Letters

Title IX Critics

Thank you to Michael Lynch for an outstanding article ("Title IX's Pyrrhic Victory," April). It conveys better than anything I've read the draconian combination of activism and bureaucracy in pursuit of "equality." I am a former college swimmer, and I have been pained to read in the last few weeks that two more universities, Kansas and Nebraska, are dropping their men's programs. I blame the athletic departments, too, which are eager to use their major sports as cash cows and glorified minor league teams. But Title IX deserves the lion's share of blame.

The irony is that I am a high school government teacher and the head girls swimming-and-diving coach at my school. I have a team of phenomenal young women who excel in the pool and the classroom. However, their opportunity to pursue a sport should not come at the expense of young men who don't fit into a numerical quota. Rather than addressing this issue, supporters of Title IX deflect criticism, instead focusing on the "Title IX babies" that have won Olympic medals.

Robert Black
Canandaigua, NY

If Title IX were applied to other areas as it is to athletics, the following groups could be in trouble:

*Engineering schools: At the University of Arizona in the mid-1980s, the ratio of male to female engineering students was about 10 to 1. I don't think it has changed all that radically in 15 years. Other schools show a similar ratio.

*Women's studies programs: Enough said.

*Nurses at federally funded hospitals: Almost exclusively female.

*The U.S. military: If opportunity means participation in Newspeak, then our Armed Forces might as well go home now.

*DEA agents, federal judges: Mostly male. Let's shut down the war on drugs (not a bad idea) on the basis of Title IX inequities in the drug warrior ranks.

This list could go on indefinitely. I used to think that no one would ever take this or any other issue that far, but all it seems to take is a crackpot judge and a boatload of lawyers with some skewed statistics to send any federally funded organization into chaos.

Andrew Varnava
Ventura, CA

Nicely written article on the Orwellian policy known as Title IX. However, I think the only thing more irrelevant than forced female athletic programs are the high-profile male athletic programs.

Far too much emphasis is placed on sports in this country. Athletes are inappropriately placed on "hero" pedestals by the masses. While at the gym during lunch time on a weekday, I noticed a college basketball game on one of the televisions. The game was in Texas, where it was about 1:30 p.m. Why weren't these players in class?

Male collegiate athletic programs are nothing more than a money mill, and I would love to see them relegated to the extracurricular bin where they belong -- though I would never support a law to affect this change.

Tim Grimes
Moorpark, CA

Hooked

As a health care provider, I had a mixed response to Ronald Bailey's "Goddamn the Pusher Man" (April). His free market arguments as they pertain to the rights of the pharmaceutical industry are unassailable. But Mr. Bailey's assertions regarding the scientific laudability of the "better health through chemistry" credo of the drug industry deserve closer examination.

There is nothing wrong with quelling one's symptoms when one is in pain or discomfort. There is something very wrong with passing that off as having fixed the problem. Or in having that be considered the state of the art. That's the case for many drugs, like acid-blocking Pepsid AC; they do nothing to change what is actually wrong with the person. Ditto for Mr. Bailey's antihistamine drug. Ditto for asthma medications.

Drugs, contrary to Mr. Bailey's fervent belief, do not save us money. Drug errors kill 98,000 Americans every year, according to the Institute of Medicine. The New England Journal of Medicine, a rather conservative periodical not aimed at the sprout-munching, crystal-gazing, guru- worshipping, sandal-wearing crowd, reported that nearly 110,000 Americans die each year in hospitals from properly prescribed medication. We spend $75 billion each year on prescription medication and another $76 billion on hospitalization cleaning up the problems caused by those medications.

Taking the aforementioned body count to its logical mathematical conclusion, we find that legal drugs are the third leading cause of death in the U.S., behind only heart disease and cancer. Yet despite all this and Mr. Bailey's admiration of the pharmaceutical industry's ability to do research independently, the National Institutes of Health gave $3.5 billion for research to 25 medical schools.

All the while, non-drug therapies that work incredibly well, like chiropractic, chelation therapy, and nutritional therapy, are given short shrift by the government and private insurers. In fact, chiropractic receives a grand total of zero federal dollars for research. This is remarkable considering the reams of patient testimony gathered over a century of clinical practice testifying to the fact that chiropractic has proven benefits for patients suffering from asthma, headaches, PMS, poor immune function, ear infections, and spinal pain, to name a few.

The drug industry, with its ally the American Medical Association, has rigged the deck so that drugs, some potentially deadly or not very effective, are happily paid for by insurance companies. This has nothing to do with research. It has to do with politics and who will continue to receive the bulk of state, federal, and private money. Remember, the AMA et al. were found guilty of conspiring to eliminate the chiropractic profession. Given the incestuous relationship of the AMA and the drug industry, one does not need to be Oliver Stone to connect the dots.

I have little space in my capitalistic heart to spend pining for the poor, vilified drug companies. I have plenty of space to worry about the accumulative physiological and psychological damage we are accruing in an increasingly drugged culture and the plight of working families who only have orthodox care like drugs paid for in their insurance plans.

Charles A. Krieger
Doctor of Chiropractic
Astoria, NY

Ronald Bailey strives to make a case for what is, in reality, a double tax billing. The cited example of Xalatan is a double taking from taxpayers. First they funded the drug's development. Then once the drug was sold, taxes were taken from them again when the drug company "paid" corporate income tax, since corporations ultimately pass these taxes through to the consumer. So the federal government -- and Phar-macia and Upjohn -- used the U.S. tax system to exact hundreds of millions from American taxpayers. Sure, even bearing the full cost of production, these companies' customers and the United States may eventually see a net benefit, because of the value of some drugs in bettering lives, but let nobody be deceived: Both the NIH grant and the "income taxes" are takings.

The fact that smoking marijuana treats glaucoma much more cheaply, moreover without incurring a tax, is ignored by the article. There are almost certainly other cheap herbal preparations that could effectively treat or ameliorate various chronic conditions. The government and drug companies suppress such knowledge; it is criminal conduct of the vilest sort.

In short, the entire article is an apology for interlaced gangs of criminals -- for mafias. Was that Bailey's intent -- to covertly make a case for removing all subsidies and taxes?

Michael G. Jones
Palm Harbor, FL

Ronald Bailey's article makes some interesting attempts to defuse critics of the pharmaceutical industry, but I'm not fully convinced. Particularly troublesome to me as a sometime small-business proprietor is the assertion that the 20 percent profit calculation based on writing off research and development as "current expenses" would shrink to 9 percent if those expenses were depreciated. This seems to me to fly directly in the face of the way the rest of us calculate our taxes.

Suppose my gross profit for the year X is $10,000. If I spend $8,000 that year to earn the $10,000, and can write that entire amount off as current expenses, then my net profit is $2,000. But if I depreciate $2,000 of my expenses over five years, then I can only write off a fifth of that $2,000 in year X, i.e., $400 of it. My books will then show a net profit of $3,600. It does not seem to be the case that I or anyone else would show a higher profit after subtracting an expense in its entirety.

This isn't the only instance of baffling logic in the piece. Drug firms argue that higher profits than in most enterprises (9 percent to their 5 percent) is justified given the start-up costs, and that important among these is the pursuit of possible products down what often prove to be blind alleys. But it is precisely at this stage in the game, Bailey points out, that federal subsidies most come into play. By funding the research, the government steps in to shoulder the risk. You might argue that government shouldn't be in the business of doing this, but so long as public money serves this function, it is difficult to see how the drug companies can make a case for higher profits to offset higher risk.

Mr. Bailey approvingly quotes Frank Lichtenberg's assertion that his study of newer versus older drugs showed that newer on the whole meant better, lowering "mortality, morbidity, and total medical expenditure." But it is not at all clear how Prof. Lichtenberg gets from those conclusions to his remarkably counterintuitive one with which Mr. Bailey follows it: that using generic drugs instead of brand-name ones "would increase total treatment costs" and lead to "worse outcomes." Any generic drug my physician may authorize is by definition identical to the brand-name drug for which it is a substitute.

The first line of defense against junk science is peer review by scientifically informed people. When dealing with cutting-edge technology issues where there are many opportunities for confusion even without anyone deliberately creating it, may we trust Mr. Bailey to see clearly and report well? Alas, the epistemological heffalump-traps in his drug article do not assure me that this will be so.

Nick Humez
Montclair State University
Upper Montclair, NJ

After enjoying REASON for over 20 years, I am finally moved to write. I liked "God-damn the Pusher Man": More consumers and voters need to understand how drugs reduce overall medical costs.

I do have a couple of concerns. First, Bailey claims that if pharmaceutical companies depreciated their research and development expenditures, their reported annual profits would decline. Over the longer term, I do not see how this would make any difference, other than to smooth out the impact of changes in R&D funding.

My second concern regards his arguments supporting the 20 percent profit level (or 9 percent, if he's right about the above). Drug discovery and development may well be very risky. But if the large drug companies are consistently making a 20 percent annual profit, it would seem they have figured out how to take the risk out if it. In a free market, this should lead to increased competition, unless there is some barrier to entry. Maybe it's size; one needs to be able to fund many projects and have a large, specialized R&D division to find a winner that pays for all the effort. Bailey quotes a figure of $300 million to $500 million to bring a single drug to market. Does that include a share of the R&D spent on products that never made it? Would a new company need to spend many times that to produce one marketable product?

Bailey quotes George Whitesides as saying, "Start-ups take 50 percent of the risk out of a product by taking it up to clinical trials." For every start-up that gets this far, there must be many that fail. Too bad Mr. Bailey does not focus on this aspect. It would be interesting to calculate the overall industry profit level after including all of the costs of the start-ups.

Jim McIntosh
Toronto, Ontario

Ronald Bailey makes a common error. Nowhere in the Hippocratic Oath does the injunction "First, do no harm" appear, nor is there any language that translates simply into that advice. It is certainly an admirable approach, and doctors (to say nothing of legislators) should heed it, but it's not in the oath.

Dan Karlan
Waldwick, NJ

Ronald Bailey replies: Some drugs do cure disease. Stomach acid-blockers combined with antibiotics can eliminate ulcers. Many future medicines will be targeted toward correcting underlying physical maladies. The Institute of Medicine study, To Err Is Human: Building a Safer Health System, estimated that as many as 98,000 people die annually from medical errors that occur in hospitals. While tragic, these errors are hardly the fault of drug companies. As for the alleged numbers from The New England Journal of Medicine, an editor from the journal assured me that they have published no such study. Dr. Krieger may be misquoting a line found on many alternative medicine Web sites, attributed to NEJM: "During 1983 to 1992, between 90,000 and 110,000 Americans died from reactions to prescription drugs." Note that it's 110,000 per decade, not per year. Finally, I agree with Dr. Krieger at least in that patients should be able to choose whatever therapies they want.

With regard to Xalatan, economist Frank Lichtenberg was only addressing the impact of R&D subsidies on the govern-ment's budget. In terms of the govern-ment's bottom line, taxpayers who do not use Xalatan were not ripped off by the R&D subsidy, and those who do use the drug presumably benefited enough to make any taxes included in the drug's cost >worthwhile. Mr. Jones raises a reasonable question as to whether such subsidies are justified. Certainly, corporate income taxes should be abolished. As for medical marijuana, I'm all for it -- and tax-free too.

The confusion over the calculation of drug company profits arises from my colloquial use of the term profit margin. Expensing R&D would indeed lower profits and profit margins, but this is not necessarily true for profit rates -- returns on investment -- which are generally considered to be the best figures to compare profits across industries.

According to economist Henry Grabowski, expensing R&D significantly understates a firm's asset base and therefore misleadingly inflates the returns. This is because a typical drug candidate takes more than 10 years and several hundred million dollars to reach the market, thus much of the company's capital is R&D in the pipeline rather than physical capital in plants and equipment. As Grabowski's studies and many others have shown, drug companies' returns on capital after this adjustment are still above the average for American industry. However, most of the studies conclude that risk-adjusted returns in pharmaceuticals are only modestly above competitive levels. As Grabowski concludes, "This seems like a small price to pay for the highly innovative performance of the industry."

Government R&D subsidies do reduce risk, to some extent. But one should not look solely at the risks borne by big pharmaceutical companies. Venture capitalists and others who invest in scores of start-ups shoulder a huge amount of the risk involved in getting drugs to clinical trials and beyond. As Mr. McIntosh points out, many of these companies fail.

Prof. Humez asks why branded drugs might be better than generics. The confusion arises over my use of the term generic. When branded drugs' patents expire, identical generic versions can be produced. However, the relevant comparison is not between generic and branded, but between older drugs (both generic and branded) and newer (branded) drugs. Lichtenberg's point is that newer drugs make for better, more cost-effective health outcomes.

As for the Hippocratic Oath, Mr. Karlan is correct. "First do no harm" comes from the Latin phrase "primum non nocere," which is a translation of a phrase from Hippocrates' Epidemics, not his oath. The oath does more or less incorporate the idea, if a bit more verbosely.

Memorial Memorandum

Michael Valdez Moses' piece on the Roosevelt memorial ("A Rendezvous with Density," April) was great! I had just finished reading John T. Flynn's The Roosevelt Myth, a wonderful debunking work on FDR. I was struck with all of the Roosevelt-Clinton parallels, particularly the mendacity, manipulation, and venality. Until I read your piece, I didn't realize the level of Clinton's interest and involvement in the FDR memorial. It all makes sense.

Stephen P. Foster
Mount Pleasant, MI

I'd like to thank Michael Moses for his delightful critique of the FDR Memorial. It's indeed only appropriate that the president who sired Big Government would have his wishes for a simple memorial ignored in favor of another public works program.

David Hall
Durham, NC

Excellent article on the FDR Memorial -- I am planning to cite it as a reading reference for my landscape architecture course this fall here at Iowa State. Moses' perspective will be a fine contrast to the gauzy and often uncritical accolades given this work in much of our profession's press.

But I must underscore that Lawrence Halprin -- who may be politically naive but was a strikingly innovative designer (see his Ira Keller Fountain in Portland, Oregon) -- is not an architect. He is a landscape architect. The two professions are related, but have diverged considerably since Frederick Law Olmsted's era. I make this distinction because, as you might imagine, my profession is often overshadowed by architecture; also, if someone I meet has heard of "landscape architecture," they almost always associate it with garden design or planting plans.

Michael Martin
Ames, IA

Michael Moses has a keen eye for the implicit ideology in public monuments, but I have to point out an inaccuracy. Moses criticizes Halprin for never having had an economic history course as he lamely explains the causes of the Great Depression. Then Moses notes that "the nation sank more deeply into the quagmire of the Great Depression in the years following the initiation of the New Deal in 1933." This is wrong.

First, look at unemployment. It rose from about 4 percent in 1929 to a peak of 25 percent in 1933. After 1933 it started to fall and fell until 1936, when it rose for about a year. After 1938, it continued to fall into the early 1940s. Next look at real gross national product. It fell from 1929 to 1933 and bottomed out in early 1933. Then it started to rise and climbed every year until the '36-'37 recession, after which it again continued upward into the early 1940s. (For more, see A New Economic View of American History, by Jeremy Atack and Peter Passell.)

Thus, the Great Depression bottomed out in early 1933 and began a slow recovery afterwards. This is not to say the New Deal turned the economy around; the recovery started before it took effect. In fact, some argue that the legislative flurry of the New Deal slowed down a cyclical recovery that was already in effect.

Dan Hardy
Austin, TX

Michael Valdez Moses replies: I welcome Mr. Hardy's suggestion that "the New Deal slowed down a cyclical recovery." As Lawrence W. Reed argues in his essay Great Myths of the Great Depression, "The 'economic stimulus' of Franklin Roose-velt's New Deal…achieved a real 'first': a depression within a depression!"

In support of my claim that the nation sank more deeply into depression following the New Deal's initiation, I would cite historian Paul Johnson. He states in his book Modern Times that "1937 was the only reasonably good year, when unemployment, at 14.3 per cent, actually dipped below 8 million; but by the end of the year the economy was in free fall again -- the fastest fall so far recorded -- and unemployment was at 19 per cent the following year." Johnson also notes that, besides a blip in '37, it was not until 1941 that "the dollar value of production finally passed 1929 levels."

In absolute terms, the Great Depression may have "bottomed out" by the end of 1933, but the unprecedented rate of economic contraction in 1937 and the prolonged duration of the depression, which lasted until World War II, argues against the notion that the New Deal was anything but a spectacular failure.

Unbalanced?

Imagine my shock when Jeff A. Taylor ("Balance Sheet," April) gave a down arrow to President Bush for wanting to reduce government spending. I am in complete shock. I empathize with Taylor, who is upset with the proposed $20 million cutback on funding for research on Parkinson's and Alzheimer's. Just imagine what could be accomplished if the government spent $40 million, or how about $1 trillion, on research! No doubt Alzheimer's would be eradicated, as well as all of society's ills. Notice my sarcasm. Mr. Taylor is obviously so perplexed by President Bush's commitment to reducing the incidence of abortion that he is willing to forgo his libertarian principles. If abortion weren't at issue, I imagine Taylor's criticism would quickly change to praise.

Josh Scandlen
Dayton, VA

Jeff A. Taylor replies:I assess plus and minuses in reference to the real world. In Taylorland, we'd have zero federal funding of such research, along with about eight fewer Cabinet agencies. But as that isn't the world we live in, the question is: Given that money will be spent on dubious things, is it possible for cash to go to the less dubious?

I consider stem cell research less dubious for several reasons. First, $20 million is absolutely nothing in the realm of federal spending. It is just a fraction of the many billions in new spending that the Bush team plans. Second, all available evidence suggests stem cell research is worthwhile -- several rungs above, say, road improvements to every cow track that passes in front of a car dealership owned by the relative of a congressman. Third, there is the sad fact that federal research money really does seem to give many labs and scientists a stamp of validity.

Mr. Scandlen is correct that abortion plays in my negative assessment of the proposed policy change. But not for the reason he suspects. The abortion angle tells us that the policy is being driven by political factors quite apart from the merits of the research. That is never a good way to run a country.