July 26th, 2011

Pharma Business Model Transformation


3 page article about many blockbuster drugs about to go off patent in the next few years. The article does a less than stellar job of explaining why large drug companies have changed the way they do drug development. There are numerous quotes from people making difficult decisions about how to cope with high copays or out-of-pocket patented prescription drugs: people without insurance, people in the "doughnut hole", etc.

I was tempted to make the subject line something clever like, "1990s Pharma Train Reaches End of Line" but decided against it.

Flameouts and Choice Rhetoric

Recently, Amy Winehouse died. She was 27. She had a brief but impressive career as a singer-songwriter, did an uncertain number of stints in rehab of an uncertain length, was diagnosed bipolar but was apparently untreated and attracted significant criticism over a period of years for erratic behavior, as well as for the content of some of her songs (notably, "Rehab", which as music was widely admired, critically and commercially).

Reactions to her death were varied, if predictable: the sadness and tragedy, the similarity to certain other artists (musical and otherwise), and that she had made bad choices.

A friend sent me a link to a public post by someone she admires and was interested in my reaction. I was going to post a response to it friends-only, but I was able to find an unrelated post that covered some of the same ground, so I'll respond to that article here and the unshared part of the commentary in a locked post.


Essentially: anyone who hasn't had Ms. Winehouse's life path is in no position to judge her or even be able to tell whether what she did was the result of a "choice". Dermody does not appear to believe that someone was coercing Ms. Winehouse, rather, this is an assertion of the limitations of the rhetorical construct "choice". The balance of the post is noting tragic things that might lead to substance abuse.

Dermody's construction of the term "choice" is absurd (that is, even more so than "choice" usually is): "I doubt as a young child, that any of them thought, "I want to become a drug addict or an alcoholic.""

The description I supplied of the circumstances in question was intended to highlight both the validity and the problems of Dermody's argument: yes, Ms. Winehouse had been quoted in the press over a period of years as being diagnosed manic depressive -- but she was also described as refusing treatment for same. And everything about her story indicates she had access to significant help in beating and/or managing her addiction but generally refused to do so.

R. accepts a lot more of the AA rhetorical structure than I do (I doubt he thinks of it as rhetorical structure; I think he really believes in it). I asked him if he thought the massive monetary and other rewards Ms. Winehouse received for her very, very, very public misbehavior had anything to do with her life arc. He doesn't. He thinks she could have had the same extremely out of control path in complete obscurity. I'm inclined to agree -- altho I would sort of prefer to blame the peanut gallery for being so entertained by her flaming out repeatedly, I don't think it's actually justified. If anything, the peanut gallery was just trying to hold the line for impressionable folk who might think of emulating her. To the extent they could be convinced to NOT, that's a good thing.

I've been trying to figure out how to say what I mean for hours now, but I'll try a quick sum-up, since even I can tell the above is very obscure:

Choice Rhetoric is risible, but serves an important purpose: it stops Us As A Group from Preventing Us As Individuals from doing unusual things. Choice is highly constrained in general. However, Ms. Winehouse's conspicuous refusal to pursue treatment for bipolar and/or substance problems require us to respect that Ms. Winehouse may have actually chosen to do what she did. And as sad and tragic as the whole arc has been, I think it might be worse to suggest that she was somehow completely powerless.

Also, there's a really good chance it was just a stupid accident (for suitable definitions of accident), and all of us can suffer from those, even if our "choices" are generally considered much wiser than hers.

You Don't Have Mail


For several years now, the post office has been trying to reduce the number of days of home delivery it is required to provide, in an effort to reduce costs. There's some question (at least in the regulator's minds) about the implications of eliminating Saturday delivery (the current plan):

"“The key factor is that the Postal Service thinks it can take all the mail that it would otherwise deliver on Saturday and deliver it on Monday with no extra cost,” said regulatory commission chairman Ruth Goldway."

That's a weird sentence. I'm not exactly sure what it means. It is probably not that important however.

The current budgetary crisis is due, in part, to the USPS being required, in recent years, to make big payments towards a fund for future health costs of retired employees: "the real issue is the $5.5 billion the Postal Service has to pay every year into a fund for the health benefits of its future retirees."

Stunningly, one of Issa's staffers is arguing the payments are necessary because "the Postal Service won’t be here in two years, let alone 10".


In related news, the USPS would also like to close some of its offices, particularly in rural areas.

"Of the nearly 3,700 proposed post office closures, slightly more than 3,000 of them have annual revenue of less than $27,500, and a workload of less than two hours per day. Compared with the $100,000 or so it takes to run a post office, many of them are not even breaking even, Granholm said."

The plan is to sell stamps and take packages in retail locations. My all time favorite post office is/was on a side street off 15th Ave E on Capitol Hill in Seattle. It was in a little shop that sold all kinds of things, and would act as a post office AND do FedEx and UPS. Enormously convenient, altho obviously no passport services.

This article indicates Congressional approval is not required -- which isn't to say Congress won't necessarily involve itself anyway. Post Offices closing generates a lot of constituent unhappiness.

I expect to see a lot more changes in the number of post offices. Whether or not this effort to eliminate Saturday service succeeds, I would expect to see a reduction in the number of days of service now AND in the future (if not now then definitely in the future). Home delivery is a relatively recent phenomenon, as postal service goes. I would not be completely shocked to see limitations on home delivery some day as well (replacing it with p/u at a post office or post office lite, which is what predated home delivery).

See? Me predicting things. We'll all get to laugh at how wrong I am.