Quotulatiousness

September 1, 2016

Don’t blame the market for the EpiPen price hike – blame the FDA

Filed under: Bureaucracy, Government, Health, USA — Tags: , , , — Nicholas @ 03:00

Scott Alexander explains why “the market” has very little to do with the outrageous price hike for EpiPens:

EpiPens, useful medical devices which reverse potentially fatal allergic reactions, have recently quadrupled in price, putting pressure on allergy sufferers and those who care for them. Vox writes that this “tells us a lot about what’s wrong with American health care” – namely that we don’t regulate it enough:

    The story of Mylan’s giant EpiPen price increase is, more fundamentally, a story about America’s unique drug pricing policies. We are the only developed nation that lets drugmakers set their own prices, maximizing profits the same way sellers of chairs, mugs, shoes, or any other manufactured goods would.

Let me ask Vox a question: when was the last time that America’s chair industry hiked the price of chairs 400% and suddenly nobody in the country could afford to sit down? When was the last time that the mug industry decided to charge $300 per cup, and everyone had to drink coffee straight from the pot or face bankruptcy? When was the last time greedy shoe executives forced most Americans to go barefoot? And why do you think that is?

The problem with the pharmaceutical industry isn’t that they’re unregulated just like chairs and mugs. The problem with the pharmaceutical industry is that they’re part of a highly-regulated cronyist system that works completely differently from chairs and mugs.

If a chair company decided to charge $300 for their chairs, somebody else would set up a woodshop, sell their chairs for $250, and make a killing – and so on until chairs cost normal-chair-prices again. When Mylan decided to sell EpiPens for $300, in any normal system somebody would have made their own EpiPens and sold them for less. It wouldn’t have been hard. Its active ingredient, epinephrine, is off-patent, was being synthesized as early as 1906, and costs about ten cents per EpiPen-load.

Why don’t they? They keep trying, and the FDA keeps refusing to approve them for human use. For example, in 2009, a group called Teva Pharmaceuticals announced a plan to sell their own EpiPens in the US. The makers of the original EpiPen sued them, saying that they had patented the idea epinephrine-injecting devices. Teva successfully fended off the challenge and brought its product to the FDA, which rejected it because of “certain major deficiencies”. As far as I know, nobody has ever publicly said what the problem was – we can only hope they at least told Teva.

[…]

Imagine that the government creates the Furniture and Desk Association, an agency which declares that only IKEA is allowed to sell chairs. IKEA responds by charging $300 per chair. Other companies try to sell stools or sofas, but get bogged down for years in litigation over whether these technically count as “chairs”. When a few of them win their court cases, the FDA shoots them down anyway for vague reasons it refuses to share, or because they haven’t done studies showing that their chairs will not break, or because the studies that showed their chairs will not break didn’t include a high enough number of morbidly obese people so we can’t be sure they won’t break. Finally, Target spends tens of millions of dollars on lawyers and gets the okay to compete with IKEA, but people can only get Target chairs if they have a note signed by a professional interior designer saying that their room needs a “comfort-producing seating implement” and which absolutely definitely does not mention “chairs” anywhere, because otherwise a child who was used to sitting on IKEA chairs might sit down on a Target chair the wrong way, get confused, fall off, and break her head.

(You’re going to say this is an unfair comparison because drugs are potentially dangerous and chairs aren’t – but 50 people die each year from falling off chairs in Britain alone and as far as I know nobody has ever died from an EpiPen malfunction.)

Imagine that this whole system is going on at the same time that IKEA spends millions of dollars lobbying senators about chair-related issues, and that these same senators vote down a bill preventing IKEA from paying off other companies to stay out of the chair industry. Also, suppose that a bunch of people are dying each year of exhaustion from having to stand up all the time because chairs are too expensive unless you’ve got really good furniture insurance, which is totally a thing and which everybody is legally required to have.

And now imagine that a news site responds with an article saying the government doesn’t regulate chairs enough.

If David Warren was the editor of Sports Illustrated

Filed under: Media, Politics, Religion — Tags: , , — Nicholas @ 02:00

… he’d have a brief but glorious career of getting the magazine a lot of media attention:

It is well that I am not the editor of Sports Illustrated; for were I so, I might commission a special burqini swimwear issue, just to provoke … everybody. All my lithe supermodels would be wearing burqini and veilkini variants, some with Marianne liberty caps and so forth. In the shoots, I would have them all posed on beaches surrounded by French policemen in their various uniforms, striking extravagant dance poses. There’d be a dwarf traffic cop in the traditional Paris “aubergine” raincoat, who’d turn up in set after set, blowing on a whistle. Perhaps one model in a wetsuit, with oxygen tanks, made to resemble a suicide vest; and other subtle topical allusions. In the background there’d be men and women in Edwardian beach attire, of extreme modesty, expressing shock. An old bathing machine would be lying on its side, with a sea turtle crawling out, mounted by an avatar of Vishnu, to extend the multicultural range.

Of course, I wouldn’t last long at “SI” — the only question, whether I’d be fired or assassinated first. But in the interim I might have the pleasure of being denounced by world leaders, and getting the company account banned by Twitter, Facebook, Instagram, &c. With luck, an outrageously goading defence, and the help of Drudge and Breitbart, I might be able to stretch my fifteen minutes of infamy to twenty or twenty-five.

QotD: People being post-things

Filed under: Humour, Quotations, Religion — Tags: , , — Nicholas @ 01:00

I recently heard someone describe themselves as “post-Zionist”, then go on to give what sounded like pretty standard criticism of Zionism. I don’t want to get too heavily into this particular example, because I understand post-Zionism is complex and every time I write something about Israel I get Israeli commenters saying I’ve gotten it wrong and other Israeli commenters saying no they’ve gotten it wrong and still other Israeli commenters saying we’ve all got it wrong. What was that saying about “two Jews, three opinions” again?

But what bothers me about post-Zionism is that it seems to carry this kind of smug “Oh, you guys are still Zionist? Don’t you know Zionism is, like, totally five years ago? Nowadays all the cool people have moved on to more exciting things,” which I don’t think really adds to the argument. Zionism versus anti-Zionism suggests a picture of two sides with two different opinions – which seems to match the reality pretty well. Zionism versus post-Zionism suggests one side just hasn’t gotten the message yet.

I feel the same way about post-rationalism. Yes, maybe you’ve seen through rationalism in some profound way and transcended it. Or maybe you just don’t get it. This is exactly the point under debate, and naming yourselves “post-rationalists” seems like an attempt to short-circuit it, not to mention leaving everyone else confused. And maybe you could give yourself a name that actually reflected your beliefs (“Kind Of New-Age-y People Who Are Better At Math Than Usual For That Demographic And Will Angrily Deny Being New-Age-y If Asked Directly”?) and we wouldn’t have to have a new “but what is post-rationalism?!?!” conversation every month.

Post-modernism can stay, though. At this point it’s less of a name than a warning label.

Scott Alexander, “These Are A Few (More) Of My (Least) Favourite Things”, Slate Star Codex, 2015-01-21.

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