag officers believe has strained military readiness and morale.

I suspect this is actually reasonably close to what Rumsfeld has, with bitter regret, decided he has to do (he'll pursue the goal incompetently however, he seems unable to do anything well). So it probably galls him to see Kerry speak the plan aloud; now it will look like Bush/Rumsfeld are following Kerry's lead.

OS X 10.4.6 and Missing Sync: wait a bit

Missing Sync 5.1 was just released -- and there's already a known serious bug with CLIE devices.

OS X 10.4.6 was just released and it includes a major overhaul of the troublesome OS X sync infrastructure.

This is not a good time for missing sync users to update either or both of these things. I'll check back on the Missing Sync archives in a week or so and see how things are going.

The law of large numbers: the iPod face on the map

This Google Map is centered on an unpopulated region between Calgary, Edmonton and Saskatoon. Zoom in. Keep Zooming in. Eventually you will see an apparent human face, seemingly wearing an iPod (it's a road).

CultOfMac referenced this image, they didn't say who made the initial discovery. I'd like to know the backstory.

There are several laws of large numbers here. Look long enough at the earth, and your brain will make some odd patterns appear. Also that there are now a lot of eyeballs strolling the planet. They're finding interesting things ....

Minnesota, home of the massive neutrino

I once visited the Soudan mine with two young children. I try not to think of the background radiation from all that granite.

It's famous now:

BBC NEWS | Science/Nature | Light shed on mysterious particle

A high intensity beam of these particles was fired through a particle detector at Fermilab, and then to another particle detector 724km (450 miles) away in a disused mine in Soudan, US.

. The mine tour doesn't visit the lab, but you can see the locked entrance. It is a spectacular tour, but it is not for those who suffer from fear of bats, the dark, loud noises, enclosed spaces, heights (the elevator ride!) or mad, sadistic, tour guides seeking revenge on the bourgeoise for the sufferings their fathers endured digging dirt for distant capitalists.

Aside from that, I highly recommend it. Don't be fooled by those innocent and cheery looking tour guides by the way. You'll learn their true nature soon enough ... I swear ours cackled when she described how long it would take to climb the ladder to the surface ...

Iowa City: invisible to the spy eyes

The southern half of Iowa City isn't imaged very well on Google Map. I've come to rely on those maps to scout out new terrain -- so this was an unexpected disappointment.

So is there a top secret alien base in Iowa City?

HIV: if you can't beat them ...

HIV came out of the closet when I was in medical school. We followed it closely, back when it was a disorder of Haitians and hemophiliacs. The gay connection came later.

There's a lot been learned about its biology since then. For an old-timer this Loom article gives a flavor of what's current (emphases mine) ...

Learning To Ignore Your Viruses. The Loom: A blog about life, past and future:

In an opinion piece in PLOS Pathogens, Viktor Muller and Rob J. De Boer ... [show] the relationship of HIV-like viruses in apes and monkeys... HIV, marked in red, is not a single lineage of viruses. One form, HIV-2, jumped from sooty mangabey monkeys into people several times. The more common form, HIV-1, descends from chimpanzee viruses, which have moved into humans many more times. As the tree shows, lots of primates get infected by their own HIV relatives, and this appears to have been going on for millions of years. But if you look at sooty mangabeys or some other monkey, you generally find abundant amounts of the virus without any sign of an overactive immune system... The blue arrows on the tree mark the rise of new virus strains in macaques that came from sooty mangabeys. This shift appears to have happened at primate research centers in the past few decades. In their new hosts, these viruses cause lots of nasty symptoms.

Muller and De Boer propose an intriguing hypothesis to explain all of this: perhaps apes and monkeys don't suffer ill effects from these viruses because they carry copies of the viruses in their own genome. After all, the authors point out, HIV's genes have been isolated in human sperm DNA, so these viruses clearly have the potential to make their way into a host genome. Muller and De Boer suggest that primate viruses got into their hosts' genome. The young primates then began making proteins from the virus, which their developing immune system recognized as part of their 'self.' When the primates then got infected with new copies of the virus, they didn't mount an attack or become overstimulated. The viruses infected the primate's immune cells, but they were only a minor burden to the primates compared to a collapsed immune system...

...It's cool but a little frightening to imagine if Muller and De Boer are on to something. It would mean that primates have not survived their own HIV epidemics by destroying the virus. Nor would it mean that the virus had become more benevolent, in order to spare its host. It would mean that they simply evolved to ignore the virus altogether...

Invite them in. Give them food. Let them take what they want. Go about one's business. Didn't China do that with the invading Mongols?

Niven scores: The organ trade grows

Larry Niven made his mark as a science fiction writer in the 1970s and 1980s. Among his earlier writings are a series of stories about organlegging, an illegal and legal trade in human organs. In Niven's books organ rejection has been solved and transplants promise a form of immortality. Jaywalking becomes a capital crime; executed prisoners are the primary source of legal organ donation.

We haven't solved the rejection problem, but Niven gets full marks anyway. Recently China's executed prisoners have been donating their organs to Japan. In 2004 the NYT profiled the sales of a Brazilian live donor kidney to an American recipient. A NYT ethics columnist was asked about another kidney sale to a US donor. Some years ago I read an extraordinary NYT article examining the sale of Chinese and Pakistani organs throughout asia, including sale to US recipients who traveled for their transplants (I cannot find the reference!).

This is a true growth industry, there's big money to be made for those who've developed their moral fiber in the tobacco industry. And what about those ethics?

From an ethical point of view, the prisoner trade is more clearly wrong. It incents the state to execute, and the prisoner gets nothing from the deal. The "voluntary" donations from the impoverished are in practice also terribly wrong, but the reasoning is more complex.

If my family was mired in dire poverty, I would probably donate a kidney for the right price. Alas, in practice the social consequences of this sort of transaction are likely to be so severe that they outweigh any theoretical utilitarian benefit to donor and recipient. In any case, in our world, such trade would take advantage of hundreds of millions of people with limited judgement and cognitive abilities -- taking their organs for a song.

This is wrong, wrong, wrong, wrong. Any physician partaking in this trade in any way should have their diploma revoked.

PS. I would be remiss if I did not mention my solution to a part of the organ shortage. In the US there are many, many adults who want to ride a motorbike with a helmet. We should simply require that than any brain-dead motorcyclist recovered without a helmet is a mandatory organ donor ...

Healthcare IT Vendor to Offer Sex in HIMSS Booths

I hardly ever comment on anything related to my real job. This column from a blog that's read daily throughout the healthcare IT industry could not, however, be resisted: The Obligatory April 1 Phony News Issue (HIStalk).

The anonymous CIO behind HISTalk was clearly feeling a bit nervous, hence the all revealing title. If you've ever had anything to do with large healthcare IT vendors, however, you really must read the column. Where's EPIC though?

Scanning developing brains: the excitement to come

The brains of very high IQ, high IQ, and average IQ children follow different developmental paths. Fascinating, and humbling. These are exciting times for brain research, akin to physics in the early 20th century. Paradigms falling and new ones rising. The next burst of excitement will come when the study is repeated across gene cluster groups, aka "races".