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Can someone explain why Hillary Clinton and her fans are upset about the EpiPen price?

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My Facebook feed is alive with Hillary Clinton fans complaining about the price of an EpiPen and also about the high income of the CEO of the company that makes the EpiPen. Here are some samples:

It’s one thing for a new experimental drug to be expensive to pay for all the failed attempts. Makes perfect sense. But buying up long established technology that by all rights should have come off patent by now and price gouging consumers is just hideous and I don’t think you want to be defending that kind of behavior? The original epipen patent is from 1977. Patent lengthening is one of many games pharma companies play to extend their monopolies as long as possible. As for regulation preventing competitors, safety matters, otherwise any snake oil salesman could sell you a would be epipen (see e.g opioid epidemic). So making blanket claims against regulation doesn’t really help here. This is a specific example of this problem and it could be solved by the government treating it as an unfair monopoly and forcing them to break it up by e.g. licensing their remaining patents to competitors.

[after a commenter pointed out that competitors couldn’t get FDA approval for their devices] Maybe, but we still have anti-trust laws. Whether the market or government regulations prevent competition is irrelevant. At some point the greater good requires the destruction of the monopoly.

[after a question about why there isn’t competition] Various alternatives have been tried but none have passed regulatory muster. Free-market zealots like to depict this sequence of events as “government regulations killed the competition.” Consumer safety advocates might use a different spin on the same phenomenon: “government regulators prevented inferior and potentially unsafe alternatives from hurting consumers.” Who’s right? Who cares? If there is a monopoly, and if the current product is the only version deemed safe and effective, nothing prevents the government from forcing the monopoly to break apart. Two companies selling the identical product could still drive down prices, just as is the case with e.g. automobiles (is a Honda Accord really that different form a Toyota Camri?). The original patent expired long ago, but follow-on patents allow the monopoly to artificially continue. The drug itself is dirt cheap but a rapid and safe delivery mechanism is critical to efficacy.

Monopoly is defined by pricing power. In this case the company happens to be abusing the patent system. But that’s irrelevant. The evidence is not that they have a patent, the evidence is that they are price gouging, and that no reasonable competition exists or can come into existence quickly enough to prevent them from price gouging. The government is under no obligation to protect your monopoly just because you have a patent. The government can decide that you have recouped your investment and profit and are now just exploiting the patent system at the expense of consumers.

Friends who love to complain that women don’t get paid as much as men (i.e., that you could make near-infinite money by starting a company that hired only women) then began to complain about Heather Bresch, the CEO of Mylan, getting paid $19 million in one year. Yet their complaint was not that, like virtually all other American women, underpaid. Apparently, despite having successfully moved Mylan to the low-tax Netherlands via an inversion, Bresch was overpaid.

[Given her family connections to the rich and powerful, could she have made more money without working at all? Wikipedia says that she has four children so let’s assume she wanted four children and had each of those kids with a different father, thus maximizing child support profits. Assuming that she keeps $10 million after taxes each year, she needs to get $2.5 million from each father in order to match her Mylan income. If she could have had sex with four men, each earning $14.7 million per year, in Wisconsin, for example (child support is 17 percent of gross income, without limit), she could have matched her most recent Mylan compensation.]

Hillary Clinton says “I am calling on Mylan to immediately reduce the price of EpiPens.” (statement)

How can we explain this? The same folks who want The Great Father in Washington to regulate drugs are now objecting to a company being compensated for navigating the regulatory labyrinth? People who think The Great Father in Washington should give out monopolies via patents object to whatever particular monopoly enables the EpiPen to sell at a high price? So an official such as Hillary Clinton should decide which patents should have economic value and which should not?

Readers: Why is it that Mylan can charge a high price for these EpiPens? Why aren’t there profits sufficient to attract competitors competent to romance the FDA bureaucrats into approving a substitute?

What equipment does a leading architectural photographer need these days?

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One of the pleasures of flying helicopters at East Coast Aero Club is that sometimes I get to fly aerial photographers (the alternative is flying with a student at the controls!).

On a flight this summer the photographer was one of Boston’s leading architectural photographers. I asked him what he was using for his day-to-day work. A view camera with a digital back? An SLR with a bunch of perspective correction lenses? He responded with “I’ve got 14 view camera lenses that are beautiful paperweights at this point. I do almost everything with a Nikon D810 and the 14-24mm zoom lens.” Perspective distortions are then fixed (by him) in Photoshop.

Good explanation of Olympic Games economics

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This interview with Andrew Zimbalist, an economist who studies the cash bonfires that cities stage for athletic events, has some interesting points:

when the tally is accurately made we’ll find that Rio has spent somewhere in the order of US$20 billion to host the games this year, they’ll receive back something around $3 billion in revenue, so there’s a deficit there of $17 billion. … What was previously seen by many people around the world as a city of immense natural beauty and great partying and a fun-loving lifestyle I think is now seen as a city that is severely troubled with water pollution and water shortages, with violence, with economic recession, with corruption in business and with political instability. So it’s more likely that the Games will have a negative impact in the long run than a positive impact, in addition to the short-run deficit.

[Where does the $3 billion in revenue come from?] They’ll receive about $1.2 billion from corporate sponsorships, domestic and international. They’ll receive about $1 billion from international television money. They’ll receive $300 million or $400 million from ticket sales and then there will be some miscellaneous revenues.

Now when the typical tourist doesn’t come and they are replaced by the Olympic tourist the Olympic tourist goes home and tells his friends, relatives and neighbours that he saw some wonderful competitions but the Olympic tourist doesn’t go to the typical tourist sites. When a normal tourist goes, if a normal tourist goes to London they go to Piccadilly Circus, they go to the theatre, they go to the museums and they come home and they tell their friends, neighbours and relatives about what a lovely place London is to go. So you get a word-of-mouth effect, which according to studies in tourism is the most important way to grow tourism. You get a word-of-mouth effect from the typical tourist that you don’t get from the Olympic tourist. So not only does the number of tourists not grow typically when you host a mega event, and sometimes even falls, but you lose the word-of-mouth benefit from promoting tourism.

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Data on the Guantánamo prison

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“Why Obama has failed to close Guantánamo” is a New Yorker article interesting for some of the data presented. (You can probably guess the conclusion regarding the title question: it turns out not to be President Obama’s fault; Donald Trump will be a dictator with unlimited power, but Obama’s hands have been tied by bureaucrats and Congress.)

There are 76 prisoners and it costs taxpayers $445 million per year (can this accounting be correct? how does one separate the cost of the prison from the surrounding naval base?). That’s almost $6 million per prisoner per year.

Generally foreign governments seem to have a keener grasp of the obvious than do we:

In February, 2009, the U.S. Ambassador, Deborah Jones, met with Kuwait’s Minister of the Interior and, according to State Department cables, warned him that Kuwait had to “show its seriousness in changing and controlling the behaviors of extremists within its society.”

The minister responded, “You know better than I that we cannot deal with these people. If I take their passports, they will sue to get them back.” He added, “If they are rotten, they are rotten, and the best thing to do is get rid of them. You picked them up in Afghanistan; you should drop them off in Afghanistan, in the middle of the war zone.”

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What do folks think of the Canon EOS 5D Mark IV?

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Canon has announced the fourth version of the 5D (dpreview first impressions), a camera that was literally awesome in its first incarnation and that has fallen ever deeper into the shade of the Sony sensors with each succeeding version.

Here’s what dpreview said about what has been the biggest Canon weakness:

The 30.4MP chip offers a decent jump in resolution over the 22.3MP chip in 5D III. And judging from the improved dynamic range in Canon’s other recent DSLRs (the 80D and 1D X II), we expect Raw dynamic range in the IV to be much improved over its predecessor, which had some of the worst shadow noise and banding we’d seen in a modern full-frame digital camera. The improvement is thanks to the recent move to a design that uses on-chip analog to-digital-conversion, resulting in lower downstream read noise and therefore less shadow noise and better overall dynamic range at lower ISOs.

There doesn’t seem to be any promise that this $3500 camera will offer image quality competitive with what you get from a $1000 Sony body or any of the Nikon bodies that incorporate Sony sensors.

Disturbingly it seems that the autofocus system may not be that great except in Live View (at which point why aren’t you just using a Samsung phone?):

In terms of AF, the increased coverage area is definitely a big deal: after all, its the exact same AF system found in the company’s flagship sports camera. The 150,000-pixel RGB-IR metering sensor, which feeds scene information to the AF system, is borrowed from the original 1D X, bringing enhanced subject identification (including faces) and tracking (‘iTR’), as well as improved metering and flicker detection. Unfortunately, we’ve found iTR to be too situation dependent to be generally relied upon, and our initial impressions from our brief time with the Mark IV leave us similarly unimpressed at the camera’s ability to automatically shift AF points to stick to your specified subject.

Readers: What have you gleaned from the Canon press releases, etc.? Are you ready to buy this camera?

Medical School 2020, Year 1, Week 1

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From our anonymous insider…

Anatomy begins at 7:00 am sharp. With the outside temperature well over 90 degrees Fahrenheit, we immediately know we are entering a different kind of learning experience kept at a chilling 55 degrees! Most of my classmates seem excited for a break from the 4-times a week, 2-3 hour morning lectures on cellular and molecular biology. Not only can these lectures be somewhat tedious, especially for the abundant biology majors, but everyone seems eager for something different from the traditional undergraduate lecture format. The class piles into the classroom and begins on time — surgeons are punctual.

The trauma surgeon instructor briefly goes over dissection tool technique and we begin the exam of our “first patient”. Our first dissection focuses on understanding the role of the “superficial back muscles” on shoulder support and joint motion. The scapulae, or shoulder blade, is an alien wing-like bone almost completely detached from the central skeletal system. Unlike most bones, the scapulae is supported primarily by numerous muscle-tendon insertions with just a single bone-bone “pivot” at the lateral edge of the clavicle, or collarbone. The fine-tuned muscle contractions slide the scapulae along the back for precise positioning of the shoulder joint.

As I look around at my new classmates, scalpels in hand, most sluggish from a night of getting to know each other over booze and late-night burgers, you see a few patterns. Aspiring physicians include an abundance of type A personalities, which means that many clamor to be the primary dissector. However, once the dissection begins you can quickly see the few who are captivated by anatomical exploration through slicing and dicing. I would bet that those few pursue the cult of surgery, addicted to the “cut” as one of my surgical physician mentors put it.

Class ends at 12:30 pm and I grab lunch with my classmate who is a young father. It turns out that his wife is also starting a graduate program meaning their budding family is entirely supported by student loans. They’re expecting a second child soon. He jokes that he’ll just use all his vomit-stained clothes for anatomy lab.

Class begins every weekday either at 7:00 or 8:00 am. Two days per week, classes, workshops, patient interviews, and other activities end before 1:00 pm. On the other three days activities conclude around 4:00 pm. We have anatomy lab once per week. The rest of the week is centered on lectures about cell and molecular biology, including signalling pathways, molecular structure-function pairings and cell microenvironment. Much of the material is familiar from my undergraduate biomedical engineering studies. However, after a year in the working world, I am surprised by how much I have forgotten. I spent a total of 6 hours doing homework this week. Dinners were off-campus with classmates. A typical weekend activity is a pick-up soccer game, getting drinks downtown, or a class hike.

The Whole Book: http://tinyurl.com/MedicalSchool2020

An Arab-Islamic perspective on Clinton vs. Trump

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My recent Baltic Sea cruise included passengers from more than 50 countries. I was called over to a gathering of young Arabs, mostly Saudis and Kuwaitis, for my perspective on the upcoming U.S. Presidential election. Some of these folks I had met on various shore excursions and we’d talked about their time in the U.S. (generally at least four years of college). On the question of politics I gave my standard answer that I wasn’t following the candidates because my vote, as a citizen of Massachusetts, is not relevant. The consensus of the Saudi/Kuwaiti group was that Trump was bad because he might make it tougher for them to come to the U.S. and they perceived him as “anti-Muslim”. They liked Hillary even less, however, and asserted that, like most establishment politicians, she was controlled by the Rothschild family, whom they believed to be worth $350 billion (i.e., more than Warren Buffett, Bill Gates, and Carlos Slim combined; Forbes, on the other hand, suggests that the family is worth in the single-digit billions; why would Rothschild family members break a sweat operating vineyards and selling wine if they are in fact worth $350 billion? You don’t see Carlos Slim-brand vino.).

Ladders to help children get up to neck-breaking heights when climbing trees

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Here’s something you probably wouldn’t see in a country that follows common law:

The trees in Fredericia, Denmark are too big/old/tall to have low enough branches for climbing. So apparently the town has put these ladders in the park to help kids get up to the lowest branches.

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What does Sheryl Sandberg actually do day-to-day at Facebook?

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I’m more than halfway through Chaos Monkeys: Obscene Fortune and Random Failure in Silicon Valley by Antonio Garcia Martinez. If you’re a fan of Lean In (my review) you might be interested to know what Sheryl Sandberg actually does in her role as COO. Martinez provides one concrete example:

First up in the Sheryl show was a product manager named Dan Rubinstein. Dan resembled a Woody Allen figure: short, thin, nebbish, but without the crackling anxiety. Also a former Googler, he seemed like one of those old PM hands who always made sure to take good notes and get his weekly report in on time. He fronted for User Ops, which was the user police, and the user-facing version of what I did on the ads side. Ever wonder why your feed never features any form of porn or otherwise grotesque imagery? It’s because a team in User Ops has managed to sift through the billion photos uploaded a day, and pick out a pile of offensive needles in an Internet scale haystack.

On the screen now, Dan launched a demo of a tool that was essentially that: on loading the Web app, a raft of user photos appeared, which a User Ops “analyst” could easily click to eliminate, like plucking weeds from a garden. That image would be banished forever, including versions with small color changes or cropping done by veteran spammers and sketchy ad types. As he walked the room through the demo, he would click on an image of a kitten—kittens evidently represented the porny pictures they’d normally filter—and that kitten would be gone, as well as all variants of that kitten image. Click, ban, reload, click, ban, reload. A well-oiled kitten-banning machine, ladies and gentlemen.

Suddenly Sheryl interrupted: “So, what’s with all the kittens?”

Dan, a bit startled, peered at Sheryl, clearly confused.

“Why are all the bad photos kittens?”

Dan flatly replied, “We use kittens as the bad photos in demos, because the real bad photos are . . . you know . . . kind of obscene.”

“Right,” said Sheryl, “but why kittens and not something else?”

The room was deathly silent with thirty-plus sets of twitchy eyes rising from barely concealed phones and laptops to stare at Dan and his kitten-banning machine. You could almost hear everyone mentally asking in chorus: Yeah, what is it with the kittens?

Dan looked up at the screen as if noticing the kitten pics for the first time, and then turned to Sheryl and answered, almost under his breath: “Well . . . for demo purposes we don’t show really bad photos . . . so the engineers use kittens instead. Because, you know . . . kittens and cats are like, pu—

He stopped right there, but he almost said “pussy” in front of the Queen of Lean, Sheryl Sandberg. “Got it!” she expectorated. After sucking in a lungful of air, as if loading for a verbal barrage, she continued. “If there were women on that team, they’d NEVER, EVER choose those photos as demo pics. I think you should change them immediately!” Before the salvo had even finished Dan’s head was bowed, and he was madly taking notes in a small notebook. CHANGE PUSSY PHOTOS NOW! one imagined they read. He looked like a forty-year-old scolded child.

I was dying inside. You could feel either awkwardness or repressed laughter seething from everyone in the room at this unprecedented display of management wrath and PM folly. Demoing the pussy filter to Sheryl. Epic!

Dan limped along with the rest of his demo, and then it was my turn. After that high-water mark of incompetence, it was hard to fuck things up. I glided through the slides, lingering on the money shot: a plot of the number of ads reviewed versus human man-hours. The former was up and to the right (MOAR ADS!), the latter was flat (fewer expensive humans!). All was right with the Ads Review world. I drowsed through the other presentations and bolted at the first opportunity.

 

More: read Chaos Monkeys: Obscene Fortune and Random Failure in Silicon Valley

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California Supreme Court rules in favor of government workers (tenured teachers)

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Vergara v. California has run its course, with the California Supreme Court today deciding not to examine an appeals court decision. It seems that the right of a government worker (schoolteacher) to continue collecting a paycheck is superior to the right of a child to an education. Not exactly news, but certainly heartening for anyone considering a career as a government worker.

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