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About
This blog is about science and science journalism: good, bad, and bogus. While most of the posts are about bad and bogus science and science writing, I try to find the time to reflect on good examples too.
I am a freelance science writer and I teach philosophy at the University of Sydney.
You can read more about the blog and me here.
Seen any bad science reporting? Seen a piece of dodgy research? Got a comment or a question?
How do you embed a hologram with a certain frequency. Frequencies have wavelength / speed and penetrate various substances, namely soft tissue. To control this frequency requires specialized equipment. This equipment will send the frequency in pulse packets and are detected upon return to the source after reflecting back. As you can see frequencies are not static nor lasting unless the source continously emmitts. I am not a believer of this hologram embedded interactive frequency device. There is no science/ research behind this product only bogus and emotional testomonials.
Wow I cant fathom who is computing all these silly posts. Your blog is on topic and it attracts many amounts of these types people. take care and keep up for the work!
Update: After newspapers everywhere broke the embargo, it was lifted late last night (Sydney time), and this post was then published a few minutes earlier than was planned.
1.5 times what?
It would be interesting to see these figures in dots-on-paper natural frequencies.
There’s an interesting interview on converting unintelligible geewhiz probabilities into tractable medical options on the ABC Health Report that shows that probabilities aren’t always that useful.
Thank you for the accurate reporting on this.
Michael,
Just curious as to why you think that
“Cartwright’s (questionable) point is that no real-world situations actually obey the laws of physics: the laws of physics apply only to imaginary situations like frictionless planes”
is questionable? Is it because you think the “power realism” of thinkers like (early) Roy Bhaksar, Brian Ellis, Stephen Mumford, Alan Chalmers, et.al., is basically the correct one?
Hi Edward,
I guess a better word there would have been “controversial” rather than “questionable”. I’m not sure what I think about Cartwright’s view. To tell the truth, I am reluctant to accept her conclusions even though I can’t see any problems with her arguments. I know that’s not a very satisfactory response but it’s all I’ve got!
:-)
A friend of mine used to take some sort of memory-enhancing pills during his university exams because he believed they helped him to study better. He always claimed that a pleasant side-effect of the pills was that he wouldn’t get hangovers… I can’t remember the details very well – think it was the kind of pills older people get prescribed when they start become forgetful – but if you come across anything like that, maybe it would be interesting.
Would definitely be interesting to hear more about the dehydration story. I always thought that’s where the hangover came from, so that you could avoid the worst of it by drinking lots of water together with your alcohol.
In my student days there were also lots of stories that you could eat greasy food or even drink some olive oil before going out to put a film on the inner lining of your stomach, which would slow down the intake of alcohol in the bloodstream via your stomach. I remember reading somewhere once that this could be dangerous: if the film ‘breaks’ at some point, your stomach suddenly starts taking in all the alcohol that has accumulated in it into your bloodstream, so you would be liable to get alcohol poisoning. Never really believed much of this story, but who knows…
Any idea what those pills were? Dexamphetamine? I’d like to follow that up.
Yep — I’m onto the greasy food story. Found some research about it. Will try to find out more.
Many years ago I stopped drinking so much that I would get a hangover.
Nevertheless, it seemed to me that if I stayed well-hydrated (hydration referring to WATER), the hangover would be less severe or less prolonged.
Any science in support of that?
-Steve
Some people (such as myself) have never experienced a hangover. I have gotten sick from drinking, but the sickness has never hung over the next day. Why is it that some people get hangovers whereas others don’t? And what determines the severity of the hangover (some people seem to get it worse than others)?
Yeah — That’s really interesting and I’ve found some research on it. That’s definitely going to make an appearance in the series.
What a remarkable conversation you all got going. I love the mix of good and specific info together with a number of intellectual thoughts. It is good to be able to at last find great discussions where I feel like I’m able to trust the text and also respect the individuals who publish it. Considering the online garbage nowadays I continually love finding some genuine presences on the internet. Thanks for blogging and keep it up, please!!
A lot of friends say that a glass of water before going to bed gets you saved from any hangover. I have also heard from my grandmother the olive oil theory since it “covered your stomach and protected it from the alcohol”. Nevertheless, eating anything greasy usually makes you throw up if you’re hung-over, so sounds like myth.
As well, pills like Hepabionta are said to protect your liver from the damage of the alcohol. Following the question of what is a hangover, I was wondering if a pill could actually protect you from a hangover.
Thank you, great idea. This must be one of the topics most full of myths.
It’s interesting what you write about dehydration.
Anyway, here is my bit: when I have really bad hangover next day, the one including head-ache, sickness and even vomiting, one bottle of gatorade, powerade or anything like that seems to help me almost instantly. Even when I throw up after drinking water, I never throw up after gatorade.
And yes, my hangover is reaaally bad :D
Usually I don’t post on blogs, but I need to say that this article very forced me to do so! Thanks, extremely nice article.
I have sometimes noticed that when I drink enough to become buzzed or drunk and stay awake long enough to return to total sobriety that I often find my attention and focused to be enhanced, and I find tasks like reading, writing, and studying much easier. I’ve had a few friends with similar experiences, and I’m wondering if this is a widespread phenomenon in many kinds of people or is possibly something that happens only in anxious people (like myself) after the alcohol dampens their overly excited brain to a state where it is better able to focus.
“our initial premise must be wrong (or one of our logical steps was wrong)”.
this does not necessarily follow: it’s possible that there are substances in the cheaper cuts that, in the presence of alcohol, will make you as sick as a brown dog the next day. perhaps it’s synergistic.
anecdotally, i sure have noted the difference in level of hangover when nasty cheap wines – particularly red – as opposed to fine wines have been drunk.
Located a good site called Freedom Disability. They can help you to apply for and win social security disabilitywith the SSA.
Hi! I’ve been digging around through the alchol lit for a bit now myself, out of morbid interest, and I’m with the Wiese et al – this effect does not appear to be alcohol withdrawl. It’s too modulated by the presence of congeners for that to be a plausible explanation.
The editorial is incorrect in assuming that moderation would lead to fewer hangovers. Far from it, as Wiese et al mentioned later in the paper, light to moderate drinkers were more likely to feel the effects of a hangover! Hardly the effect one would use for a public health tool.
Yeah. They seem to be right.
RE moderation — I think they mean simply not drinking enough to experience a hangover. That’s certainly possible! :-)
I’d like to understand why some alcoholic drinks elicit different behaviors than other alcoholic drinks. Or if that’s a myth. For example, are some people “mean drunks” when they drink tequila, but jovial when drinking beer? Why would that be?
Not drinking will solve all problems, I guess.
Um. No. Hangovers are caused mostly by dehydration and electrolyte loss.
http://alcoholism.about.com/od/hangovers/a/cures.htm
http://www.timesonline.co.uk/tol/life_and_style/health/article5370363.ece
1. Prevention is better than cure: switch to water before you get too drunk, and regardless, hydrate thoroughly before bed. If you can, take an advil to mitigate tissue swelling, and some electrolytes.
2. Failing that, or supplementing it if you way overdid teh booze, continue to hydrate throughout the hangover. Add electrolytes and food as needed. Rest.
Using this, I can recover rapidly from even a blackout-and-say-rude-things-you-don’t-remember night with minimal hangover symptoms. The emotional fallout from drunken gaffes.. well, there’s no cure for that. =P
I’m going to post about the idea that hangovers are (mostly) dehydration. A bunch of evidence seems to suggest otherwise.
Ah, sorry there Luxury. I guess I replied via the wrong link.
Okay his would be true in teh case of an alcoholic maybe but i can say through my experience as a responsible drinker the hair of the dog does actually work.
What i was taught is when you wake up the next day after a few too many with a splitting headache or you feel horrible you hae a glass of whatever you were drinking the night before and your fine for the day.
you continue the day, sleep and the following day effects are totally gone. Worked for me everytime. Even if there is psychological it bloody works. i dont believe its the early stages of Alcoholism.
I have found that, if I can still stomache it, fruit can help me in these dark hours. Greasy food, preferably with carbs and salt, also has a positive effect. I’m always juggling the two since they don’t combine easily.
Looking forward to the whole series! Good stuff.
Am not sure where I read it, but the premise was that part of an alcohol hangover is low blood sugar, as the body has been ignoring its glycogen stores because processing a toxin takes priority.
So the advice that I read was to start with a simple carbohydrate to raise the blood glucose level – and that’s why hangover cures like Gatorade get traction.
I would love to read more that isn’t just half remembered gobbledy gook from my brain. Thanks for the series!
I am most interested in the topic of alcohol intolerance for the following reasons. I am now in my mid-50s. I started drinking in college – and, like many dumb college students, did engage in binge drinking on occasion. I continued to drink after college – but mostly only beer. I have always suffered from severe hangovers if I drank too much. In my late 20s I started to develop an intolerance to alcohol such that, ultimately, even one beer (or less) would give me a hangover – almost instantly. Needless to say I stopped drinking. Around the same time I started to experience fatigue and tingling. This culminated (over a period of a couple of months) in losing sensation entirely on the left side of my body. I was dragging my left foot which seriously affected my gait. After being hospitalized and tested (pre-MRIs), a tentative diagnosis of MS was pronounced. It did not get worse — though, in fact, some of the worst symptoms abated. I have continued, however, to experience (virtually on a constant basis) fatigue, transient numbness, tingling, and “dark spots” in my vision. I still was unable to drink. I also found that I developed sleep problems – in part because getting a good night’s sleep became essential to my feeling as well as I possibly could. After some years of dealing with these sleep problems I got on a low dose of Elavil – which I still take today (25 mg/night). Some time after I had been on the Elavil a while, I had the occasion to try a glass of wine. Much to my surprise – I was able to drink without getting instantly sick. This remained the case for many years. But then in my late 40s/early 50s – I once again started to lose my tolerance to alcohol. Today, I cannot drink even one glass of wine without getting a hangover.
I read a recent article (as of Jan 2010) touting the discovery that alcohol intolerance is caused by the inactivity (in some people) of the enzyme aldehyde dehydrogenase (ALDH2), and that a molecule called ALDA-1 can activate the defective enzyme to help break down the toxic compounds in alcohol. There is also belief that the defective ALDH2 enzyme can cause disorders of the CNS – including Parkinson’s Disease and Alzheimers.
I wonder if my “MS” is caused by a a defective ALDA-2 enzyme — that may be helped by the intravenous administration of ALDH-1? (Right now there is no pill-form of ALDH-1 available).
According to the January, 2010 article, the administration of ALDA-1, which activates the defective ALDH-2, effectively combats alcohol intolerance.
Any light you can shed on the above recent discoveries — including where one can obtain an injection of ALDH-1 – would be greatly appreciated.
I don’t know about the early stage alcoholism thing.
I started drinking when I was 13 years old and for the first 2 years I had drinking binges only occasionally and I never got a hangover. I remember I used to brag about it (stupid, needless to say). Nevertheless, I remember I almost religiously drank a Gatorade when I woke up. Later, when I was 15, I started to drink heavily more often (once or twice per week) and one day I suddenly woke up with a hangover. Now, drinking more alcohol works with the mild ones, but Gatorade doesn’t do anything except ridding you of a dry mouth. With the tough ones, only sleep gets you through. So, I find that when drinking more alcohol doesn’t work it is because nothing works. Nevertheless, I don’t know if irritated stomach/liver beats alcohol need in the body; meaning that I don’t know if I throw up the alcohol anyway because my stomach can’t stand anything or because it simply isn’t early stage alcoholism. I agree more with your theory. E.g. If your leg hurts and you start drinking you forget about it, people go out to forget their “heartaches”, etc. So, regardless of the no evidence situation, it makes sense.
From the research that I’ve read (I can’t locate a link online, unfortunately) hangovers are caused by the cogeners in the alcohol, which are the things like methanol and the like, which esentially add flavor to the alcohol. The ethanol (drining alcohol) itself has little impact on hangovers. As explained in the article, “hair of the dog” simply works the same way that pain killers do; you no longer feel the symptoms. There is no “cure” for a hangover, you can either treat the symptoms, or you can prevent it to begin with by avoiding alcohol heavy with cogeners. As strange as it seems, a colorless, flavorless alcohol like vodka or everclear is the least likely to cause a hangover. Also, higher quality alcohol (read as: more expensive) is less likely to cause hangovers because more of the cogeners can be drawn off and seperated since the company is less likely to be concerned about that small volume of liquid. That is, by no means, however, a garauntee that any alcohol will not cause a hangover, unless it is 100% cogener-free. Hope that helps everyone.
absolutely, after falling victim to the so called Power, balance and flex bracelet i feel like a total chump. it has no effect and no susbstantial tests have been done.For some reason the brain needs something physical to believe it is strong(the mind is the most powerful tool)… so if it costs R300 to for you to believe, then good for you, but if anyone convinces you it doesnt work be warned youll be out of 30L of fuel and feel like I do… spend youre money on something else!
Very interesting….
When talking about ’small studies’ it’s probably useful to describe the kind of sample size you’re talking about. From the paper, we can see that they classified a study as ‘large’ if the average number of patients in a treatment arm was 100, for example one with 110 in one arm and 95 in another would be ‘Large’ because the average number of patients is 102.5. This is crucial information for someone trying to understand your blog post and its relevance to their particular interest.
Yes — You’re absolutely right. In fact I did say it in the first version I wrote and must have accidentally deleted it in an edit. Thanks!
Actually, just a further thought: Their definition of what a small study amounts to is not so crucial for understanding the post since the analysis I focused on was the funnel plots. In them, the y-axis is (something similar to) sample size and they do not merely compare “small” studies with non-small ones.
Nevertheless, it was remiss to not mention their definition. Thanks.
Yes, I realised upon reflection that I could have been clearer that I meant it was crucial for someone considering their own work in the context of what you were writing, though the general argument itself would not be undermined without the classifying information.
Interesting piece. However, I’m not sure this tells us anything particularly new. Publication bias is a very well studied phenomenon, and we already know that small negative studies are less likely to be published than small positive studies. I suspect most of the “small study bias” just comes down to publication bias.
Yeah — it’s definitely something that people already think happens but this is definitely a new piece of evidence. It’s the first study to show the details of this bias with anything other than binary outcomes. And the funnel plots are really quite a striking way to illustrate the phenomenon too.
Here’s what the authors write about their study and the state of the literature:
There was an interesting study recently about coffee withdrawal:
Coffee Consumption Unrelated to Alertness: Stimulating Effects May Be Illusion, Study Finds
It found that frequent consumers of coffee may feel alerted by coffee, but that this is actually merely the reversal of the fatiguing effects of acute caffeine withdrawal. I wonder whether something similar could be happening with alcohol?
Hey cool. Thanks — I’ll check out that research when I get a chance.
From what you say about the coffee research it seems to make a lot of sense.
I like your blog by the way, westius.
Ah! So cool you brought that up! I feel that is a similar explanation for the smoking habit.
People say it “relaxes them”, or otherwise puts them at ease, though in reality its simply a submission to the habit, or nicotine withdrawal.
I am a smoker so suffice to say, I’ve done my research. The body wasn’t born addicted to nicotine, nicotine was introduced into the body and the body learned. It learned to “whine”.
So basically, smoking a cigarette doesn’t relieve a smoker’s stress, it simply ceases the stressful sensations associated with wanting another cigarette.
As an (ashamedly) experienced alcoholic I recognize many of these ideas as effective “cures” for a hangover though some provide a better response from my own body. It’s important that the terms “cure” and “prevention” be properly defined as this allows for proper disambiguation of the physiological and psychological traumas one speaks out during a hangover.
Prevention: “Too much of anything is bad for you”. This quote is inarguable through its wording. “A lot of money” is different than “too much money” which implicates a problem BECAUSE of excess. Same with booze. Most people who have read this post (and others prior) already knew better and are likely looking for a “cure”.
Cure: The human body is a beautiful machine that is most resplendent when considering its healing properties. Even though our
systems have mended our broken bones, sealed sliced skin and even outmatched cancer, you have to keep time in perspective. Break a leg and you can understand 6 weeks of discomfort. Spend a night out overindulging and your next 8 hours may be the most horrific experience of your life.
We can’t cure hangovers; we treat them:
It’s been argued through previous posts, but many hangover symptoms occur due to an acute form of withdrawal. Why does another drink, or hair of the dog work for so many people? Because it puts you backwards. Closer to the “I feel great!” state you were in when you had the last shot you remember but before the infantile “I feel terrible, why me?” point in the morning. It’s like trying to drive the long way across your state with fumes in your tank and a five dollar bill in your pocket. Put $3 at the first gas station and you’re lucky if you make it to the second station. Either way, you’re going to run out of gas before you reach your destination. You’re simply better off without another nip.
Dehydration?
I believe dehydration is a constant threat and more so to the routine imbiber. Dry mouth? Aching in muscles you don’t even
remember using? Try over exaggerating a smile. Do your lips feel tight? Did you pee when you woke up? How much? What color was it?
Could you smell it distinctively? Sounds gross but I think these are sentiments most people can appreciate at some point in their lives. So we have to rehydrate, right?
Rehydration?
Rehydrating after a hangover isn’t about gulping down as much water as possible in the quicket fashion. For starters, our
stomaches’ have a certain rate of clearance and the rest of our system has a certain rate of absorbtion. The “drink to you pee clear” idea isn’t very substantial because you can drink a lot very quickly and it will be eliminated from your body in the same fashion. 8 ounces/30 minutes is what I feel is reasonable but not all drinks are the same.
Electrolytes!
One of the most critical elements of hangover treatments involves the reuptake of electrolytes. Consuming large amounts of water when you’re hungover isn’t simply inefficient but can be counterproductive: You’re encouraging the escretion of products already in great demand. Sodium. potassium and magnesium are important electrolytes and are found it most sport drinks. Personally, I mix 1 part gatorade with 4 parts water. The excessive sodium and caloric (sugar) content of regular gatorade is absurd.
Foooooood!
You can’t NOT eat. If you CAN’T eat (because you’re hungover) don’t expect to feel much better. You just spent the evening pissing out most of the vitamins and minerals your body holds dearly!
*DISCLAIMER
I’m not a doctor though I’ve done a good amount of “active” research. Nothing anyone else with half a brain (and twice the liver) could do equally and or oppositely. :)
I just thought this would be interesting, is what Alcohol Edu tells students about hangovers.
Causes of a Hangover
After a night of drinking, a person might experience what we call a hangover. With a hangover, a person usually suffers from nausea, fatigue, headaches, extreme thirst, and a sensitivity to light and loud sounds. Having a hangover can make paying attention in a morning class difficult and pretty unproductive.
One of the key causes of a hangover is dehydration, which is the source of a person’s headache. Drinking alcohol alters activity in a brain region called the hypothalamus and causes the body to get rid of more water than it should. Dehydration can also cause a person’s brain to slightly shrink away from its skull—which can cause a person to have a nasty headache.
Another cause of a hangover has to do with the breakdown of alcohol by the liver. When alcohol is metabolized, a toxin called acetaldehyde is produced. This toxin is responsible for a person feeling just plain old sick after drinking.
Dealing with a Hangover
Unfortunately, there isn’t a whole lot you can do to cure a hangover. Drinking water will help with the dehydration, but really all you can do is wait it out. Contrary to what you may have heard, drinking more alcohol won’t cure your hangover, but it will just make you all the more sick!
I believe the atheists MUST be **investigated** because of their METHODS to **target and attack** medical journals.
“One of the blogs that brought the paper to notice was This Scientific Life, by Bob O’Hara.”
“Blag Hag: A large list of awesome female atheists
-5:24am 3 Jan 2010 … Bob O’Hara said… Grrlscientist is also an atheist and blogger. I think she’s awesome. But then I did marry her, so I might be biased.”
” Kam L.E. Hon from the Department of Paediatrics at the Chinese University of Hong Kong, was astonished” the article had produced such a negative response since it was only intended for thought provocation.”
“He said he would never to write this kind of article again.”
THAT smacks of cyberbullying.
In Scientific circles that is unlawful.
Imho.
Drug companies like Roche produce treatments that save lives. But they don’t do so because they save lives. Rather, they produce the drugs because they can make the company money.
This is a direct result of adopting a belief system that says the desire to make money will solve all of humanity’s problems. That is, the Friedman-esque idea that an unregulated free market will always self-correct, always police itself, and always deliver the highest possible results for society.
We are so blindly devoted to that belief that we fail to see the obvious problems it causes. Markets can get hijacked by those who can control them (megacorporations), the mandate for corporations to produce the products as cheaply as possible and sell them for the highest possible price, price-fixing, and human corruption all can pervert markets. Add in the fact that a lot of money can be made off human suffering, war, and disasters, and you have a recipe for a market controlled by huge megacorporations that is based on exploiting the suffering of humanity.
It wasn’t supposed to work out that way. It was supposed to provide us a gleaming future where everybody had good jobs, and access to the best hearlth care and technological conveniences science could offer. At least that’s what the Friedman people promised us.
If you want someone to find an economical way to help others, you don’t simultaneously charge them with a mandate to make as much money as possible with any proposed solutions they may deliver. Yet that’s exactly the double-sided agenda we give Big Pharma.
Gee, how many masters’ degrees in economics does it take to figure that out?
More than most of our top economic advisors to the President have, apparently.
I’m not sure what I said that is a direct result of that belief system… But otherwise I agree. There are lots of things that markets will not deliver, and cheap effective drugs is one of them.
“It was supposed to provide us a gleaming future where everybody had good jobs, and access to the best hearlth care and technological conveniences science could offer.”
You’re telling me this doesn’t describe the US?? At least before the last economic downturn when unemployment began to skyrocket…
I’m not sure where you have been getting your history, but the battle between democracy/capitalism and collectivism/socialism/statism pretty much dominated the twentieth century. And I thought it was pretty obvious that democracy/capitalism came out on top by a wide margin. Whereever those two concepts have been put into practice, people have flourished. On the opposite end of the spectrum, you get things like East Berlin, North Korea, or Iran.
Additionally, the unregulated free market you describe just doesn’t exist in reality. You attempt to knock down a huge straw man, but then fail to do that very well. Under the system you describe, how on earth does a place like Wal-Mart exist? Because it’s obviously their goal to charge the absolute highest prices on the planet for everything they sell…
Last point – have you ever met anyone in the medical or pharma community? They’re people, just like you and me. If they had a drug that would cure cancer, but wouldn’t make their company a single penny, absolutely they would bring it to market in a heartbeat. Anyone would except, perhaps, straw men of your own invention.
Can anyone name one treatment or drug that is effective at treating, well, anything that hasn’t been made publicly available because it wouldn’t make a drug company money? Start with concrete examples first, drop the straw men, and maybe I’ll start to listen to your argument.
Hi Tom.
I’m not arguing for socialism (not here anyway!) but a few things you say are not quite right.
Of course it doesn’t. The US has one of the worst health care systems in the western world. Hopefully it will start to improve now, but it has nothing on most of Europe, Australia or Cuba. Millions of people do not have access to, what you describe as, the best health care technological conveniences.
The market that wallmart operates in is very different to the international pharmaceutical market. It’s not really even worth outlining the many differences since there’s almost nothing they have in common. As you say, “free markets” rarely exist and while the one that wallmart operates in is, in some ways, a free market, the pharma market is not.
Yeah, I deal with pharma everyday. Of course they are mostly great. But no company will pursue a strategy that will not make them money. Developing drugs costs a hell of a lot of money and it’s a simple fact that they will not develop a drug that is unlikely to make them any money.
What this post was about was not about pharma not bringing drugs to market because they’re not profitable, but not developing them in the first place. So it’s a bit hard to point to drugs that haven’t been developed. However, the issue raised in this post is as close as it gets: no pharmaceutical company is going to fund trials of combinations of existing drugs because they can’t make a profit on that. It just doesn’t happen. Instead, there’s lots of trials of combination therapies of new, expensive drugs. This is not just the opinion of this blogger or the above commenter, but the opinion of the expert writing in the Lancet.
There are, however, plenty of cases of drugs that were initially not distributed because of lack of profit possibilities. The first antidepressants in the 50s is one case. Not until the definition of depression changed so that the drug had a bigger market, did pharma decide to market them. Aids drugs is another classic case. There are drugs that essentially let people with HIV live out a full, normal life. And they could be marketed to people in Africa if it weren’t for the requirement for pharma to make as much profit as possible.
Michael,
I appreciate your reply. I was directing my comments about free markets more to yogi-one, but you bring up some interesting points that I respectfully disagree with. Let me make my criticism a bit more clear.
Let’s assume your premise for a moment. If there are indeed treatments out there waiting to be tested if someone would only spend the money, would there not be scores of medical journal articles, op-ed pieces, or TV interviews given by doctors or researchers bemoaning this fact? The Lancet is making the point that we don’t know what we don’t know, and we don’t know it because pharma is out for profit. I would argue that if this were indeed true, we’d know a little more about what we don’t know and we’d be having a different conversation.
Big pharma makes money. They have to because, as you’ve stated, it costs a lot of money to develop and get drugs approved. But there are other options when it comes to something like, say, the AIDS drugs you mentioned.
For starters, I disagree with your premise that drug companies didn’t market those drugs to Africa because they are ‘required’ to make as much money as possible. Obviously, if something like that is going to put the future of the company at risk they’re not going to do it (why would/should they?), but the rest of the world in the case of Africa wasn’t much help. International aid organizations or other governments could have funded the drugs on a massive scale, but they didn’t. Hell, African countries could have funded the drugs but they didn’t. And as it is almost exclusively a sexually transmitted disease, Africans could have stopped it, but for the most part they didn’t. And this is an argument after the fact, but how did Africa as a whole get into their predicament in the first place? Because of the lack of democracy and capitalism.
The trials you and the Lancet argue may be needed can be done, but its incorrect to blame pharmaceutical companies for not doing them. Governments fund all sorts of research (ask someone working on Global Warming, for example) so if there was political will, there would be a way. Don’t make drug companies the target. They are for-profit businesses, and that’s a good thing. I would argue that medical treatments would not be as advanced as they are right now were it not for companies that make a profit.
On the other side of that coin, I disagree with your assertion that pharmaceutical companies don’t have an altruistic bone in their collective bodies. They are mainly led by doctors, all of whom (I would assume) have taken the hippocratic oath and would jump at the chance to cure X and be able to say their company did it. And I have no doubt they’d come up with a way to monetize it, somehow.
Finally, you said that you weren’t arguing for socialism, but once you start demonizing companies for making a profit, you’re well down the path. Someone once said that communism (which I’ll equate to socialism here for our purposes) is real good at making everyone equal….equally poor. Same thing applies to medicine – I continue to read horror stories from the UK and Canada about their socialized medical programs.
The UK is beginning to free theirs up as a result. If you want decisions about how to treat an illness or fund a drug trial taken out of the hands of for-profit companies, then you almost by necessity put them in the hands of politicians. Politicians, in the US at least, have given us things like the Post Office and the Department of Motor Vehicles. I don’t want them in charge of my medical treatment.
I sympathize with your sentiment. It would be nice if doctors weren’t worried about money. World peace and an end to oppression and slavery and prostitution would be nice, too. But we’re talking about reality here, not utopia, which means there are going to be trade-offs and hard choices. Going back to my earlier point, at a public policy level striving for utopia gets us things like North Korea and, I’m afraid, Cuba.
To summarize – you may have a point (I won’t yet concede that you do), but if you do it’s certainly not the fault of the pharmaceutical companies, nor is it their job to correct it.
Hi Tom,
I’m not sure what there is to disagree with regarding the claim about what Pharma chooses to pursue. There are announcements made everyday about what pharma is deciding to invest in and what they aren’t and nobody tries to hide the fact that these decisions are made based on where the most profit to be had is.
Saying that, is not demonising pharma. (There are other reasons to demonise pharma. See: avandia and vioxx.) It’s merely pointing out that if we rely on two things: randomised trials, and pharma funding them, then we won’t find out about treatments that are not profitable.
And one example of this kind of treatment was given in the Lancet article: combination therapies made up of cheap, existing drugs.
I agree with you that we wouldn’t have lots of the great treatments that we have today, were it not for pharma. But I think you also seem to agree with me that if we want things developed that aren’t profitable, then we need to either find new ways to develop them, or new ways to fund their development.
You say that you’re worried about the decisions that government would make if they were developing drugs. But that is not warranted since all the decisions about the implementation, the sale — everything — of drugs is made by the government (the FDA in the US, the TGA in Australia etc.)
So I’m not so much arguing for revolution, as for people to come up with ways of making sure that we get treatments that won’t necessarily make money for pharma.
Michael,
I think we have found common ground, but it also seems that ground is a far cry from the rather paranoid comment from yogi-one, which you said you mostly agreed with.
And unless I’m mistaken, the FDA in the US only certifies the efficacy and safety of a drug that a company wishes to sell. I’m not an expert, but if they already control “everything” about drugs then that is news to me.
One final thing – something I haven’t articulated well in the last two comments – if there is a demand for something, anything, then it will be profitable for someone. With the exception of the air we breathe, I can’t think of another commodity that someone isn’t making a profit on somewhere. You and The Lancet is say there’s a possibility that there may be combinations of existing, low cost drugs to treat some sort of ailment. My point is, were there science-based medical evidence pointing to a treatment of that type, someone (maybe not a drug company) would have found a way to test it, package it, and make a profit from it. People make a profit selling homeopathy and acupuncture for God’s sake, and there is a booming market in generic drugs.
So I think we still have a little disagreement, but you’re right that there are many points upon which to agree.
Hi Tom — glad we agree on a lot. But there’s one fundamental thing I think you’re quite mistaken about.
You have a faith in markets that not even Adam Smith would have had.
That’s just not true. Let’s just take a made up example to simplify matters. Let’s suppose that lots of people would like product X. Now, imagine that there are 1million people in the US willing to pay $5 for an X. But now suppose that developing X into something you can package and sell costs 5 million dollars. It is therefore not profitable for anyone to try to take X to market.
This is exactly the case with combination therapies of existing drugs. You cannot take a therapy to market unless you have the evidence showing a benefit. But gathering that evidence might cost half a billion dollars. For existing drugs for which there are many generics, the company that produces that evidence is not going to make their money back.
You could imagine lots of markets for which there is demand, but it would be crazy to try to bring the product to market because the costs will not be recouped through profits. I don’t know, I’m just making things up but imagine moon rocks. I’m sure there’s a market for rocks taken from the moon but nobody will pay enough for them to cover the costs of them being collected. Luckily, moon rocks are not important. But good combinations of current drugs could save a lot of lives — they just won’t be able to make a profit for the company that proves that.
Just one further rejoinder: This fact is so well accepted that its the basis of allowing patents on new products. The problem is that combinations of old products cannot be patented — and so nothing can ensure profits will be made.
Michael – you’re correct that I do have faith in the free market system, although I couldn’t quantify whether I have more or less than Adam Smith.
One obvious thing you may be overlooking is that demand for medical X (services, drugs, etc.) is fairly inelastic. Gasoline is another example of this – it is a product which is necessary (right now) for many things in our daily lives. As a result, we’re willing to pay a relatively high price per gallon for it before we change our behavior to consume less of it. If combinations of existing drugs were shown to cure/alleviate/supress X better than anything else on the market, then those 1 million people would almost certainly pay $6 (or more) instead of $5.
Smarter and more experienced people than I would have to do a cost/benefit analysis, of course, but again given the fact that any number of bogus and completely ineffective treatments are currently sold for a profit I feel certain that someone would be willing to try. Which brings up another benefit of free markets – people are always willing to try new things…and fail spectacularly. These are almost always smaller or upstart companies – a big, established company has too much to lose.
And again – all of this assumes that the unknown unknowns described in the Lancet article actually exist, something I have trouble believing.
As for patents – Bayer still markets and sells branded aspirin even though the patent for it has long since expired and cheaper generic brands flood the market (and I’m not even sure who held the original patent). You do have a point that the start-up costs for an endeavor like the one we are debating could be high, but in a free market that values and encourages entrepreneurs I do have faith that someone would take the plunge. And if not, or if there is the political will to speed matters up a bit, government can always incentivize the behaviour through tax breaks or straight subsidies.
Tom — asprin is not a counterexample. To market asprin, you do not have to undertake an enormous randomised controlled trial. Of course there is a market in generic drugs. But the whole reason why you can have patents on new drugs is so that people can recoup the costs required to develope them. The problem is that similar costs are involved with combining old drugs, but no patents are possible. There’s really nothing to disagree with here — not even the drug companies would disagree with this. In fact, I bet that if they were engaged in this debate, they would argue for expansion of the patent system.
Michael – fully stipulated. My point in bringing up aspirin was to say only that companies will produce and market – and people will pay higher prices for – a branded product functionally identical to a cheaper generic version. By extension, they should be willing to pay higher prices for any potential new combinations of drugs like the ones we’re discussing (and in the hypothetical example you used, would cost $5). Looking back at my comment now I wasn’t being very clear.
Another thought occurs to me, however, a question for which I don’t know the answer. What is the primary driver of cost in drug R&D? If it is the trials themselves then I think we both have valid points and are debating around the margins. If the primary driver of costs is the research and design of the drug itself and not the trials, then costs in the model we are discussing should be significantly lower as the drugs we’re talking about have already been discovered. As I said, I don’t know the answer, and as I’ve been out of my depth for the better part of our discussion I won’t speculate further.
Yeah — that’s right. The issue here is about the trials. The question of which is more expensive depends a lot on the drug.
The fact that people will pay more for the combination drugs if forced to is irrelevant because there are other companies that can undercut the company that payed for the trials. I can wait for you to do the trial, and then sell the drug at cut-price myself.
If Verlinde’s theory is correct, then of course gravity does not exist.
HI Joe. Why do you think so?
That’s Dara O’Brian – as well as being a comedian, he has a degree in theoretical physics.
I’m glad someone was willing to finally clear things up on this. I have contemplated it many times before. :)
What a fantastic blog.
Would you be interested in posting this article on http://www.yopinion.com.au?
It’s a new online forum for social and political commentary, run by a bunch of uni students from Sydney. Our new article for next week will be on marijuana and the arguments surrounding whether or not it should be legalised.
Thanks!
Henry,
for Yopinion