mahiwaga

So I had this weird dream that I was at work. But instead of my usual office, it looked like the Whitefeather law firm from “Crazy Ex-Girlfriend” and it was a combination internal medicine-pediatrics clinic and dental office.

The clinic abutted a very tall mountain range.

And after closing at 5 p.m., they set up a fight club in one of the conference rooms. It was run by East Asian women and the opponents fought in their white-collar work clothes.

And because it was—inadvertently—my first time there, I had to fight.

I was worried that I would get home really late and ﾐA彡 would worry about me.

But the East Asian women running the fight club wouldn’t let me leave and would throw me back into the makeshift arena, where I was fighting a five foot tall East Asian guy wearing a black long-sleeve button shirt and black slacks, and he was totally kicking my ass.

According to this meme going around Facebook, the average hip replacement in the U.S. costs $40,364 while in Spain it costs $7,371

Now, I’m not sure where these stats come from, but this NY Times article quotes $13,660 for a hip replacement in Belgium vs. $65,000 not including surgeon’s fees in the U.S.

Of course, >$65,000 is probably just what the hospital and the surgeon bills your insurance. What the insurance company actually pays is going to be far less than that. But if you add up your premiums, copays, and coinsurance, it’s still possible that it will be more than $13,660 out-of-pocket even if you have good insurance.

And as far as living expenses in Spain are concerned, this site estimates that it would cost $8,570.28 for a single person to live in Madrid.

Despite the passage of the ACA and despite reams and reams of analysis papers, the task of containing costs still seems wildly out of reach.

One of the frequently criticized sectors is the pharmaceutical industry.

It’s a well known meme that U.S. pharma makes vast profits compared to pharma companies in the rest of the world. (This is not strictly true, as most large pharma companies are actually multinational corporations.)

Many argue that since it’s so expensive to fund research and development, and new drugs can save a lot of lives, pharmaceutical companies should have a right to charge whatever they need to in order to at least break even or make a modest profit.

But many sources suggest that the idea that R&D costs are what are hobbling innovation may just be a myth.

Medications that make the biggest impacts tend to be the ones that make the least profit. U.S. pharma companies have all but abandoned antibiotics because the time for bacteria to develop resistance is too short for them to make any profits. And yet antibiotics have major impacts on morbidity and mortality.

Drug design is unfortunately a lot like roulette. One success will make shareholders exceedingly wealthy but one failure can utterly bankrupt all but the biggest pharma company and there’s no real way to tell what’s going to work and what’s not without doing the trials. So to make money, a lot of pharma companies just make tweaks to existing meds in order to extend patents, even if the benefits are marginal or essentially nil.

If anything, the broken way patents work in this country contribute to how expensive meds are.

(crossposted on Facebook)

Pharmaceutical research and development: what do we get for all that money? • 2012 Aug 7 • Donald W Light and Joel R Lexchin • BMJ

Data indicate that the widely touted ‘innovation crisis’ in pharmaceuticals is a myth. The real innovation crisis, say Donald Light and Joel Lexchin, stems from current incentives that reward companies for developing large numbers of new drugs with few clinical advantages over existing ones.

Explaining Research – Drug Company Expenditures Part 1 • 2009 Oct 25 • Aaron Carroll • The Incidental Economist

So it’s a little disingenuous to claim that Americans must continue to spend so much to fund R&D when you could make cuts to either profits (which are big) or to marketing and administration (which is gargantuan). R&D just isn’t that big a piece of the pie. There’s plenty of fat to trim in there before research and development.

This picture of a wolf pack walking single file through the snow has been making the rounds on Facebook lately.

The caption reads:

A wolf pack: the first 3 are the old or sick, they give the pace to the entire pack. If it was the other way round, they would be left behind, losing contact with the pack. In case of an ambush they would be sacrificed. Then come 5 strong ones, the front line. In the center are the rest of the pack members, then the 5 strongest following. Last is alone, the alpha. He controls everything from the rear. In that position he can see everything, decide the direction. He sees all of the pack. The pack moves according to the elders pace and help each other, watch each other.

Snopes debunks this notion and quotes the actual caption:

A massive pack of 25 timberwolves hunting bison on the Arctic circle in northern Canada. In mid-winter in Wood Buffalo National Park temperatures hover around -40°C. The wolf pack, led by the alpha female, travel single-file through the deep snow to save energy. The size of the pack is a sign of how rich their prey base is during winter when the bison are more restricted by poor feeding and deep snow. The wolf packs in this National Park are the only wolves in the world that specialize in hunting bison ten times their size. They have grown to be the largest and most powerful wolves on earth.

The idea of the “alpha” itself is problematic.

See also: Why everything you know about wolf packs is wrong • 2013 May 12 • Lauren Davis • io9