Archive for January 5th, 2012
Well worth reading. By Charles McGrath, the profile will be in the NY Times Sunday Magazine:
There used to be just two Stephen Colberts, and they were hard enough to distinguish. The main difference was that one thought the other was an idiot. The idiot Colbert was the one who made a nice paycheck by appearing four times a week on “The Colbert Report” (pronounced in the French fashion, with both t’s silent), the extremely popular fake news show on Comedy Central. The other Colbert, the non-idiot, was the 47-year-old South Carolinian, a practicing Catholic, who lives with his wife and three children in suburban Montclair, N.J., where, according to one of his neighbors, he is “extremely normal.” One of the pleasures of attending a live taping of “The Colbert Report” is watching this Colbert transform himself into a Republican superhero.
Suburban Colbert comes out dressed in the other Colbert’s guise — dark two-button suit, tasteful Brooks Brothersy tie, rimless Rumsfeldian glasses — and answers questions from the audience for a few minutes. (The questions are usually about things like Colbert’s favorite sport or favorite character from “The Lord of the Rings,” but on one memorable occasion a young black boy asked him, “Are you my father?” Colbert hesitated a moment and then said, “Kareem?”) Then he steps onstage, gets a last dab of makeup while someone sprays his hair into an unmussable Romney-like helmet, and turns himself into his alter ego. His body straightens, as if jolted by a shock. A self-satisfied smile creeps across his mouth, and a manically fatuous gleam steals into his eyes.
Lately, though, there has emerged a third Colbert. This one is a version of the TV-show Colbert, except he doesn’t exist just on screen anymore. He exists in the real world and has begun to meddle in it. In 2008, the old Colbert briefly ran for president, entering the Democratic primary in his native state of South Carolina. (He hadn’t really switched parties, but the filing fee for the Republican primary was too expensive.) In 2010, invited by Representative Zoe Lofgren, he testified before Congress about the problem of illegal-immigrant farmworkers and remarked that “the obvious answer is for all of us to stop eating fruits and vegetables.”
But those forays into public life were spoofs, more or less. The new Colbert has crossed the line that separates a TV stunt from reality and a parody from what is being parodied. In June, after petitioning the Federal Election Commission, he started his own super PAC — a real one, with real money. He has run TV ads, endorsed (sort of) the presidential candidacy of Buddy Roemer, the former governor of Louisiana, and almost succeeded in hijacking and renaming the Republican primary in South Carolina. “Basically, the F.E.C. gave me the license to create a killer robot,” Colbert said to me in October, and there are times now when the robot seems to be running the television show instead of the other way around.
“It’s bizarre,” remarked an admiring Jon Stewart, whose own program, “The Daily Show,” immediately precedes “The Colbert Report” on Comedy Central and is where the Colbert character got his start. “Here is this fictional character who is now suddenly interacting in the real world. It’s so far up its own rear end,” he said, or words to that effect, “that you don’t know what to do except get high and sit in a room with a black light and a poster.”
In August, during the run-up to the Ames straw poll, some Iowans were baffled to turn on their TVs and see . . .
The last thing on earth that Big Pharma wants is ANY sort of investigation into the relative benefits of their various money-makers. Big Pharma wants drugs purchased based on marketing, not on usefulness. Josephine Johnson has an interesting article on this in The Scientist:
In 2009, the US government made a major investment in the kind of research that pharmaceutical and medical device companies loathe. Along with tax relief, extended unemployment benefits, and money for roads, bridges and schools, the American Recovery and Reinvestment Act—otherwise known as the Stimulus Bill or the Recovery Act—directed $150 billion in new funds to health care, of which $1.1 billion was to be used for comparative effectiveness research. Because such research isn’t much use if clinicians don’t know about it, part of that money is being used for dissemination of those results, including by a practice known as “academic detailing.”
Although the precise definition of comparative effectiveness research is a matter of some debate, as its name suggests it compares the efficacy, safety, and sometimes the cost of available treatment options for a given medical condition. Old drugs are compared with new drugs, surgical treatments with nonsurgical options, wait-and-see approaches with radical interventions. This research is quite unlike the kinds of clinical trials that drug and device companies conduct or sponsor in order to obtain FDA approval for their products. For one thing, it compares a range of available treatment options, instead of just pitting the company’s drug or device against a placebo. In addition, comparative effectiveness research often uses a more diverse patient population in a broader range of clinical contexts to get closer to “real world” use.
Federal money has been used for this kind of research for some time. In 1997, the Agency for Healthcare Research and Quality (AHRQ) began providing funding mainly to academic institutions for the development of Evidence-based Practice Center reports, which would review the available literature on a wide range of clinical topics, beginning with the diagnosis of sleep apnea, rehabilitation for traumatic brain injury, and the pharmacological treatment of alcoholism. In 2003, the Medicare Modernization Act authorized AHRQ to extend this work to include the funding of new research, as well as dissemination of its results to a variety of audiences. The stimulus money was a considerable boost to these efforts—in 2009, the appropriation to AHRQ for comparative effectiveness research was $300 million, ten times what it had received for those activities the year before.
Academic detailers are providing the kind of analysis that is quite a bit closer to the calculus physicians are supposed to be undertaking each time they write a script.
It’s easy to see why drug and device manufacturers are wary of comparative effectiveness research. These studies can sometimes conclude that older drugs, some available now as generics, are better than newer ones, or that a nonmedical therapy is better than implantation of an expensive device. But they are not the only ones concerned. Some politicians and commentators fear that the research results will be used by payers, including Medicare and Medicaid, to mandate particular treatments or to deny coverage. That fear is not completely unfounded: comparative effectiveness research is among the kinds of data that the UK’s National Institute for Health and Clinical Excellence (or “NICE”) relies on when drafting its clinical guidelines for the National Health Service—guidelines that significantly affect the care choices available to UK citizens.
Nevertheless, many clinicians, researchers, and policy makers believe that comparative effectiveness research is both sorely needed and likely to be instrumental in improving the effectiveness and value of health care and reducing unwarranted practice variation. Of course, just conducting the research isn’t enough—the results have to be disseminated to those who need it most. Like much scientific research, comparative effectiveness studies can make dry reading. And it just isn’t realistic to expect busy clinicians, particularly nonspecialists and those working outside academic medical centers, to keep on top of the latest developments. Some of the stimulus money, therefore, was earmarked for academic detailing.
The birth of academic detailing
Developed more than 30 years ago by physician Jerry Avorn and colleagues at Harvard Medical School, academic detailing takes a leaf from the pharmaceutical industry’s marketing playbook. For more than half a century, drug companies have spent a considerable amount of money marketing directly to physicians, including by sending sales representatives to visit doctors in their offices. In 1958, the industry estimated that its “detail men” made as many as 20 million calls. By 2005, approximately 100,000 individuals were employed as drug reps. Today, companies continue to use specially trained sales reps (although the numbers are reportedly down a little), but they also employ physicians and “medical science liaisons” (individuals with advanced scientific degrees) to meet with physicians about treatments.
These in-person calls have proved an extremely effective way of increasing sales, in part because . . .
Good summary by Jillian Rayfield of TPM Muckraker of what’s on the horizon this year with regard to gay marriage. In general, it is advancing, which I view as good news though I understand my view is not yet universal.
David Sirota points out in an article in Salon how those favoring the War on Drugs, a pernicious and pointless waste of money and wreckage of lives, are reduced to lying to support it, since any look at the truth shows that we are totally going the wrong direction:
Almost exactly eight years ago, I wrote an essay for the Nation magazine looking at how terms such as “centrism” and “moderate” were beginning to be deftly manipulated to shape the parameters of America’s political discourse. In almost every policy debate, these words were being used in with-us-or-against-us fashion to delineate what was — and what was not — acceptable. Through such linguistic propaganda over the last decade, America was gradually taught that anything called “centrist” or “moderate” was Good and Serious because it supposedly represented “mainstream” thinking in America — even as “centrism” was being used to describe policies and politicians that, based on empirical data, increasingly diverged from the actual center of our nation’s public opinion. By contrast, anything positioned in opposition to that branding was wild-eyed “leftist,” “extremist,” “ideological,” “fringe” — and most of all, Evil and Unserious.
As dishonest as this kind of agitprop is, it unfortunately — but predictably — continues unabated. This is, after all, the golden era of agitprop — a moment in which wars are no longer wars, corporations are people, and top New York Times scribes are given a national platform to declare that a key architect of the Republican Party’s infamous K Street Project “is not a representative of the corporate or financial wing of the party.” And so when it comes to who is a “centrist” or “moderate,” the distortions persist without so much as a peep of editorial protest.
The latest example of this insidious framing comes in the form of a Monday New York Times Op-Ed. The piece is written by Kevin Sabet, formerly one of President Obama’s top drug policy officials. Titled “Overdosing on Extremism,” he employs the “centrist” and “moderate” code words to criticize those pressing for reforms that, for purposes of law enforcement, would treat currently outlawed drugs such as marijuana just like far more dangerous yet legal drugs such as alcohol. With the possibility of these reform proposals roiling the presidential race and appearing on statewide ballots in 2012, a breathless and hysterical Sabet sounds an old fear-mongering alarm, writing (emphasis added): . . .
This is pretty cool: a safety razor made from a threaded bolt (the handle) and two pieces of PVC pipe of different sizes (the baseplate and cap). The inventor takes credit only for the handle, but really I think the entire razor merits recognition—indeed, the handle is the least interesting part. Take a look.
Losing the weight seems to have helped: my fasting blood glucose level was 92, very comfortable. (Normal range for fasting blood glucose is 70-99 milligrams per deciliter, so 92 isn’t bad at all.) My HbA1c was slightly up from last time—5.5%, 5.3% before—but still within normal range (below 6%).
Altogether, things are going well on the diabetes front.