Open Thread for Wednesday, August 24, 2016

Busy day today, so talk amongst yourselves:

  1. Turkish Military Storms Syrian Border in Major Assault on ISIS — They are being supported by U.S. air assets and special forces.
  2. Earthquake in central Italy leaves dozens dead — It happened last night, and the death toll, as usual, is expected to rise.
  3. Democrats Have 60 Percent Chance of Retaking the Senate — First time I’ve seen a number like that. Of course, I don’t care. Let the Whigs take the Senate, as long as Trump loses. (Although I’ve prefer the Federalists, so I do have preferences.)
  4. ‘This is not a photo-op issue’: Obama tours flood-damaged Baton Rouge — “The President say, “Little fat man, isn’t it a shame…?”
  5. U.S. lawmakers demand investigation of $100 price hike of lifesaving EpiPens — I think mine are out of date, but there’s no way I’m buying new ones until this is straightened out.
  6. How will Spurrier’s autobiography compare to these coaches’ memoirs? — Alas, I will never know. I must learn to live with that.
coolidge flood

President Coolidge may well have said “Isn’t it a shame.” But it’s not like he was going to go overboard helping…”

51 thoughts on “Open Thread for Wednesday, August 24, 2016

  1. Claus

    Live in a river bottom, expect to get flooded out at least once in a lifetime. What gets me are the idiots who are crying about how every 5 years they lose everything to high water. Sam Kinison did a bit about Arabs living in the desert once… same could be said about these people.

    Reply
  2. Doug Ross

    “How will Spurrier’s autobiography compare to these coaches’ memoirs? ”

    I expect to start reading Spurrier’s book and then quit when I don’t think it will end well. Whatever good
    Spurrier did for the program, his behavior from the moment he decided to quit was terrible.

    Reply
  3. Bryan Caskey

    Other news for today: On this day in 1954, my dad was born.

    Ten years earlier, on 8/24/44, the first elements of the French 2nd Armored Division entered Paris late in the evening and arrived to liberate the City of Light from the Nazis.

    My dad likes that his birthday and the Liberation of Paris are the same day. It’s a good excuse to have a glass of champagne.

    Reply
    1. Brad Warthen Post author

      And today is my son’s birthday. He was born only 24 years after your Dad, who was born almost a year after me…

      Just to put everything into perspective…

      Reply
      1. Bryan Caskey

        We’re taking my dad out to eat somewhere tonight. In honor of him, and in the spirit of Jack and Stephen, I think I’ll raise my glass at dinner and say, “A glass of wine with you, sir.”

        I also wish your son joy on his birthday, sir.

        Reply
    2. Brad Warthen Post author

      And I think of MY Dad as being young. Most of my contemporaries in school were the children of WWII veterans. My Dad was just barely too young. The Japanese attacked Pearl Harbor on his 13th birthday, so he was still too young to serve on V-J Day.

      He went into the Navy after he graduated from Presbyterian College in 1951. Hence I am more a child of the Cold War than WWII…

      Reply
  4. bud

    5. The Epipen story is disturbing on many levels. How does a company get a monopoly on something as basic and old as this? Does not reflect well on free enterprise.

    Reply
        1. Doug Ross

          It’s important because we’ll get to see how hard the other congressmen come down on her when she appears before a Senate committee. It’s always fun to watch the hypocrisy of the Senators depending on the political background of the person testifying.
          My guess is that the Democrats will somehow turn this into a Republican issue.

          Reply
    1. Claus

      I’m angry that Apple has a monopoly on iPhones. Excuse me, I’m going to go out and yell at the clouds.

      They have a monopoly on the Epipen… because nobody else apparently wants to make it.

      Reply
      1. Brad Warthen Post author

        I’m not following you there, Claus. Apple has a monopoly on the iPhone because Apple invented, developed, perfected and patented it.

        Epinephrine is a generic drug — it’s something that is produced naturally by our bodies.

        How Mylan got a near-monopoly is complicated, and I don’t pretend to understand it.

        Doctors want me to carry epinephrine, or adrenaline, with me at all times since I have potentially life-threatening food allergies. I seldom do that (one exception was when I was in Thailand, where the language barrier created the possibility of accidentally getting something I was severely allergic to), largely because the EpiPen is awkward to carry around. It doesn’t fit easily and unobtrusively in a pocket, for instance. (This gives you an idea of the size and shape.)

        Over the years, allergists have prescribed a number of alternatives for me — products that fit more easily in, say, a shirt pocket. A decade or more ago, I got a prescription for a device the size and shape of a ballpoint pen. But that was recalled before I filled it. A problem with the dosing.

        Then a year or two ago I was prescribed a supposedly idiot-proof device that was like a thick, bulky credit card. Not only did it fit nicely in a pocket, but it TALKED you through the procedure (one tricky thing about these devices is that one seldom has to use one — I’ve NEVER had to use one on myself — so you can find yourself in a situation in which you’re gasping for breath and, in order to save your life, you have to do something you’ve never done before).

        The perfect solution. Except that, even with the “discount” coupon, the thing cost several hundred dollars. It was like buying a smartphone without the service-provider discount. There was no way I was going to shell out money like that for something I would most likely never use.

        So time and again, alternatives have fallen through, and I’ve ended up with the bulky, awkward EpiPen — which usually sits at home in a drawer after I buy it…

        Reply
          1. Bryan Caskey

            Yeah, I would assume the drug has a shelf life. I don’t know anything about the EpiPen price thing, but it seems (maybe I’m being naive here) that this is an excellent opportunity for some other drug company to create a competing product and sell it for far less. Why that isn’t happening, I couldn’t tell you.

            Whatever the obstacle is, it’s an artificial one that is preventing the free market from operating as it should. The market, if left to operate naturally, would put Mylan right out of the EpiPen business if they refused to lower their price.

            Maybe someone can drop some knowledge on me about the whole matter.

            Reply
            1. Doug Ross

              “Whatever the obstacle is, it’s an artificial one that is preventing the free market from operating as it should. ”

              Most likely a patent that Mylan would protect with all its legal power to prevent lower cost alternatives from entering the market. They will claim “oh, we have to protect our investment in research and development of the product” and “we have to pass along the cost of complying with the FDA on testing”.

              Maybe we should start with fixing both of those artificial barriers to developing a true free market.

              Actually there is a price where some other company will invest in finding a lower priced alternative if they think they can make a profit (horror!). We may be there now.

              Reply
              1. Bryan Caskey

                Seems like someone could come up with another way to safely inject a drug into a child that isn’t exactly the same thing as the EpiPen. There sure is a lot of money to be made if you could do it.

                Reply
        1. Claus

          What I was getting at is the EpiPen isn’t monopolized by one company, Any company that wants to produce an EpiPen can. I”m sure there are patents on the device, but like a ball point pen I’m sure that someone interested could produce something that would bypass that patent. Up until the price increases there likely wasn’t enough profit to look into it.

          Reply
    1. Doug Ross

      Here’s an interesting section from that link:
      “Before her hire as CEO, Bresch — daughter of U.S. Senator Joe Manchin (D-W.Va) — was Mylan’s chief lobbyist. In November of 2013, a bill requiring all public schools to carry EpiPens for students with food allergies was signed into law by President Barack Obama. Over the following three years, as schools nationwide bought EpiPens by the truckload, Mylan implemented double-digit price hikes for the EpiPen every other quarter.”

      Nice to create a mandated demand for a product that has a monopoly. Too bad Obama didn’t put in a price cap into the bill. What exactly has Obama done to make healthcare affordable?

      Reply
      1. Brad Warthen Post author

        Well, it was certainly a good idea for all schools to have an EpiPen on hand.

        I guess it didn’t occur to Congress that the supplier would jack up the price of such an old product.

        I’d still like to see a good explainer as to why they’re able to do this (the stories that purport to do so fall short). Not just legally, but economically, how does this happen?

        When I think of epinephrine, I think of prednisone — another key weapon in the fight against allergies. Prednisone is unbelievably cheap, like a dollar or two for a full course of it. (The difference is that prednisone takes a day or two to have an effect. Adrenaline is for saving your life RIGHT NOW! That is to say, you don’t need prednisone as urgently.)

        Apart from the delivery mechanism, I would expect this to be just as cheap. But it isn’t. Maybe it’s really hard to come up with a safe, effective mechanism that anyone can use in an emergency. But it doesn’t seem like it would be. I wonder what those little syrettes of morphine that soldiers were issued in WWII cost? This seems comparable…

        Reply
        1. Brad Warthen Post author

          Getting the right dosage is important.

          It didn’t occur to me until years later that the first time I was ever given a shot of adrenaline, it might have been an overdose.

          I was having terrible asthma, really struggling to breathe, over Christmas vacation when I was in high school in Tampa. My parents took me down the road to the MacDill AFB hospital. They gave me a shot — I’d never heard of giving shots of adrenaline before — and told me to sit and wait for awhile before leaving.

          I was sitting there, hunched over the way asthmatics do when struggling to breathe, and staring at my feet. After a moment or two, I started tapping them on the floor. Faster and faster. I would not be able to do it that fast normally. I was sort of playing “Wipeout!” with my feet, which I found fascinating.

          My pulse was throbbing in my throat like a sledgehammer. I’ve never felt anything like that before or since. I reported this, and it didn’t seem to alarm the medics. They sent me home.

          Home was just three or four blocks away. When we got there, I felt AWESOME! Mind you, earlier I could hardly walk to the car. There was a football on the lawn, and I picked it and said, “Come on, let’s play!” My parents talked me down and persuaded me to go inside.

          I ran around a bit in the house, then went into a bedroom and plopped myself down, lying on my belly diagonally across the bed. I fell into the deepest, more restful, restorative sleep I had had in quite some time. (Few things will interfere with sleep more than asthma.)

          I woke up a couple of hours later feeling great, but calmer.

          I’ve had epinephrine injections several times in the years since. I’ve never had a reaction remotely like that one — especially not the pounding in the throat.

          So I’m thinking they overdosed me…

          Reply
          1. Kathryn Fenner

            Not a doctor, but I think an overdose of adrenalin is one that kills you?? You just got a good dose, it seems to me….maybe now you have a tolerance built up? I mean, people talk about feeling like that when they first smoke a cigarette, but soon that goes away….

            Reply
            1. Brad Warthen Post author

              Technically, I don’t think an overdose has to be fatal, by definition.

              I would think one could have a dose that would cause a dangerous amount of tachycardia or rise in blood pressure, but which wouldn’t kill an otherwise healthy young person.

              But y’all could be right, too. I don’t know.

              One argument in favor of the dose being a little heavy — I was the same height I am now, but weighed close to 70 pounds less. The medics could have looked at me, thought “adult male” in devising the dose, not realizing I weighed less than 115 pounds.

              I remember my weight because I was on the wrestling team at school at the time, and that was my weight class. I was a good bit taller than the other guys in my class, which gave me an advantage with holds that involved leg leverage. But my illness over those holidays resulted in my having to quit the team. I just fell too far behind in conditioning over the couple of weeks that I couldn’t practice.

              The next year, I was in the 132 class, so I was starting to fill out finally, a little bit anyway. THAT year I had to quit before the season due to injury

              Reply
        2. Doug Ross

          One explanation:

          “A French pharmaceutical company offered an electronic device that actually talks people through the steps of administering the drug, but it was recalled because of concerns about it delivering the required dose. Just this year, Teva Pharmaceutical’s attempt at bringing a generic epinephrine injector to market in the US was blocked by the FDA. Adrenaclick and Twinject were unable to get insurance companies on board and so discontinued their injectors in 2012.

          Adrenaclick has since come back, but it is still not covered by many insurance plans, and the FDA has made it illegal for pharmacies to substitute Adrenaclick as a generic alternative to EpiPen. Another company tried to sidestep the whole auto-injector patent barrier by offering prefilled syringes, but the FDA has stalled them, too.

          Mylan has been repeatedly protected from competition, and it has repeatedly (and predictably) increased the price of EpiPens in response. Allowing all of these companies to compete in producing epinephrine auto-injectors would be the best course for all of the many patients who want a cheaper solution for severe allergic reactions.

          One thing is for sure: capitalism is not to blame. Government regulations have choked this market and many others. What we need is a big dose of freedom.”

          You want the FDA, you get a closed market. Closed market = high profits.

          How about Obama signs one of his famous executive orders to allow the competitors access to the market? Bet that drops the price in half.

          Reply
  5. bud

    The patent for the Epipen expired 20 years ago. Anyone can manufacture the device. Eventually that will happen but in the meantime we have a huge market failure. Sometimes the invisible hand shakes rather badly. This is one of those times.

    Reply
    1. Doug Ross

      Do you just ignore all the facts that show the only hand guiding this situation is the government hand? This is a monopoly allowed by the FDA.

      Reply
      1. bud

        Really Doug? This device was invented by the government. Why is it so hard to just accept the fact that free enterprise just doesn’t work all that well at times. We had Bernie Madoff, Enron, the BP oil spill, the banking crises, poisoned peanut butter. And on and on. We’re currently dealing with a global warming crisis that ONLY government can address. And yet according to Ayn Rand worshipers, a sort of cult really, they cannot accept the necessity to have a government that can correct market failures. The Mylan corporation found itself with a monopoly by shear luck and then out of a breathtaking amount of greed exploited people’s illness to line their pockets with a largesse that is beyond the pale. No Doug, I’m not the one ignoring the facts.

        As for the FDA, maybe it’s just possible that they kept dangerous and/or ineffective products off the market. Is that really such a stretch? Besides, even IF the FDA did drop the ball that still doesn’t excuse this kind of exploitation.

        Finally, a similar device in Europe called Jext, sells for far less in Europe, a place with a far greater government role than here: From the Jext website (Cost: Jext 150 and Jext 300 are available as single unit doses at £23.99 each, about $30 in the UK).

        From Wiki:

        “The first modern epinephrine autoinjector, the EpiPen, was invented in the mid-1970s at Survival Technology in Bethesda, Maryland by Sheldon Kaplan.
        One autoinjector, the EpiPen, is derived from the Mark I NAAK ComboPen, which was developed for the U.S. military for treating exposure to nerve agents in the course of chemical warfare.”

        This shows how important it is to keep the Libertarian party from ever gaining significant market power. We’d soon have ourselves back in a dangerous version of the guilded age with only a handful of greedy plutocrats controlling the vast majority of the resources. That’s what we had the last time the Libertarian philosophy was in vogue in thee 1880s-1910s. I shudder at the thought.

        Reply
        1. Doug Ross

          Hey, bud, I have an idea. It’s so easy to become a millionaire, just go invent a replacement for the EpiPen. It’s something anyone can do if they just decide to do it. Doesn’t take skill, just luck.

          I’ll wait for you to get FDA approval. See you in a decade.

          Reply
          1. Claus

            I wish I could say things like that and not get them blocked.

            I read an article yesterday where the medication costs pennies, it’s the pen that is expensive. The article was about producing a pen that could use replacement cartridges.

            Reply
            1. Bryan Caskey

              Replacement cartridges. Seems like a pretty good idea to me. Maybe we should get FN, Ruger, or Glock on something like that. If they can make handguns, I’m pretty sure they could make a little plastic device to inject some medicine.

              Reply
              1. bud

                The Jext device is fairly new, introduced only in 2011, and is being sold in the UK alongside the Epipen. Apparently they have attempted to market it here. It would take time to pass FDA muster but there’s no government conspiracy to keep it off the market. If you believe there is I have a Kenyan born president I’ll introduce you to.

                Reply
                1. Doug Ross

                  Only a government worker would think five years is a reasonable amount of time to approve a drug delivery mechanism that is used in other countries.

          2. bud

            Hey, bud, I have an idea. It’s so easy to become a millionaire, just go invent a replacement for the EpiPen.
            -Doug

            If I did I probably wouldn’t make much money. The inventor of the Epipen never made much. It was the Pharma trolls that somehow acquired the rights to it that are raking it in. So if your point is that hard work and industry is the way to make big money, that is exactly the problem.

            Reply
            1. bud

              The first modern epinephrine autoinjector, the EpiPen, was invented in the mid-1970s at Survival Technology in Bethesda, Maryland by Sheldon Kaplan.

              Reply
        2. Doug Ross

          Do you understand that the Jext device you mentioned can’t be sold in the U.S. Why? Because of libertarians?

          The government has created the monopoly that allows prices to rise. Nobody else. Mylan is a for profit business — I know you want them to be a charity but that’s not how healthcare works in our government.

          Reply
      2. Brad Warthen Post author

        It’s complicated. There are market forces as well as government involved.

        “EpiPen” has become like Kleenex. People don’t say “epinephrine autoinjector,” which is the generic term. They say “EpiPen.” That’s a huge market advantage that has to do with public perception, not government mandate.

        This piece explains fairly well what happened, but it’s too complicated for me to summarize. You have to read the whole thing.

        Doug mentioned the big, bad government “mandating” EpiPens in school, suggesting that caused the problem.

        Well, yes and no. Congress passed a law that provided incentives to states to require epinephrine autoinjectors in schools. A total of 11 states mandated that schools stock epinephrine.

        Then marketing steps in — Mylan offered free EpiPens to the schools. Consequently, school nurses got trained in how to administer epinephrine using the EpiPen specifically. Here’s how that affected the market:

        “Their most brilliant maneuver, clearly, was giving them [EpiPens] away to schools and making it the thing that they could say, ‘Well, the nurse knows how to use it,’ ” said R. Adams Dudley, a pulmonologist at the University of California at San Francisco. “What are the parents afraid of? Their child will be away from them, and they won’t be there to use it. If they can say the school nurse knows how to use an EpiPen; she’s never seen an Adrenaclick … It’s just a fear thing.”

        So you see, a mixture of public and private causes.

        The only other way I see the government being involved is by requiring competing injectors that were found not to provide the right dosage consistently to be withdrawn from the market.

        But let me ask this: Would even the most ardent libertarian not want the FDA to protect the public from dangerous dosages?

        That said, I personally found it ridiculous when the nice, convenient injector the size and shape of a ballpoint pen was removed from the market. The reason was that the dosage might not be sufficient. But the thing contained two doses. If the first didn’t do the trick, couldn’t I just inject myself again?

        Of course, that’s assuming an adult who is in full use of his faculties and hasn’t passed out from lack of oxygen because his throat has swollen shut…

        Reply
        1. Doug Ross

          “Would even the most ardent libertarian not want the FDA to protect the public from dangerous dosages?”

          Of course. The question becomes when do the regulations become so onerous and expensive that they protect monopolies. Look how long it takes to get a generic medicine to the market. That surely has caused more deaths, more pain, more expense. The government should not be picking winners and losers. The delivery of Epinephrine cannot be rocket science where complexity and up front investment limit competition. The right role of government would be to sponsor an open competition for the delivery mechanism.

          Reply
          1. Doug Ross

            And your Kleenex analogy is not the same thing. There has never been regulation of tissues. There have always been competitors. They just did a better marketing job.

            Explain why items like big screen TV’s and computers and smartphones keep getting better and better with either small price increases or price drops? Competition. This is despite there being patents on all the technologies involved.

            Reply
            1. Bryan Caskey

              It is a bit telling that we have all sorts of new technologies blossoming and flourishing, but we’re somehow stuck with one manufacturer for what is essentially a thing that gives you a shot.

              What about tranquilizer guns? Couldn’t we just let parents start carrying those with some Epinephrine cartridges? If your kid starts having an allergy attack, you just whip out your pistol oops, (I mean High Speed Medicine Delivery Device) loaded with Epinephrine, and you shoot him.

              Boom!

              You could do it from across the room. I’m seeing big potential, here.

              :)

              Reply
          2. Brad Warthen Post author

            You would THINK it would be easy to produce such a thing. But one competitor after another seems to have failed to match EpiPen’s reliability on dosage. I can’t imagine why…

            Reply
  6. bud

    Doug’s defense of Mylan and the Epipen episode illustrates why I had to part ways with the Libertarian cult many years ago. To Doug the greed aspect of capitalism fuels a sort of synergy within an economy to drive ever greater and greater gains to the populous. Any impeditment to private profit is automatically evil. Any government effort to reign in excesses within the economy will fail either through unintended consequences, incompetence or malfeasance. Private companies are automatically regulated by market forces regardless of the greed endemic within the free market tactics. In effect greed will counteract greed in a sort of matter/anti-matter reaction that propels the common good forward. This greed dynamic is always couched in terms of “freedom”. But this so-called freedom fails to recognize the history of failures whereby greed by someone in power ultimately overwhelms greed by those without such power. In other words all greed is not created equal. Worse, sometimes greed can become so pervasive and powerful that it results in actions that result in terrible damage to the economy or the environment. These spillover costs won’t be constrained by the greed/greed paradigm. Yet Libertarians will always see “freedom” as the way forward with government as a sort of Satan. The disciples of this movement go through life in a zombie like trance that deflects any evidence that their cult mania is wrong with non-sequetors, insults and mostly charges of jealousy. Anyone that does not adhere to the obvious Libertarian “truth” is branded as a sort of heretic. When cornered the libertarian cultist lashes out more aggressively in their mania to defend the indefensible at all costs. This is a dangerous cult that cannot be allowed to permeate the body politic. If this cult is successful we will lose protections that keep our environment clean, our workplaces safe and our economy a place where hard work can be rewarded rather than stolen to enrich the lucky few who successfully leverage greed for their own tawdry gains. This is the world of the Ayn Rand as messiah. And it’s a world that I want no part of.

    Reply
    1. Doug Ross

      Yawn. I believe in hard work and efficiency. You keep using Ayn Rand in rebuttals and yet nobody ever mentions her but you. Hey, you have a tough job – defending government agencies that are full of corrupt, lazy, unmotivated, unaccountable people. The mythical libertarians you use as a phony excuse for government inefficiency don’t exist. You also make a severe error in logic when you equate libertarian views with greed. You continue to confuse selfishness with libertarian philosophy. They are not connected. Who’s more selfish? The person who wants the freedom to succeed or fail on his own or the guy who wants a free ride from the government?

      Reply

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