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March 26, 2014

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We seem to have take the torture thread comments down the open thread path. I suppose it will take a while for us all to relocate....

splendid.

the microscope, that is, not the torture thread threadjack.

thanks for sharing this, LJ.

Making diagnostics and treatments cheap and robust is a major focus in the biomed community right now.

I went to a talk by another researcher from Stanford, they are really doing a lot of very good stuff there. At the time, the microscope was just a footnote, but you could tell the guy was excited about it.

One of the really cool examples they gave in the talk was they identified a problem in india: Leg braces were expensive, so expensive that ambulances were taking the braces back when they dropped an injured person off at the hospital.

That was a problem because broken bones were unstable while they were transferred from the curb to their bed.

Having identified the problem, they developed a cheap, disposable paper leg splint. Ambulance companies don't mind using and losing them (they cost like 75 cents or something, I don't remember exactly). And the patients have better recovery because the leg is stabilized the entire time.

As a sidenote, much of this program is structured around spinning off startups and turning a profit in the field of low-cost medicine. Self-sustaining and not charity.

There are some more examples here:

http://biodesign.stanford.edu/bdn/india/news.jsp

Anyway, I think it's a really exciting time to be in biomed research. Medicine is going to change dramatically over the next few decades.

Biomed, and biotech generally, feel like they are today about where personal computers were in the mid-80s. You can see that it is going to grow explosively. And anyone who says he knows how and in what directions it is going to grow is crazy. (If he can do that, he's already made billions forecasting, and retired long since to a tropical island somewhere.)

And anyone who says he knows how and in what directions it is going to grow is crazy.

Well, not specifically. But I think medicine and medical devices will get cheaper, more personalized, and more ubiquitous.

Just like it did with computers.

3D printed skull implant:

http://www.wired.co.uk/news/archive/2014-03/26/3d-printed-skull

That far, I'm with you. I was thinking more of every company, pretty much regardless of size, having a web page -- because otherwise their potential customers will never hear of them. Or kids routinely having a tablet computer (more powerful than most mainframe computers in the mid-80s) . . . in grammer school. Let alone predicting the next Google.

wj:

Oh, absolutely. That's what's so exciting about it.

I'd have to say that we are exceptionally lucky** to be alive when two such enormous bursts of innovation are coming thru. Just loving it! And wondering what the burst after biotech will be -- say around 2040?


** Of course, those who are allergic to change would say that it's BAD luck. It's a hard time for folks who want the world to have frozen in place the way it was when they were 20.

I tend to ask myself, if I'd be better off being 10 years older or 10 years younger (being born in 1973). On the one hand I see the concrete progress like the way that dentists have lost most of the horror they held when I was a kid (full blown dental surgery now being less unpleasant than a simple filling a few decades ago), on the other I am deeply pessimistic about the future in social terms. I am not even thinking of climate change but the rise of neofeudalism and the systematic destruction of the social contract. as it looks to me, we will not lift the 3rd world population to our own level of comfort but we ('we' as in 'the not super rich') will get pushed down further towards them and if there is a revolution it will just accelerate the process. In other words I believe in 'peak comfort' and think that our best times are either already past or we are very close to the peak and will witness the decline in our own lifetime.

I don't think libertarians, as much as we may object to the way things are at the moment, are anywhere near that pessimistic. Most of us are cautiously optimism. At lease, I am.

I'm certainly optimistic. In my childhood, a case of strep throat would have killed me but for antibiotics, in my 30's I broke my leg, and would have lost the foot to the medical technology of a couple decades before. In 2010 I was diagnosed with a cancer that would have been a death sentence a decade earlier, but had a 95% cure rate when I got it.

So far I'm catching the medical progress as I need it, and hoping that continues.

To revisit an old conversation, pending appeal student-athletes are actually athlete-students. Well, the ones getting scholarships, anyway.

Charles:

I would also say I am optimistic about the future. I don't know if that is a general trend with 'libertarians' or not.

Although I suppose having some level of faith in humanity is required to think people can in many cases sort themselves without government intervention.

Libertarian or not, I don't understand the dim view of the future.

Nationally, SSM is a great example of positive (imho, anyway) social change being affected at a rate that would be considered impossible a few years ago.

Internationally, I think the Arab Spring was a good thing, even if it is still in progress and didn't result in an immediate utopia in the middle east. But I think progress has been made and the future will be brighter for it.

I'm sure there are other examples, but those are what come to mind.

I would say if things stayed the way they are in my part of the woods I'd be quite happy. I am aware that my high level of comfort is based on the misery of others less comfortable. I like to compare it to the process of Ostwald ripening with still enough small particles to lend seeming stability to medium sized ones (to which I belong). But what I see is an increasing pressure to destroy that pseudoequilibrium through shift of the critical diameter and increase of the 'natural' redistribution. To finally overstretch the analogy, someone is pouring cosurfcatant from a bottle labeled 'libertarianism' into the mixture while lying about the chain length. short term effect: the ripening process accelerates; long term result: the solution collapses. The Someone hopes that the latter will not happen before the former process is completed. And I am inclined to say 'please pass me the acetone'.

As I have said above, I appreciate the huge progress in medicine and other fields and my own comfort is vastly increased by it. But I see that increasingly the fruits of this progress become unavailable to those lower than me on the social scale due to pricing and wage depression. Sooner or later that process will reach me (I already see more and more dentistry removed from the basic health insurance menu). Two class medicine is on the doorstep even around here and what use are the wonders of medical invention to those who cannot afford them any longer and even begin to lose what they yesterday still had? It's two forces working in opposite direction and imo the downward one is going to win for the majority.

NV, I think things would get far better if the NCAA required that universities NOT admit any athletes except on the same criteria as other students. That is, you have to get in just like anyone else. Then, and only then, can you even be considered for an athletic scholarship.

And I would probably exclude whatever lower standards apply to children of alumni or whatever other oddities a particular university has. You've gotta get in on scholastic merit before you get to play.

Of course, the universities make so much money off of athletics (specifically football and basketball) that they would fight it tooth and nail. But I suspect that most of them would find that they were doing just as well if not better, with the playing field leveled that way.

And I thought I was prone to obscure analogies.

As I see it, we are in a race between the expanding capabilities of technology to improve our lives, and the expanding parasitic load of government and the crony capitalism it entails. At present most of the increased welfare technology produces is being diverted to a small segment of the population, not as a natural consequence of economics, but as a deliberate government policy.

For the same reason a dairy prefers a cow to a quarter million mice, the government prefers a wealthy person to a thousand prosperous people; It lowers the overhead in terms of wealth extraction. Additionally, the poor people produced are easy to render grateful with handouts, while moderately prosperous people can't be bought off cost effectively.

So the government optimizes both it's financial and power take, and the votes that keep it in a position to do so in a democracy, by increasing inequality of wealth.

But, all the while, the level of technology IS rising, and a lot of it has major disruptive potential. 3d printing, for instance, has the potential to move a lot of manufacturing into the home. Cheap powerful sensors coupled with software can do a lot of the work of doctors. There are people laboring to do to biology what has been done with PCs and printers, enable hobbyists to do what professionals can't do today.

The Empire is striking back, for instance the attack on 23andme. But I think in the end the insurgents might win, with biology being as amenable to small scale work as wood and metal working are today.

Who knows, by the time my body is really falling apart, maybe I can get a new one printed?

But I see that increasingly the fruits of this progress become unavailable to those lower than me on the social scale due to pricing and wage depression.

Yes and no. I see some dips locally, especially with the effects of the recession. Income inequality is a problem (although I doubt we see the same solution).

But globally?

There is a huge drive to make medicine and tech cheaper, more robust, and more accessible to the large swathes of the population. And that gives me hope.

I worked with my local Engineers Without Borders chapter for awhile and I still keep up with their progress. They go into areas that have nothing and leave them with sanitation and clean water. That reduces sickness, which in turn increases productivity, which in turn reduces poverty, which in turn...etc etc

The world is getting to be a better place, IMHO. Not every single aspect is trending positive every moment, but enough are that overall I think it is getting better.

Maybe I just have rose-colored glasses on, I don't know. Time will tell.

And I would probably exclude whatever lower standards apply to children of alumni

I think the primary difference between the child of an alumnus and some other applicant is that an application from the former will get a "real" review during the admissions process; not generally lower standards.

thompson, I hope you are right. I just doubt it, longterm.

Technology keeps finding new resources and making more efficient use of current ones. Less than ten years ago, I was still reminding myself to lift with my legs, not my back, when moving a 21" computer monitor. Now I can lift one with a finger and thumb.

@Hartmut: I see that increasingly the fruits of this progress become unavailable to those lower than me on the social scale due to pricing and wage depression.

What I see is that new advances are extremely expensive. But over time, the price comes down, and they become more affordable for everybody. Things are more expensive in the US than anywhere else, but even here, the prices eventually come down. Not down to the levels you see in Europe, but down nonetheless.

Brett: As I see it, we are in a race between the expanding capabilities of technology to improve our lives, and the expanding parasitic load of government and the crony capitalism it entails.

Would it be rude to point out that the basic research on which these technological advances are based (both biotech and computer tech) were mostly the result of government-funded basic research? Although admittedly the "conservatives" in Congress are increasingly succeeding in cutting that part of the budget. Even though they show much less inclination to cut things like subsidies for agriculture, hedge funds, etc.

Costs go down but do prices necessarily too? At least as far as advanced pharmaceuticals go the disparity grows in many cases. Rather recently a drug company bigwig made the mistake of speaking honestly uttering something along the line of 'we develop for rich people in the West not 3rd world natives' iirc in the context of a drug his company has a monopoly on that can be produced rather cheaply but is sold for an obscenely high price (and the guy did not bring up the valid argument that the development was risky and expensive leading to the need to recoup the costs before the patent runs out).
He who controls the process will coldly calculate how much can be squeezed out of the customers and set the prices accordingly. They'd do the same with oxygen, if they could get hold of the supply. At least in the West the state is reluctant to meddle there (in most cases with good reason) but we have seen a few cases where the state was in cahoots with the companies (cf. shakedowns of US seniors at the Canadian border that were suspected of buying their prescription drugs there at a third of the US price).

Hartmut:

thompson, I hope you are right. I just doubt it, longterm.

I hope so too. Nobody has a crystal ball.

wj:

But over time, the price comes down, and they become more affordable for everybody.

Exactly. Look at cell phones, or the internet.

At least as far as advanced pharmaceuticals go the disparity grows in many cases.

In some cases. But that only lasts as long as the patent (not that there aren't some problems with patent law). And, as you mention, there is substantial cost and risk associated with the development and testing of a drug.

made the mistake of speaking honestly uttering something along the line of 'we develop for rich people in the West not 3rd world natives'

I'd agree companies should have a conscience and should look to better society overall. In my experience working with pharma scientists (not much interaction with management, so can't speak to it), they in general care about their fellow man. My impression has been that most of them are there to make a difference and feel that they do.

I don't want to speak too broadly about what this CEO said as I don't have a quote or context, but from your take on it, it seems like he was pointing out a sad reality of the system (not making any claims about him finding it sad or not, but I find it sad). It's expensive to develop drugs and the failure rate is high:

http://en.wikipedia.org/wiki/Drug_development#Success_rate

If you had to do that all in an environment where your successes were sold at a small markup, you would never recoup development costs with in the patent window.

There is one interesting point. Yes, it costs a lot, and there is a lot of risk, in developing a new drug. But what is interesting is that, as a first approximation, the entire cost/risk premium is folded into the price charged to customers in the US. Customers in Europe and other rich-world areas pay substantially less. Even before the patent runs out.

wj:

Yeah, I think that's an example of how broken our healthcare system is.

One of the major failings of our system, IMHO, is that the pricing of medicine and procedures is opaque. People have no concept of what anything costs, and none of the major players want them to. It's really easy to skim off the top if nobody knows what the top is.

The US is somewhat unique in its massive, tax-free, employer given health insurance network. Actual costs are concealed, it's impossible to comparison shop, even if there was any motivation to, and nobody is really interested in changing any of that.

Pharma companies have lobbyists in DC and a national healthcare system that hides actual costs. It is an environment conducive to high prices.

"Would it be rude to point out that the basic research on which these technological advances are based (both biotech and computer tech) were mostly the result of government-funded basic research?"

Would it be rude to point out to you that that doesn't help, if the government arranges for the whole gain from both public and private sector research to be captured by itself and a tiny segment of the population?

The whole gain? What % of the whole gain is the govt capturing and how?

I don't understand the dim view of the future.

It seems to me that technology makes some things better, and some things worse.

It also seems to me that, historically, technology spreads its benefits less than equally.

My view of the future is not so much dim, as it is different but not necessarily better. Or, better but only in some ways, in some ways worse.

So, dim or rosy depends on whether the benefits of change flow your way or not.

But if we're depending on technology per se to solve our problems, IMO we (or whoever is around) are going to be disappointed.

More to the point, maybe, if we're depending on technology to solve our problems, I think we're trying to solve the wrong problems.

More to the point, maybe, if we're depending on technology to solve our problems, I think we're trying to solve the wrong problems.

We could end a good deal of the human misery on our planet with existing technology. We, the human race as a whole, just don't allocate resources in a way that will allow that to happen. We could feed every goddamned person on the planet and wipe out disease on a massive scale were it not for the lack of collective will.

We could also be happier as individuals if we weren't so materialistic and status seeking. No new technology required there, either. We might even benefit from freeing ourselves from some existing technology.

thompson: Actual costs are concealed, it's impossible to comparison shop, even if there was any motivation to, and nobody is really interested in changing any of that.

Insurance companies "comparison shop", I bet. And they do it before their leg gets broken or their chest starts to hurt. The bigger the insurance company, the more bargaining power it has to drive down "actual costs", I suspect. And what's the biggest insurance company in America? Brett knows.

Brett: ... the government arranges for the whole gain ... to be captured by itself and a tiny segment of the population

Indeed. Medicare and the VA enrich Uncle Sam and the tiny segment of the population that is old or veteran.

Russell: It seems to me that technology makes some things better, and some things worse. It also seems to me that, historically, technology spreads its benefits less than equally.

Cellphones. I heard a story on the radio yesterday about a government program to provide cellphones to homeless people.

Before Brett goes nuts about that, let's remember that it makes more sense than providing land lines to homeless people. But I digress.

The point is that cellphones are a technology that is by now practically indispensable for anyone who wants to participate in The Economy. Technology per se shrugs its shoulders and says "It's not up to me to decide who gets to participate in the economy."

--TP

Technology isn't a solution to problems. A new technology merely offers options: a new way to possibly solve a problem, should human beings choose to use it. A decision which is (or should be) based on an evaluation of the benefits vs the costs of the solution -- to the extent that the costs can be evaluated ahead of time.

For (a historical) example, technology provided us with a way to move water from the Colorado River and from Northern California to the Los Angeles area. That solved the problem that there were too many people and not enough water in the LA basin. A lot of dam building and canal/pipeline building technology was required to move that water. Until we developed it, there wasn't a solution on the scale that the current infrastructure provides.

There were two costs to the solution:
- First was the cost of building the infrastructure. That was known, or at least roughly knowable, up front.
- Second was the environmental impact of all that water not going where it previously had. As far as I am aware, it didn't even occur to anyone that they should consider that back when the projects were being approved.

Am I the only one who initially reads "whole gain" as "whole grain"? And why hasn't anyone mentioned the "An" beginning the title of the post?

For (a historical) example, technology provided us with a way to move water from the Colorado River and from Northern California to the Los Angeles area.

The centrifugal pump certainly played a role, but the basic technology is no big deal.

However, the politics of how it came to be are, to say the least, fascinating. You've never read Cadillac Desert by Marc Reisner? Highly recommended.

And why hasn't anyone mentioned the "An" beginning the title of the post?

Because everyone is wary of incurring my wrath? I had an adjective that began with vowel there, but now I can't remember what it was.

The basic technology, as in build a dam and a canal, goes back for centuries. But the technology to actually build something like Hoover Dam? Much more recent.

Pioneering design and construction techniques, which can reasonably fall under the heading "technology," at the very least.

Insurance companies "comparison shop", I bet.

To some extent. But they are basically engaging in a form of arbitrage, imho. With a large risk pool, good actuaries, and contracts that only last a couple of years, they can pass costs fairly directly on employers buying the plans. And the more expensive healthcare is overall, the more money they can skim.

If you were in a position to where you could recover 5-10% of benefits paid out as profit, how motivated would you be to ensure benefits paid out are as small as possible?

Clearly its a little more complex than that, I'm just not seeing insurance companies being incredibly motivated to institute changes in the system which will decrease healthcare costs overall.

As long as they can maintain a balanced risk pool, they are in a great position of taking money from the population, taking a cut, and redistributing the rest.

And they do it before their leg gets broken or their chest starts to hurt.

And emergency care is a tiny fraction of our healthcare costs. Managing chronic disease is a huge cost. And the costs of chronic conditions are growing, and the major driver of medicare expansion.

~95% of the healthcare costs of the elderly is for chronic conditions:

http://jama.jamanetwork.com/article.aspx?articleid=410506 (paywalled, sorry)

Medication you are taking every day for the rest of your life is exactly the kind of thing that should be well positioned for comparison shopping.

And back to technological advances:

http://www.sciencemag.org/content/343/6178/1426.full

Researchers fully replaced a yeast chromosome with a completely synthetic one. This has broad implications in biotech and medicine. A major one I can think of is the ability to more efficiently produce and modify human proteins in yeast bioreactors.

Therapies that require protein treatments are often staggeringly expensive.

And many proteins which are natively processed by human cells into their functional form can't be produced in yeast due to a lack of the processing machinery, making them either cost-prohibitive or impossible to produce for treatments.

Potentially, this could open new doors into cheaper and more effective protein-based therapies.

Many years out, but again, exciting times we live in.

An example of new Alzheimers' diagnostic tests on the near horizon that could cause the remaining long-term care insurance companies to raise their premiums drastically and eventually stop offering the policies altogether.

http://seekingalpha.com/article/2114603-how-alzheimers-blood-tests-could-paradoxically-free-the-long-term-care-market

The author's ultimate point is that this will "free" the long term care facility market to lower prices drastically, but he offers no detail on where these costs cuts would be attained.

Labor: it's already near minimum wage subsistence living to have an individual changing diapers in an Alzheimer's ward.

My family now pays nearly what it would cost to place my mother in a private facility (she has no long-term insurance) to keep her in her home with home-care companions on hand roughly 60 hours per week.

These individuals are not paid well for the work they do, and I know this, because I do the work, as does my brother, when I can travel there.

Our wonderful home care providers of course can return to their lives and families after their shifts are over, but the sheer mental/psychological toll on the family member(s) who have it their faces 24 hours a day is overwhelming.

I suppose robotics and surveillance advances might help in some aspects, and I suppose dementia might be cured or prevented pharmacologically, though I'm hard-pressed to see how it could be reversed in those who already suffer, but I'd like to see the robot who can wipe my mother's tush up to eight times a day on some days and reason with her as it happens on her bad days, which are becoming more frequent.

I suspect that if the author's projections are correct and the long-term care market collapses, and Medicare and Medicaid are drowned in the bathtub as well, as so many murderers in our midst desire, the only "technology" that will alleviate society's problem will be the technology of euthanasia, perhaps printed out at home.

If my mother as I knew her most of my life could observe for one 24-hour cycle her current condition, she would turn to her family and beg us: "Please help me to go!"

Brett wrote:

"Who knows, by the time my body is really falling apart, maybe I can get a new one printed?"

Would you print out the identical body, or perhaps go for something more custom, perhaps Sean Connery's, or God forbid, Jessica Rabbit's.

Send us photos.

...perhaps Sean Connery's

That's not what your mother said, Trebek!

Count, my deepest condolences for your mother. Both of my grandmothers suffered from Alzheimer's before passing long ago. They were fortunate that their husbands were alive and well enough to take care of them.

But the toll on my grandfathers was enormous.

I hear of of promising lead candidates every now and again from friends in the pharma industry. None have panned out so far, but I feel we are getting closer.

None of this helps you, but perhaps you can have some comfort that there is headway against the disease and some future generation will not be as afflicted as you are now.

It's a horrible disease. You have nothing but my respect and sympathy.

Thanks, thompson. It is what it is and millions of families are in the same boat.

Crap. After reading thompson's comment, it seems I didn't even think about the words "your mother" in my SNL quote there. Sorry. That's not remotely where I intended that to go.

...I'll just be over here in the corner shoving toothpicks into my eyeballs for the rest of the day.

Hey, no sweat, hairshirt, it's right up my humor alley.

My mother of a few years ago would have laughed at that SNL bit, as I did. Of course, if she saw it today, she might think to ask "Who's Sean Connery?"

After I read your comments, I walked around doing my Scot's mushmouthed Sean Connery impression (Thatsh noat what your mother shaid lasht night, Trebek) to great applause from my furniture.

Even though it sounded alarmingly like my Jimmy Durante that went on for some time yesterday, Mrs ... Calabash!

Less hairshirt, more hedonist.

"Would you print out the identical body, or perhaps go for something more custom, perhaps Sean Connery's, or God forbid, Jessica Rabbit's."

The younger me wasn't a bad look, once I got my teeth straightened. More Irish then, the German has come out as I aged. Might go for my favorite comic book character, Adam Warlock, though, if they've got metalic skin as an available option...

Would you print out the identical body, or perhaps go for something more custom, perhaps Sean Connery's, or God forbid, Jessica Rabbit's.

You guys are thinking way too small-bore.

If you're going to print yourself a brand new body, you might as well go big.

Print up the new you as Godzilla, or maybe something with wings. X-ray vision, or even full electromagnetic spectrum vision.

Maybe some funky iridescent skin, or hair that glows in the dark.

Inflatable air sacs so you never have to worry about drowning. Hell, go for gills.

Dual voice box so you can sing like a great big thrush.

Seriously, we built out this great big internet, and we use it to look at each other's cats. Let's not let 3D printing go down that same pedestrian path.

Count, so sorry about your mom.

I had an adjective that began with vowel there, but now I can't remember what it was.

Because you can't stop me, I'm going to assume "inexpensive".

Seriously, we built out this great big internet, and we use it to look at each other's cats. Let's not let 3D printing go down that same pedestrian path.

This. A thousand times this. We need to make sure 3D printing doesn't descend into vapid pedestrian distractionism and truly makes a difference in the world, and in doing so, we need to pull the Internet back up out of that same pit so much of it has slumped into.

We need to use 3D printing to print out each other's cats.

Thanks, Count. Like the ghost of the little girl from The Sixth Sense said, just after vomiting on her jammies, "I'm feeling much better now."

Well, I'm sorry to be relentlessly cheerful, its a curse I suppose. But:

Seriously, we built out this great big internet, and we use it to look at each other's cats.

I'm not taking that comment as the end all be all of Russells thoughts on the internet, but we have done SO MUCH MORE then pictures of cats wanting cheezeburgers.

I consider twitter and facebook among the most vapid platforms out there: but they've organized protests and revolutions.

In seconds I have more data available from Wikipedia than a room full of reference books would have provided.

There are millions of peer-reviewed papers archived on the internet (largely paywalled but one thing at a time) accessible.

I can video chat with my wife every night even though we live miles apart.

I had a conversation with some friends awhile ago about 3D printing. We talked big and waxed eloquent about all the things, big and small we will be able to do. But we came to one conclusion that seemed basically inescapable:

People are going to print out sex toys. It's going to happen, if it hasn't already.

But you know what? Good on them. It'll push the technology forward, just like porn did for the internet. And we still get 3D printed skulls and tracheas (http://www.nature.com/news/3-d-printed-windpipe-gives-infant-breath-of-life-1.13085).

Every technology is going to be used for perfectly pedestrian things. But those don't detract from the good things that result.

IMHO, of course.

Wow, just realized that comment was very stream of consciousness. Sorry if it's a little unclear, major points:

-Not trying to bag on russell for the cat comment. It's true, but I don't think its the whole story.

-We've done some great stuff with the internet

-3D printing...regardless of what pedestrian things it is used for, it will be used (and has been) for great things as well.

People are going to print out sex toys. It's going to happen, if it hasn't already.

It's happen already.

Well *I* want to have a built-in 3D printer accessory for my new artificial body.

Okay, so all the wimminz would say "already got one", but its repertoire is so limited.

If you're going to print yourself a brand new body, you might as well go big.

Print up the new you as Godzilla, or maybe something with wings.

That works if, and only if, you are also seriously rich. It may have escaped your notice (depending on your current size), but the world is designed for short people. Anyone over about 6' tall has encountered this. Anyone over 6'3" encounters it all the time -- and not just on airplanes.

so if you are going to be lots bigger, you are either going to seriously constrict how you can travel and where you can go, or you are going to have to be rich enough to buy your own plane, vehicle (can't really call it a car any more, if it is big enough to hold Godzilla!), etc. And have a custom house built, because standard ones won't have adequate dimensions. And hire on a cook (if you don't do all your own cooking), because you won't fit in restaurants either. And so on and so on.

Yeah, if you got picked on as a kid (or even as an adult), being bigger sounds great. But think a minute about your average day. And what will not be possible if you get too much bigger than the median.

Something I never realized (consciously anyway):
"Ink is two times more expensive than French perfume by volume," . . . : Chanel No. 5 perfume costs $38 per ounce, while the equivalent amount of Hewlett-Packard printer ink can cost up to $75."

See this article on how to save the government money by just changing the font used on government forms.

"And a little child shall lead them."

If you were in a position to where you could recover 5-10% of benefits paid out as profit, how motivated would you be to ensure benefits paid out are as small as possible?

Highly. In fact this is exactly what has been observed in the real world. In fact, if free market principles could actually apply in the health care market (they can't, by the way) insurers would squeeze suppliers just as hard as the Walton family squeezes theirs.

As for the investment risk undertaken by the poor pharmaceutical companies...there are other ways to manage that risk. See Dean Baker for the details.

You don't have to be a full-size Godzilla, just scale it down enough so that you can still buy suits.

Suits with slits to accommodate your scaly spinal plates.

We need to use 3D printing to print out each other's cats.

With gills!

I think you're getting your biotech and 3-D printing ambitions twisted up, russell.

While the husband is in his basement shop printing out the new sex toy for his wife, the wife is upstairs in the spare bedroom printing out the entirely new husband.

Women think big.

"That's not what your mother said last night, Trebeck", said the 3-D Sean Connery.

I think you're getting your biotech and 3-D printing ambitions twisted up, russell.

Hey, Brett started it, with his "I'm gonna print myself a new body" talk.

All I ask is that we never combine 3D printers and fax machines.

It's bad enough walking into our home office and finding a pile of ads for seamless gutters, penny stocks, and pizza delivery, I don't want to walk into a room full of unanticipated Lego creatures.

bobbyp:

I'd seen that Baker piece before. It doesn't really offer solutions.

He offers some rough conjectures about inefficiencies inherent in the current system, which are reasonable, but doesn't offer much evidence that a publicly funded system would necessarily be more efficient.

Most of the inefficiencies he's identified are not solved by public funding, but by providing separation between the company developing the drug and the company running the trial. As far as it goes, I don't think that's a terrible idea.

Again, he doesn't really attach specific costs to any of these inefficiencies, just points out that they are there.

And finally, his analysis only covers clinical trials, and glosses over the preclinical discovery phase, which accounts for around 40% of the cost of bringing a drug to market.

How does he get cost savings from public funding?

"If the public financing of drug trials is tied to a mandated reduction of 40 percent in the prices paid for drugs in the Medicare drug program"

Basically, if we mandate reductions in how much we spend, we'll spend less. Shocking, I know.

He wants to use public funding of clinical trials to politically negotiate for lower medicare drug costs.

Or, you know, CMS could negotiate lower rates like the VA has done. No need for public spending on the clinical trials.

"...why hasn't anyone mentioned the 'An'...?"

Hey! I had to read the comments first to see whether anyone had yet!

I do have a theory on that, though: you can use "an" as the, like, formal/honorific/high-falutin' form of "a" - this comes from the confusion caused by the finger-quote "optional" use of "an" before certain h-words.

Try it!

Since this is an open thread, I found this migration data. I wish I could show the chart, its pretty cool.

http://qz.com/192440/where-everyone-in-the-world-is-migrating-in-one-gorgeous-chart/

The amount of immigration to the UAE is rather astonishing. I knew that they had a lot of ex-pats (to do all the work tha the natives find beneath them). But the numbers are higher than I would have thought -- the place just isn't that big!

wj:

A friend of mine is an Indian expat (would love a green card, but our immigration policy is...not functional.). Most of his family works/worked in the UAE at some point. I got the vague impression from him that the UAE is a major destination for Indians trying to get out of India.

But I didn't think the efflux would be that large. Thanks for the link, Marty.

Is there a libertarian perspective on the legitimacy of national borders?

An interesting link from Mother Jones on Apples view of what innovation is....

http://m.motherjones.com/kevin-drum/2014/03/apple-has-patented-clicking-phone-number-dial-phone-seriously

Now we're talking

On obviousness.

Ugh:

I've never seen one that phrased the question that way. Most libertarian's I know personally are largely in the open border (or close to it) camp. The US-LP has a fairly soft stance on immigration restrictions:

http://www.lp.org/issues/immigration

So I would say the open border movement has a home in the LP, although that's hardly universal:

http://openborders.info/libertarian/

http://en.wikipedia.org/wiki/Libertarian_perspectives_on_immigration

http://mises.org/journals/jls/13_2/13_2_3.pdf

http://mises.org/journals/jls/13_2/13_2_4.pdf

Dobe, you're an honest and decent man, with the exception of:

https://www.youtube.com/watch?v=XlVcrsjHPbg

I had a snappy comeback but got sidetracked with this documentary on our upgraded intelligence capabilities:

http://m.youtube.com/watch?v=dUolPUFEpZo

Wow, I really messed that URL up:

http://m.youtube.com/watch?v=ppOUee-dyi0

In media news today, CNN is going to load up a 787 with its entire domestic and international news teams and relatives and fly it along the exact route the ill-fated Malaysian Airlines flew, until they run out of jet fuel and hopefully put it into a dive exactly where the first plane crashed.

They'll have a live feed of the goings-on on board, with passenger interviews as luggage topples from the overhead compartments, until the bitter end.

Their new broadcast motto: When there's not enough news, make some!

NEWSMAX will then report that Barack Hussein Obama ordered the Muslim hijacking of a second plane to crash into Obama bin Laden's crash site in the Indian Ocean.

Roger Ailes will throw a paperweight across the room at his producers and roar "Can any of you emaciated bastards tell me why we didn't have some of our people on board! What the hell was Hannity doing that was so important!"

In other news, even the gun lovers are becoming frightened of the violent Republican rhetoric directed at gun legislation and public figures by demonstrators in new York State.

If they are so frightened by violent threats, why don't they shoot the demonstrators and save the gummint the trouble.

I thought that was the point of concealed carry and so on, to defend against perpetrators in our midst who are threatening to hurt people.

What, they aren't wearing hoodies?

Here's their chance.

http://talkingpointsmemo.com/livewire/thomas-king-gun-control-rallies

An interesting link from Mother Jones on Apples view of what innovation is...

LOL.

I'm waiting for the patent on "use of the color blue in a computer user interface". Don't laugh, it could happen.

Also, what could be better than Dobie Gillis and F Troop in the same thread?

Libertarians favor open borders, we also favor a nightwatchman state. These two policies are not unrelated; you can't have open borders AND a welfare state, especially when there's a third world contry on your border.

The order these two goals are acheived in is rather important. Some Libertarians don't agree, of course.

Well, maybe you can't have open borders and a below radar job market with work that no one else will do, welfare state or not.

Mexican immigrants work their asses off. Their children work their asses off.

They pick, and you eat cheap.

How is it that this ....:

http://www.newrepublic.com/article/117170/lgbt-rights-sidelined-after-ukrainian-revolution

... is just like this:

http://mediamatters.org/blog/2014/03/28/extreme-anti-gay-group-is-hosting-an-evening-wi/198658

How does Moe Lane sleep at night?

Libertarians favor open borders, we also favor a nightwatchman state. These two policies are not unrelated; you can't have open borders AND a welfare state, especially when there's a third world contry on your border.

Why not?

Ugh, the assumption is that people in third world countries have no work ethic. And so will simply arrive and live off the welfare system. No evidence for that, of course. But projection is a very powerful psychological feature....

The assumption is that SOME people in third world countries have no work ethic, just like everywhere else. And that, if you hand out free stuff, you'll attract them.

I take it you believe otherwise? Setting up perverse incentives, and then being shocked when people respond to them is a liberal thing, I guess...

Anyway, I'm sure there are investment opportunities for a man who wants to build an all-included resort next to a slum, and omit the fence.. Go for it!

If you're really that lazy, you're going to have a hard time getting here in the first place. You don't exactly stroll casually across the border, stopping at the lemonade stand along the way.

That aside, ask Marco Rubio.

I'm waiting for the patent on "use of the color blue in a computer user interface".

Why not prompts in English (or any known language, for that matter)?

Brett, there are far more people (although still not a huge percentage) who are looking to loaf at others' expense in countries where there is a welfare system for them to use. Which, amazingly enough, isn't most third world countries. The people there want to work -- they aren't interested in a handout, just an opportunity to work their way up.

And, FYI, not seeing people in a cynical fashion is also a conservative thing. At least for this conservative. But perhaps always seeing the worst in people is a libertarian thing....
(touche)

The last thing Australians want to see is an American of any sort trying to gain citizenship.

Canadians and Americans -- which way does the flow ... flow?

Word has it that Mitt Romney sends his money abroad to gallivant and loaf like a trust-fund baby or a debutante.

And, FYI, not seeing people in a cynical fashion is also a conservative thing.

Tell that to any Bible thumper and he will start a rant on how Man (and Woman in particular) is wicked through and through. If he is really conservative he will also have his doubts, whether baptism works on everyone (since some may be irredeemably wicked by heritage).

The assumption is that SOME people in third world countries have no work ethic, just like everywhere else.

Spoken by a guy who posts on a blog all day long on any given workday.

And hey, I'm here too, right? But I'm not pointing any fingers about other folks' work ethics.

Here's the latest joke going around:

How many Mexicans does it take to build... oh, wait, they're done!

I tend to see those folks as reactionary, rather than conservative. A reactionary being someone who thinks the current world is terrible, and we should go back to the way that (he thinks) it was. A conservative simply is reluctant to make changes unless someone demonstrates that the change is really necessary and desirable.

I don't know how things are in Europe. But in the US a substantial portion of those who call themselves "conservative" are actually reactionaries. Not all, by any means, but an awful lot.

They have siestas in Mexico, don't they?

And yet I choose to stay in this country and take mine, despite it's being frowned upon.

I'd wade across the Rio Grande to seek the free siesta ride down there, but I'm too lazy.

In fact, I was tempted to tell the Hispanic folks who clean my building to keep the vacuum noise down in the hallway outside my door, but I knew they would ignore me and just keep busy-beavering away like the fat, black welfare queens of Reagan's imagination (well, there was one, I think, but she was outnumbered by the skinny white welfare kings and queens south of the Mason Dixon) all those years ago.

True Americans need their beauty sleep.

wj:

But perhaps always seeing the worst in people is a libertarian thing....

Eh, it depends. Charles (I think) and I had an exchange about libertarians and optimism upthread. I'd extend that to people.

I generally believe people are good and responsible, and libertarians I know do as well.

I generally believe people are good and responsible, and libertarians I know do as well.

They just think markets are even better. ;^)

thompson, I was merely being snarky about Brett's tendency to assume that anyone who disagrees with him is a empty-brained liberal. That someone might be a conservative, and even mildly (though obviously not a purist!) libertarian, and still disagree with him seems to be outside his world-view. And it bugs me.

Hey, open thread:

Do it for the planet.

Brothers, do your duty!

I know I'm doing my part, even if not by choice. :)

Watch out, Countme-in; Mexican prnalties for illegal immigration are remarkably harsh.

Over the last ten or twelve years I have had quite an education in the basic biases of quite a few cultures.

I worked with a Spanish company, the general agreement inside of which was unequivocal in his disdain for all peoples not Spanish. Oddly, Mexicans were rated pretty low, Indians lower, Americans clearly inferior.

The Austrian firm I worked with was violently anti German leaning, anti French, ambiguous on both Spanish and Americans.

The Canadians were very nationalistic, but often expressed their wish that their management workforce was more like a US workforce. Then spent much time talking down Americans in general.

The Indians I worked closely with simply thought Americans were stupid and lazy.

It is interesting to me that many people get so insulted that someone would note that many Mexicans come here and quickly end up on food assistance, without insurance and living in a underground economy. Those are facts. They know that a poor person here is much better off than a poor person in Mexico, so there is a massive incentive to get here. Even more if their kids will be born here.

Not once in that paragraph did I say they were unwilling to work. Or work hard. Unfortunately many of them are not able to work immediately or consistently when they arrive. Language, training, culture all work to leave them struggling to be day laborers or migrant workers, sometimes competing with the legal migrant workers.

An open border would no doubt restoke the illegal influx, which has been dwindling in recent years, taking away the risks while leaving the positives in place. Counting on the welfare state isn't why they come, it is why they feel they can come and survive until they can make their way.

Documents filed with the Department of Labor and dated December 2012—three months after the company's owners filed their lawsuit—show that the Hobby Lobby 401(k) employee retirement plan held more than $73 million in mutual funds with investments in companies that produce emergency contraceptive pills, intrauterine devices, and drugs commonly used in abortions. Hobby Lobby makes large matching contributions to this company-sponsored 401(k).

http://www.motherjones.com/politics/2014/04/hobby-lobby-retirement-plan-invested-emergency-contraception-and-abortion-drug-makers

morals. it's all about morals. and Freedom™

The Austrian firm I worked with was violently anti German leaning

I can assure you the feeling is mutual. These guys get us into wars and then claim to be the first victims of our aggression. And they are about as willing to concede past wrongdoing as the Japanese. Plus their accent is dreadful. I'd rather be surrounded by Saxons (even from Dresden) than Austrians (esp. from Vienna).
Btw, Mozart was neither German nor Austrian. Salzburg was independent at the time, so at least that notorious debate is futile.

cleek, the Vatican was for many years the majority owner of an Italian company producing oral contraceptives. Why be more catholic than Paul VI.? ;-)

i hear Canadians are sick of the Swiss...

http://www.youtube.com/watch?v=i2XTuc6i1Uo

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