"Unbridled Promotion" a No-No

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Sez Topol–no, not the second-rate Zero Mostel impersonator, nor the namesake of "the smoker's toothpaste." It's Dr. Eric J. Topol, a big wheel of cardiovascular medicine at the Cleveland Clinic, who's down on direct promotion of drugs to consumers. Looking upon the recent problems with Vioxx, Celebrex, etc., he despairs:

"Unbridled promotion exacerbated the public health problem…The combination of mass promotion of a medicine with an unknown and suspect safety profile cannot be tolerated in the future."

Whole story here.

A few points in response:

First, direct-to-consumer drug advertisements obviously increase awareness of a given product; that's the point. But that doesn't translate into a lemmingsesque population demanding their inalienable right of Celebrex or heartburn relief. It may (may) be precondition for consumer demand, but it's hardly sufficient.

Second, many, probably most, doctors don't keep up with anything and the information encoded in ads helps patients get around the gatekeeper function often served incompetently by out-of-touch general practitioners and the like. Indeed, the real problem may be with the prescription regime itself, which creates all sorts of weird issues in both the development of, promotion of, and information flow about drugs. If pot and cocaine should be legal (without a prescription), so should Vioxx and Celebrex.

Third, drug companies want to sell drugs and make huge profits (not that there's anything wrong with that, as Ronald Bailey pointed out a few years back). If they are making grandiose and misleading statements about the effectiveness and efficacy of their products–and the case against many prescription drugs such as say, Vioxx, is far from clear-cut–then choking off the information flow is hardly going to help. Really, is there any other product field in which having more people know less leads to better results?

As a summa cum laude graduate of the Quinn-Martin School of Hard Knocks, I know that corporate tycoons are evil and that their main goal is to sell shit that will in fact kill their customers. But I also know, as Milton Friedman once said in the pages of Reason, the genius of a market system is that, when free of interference (such as we see with the Food and Drug Administration, the prescription regime, current licensing practices, and more), it sets producers against one another to debunk themselves in a competitive marketplace. The process isn't perfect or error-free, but it's better than alternatives, including centralizing all approval and information in a single expert source.

Which is what Dr. Topol is talking about ultimately. Indeed, I find it hard not to read his–and similar–criticisms as an attempt to regain control over a medical system from which power has been moving from established authorities towards patients. There's no question that doctors–like lawyers, teachers, politicians, clergy, and other established authority figures–have taken it on the chin over the past several decades, increasingly bypassed or minimized by masses who feel empowered by general increases in wealth, education, and technology. Doctors are still rich and high status, but they increasingly resemble high-end car mechanics and other service sector types who must trade in "customer service." That is, their days as demi-gods in American society are coming to an end and they will certainly try to maintain their position for as long as possible. And will try to do so by arrogating for themselves the right to make decisions for patients/consumers.

NEXT: "65,000 death toll 'may be dwarfed'"

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  1. many, probably most, doctors don’t keep up with anything and the information encoded in ads helps patients get around the gatekeeper function often served incompetently by out-of-touch general practitioners and the like.

    certainly true at least some of the time, and

    The process isn’t perfect or error-free, but it’s better than alternatives, including centralizing all approval and information in a single expert source.

    one can make this case, mr gillespie. but,

    direct-to-consumer drug advertisements obviously increase awareness of a given product; that’s the point. But that doesn’t translate into a lemmingsesque population demanding their inalienable right of Celebrex or heartburn relief.

    we don’t need to be rousseauian and pretend the masses are wise. yes it does. in the main, people in the thrall of advertising are no better than panicky cattle, and having a pharmacist for a wife brings me bizarre evidence of it almost daily.

    i submit that, if we are to insist on the empowerment of the people as the best possible method, despite their obvious uncritical dimness, we should at least acknowledge that much.

  2. Word up, Nick. While I’m annoyed at doctors today, I’m still pissed at the dead and gone doctors (and their lackeys in government) who confiscated massive amounts of power and authority when they stumbled upon a few good ideas (like germ theory) back in the day.

  3. “Other leading academic researchers have suggested that new drugs should be subject to a trial period before they can be touted directly to patients.”

    Ummmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmm. Are these academic researchers from the art department or something? How many billions of dollars are spent on clinical trials every year?

    From the NYTimes, Aug 11 2004:
    To the Editor:

    Re: “In Drug Research, Some Guinea Pigs Are Now Human” (front page, Aug. 4):

    This development is not surprising but simply one, clinical aspect of a larger phenomenon: the use of the consumer population as the subjects of ”market experimentation.”

    By that I mean the process by which the public is used as subjects of many inquiries into the possible hazardous effects of new products and procedures. That process is a necessary part of innovation.

    Being guinea pigs is therefore part of the fate of being modern consumers, and it often leads to progress.

    A principal problem for the law is to keep various kinds of experimentation within bounds. One of the main ways to do that is to provide consumers — consumers generally as well as subjects of formal experiments — with relevant information about risk. Another, sometimes desirable check on experimentation with human beings is to require compensation for injuries.

    Marshall S. Shapo
    Chicago, Aug. 4, 2004

    The writer is a law professor at Northwestern University.

  4. Everything’s Fine! Nothing to see here. The only lesson to be gleaned from the Vioxx episode is that there should be less testing of drugs. Patients insisting on the brand names they see on TV has proven to be a highly effective method of treating disease. Except that patients don’t really act that way, so don’t worry. But even if they did, it would be just fine. Oh, and doctor’s don’t really know much about how medicines work, at least not any better than patients. The real story here is that Vioxx was tested too stringently.

    What part of libertarianism requires one to believe that no one could possibly be better informed about any topic than a person watching an ad on television?

  5. Gaius Marius said “we don’t need to be rousseauian and pretend the masses are wise. yes it does. in the main, people in the thrall of advertising are no better than panicky cattle, and having a pharmacist for a wife brings me bizarre evidence of it almost daily.”

    I would offer that perhaps your wife is not seeing a random sample, but is instead seeing the small minority of the population that is lemmingsesque. Perhaps she doesn’t see the majority of the population that views advertising and integrates the information, but doesn’t respond with a panic.

    DTC advertising is yet another bogeyman for statists. I often hear arguments that DTC advertising creates ‘artificial demand’ for drugs that otherwise wouldn’t exist. As if seeing an ad for a statin suddenly artificially increases a person’s lipid count, or seeing an ad for a COX II inhibitor suddenly makes people come down with arthritis.

    No doubt some people will overreact to DTC advertising. But, some people were hypochondriacs long before DTC advertising was allowed, too.

  6. “What part of libertarianism requires one to believe that no one could possibly be better informed about any topic than a person watching an ad on television?”

    None. It just permits anyone to try to provide information. Will DTC ads allow some people to behave foolishly? Sure. But it will also prevent others from being forced into foolishness due to lack of information.

    The idea of restricting DTC ads is to protect fools from their foolishness. The net result of which is to fill the world with fools.

  7. What part of libertarianism requires one to believe that no one could possibly be better informed about any topic than a person watching an ad on television?

    What part of arrogance requires you to believe no one can be trusted to think for himself?

  8. What part of media-slavishness requires you to believe “thinking for yourself” requires corporate advertising?

  9. jeffie, the number of fools will remain the same, regardless. We have a prescription regime because it is safer, and better for public health, if decisions about medication are made by someone who is remotely qualified to make an educated decision.

  10. small minority of the population that is lemmingsesque.

    did you miss nasdaq 5000, mr hoon?

  11. To paraphrase Rummy,
    For homo sapiens to continue to evolve, we must start with the homo sapeiens we have.

    If the Founders of the USA had foreseen this silliness about drugs, they would have made the right to self-medicate the Second Amendment.
    Guns are dangerous. Drugs are dangerous. Duh.

  12. Damn, I guess teevee ads really are a big part of your thought process! But don’t worry, nobody really shows up at the doctor and demands an inappropriate medicine because of advertising. Except that, without the advertising, there wouldn’t be as many people going to the doctor to get the drug. Or something.

    Direct to consumer advertising should be restricted, because it is effective at doing exactly what it is intended to do – create demand for drugs above and beyond medical practitioners would recommend.

    Yes, Twba, you’re too fucking ignorant to know which drugs are best for which conditions, given your specific medical history. So am I. So is everyone who works for any drug company, or advertising company. Putting out misinformation doesn’t improve the efficiency of the drug market, it reduces it. Information that makes people want drugs that aren’t appropriate for their condition is misinformation.

  13. By your reasoning joe, you should not be allowed to post any comment about medicine. Remove your hands from the keyboard and let the experts do their jobs.

  14. Mr. Marcus,

    I did observe nasdaq 5000. I also observed DJIA 12,000, then 7,000 and now 10,700. I think there are striking differences between investing in cyclical markets and medication, and I don’t see the parallel.

    My point is that your wife is observing a portion of society that isn’t representative and drawing a general conclusion. It is as if the aid worker from skid row were to conclude “I don’t see why these crazy beer companies are telling us to drink responsibly. The homeless winos I see every day could never do that.”

    No one would expect a homeless wino to drink responsibly, but the skid row worker is projecting the results from a biased sample to the general population. In fact, the great majority of the general population are not homeless winos, and can drink in moderation.

    I contend that the great majority of people are also capable of making informed choices about medication. Not necessarily on their own, but in consultation with their doctors and assimliating all information available, including DTC advertisements.

  15. Twba, I don’t recommend prescription drugs to people in my comments. Nice try, though.

    Mac Daddy Houn, why do assume Marcus’ wife’s customers are not representative? What he says she describes to him sounds a lot like what the doctors I’ve spoken to tell me. You seem to assume that, because the events aren’t what your predictive model of customer/patient behavior would predict, that it’s the events that are inaccurate. Isn’t is possible, rather, that it is your predictive model that is flawed?

  16. “the number of fools will remain the same, regardless. We have a prescription regime because it is safer…”

    No. Fools that suffer the consequences of their foolishness either learn or perish. Either way the number of fools decrease. We have a prescription regime because people have been fooled into believing it is safer. We count the number saved due to FDA mandated testing, we don’t count the number lost due to delay and cost. Guess which one is greater?
    Several Nobel Prize winners have blasted the FDA as inefficient. Are you claiming that you’re expert enough to choose which expert to believe? And in the process claiming that I’m not?

  17. How many of those seven recommend doing away with the FDA altogether, rather than streamlining its operations?

    And which is it – would doing away with the FDA and prescription laws lead to more “fools” perishing? Or would there be no significant increase in people hurting themselves with ill-advised drug regimines?

    Always the two-faced argument – the government doesn’t actually help people, except that it does help people we’d be better of letting die.

  18. investing in cyclical markets

    not to go o/t — but is that really what you think you saw there?

    dear sir — i humbly disagree.

  19. Twba, I don’t recommend prescription drugs to people in my comments. Nice try, though.

    You advocate people not ask doctors about new medicines advertised during televised football games. I just want to know if my cock will stay stiff while I toss a football through a tire swing. Don’t tell me how to live my life. Let me have a taste of the Rockies in a silver bullet. My Chevrolet is like a rock. I want a prick like a rock. Whaaaaassssssup? It’s Miller time. Silly libertarian, tricks are for bureaucrats. Side effects include but are not limited to….

  20. how disturbing. i picked that up sunday at a post christmas 1.99 sale at b&n.

  21. Fools that suffer the consequences of their foolishness either learn or perish.

    this is it, in a nutshell. anyone who reads this and cannot see the absurdity of hyperindividualism and its completely antisocial, savage consequences is beyond me.

    implicit in the perverse argument of solitude as self-interest is the arrogance endemic to the libertarian — if i were left alone, i wouldn’t make the mistakes that would kill me — and the ignorance of the role of chance.

  22. it’s a great book, mr dhex.

  23. joe
    As I remember the recommendation was that getting rid of the FDA was better. As it is the number lost due to the FDA is greater than the number saved. At any rate, do you want to be one of those that hear “there’s a promising new drug in trials but it’s not expected to be out for a year, unfortunately you only have six months to live”?

    Tell you what, let’s call a truce. I’ll let you listen to the FDA and take the chance of losing your life because you won’t take a drug they don’t approve, you let me make up my own mind, with expert advice and drugs I choose, and take the risk of losing my life due to my own error.

    That’s what libertarianism is about, calling a truce.

  24. Twba, I’m sorry you don’t believe you can do those things without advertising.

    We tried your way. People took snake oil infused with mercury. No sale.

  25. The JOURNAL of the AMERICAN MEDICAL ASSOCIATION (JAMA) Vol 284, No 4, July 26th 2000 article written by Dr Barbara Starfield, MD, MPH, of the Johns Hopkins School of Hygiene and Public Health, shows that medical errors may be the third leading cause of death in the United States.

    The report apparently shows there are 2,000 deaths/year from unnecessary surgery; 7000 deaths/year from medication errors in hospitals; 20,000 deaths/year from other errors in hospitals; 80,000 deaths/year from infections in hospitals; 106,000 deaths/year from non-error, adverse effects of medications – these total up to 225,000 deaths per year in the US from iatrogenic causes which ranks these deaths as the # 3 killer. Iatrogenic is a term used when a patient dies as a direct result of treatments by a physician, whether it is from misdiagnosis of the ailment or from adverse drug reactions used to treat the illness. (drug reactions are the most common cause).

    Don’t think for yourself. Give me a break.

  26. Mr. Marcus,

    You failed to include the last section sentence in my post, where I say that people can make informed decisions about medication perhaps in consultation with their doctors. I don’t have to be an expert in medication to ask my doctor “Hey, is this new pain medication I saw on TV a good choice for my arthritis?” How is this a bad thing?

    I am not an expert, and in fact know next to nothing about how computers work, about how cars run, etc., but this doesn’t stop me from making informed choices about these items. Why is medecine different?

  27. That should be mr. marius.

    Many apologies.

  28. jeffie,

    “there’s a promising new drug in trials but it’s not expected to be out for a year, unfortunately you only have six months to live”

    …so we’re enterring you in a Phase II trial. In the real world, end stage patients have access to all kinds of new, untested drugs.

    You’re truce suggestion ignores the fact that such an arrangement would not only change what you do, but would also change the way the drug companies and doctors have to do their business.

  29. joe,

    The main source of information for most doctors, when it comes to what new medications are available and their respective merits, is (surprise, surprise, surprise) sales reps from the pharmaceutical companies.

    Most MDs go through a med school curriculum designed to mass-produce interns with an acute care focus. Given the role of drug company money in medical research, setting the “standards of practice,” etc., we have a medical model that strongly discourages doctors from minimizing drugs or seeking lower-cost alternatives to the latest patented cash-cow.

    So in short, your MD probably prescribes a medicine because he “saw it in a commercial.” The paradigmn of American allopathic medicine is not an alternative to the unbridled rule of Big Pharma–it is an *instrument* of that rule.

    mr. marius,

    A cursory reading of Thomas Kuhn should cure you of your faith in disinterested expertise. Or “Trust Us, We’re Experts” by Sheldon Rampton. The conventional wisdom in any field of specialization is likely to reflect an institutional mindset, and that mindset is likely to be influenced by motives somewhat less pure than the pursuit of truth.

  30. Ah yes, since doctor’s make bad decisions, we can expect better outcomes by having those decisions made by people with MBAs and hair styling school certificates instead. Brilliant reasoning, twba.

  31. “The main source of information for most doctors, when it comes to what new medications are available and their respective merits, is (surprise, surprise, surprise) sales reps from the pharmaceutical companies.”

    No, the main source by which doctors make judgements about medications and treatments is their rigorous education and experience with patients, which give them the tools they need to properly evaluate the information provided to them by drug reps, trade reps, and other up to date sources.

    “The conventional wisdom in any field of specialization is likely to reflect an institutional mindset, and that mindset is likely to be influenced by motives somewhat less pure than the pursuit of truth.” The issue is not whether the ability of doctors to make decisions is perfect, but whether it is better. The “mindset” of an educated and experienced doctor is far more effective at making these decisions than the “mindset” of a teevee viewer.

  32. one aspect of pharmaceuticals that gets ignored that has only been brushed on here is the active role of the patient in wellness. we have people popping prozac, which probably doesn’t work unless 1) something is really wrong and 2) it’s adjunct to lifestyle modifications including talking therapy.

    and we have people popping lipitor as the first-line against hyperlipidemia. not diet and exercise with lipitor as adjunct therapy.

    and we have people wanting a “z-pak” or whatever the fuck it is. and they feel better after two days and leave the rest.

    then we have florida setting up a drug list where a 23 year old who has a list and even less pharma knowledge than we all have, and he (or she) decides which drugs are on the list. so depakote DR is on the list, while ER, with different indications is not. because they’re considered “the same”.

    or we get baycol getting pulled back in august 2001 for complications when it was written in combo with gemfibrozil. problem is that the pi for baycol specifically said that it was effective with tricor (fenofibrate), not the other fibrate, gemfibrozil, where it was dangerous. i’ve watched our pharmacist “advise” someone about the price of gemfib and tricor and suggest they change. (!)

    reps from generic houses detail your pharmacist at wallgreens everyday. it is my understanding that this practice is illegal, but i’ve watched them, and know someone from a generic house who routinely does this.

    yes, it is a problem that patients see that they can take a pill and they’re fine. and they think that certain therapy is appropriate for them, and they’ll shop around, or worse, sue, to get the therapy they desire.

    i don’t know the solution, but i do know that the further medicine gets from the physician-patient and closer to the bureaucrat-politician, the worse-off we are.

    just remember that many doctors are mere assholes with tongue depressors and that due dilligence is a part of taking responsibility for your own wellness.

  33. “implicit in the perverse argument of solitude as self-interest is the arrogance endemic to the libertarian”

    Where did I espouse “solitude as self-interest”? On the contrary, libertarianism embraces social interaction. Notice I said social, not forced by government. As for arrogance, which is more arrogant , taking responsibility for myself, or claiming responsibility for someone else ( aka FDA )?
    Which is more arrogant, saying “you must die because I haven’t approved the drug (FDA)” or saying “I will take responsibility if this drug kills me, you choose for yourself”?

    The mistakes a Libertarian make kill only themselves, and in their death provide the information for others to save themselves. The mistakes the FDA make kill thousands, if not millions. Which is more savage?

  34. Joe,
    Doctors also prescribed snake oil infused with mercury. The common treatment for VD was an injection of mercury into the urethra.

    I don’t think anyone is arguming for a utopian drug regime where everyone gets exactly what they need and nothing they don’t, but I would like to make the choice for myself. If I don’t consult with experts and die, that’s my fault.

  35. OK, Joe, let’s hear an alternative.
    You assert that there is a claim on the table that “since doctor’s make bad decisions, we can expect better outcomes by having those decisions made by people with MBAs and hair styling school certificates instead”.
    What would you propose changing?
    Or are you all right with the way things are today?
    And, by the way, your claim that “In the real world, end stage patients have access to all kinds of new, untested drugs”, while true, is at best disingenuous.
    The fact, cold hard brutal fact, is that many many end stage patients do not get access. You trivialize the problem, as well as the pain and suffering imposed by the FDA, with this cavalier attitude.

    Shirley Knott

  36. Joe said “The “mindset” of an educated and experienced doctor is far more effective at making these decisions than the “mindset” of a teevee viewer.”

    Wow, you really have a poor opinion of people, don’t you?

    Earlier you asked if perhaps my predictive model was flawed because I suggested that a sampling of patients in a pharmacy wasn’t random, or something to that effect.

    In fact, I have no proof that my predictive model isn’t inaccurate. It is possible, I suppose, that I am (and my colleagues etc. are) in the top echelons of society, well educated and independent while the vast majority of people are average, uninformed hysterical fools completely dependent on others to take care of them.

    Or perhaps, I am just average. Maybe average is a lot better than people give credit for, and in fact the dependent hysterical fools are the lower echelons of society. Unfortunate yes, perhaps even tragic, but hardly representative.

    I would love to think that I am in the upper echelons of society, but I think it is much more likely that I am just average.

    Too bad for me.

  37. “could a private agency do as well? probably, i think. but the motive of such agency is profit, and profit means that these agencies can be bought.”

    You mean like Consumer Reports and the Snell Foundation? You forget that money isn’t the only form of currency. Ever hear of political power? What makes you think the FDA can’t be bought with it?

    Actually, the profit motive of independent agencies serves to protect their integrity. Without integrity, and effectiveness, those agencies have nothing to sell. Without integrity and effectiveness, the FDA still exists.

  38. “If I don’t consult with experts and die, that’s my fault.”

    It is also a negative outcome that official policy should discourage. That’s the real argument here – I believe the government should work to reduce people dying from bad medicine, and you don’t. It’s a value judgement, one we disagree on. Fine.

    What would I propose changing, Shirley? I wouldn’t propose any major changes. I would leave that up to the people who are in a position to properly weigh proposed changes on a rigorous cost/benefit analysis, as they did when they approved the distribution of experimental drugs via trials. The last thing the system needs is uneducated ideologues basing decisions on what their ideology presumes MUST always result in the best outcomes.

    Give me a break, Shirley. A poster upthread commented that we’re better off if fools kill themselves, which you let go, but I’m trivializing people’s pain and suffering by pointing out the fact that the FDA has, in fact, made changes to its regulatory system to address the problem you raise, and that it has been successful. So to sum up, viewing deaths as a positive outcome is Surely Not worth commenting on, but praising the FDA for largely, but not completely, addressing the problem you raise is callous and irresponsible. Surely, you are not being honest or fair.

  39. gaius,
    You mean government can’t be bought? Regardless of gov’t or private, profit is the motivator. Without any hope for gain, nothing gets done. Gov’t simply must use force to get its business, because efficiency and cost aren’t their forte. If not forced to use gov’t services, very few people would because it would cost so much more.

    Likewise, if gov’t agencies had to run as a business and worry about cost and profit to stay in business, which as they are now would have went bankrupt ages ago, they wouldn’t be government agencies.

  40. “Indeed, the real problem may be with the prescription regime itself,”

    Hear hear! If I know what drug I need, why should a doctor get paid to rubber stamp it? For that is mostly what they do. The only information they have as to my particular condition is what I tell them and what I fill out on the form. It’s not like they give you a complete physical every time to catch potential problems with any given drug. So in other words, it’s all up to you. Well, if it’s all up to me, why am I paying the doctor?

    There is such a plethora of drug information on line, that it is easier than ever to be an educated consumer. In fact, I don’t take drugs the doctor has prescribed until I get home and check it out online. Consumers with the motivation and ability to get their own information and be honest with themselves about their own condition shouldn’t be punished because others are ignorant.

    This particularly applies to repeat prescriptions. Why my doctor wants to see me once a year to reissue a prescription for a drug I’ve used for years is beyond me. Oh, I know, he wants more money. Those visits are entirely formalities, with no medical merit whatsoever.

  41. I’m with jeffie when he said:
    “Actually, the profit motive of independent agencies serves to protect their integrity. Without integrity, and effectiveness, those agencies have nothing to sell. Without integrity and effectiveness, the FDA still exists.”

    I’d also like to see patents on drugs abolished, but that’s another topic.

  42. joe writes “I believe the government should work to reduce people dying from bad medicine, and you don’t. It’s a value judgement, one we disagree on. Fine.”

    Except that you just don’t simply disagree. You support using the force of government to impose your value judgement on others, ignoring the number of people the government kills by delaying good drugs while working to reduce deaths by bad drugs.
    Ever hear of Vioxx? In spite of your claims, the FDA doesn’t work, never has, and if it ever does it will be a miracle. Remember, I have several Nobel laureates to back me up. How many do you have?

  43. dead elvis,
    Should we trust a dead person to be giving self-medication advice? Especially Elvis!

  44. Try this stuff. It’s the shit that killed Elvis. Drug advertising at its best.

  45. “Wow, you really have a poor opinion of people, don’t you?”

    No, Mac, I have a high opinion of education, experience, and expertise as being useful when making highly complex decisions involving specialized knowledge. I’m sure those teevee viewers have their own fields of expertise, about which doctors should defer to their opinions.

    I’m sure that you are quite a bit above average in pimpin’ da Hoon ho’s, but it is not an insult to you to suggest that there are areas of knowledge you don’t know very much about.

    “Likewise, if gov’t agencies had to run as a business and worry about cost and profit to stay in business, which as they are now would have went bankrupt ages ago, they wouldn’t be government agencies.” That is why, Pint, there is a division of labor between the government and the private sector. There are some things that need doing that aren’t profitable.

    “There is such a plethora of drug information on line, that it is easier than ever to be an educated consumer.” And even easier to be a miseducated consumer, who overestimates the capacity of his “little big of learning” to substitute for the judgement of a professional.

    jeffie, if you and your hand-picked Nobel lauriates can win in the marketplace of ideas, the law will be changed. But you can’t; at most, you can effect incremental changes on the merits, sometimes.

    Yes, I support the use of force to compel the drug market to function one way, and not another. So do you – you don’t want drug companies to be allowed to lie about their products without consequence. You want force to be used to compel them to pay for the damage they cause to people, so get the moral high horse. The issue isn’t whether government force should be used to shape how drug companies operate, but how and when.

  46. Ah yes, let’s consider Elvis. Now THERE was an empowered drug consumer. He and his enlightened medical employees didn’t let laws and regulations and, er, medical knowledge get in the way of his right to determine his drug regimine. Heck, he had the Merck Manual memorized, from what I’ve heard.

    All hail the independent, home-schooled drug prescriber!

  47. Joe-
    I agree with you that a legitimate function of government is protecting people from OTHER PEOPLE, but why do you continue to promote the use of government to protect people from themselves? Especially when they don’t WANT to be protected? You, Joe, are not just advocating using force against drug companies, but against consumers as well.

  48. “Actually, the profit motive of independent agencies serves to protect their integrity. Without integrity, and effectiveness, those agencies have nothing to sell. Without integrity and effectiveness, the FDA still exists.”

    mr jeffie, mr ruthless — you assume that enterprises will function ethically because it is in their rational self interest.

    there are two problems with that.

    first, what if it is not in their rational self-interest? what if the barriers to entry are so low that profit can be made in repeated fraud with less effort? there is nothing that says it cannot be so — and indeed, the internet is rife with the evidence of such activity. and the credulous masses line up to believe it.

    second, what if they are not rational? why does any company undertake a widespread fraud despite the certainty that it will come crashing down in time? why enron? why global crossing? because the assumption of rationality is invalid — not only are the masses animals, but the bourgeoisie too.

    the compact of government afford us the opportunity to use the force of arms to impose restraint where self-restraint fails on both the prole and the bourgeois — and hopefully, in an open system, on the sovereign as well.

  49. why do you continue to promote the use of government to protect people from themselves? Especially when they don’t WANT to be protected?

    is it possible, ms jennifer, that people often (even usually) aren’t intelligent enough to see when they are committing suicide — and that their suicide is not an entirely self-involved act but affects the well-being of others in the society? and that, this being so, any system of laws MUST invade the individual prerogative on some level to protect the society by protecting the irrational and the unintelligent from themselves?

    just a thought.

  50. Let’s step away from the food fight over prescriptions and ads and markets and “what part of libertarianism requires you to be an idiot?” (the answer, btw, is “purity”)

    Let’s look at this from the perspective of legalizing the currently illicit drugs. I think most people here (joe included) agree that it’s better to legalize things like heroin and pot, because otherwise we get a destructive black market. So far so good.

    Now, what about drugs that are legal by presciption but still sold on the black market because there are people who want them for recreational use? The same black market pathologies are present, just on a smaller scale. I would argue in favor of legalizing non-prescription sales of vicodin, ritalin, percocet, etc.

    How many are still with me?

    OK, now ask yourselves this question: If it should be legal to obtain vicodin without a prescription, why should it be illegal to obtain heart medication without a prescription?

    My solution to the issue of prescriptions is this: There shouldn’t be laws on what people are and aren’t allowed to buy. But insurance companies should be free to say that they’ll only pay for drugs that have passed clinical trials and only in quantities prescribed by a doctor. (And yes, I know, not everybody here is a fan of health insurance, but as long as it’s around I think we could agree that insurers should be free to impose some quality controls.)

    The only drugs that I might see regulating the use of, incidentally, are antibiotics. And only then because overuse of antibiotics can lead to the rise of stronger bacteria that hurt people who weren’t over-using.

    Finally, I would just observe that if FDA approval was advisory and had no regulatory effect, the drug companies wouldn’t spend nearly as much money trying to corrupt the gov’t.

  51. “Ah yes, let’s consider Elvis. Now THERE was an empowered drug consumer. He and his enlightened medical employees didn’t let laws and regulations and, er, medical knowledge get in the way of his right to determine his drug regimine. Heck, he had the Merck Manual memorized, from what I’ve heard.

    All hail the independent, home-schooled drug prescriber!”

    Elvis, and so many other rock stars, simply abused drugs. Lack of self-restraint is the problem. Notice that’s “self” restraint.
    His problem might be reframed as thus: He wasn’t paying attention to what his body was telling him, instead relying on “expert” opinions of people and drug companies. If he had indeed been *more* self-reliant for his medical care, perhaps he could have saved himself.

    Not to mention his diet! That would have killed anyone regardless of drug abuse.

  52. Gaius and Joe-
    If I might make a feline analogy: some people choose to be outdoor cats, even though they know indoor cats live longer lives. And they don’t need or want the likes of you forcing them to stay indoors all day, thank you very much. As for that comment about “protecting the irrational and unintelligent from themselves–” well, in this context, anybody who wants to make their OWN decisions about life qualifies as irrational.

    The writer Balzac drank ungodly amounts of coffee each day, which ruined his health and likely caused him to die earlier than he otherwise would have. But it also fueled his art. Do you think he should have been protected from his ‘irrational’ and self-destructive urges? How DARE he decide to put his art before his health! How DARE he think his life was HIS, rather than society’s! If only the French government could have used the full force and majesty of the law against him.

  53. If deregulation of medicine would be such a humanitarian disaster, then perhaps we could merge a few threads by suggesting that the Ayn Rand Institute lobby for an end to all medical regulations in Iran.

  54. gaius
    What if the rational self-interest of government, and/or FDA, runs counter to the interest of the public?

    joe
    Elvis is an example of a fool who volunteers to die so that others have an example of what NOT to do. Without him, who would believe the danger of drug abuse?

  55. gaius “because the assumption of rationality is invalid — not only are the masses animals, but the bourgeoisie too.”

    Now who’s arrogant?

  56. Elvis is an example of what not to do. Keith Richards is an example of what?

  57. Now who’s arrogant?

    mr jeffie, it’s no matter of arrogance — i don’t claim to be anything but an animal myself.

    What if the rational self-interest of government, and/or FDA, runs counter to the interest of the public?

    what if it does, indeed? i fully admit such periods can and do occur.

    As for that comment about “protecting the irrational and unintelligent from themselves–” well, in this context, anybody who wants to make their OWN decisions about life qualifies as irrational.

    ms jennifer, this dismissal does not contain an argument. when people living the life they have individually ordained causes the other members of society to suffer, is there valid remediation? i submit that, if there isn’t, anarchy ensues. this is why government can and should interfere with the individual prerogative.

  58. Joe, let me quickly respond to
    “Give me a break, Shirley. A poster upthread commented that we’re better off if fools kill themselves, which you let go, but I’m trivializing people’s pain and suffering by pointing out the fact that the FDA has, in fact, made changes to its regulatory system to address the problem you raise, and that it has been successful. So to sum up, viewing deaths as a positive outcome is Surely Not worth commenting on, but praising the FDA for largely, but not completely, addressing the problem you raise is callous and irresponsible. Surely, you are not being honest or fair.”

    First off, I am giving you a break — in that I take you far more seriously, and (believe it or not) have much more respect for you and your opinions than I do for the ‘tard who suggested “let them die” as an alternative.
    Furthermore, I would generally like to believe that notions such as “let evolution do its thing, people too stupid to choose the correct drugs can always die and improve the race” as too absurd to require abjuration or comment when they show up.
    But notions such as yours, that “things are really OK with the current FDA regime, look at all the good they do the terminally ill with Stage 2 trials” are more subtly noxious, as well as being indicative of an underlying humanity that might be reached and reasoned with.
    Secondly, I completely reject your unsupported assertion that the FDA’s minimal changes to enlarge Stage II trials counts, or should count, as “a success”. In fact, the evidence, some of which has appeared on this thread, indicates pretty overwhelmingly that the FDA is a merchant of death, not of health, that its successes lie on the corpses, and pain-ridden bodies of those it claims to serve, and that it brooks no opposition to its mandates.
    So I ask again, what are you proposing be done?
    Are you, as it increasingly appears, hunky dory with the current situation?
    Or do you think that regulation is generally a good thing but may be too restrictive as applied by the current regime?
    Or do you think that some other approach (please specify) is called for and would be both an improvement over the FDA regime as well as an improvement over strictly unregulated drug sales?
    Inquiring minds want to know.

    Nice way to hijack the point, though.

    Shirley Knott

  59. “mr jeffie, it’s no matter of arrogance — i don’t claim to be anything but an animal myself.”

    True. Claiming that you are an animal is not arrogance. Claiming that the masses are is.

  60. Jennifer,

    Not a scientific study by any means, but the outdoor cats I’ve known have actually lived longer than the indoor ones. (Of course, I don’t mean stray cats, but outdoor cats that were taken care of by their owners.) I’ve heard it has something to do with the sensory deprivation that plagues indoor cats.

  61. Indoor cats are more likely to be obese from watching too much telly and not exercising.

  62. Use of force arguments aside, if the FDA gets credit for every bad drug they prevent from coming to the market, they get the blame for the delays they enforce of effective medication. Every ounce of suffering from anyone who was willing to take a risk is on the FDA’s head, so is every death.

    The problem with FDA mandates (I really don’t have a problem with FDA recommendations) is not resolved by their level of education, because they are not educated enough to balance risks for each person and make a decision for them. A technocrat can tell you that there is an objective risk of so and so happening, or that the risks of a given treatment are completely unknown. They can not tell you that those risks are unacceptable. That is not part of their expertise, and they have absolutely no knowledge that would help them make that assessment.

    It is also not the case that those who work for the government are automatically exempted from the ‘ideologue’ label. Call me crazy, but I think I’ve heard some big government types call members of the current federal government ‘ideologues’.

  63. OK, to merge even more threads, let’s move all of Iran’s cats indoors. Being more obese they’ll be unable to catch as many mice. The mice will proliferate and spread disease and cause more Iranian deaths, which will make Peikoff happy!

  64. thoreau,

    TBH, I wouldn’t be surprised if the DoD has some such “feline warfare” scenario in their vast archives. I mean, don’t we still have wargame scenarios for a global war against the UK?

  65. thoreau, our dear hit and run friend: it’s time for an intervention on your behalf. please stop channeling warren before he’s had that drink.

    and stop pretending that under kerry things would be worse. you see, kerry is part tribble. and he’s a mite that reproduces by masturbation (fletch lives). as far as you know.

    now slowly back away. that’s good. it’s time for a break. have a puff on that hand-dipped cigar billy gave you and you’ll be fine.

    you see, we do care here at hit and run.

  66. “i submit that, if there isn’t, anarchy ensues.”

    mr. marius,
    Are you unaware this is the blog site that is trying to get anarchy to ensue?

  67. “for the ‘tard who suggested “let them die” as an alternative.”

    I believe I’m the one that prompted this, although it’s not quite accurate. My original post was derived from
    “The ultimate effect of shielding fools from the effects of folly is to fill the world with fools”
    – Herbert Spencer, English philosopher 1820-1903

    The point being that shielding (or coddling) people is not always, or even usually, in society’s best interest. Sometimes allowing fools to go their way does in fact result in death, more often it results in them ceasing to be foolish. Preventing this may seem kind, but neglects all the other people that now have lost the opportunity to learn from other people’s mistakes. These people may now repeat the foolishness. Will/can anyone be there to protect them all? Who will do this once the world is full of fools?

  68. I don’t think it’s so much about learning from their mistakes as it is keeping the non-fools or not-so-foolish from taking the risks that advance civilization.

  69. Hasn’t the Ayatollah ruled that cats remain indoors unless chaperoned by an adult male relative?

  70. No, dead elvis, you mortal self was not taking the advice of medical professionals when he made those decisions. He made the call, and his employees followed his directions.

    Indoor cats breathe more second hand smoke. heh.

    Shirley, “all is hunky dory” is an unreachable goal. There would be pain and suffering and corpses resulting from a radical deregulation, as well. It wasn’t consumer demand that got rid of thalidomide, but the FDA. I think the system needs modest, case-specific tweaks, as occurred when AIDS patients were given novel anti-viral drugs.

  71. Isn’t thalidomide still being used, but not by pregnant women?

  72. I just realized, this thread has fallen into libertoid black hole hell. “Should prescription drugs be marketed directly to patients?” becomes “Should there be prescription drugs?” becomes “Should there be an FDA?” becomes “Should there be a federal government?” becomes “Should there be a govenrment?”

    I will stipulate, IF there were no need for prescription drug laws, THEN there is nothing wrong with marketting directly to consumers. My criticism only makes sense if you assume that limiting the availability of drugs by prescription is a good idea. Given the paucity of people willing to argue from that assumption, I don’t really have anything constructive to add.

    See you later.

  73. Gaius-
    You terrify me with your talk of all that the individual owes to society. When you say “my lifestyle shouldn’t cause other members of society to suffer” I agree to a point–I certainly should not be allowed to steal from others, for example–but exactly where do you draw the line between society’s interests and my own?

    Y’know, my mother always said I should have been a doctor, or at least a nurse. And I’m certainly smart enough to have gone to medical school, but I had and have no desire to do so. Thus, you could say that I have selfishly “deprived” society of a doctor. I doubt you’d recommend that people be forced into careers they don’t want, but where exactly do you draw the line between individual interests and society’s interests?

    And I’d still like to know if you think Balzac should have been forced to give up caffeine. I imagine many members of his society were extremely unhappy when he died.

  74. drf-

    Thanks for caring, man!

    To be serious for a moment, I’d like to ask joe a question, if he’s still in this thread: How do you explain why cocaine should be legal for consumption by anybody who chooses to, but argue for gov’t vetting of, say, arthritis medications?

    And, for the record, I’m not one of those “the market will solve all ills!” types. I wouldn’t get upset over mandatory labeling of contents (which is different from mandatory warning labels), as well as stricter anti-fraud laws for pharmaceuticals. I wouldn’t get upset if the FDA served as an advisory body. (And yes, I know, some would argue that it would still be an unjust use of tax money, yadda yadda, but if it became an advisory body its budget and power would shrink drastically, which is good enough for me, at least for now.)

  75. exactly where do you draw the line between society’s interests and my own?

    this is not for me to answer, but it is up to our society. i happen to think individuals in the united states have been given immense latitude to do whatever they wish — too much, probably, for the good of social cohesion. this has, to paraphrase mr spencer, filled the society with antisocial brats — people whose self-fulfillment is now too important to be encumbered by consideration for their fellow man. too much of a good thing, i’m afraid. the death of compomise is the spark of chaos.

    history, it seems to me, indicates the likely path from here is anarchy and then tyranny. i would like to revert to a lockean society of modest people with moderate tastes and a love of compromise — that temper by which republics function best — but that seems highly unlikely.

    And I’d still like to know if you think Balzac should have been forced to give up caffeine.

    i think balzac was an artist, and an artist’s life should be difficult and rare. what society cannot be is a society in which everyone is an artist — and that is what we face.

    for balzac to succumb to his passions is one thing. for all of us to do so is quite another.

  76. Jennifer-

    You would have hated taking classes with premeds. Or at least you would have hated the first few weeks of it. After the first freshman chemistry midterm the premed population drops dramatically. After the final exams of chem 101 the population drops even more.

    I wasn’t premed, but I took freshman chemistry and calculus right alongside all of them. No matter what sort of grading system a professor might employ, the premeds were ready to argue that it is inherently unfair. Me, I thought it was unfair that some day my prostate cancer will be diagnosed by a guy who preferred to argue over grading scales while I was pacing back and forth with a chemistry book in hand all night long.

  77. I’d argue that prescriptions are a reasonably low cost alternative to the costs of unregulated drug commerce, especially of medicines that eventually cause resistance such as antibiotics. Sure, you could set up an insurance fund that charged a premium on every hit of penicillin in the 1940s so that there would be money for replacement drugs when the idiots improperly use it and every bug that is out there no longer is affected by penicillin. The overhead costs of doing this are currently way too much and would require too much intrusive oversight.

    When you can drive down the overhead costs so that it’s an actual superior alternative to the tried and true prescription regime instead of a theoretically better one, I’ll revisit the question. Until then, you have huge negative effects of unregulated medicine, including but not limited to drug resistance, accidental overdose, purposeful overdose, and an uptick in poisonings that can’t really be helped because there’s so much stuff out on the streets that you can never show how the poison was obtained.

    Only idiots want to take a reasonably functioning system and toss it out before there is some sort of working alternative in place or at least a realistic transition plan. Only the most ironic of idiots hide behind a magazine labeled “Reason”.

  78. Gaius–
    You mention “people whose self-fulfillment is now too important to be encumbered by consideration for their fellow man.”

    You’re changing the subject. I have already agreed that a function of government is protecting people from other people; that’s why I support the laws against theft, rape, murder, extortion, etc. What I DON’T support are laws protecting adult individuals from their own selves, and when asked to defend them you muddle them up with the protection-from-others rules.

  79. TM-
    Your argument would work well for agoraphobics(sp?); I could go outside, but I don’t know that it is worth it and this room suits me just fine, I’ll just stay here until I’m sure.

    It may have worked better before the FDA also, if hysteria hadn’t won out over the we don’t know if the FDA will work crowd.

  80. Tried and true?

    Are we talking about the same agency?

  81. What I DON’T support are laws protecting adult individuals from their own selves, and when asked to defend them you muddle them up with the protection-from-others rules.

    ms jennifer, this is because there’s no real difference.

    europe has strict personal debt limit rules which effectively prevent people from destroying themselves on credit — i think the limit at which you have to start filling out forms with the belgian gov’t is $1600.

    america, quite plainly, has no such rules. the banks are ostensibly the arbiters of when someone has borrowed too much. except that they’re motivated by profit, which means they have a strong incentive to lend. this they do — all but throwing debt at american consumers, who now save nothing of their income (as opposed to the euro savings rate of nealy 11% of disposable income). rational prudence has in many cases completely left personal banking.

    so personal profligacy has become a major problem in the united states, where personal bankrupties are common and interest rates will be forced higher by defaults — and the possibility of an credit crunch or honest-to-god collapse looms. this is a price we will all pay — even those who behave prudently — so that those who chose to be profligate could live unimpinged by responsibility.

    there is no way out of it, ms jennifer. we are in a society; our actions, all of them, have ramifications for our neighbors. nothing we do occurs in isolation — a concept blissfully lost on some libertarians. the only question is how these ramifications are to be tolerated by society and, when they cannot be tolerated, managed or punished.

  82. this idea of blessed solitude as an ideal, fwiw, is a product of rousseau and the romantics. the likes of locke would, i think, have been appalled by the idea of isolated action affecting nothing as fantasy. quite the contrary, locke viewed social pressure — absolutely including moral pressure — as an essential component of a functional, orderly society. “the government of our passions the right improvement of liberty,” were i think his words.

  83. gaius:

    libertarianism and capitalism rely HEAVILY on social interaction. They both rely on people to transact with each other in a fair and honest manner (while understanding that the other party may not be).

    To say that libertarianism or even anarcho-capitalism are some forms of isolationism is just plain false. They simply say that one should be able to choose his or her level of social interaction/influence.

  84. “Only idiots want to take a reasonably functioning system and toss it out before there is some sort of working alternative in place or at least a realistic transition plan. Only the most ironic of idiots hide behind a magazine labeled “Reason”.”

    T M Lutas,
    You are right. This isn’t a conservative blog site.

  85. ?the banks are ostensibly the arbiters of when someone has borrowed too much. except that they’re motivated by profit, which means they have a strong incentive to lend. this they do — all but throwing debt at american consumers, who now save nothing of their income?

    gaius:

    I?m not sure why these transactions are unjust or should be disallowed in your mind. This is a private enterprise loaning to an individual on the promise that they will repay the principal. Sounds pretty reasonable to me. If the individual is irresponsible so be it. Again, suggesting that we prohibit the flow of capital because some people do not manage their money effectively is a slippery slope we should not go off. I have a significant amount of personal debt, but I also anticipate making more money in the future. If I don?t I will be unable to repay the loan and will be bankrupt. The banks take their risk in loaning to me, I take my risk in promising to repay the loan. Welcome to capitalism.

    Btw, banks have plenty of disincentive to lend if they think they?re not going to get paid back. Go try and get a loan for $1 million tomorrow. See how that goes. I think you?ll find that there is no interest rate that a bank will give you for that amount of money. Banks take calculated risks. They give UNSECURED loans to individuals with no principal reductions required. Credit losses affect their profit significantly. But banks are very good at what they do. They communicate with each other (and rightfully so) and diversify their client base to manage risk.

  86. They simply say that one should be able to choose his or her level of social interaction/influence.

    exactly, mr patriot. it pretends that one can turn social interaction on and off as it suits you. “i can interact for the acquisition of desirable goods, but not when i get on the horse.”

    that is an individualist emancipation fantasy, and is inherently antisocial. all actions have social consequences — some smaller than others, but always there.

  87. this has, to paraphrase mr spencer, filled the society with antisocial brats — people whose self-fulfillment is now too important to be encumbered by consideration for their fellow man.

    Are these the same antisocial, self-fulfillment-obsessed brats who, in an amazing display of spontaneous order, raised over $2.5 million in two days for disaster relief at Amazon.com? My wife works for a major American charity — according to her, they had $850,000 in donations for relief of the tsunami victims by late Monday morning, before any appeals had even been made.

    the banks are ostensibly the arbiters of when someone has borrowed too much. except that they’re motivated by profit, which means they have a strong incentive to lend.

    As any banker knows, there’s nothing more profitable than a bad loan. I don’t think I can roll my eyes far enough to demonstrate how sarcastic I’m being here, by the way.

  88. Sounds pretty reasonable to me.

    until their irrational irresponsibility collapses the banking system. don’t subscribe to the fantasy that people make rational decisions as a matter of course.

    banks have plenty of disincentive to lend if they think they?re not going to get paid back.

    that they ignore it is the problem, in my experience as a hedge fund administrator. they often have no idea if they’re going to get paid back, how their loan is employed and often don’t care, being under pressure to deploy deposits, so long as the right person is asking.

    there is a widespread fallacy that the banking system is some paragon of responsibility and solidity. believe me, it isn’t so — even as many of the bankers would swear it is. it is nowadays an extremely risky venture, with many banks closely resembling hedge funds.

  89. ” it pretends that one can turn social interaction on and off as it suits you.”

    Gee, and here I’ve been turning on and off social interaction my whole life. I must be living in a emanicpated fantasy.

    “that is an individualist emancipation fantasy”
    Does that mean reality is slavery? In a free country?

    It’s my interaction with the government that I can’t turn on and off. I MUST pay for a doctor to write the prescription for the drugs I need to live. I can ONLY get the drugs the FDA approves, even if my life depends on them.

  90. Are these the same antisocial, self-fulfillment-obsessed brats who, in an amazing display of spontaneous order, raised over $2.5 million in two days for disaster relief at Amazon.com?

    i’ve always been amazed, mr phil, at how these very same brats will pass the same destitute in the alley behind their building every day without whispering a word or offering help. far easier to assuage one’s guilt by writing a check than by actually doing something. i’m one of them myself.

  91. TM Lutas-

    I have stated that I am open to the idea of regulating antibiotic use because overuse can hurt other people. It may not quite pass the libertoid test of force or fraud, but it’s definitely something that has a direct, unwelcome, and largely unavoidable effect on other people.

    However, I’m much less favorable toward regulating, say, arthritis medicines, where misuse would primarily hurt only the user.

  92. ?they often have no idea if they’re going to get paid back, how their loan is employed and often don’t care?

    Now you?ve gone and done it, gaius. I happen to be a commercial banker with one of the three largest firms in the country. I assure you credit quality is a key to success in this industry. In our consumer loan area, you?re right the credit losses are considerably higher (5%-7%) than in the commercial (1%-2%). However, interest rates are also considerably higher in the consumer division.

    ?there is a widespread fallacy that the banking system is some paragon of responsibility and solidity. believe me, it isn’t so — even as many of the bankers would swear it is. it is nowadays an extremely risky venture, with many banks closely resembling hedge funds?

    The banking industry is very stable in the US. This is partially a result of the significant amount of regulation in the industry, which lowers competition and drives up prices. I?m not sure where you get your information, but we know what we?re doing and we do it well. It is probably one of the most stable industries in the economy. Check out the credit ratings of major commercial banks some day. This stuff isn?t just pulled out of a hat.

  93. I assure you credit quality is a key to success in this industry.

    that’s lovely, but you folks should be more careful, frankly speaking. what percentage of a household’s income will you extend in credit? what will you demand down?

    and you should understand as well as anyone that investment banks like GS are walking the tightrope.

    The banking industry is very stable in the US.

    it’s comments like these emerging from bankers in the midst of the greatest debt expansion in world history in the aftermath of decades of greenspan moral-hazard-building — when you’re all using the same risk models — that make people in my line of work nervous enough to start shorting you lot.

  94. gaius-

    OK, here’s a market-based challenge to your claims. In almost every tragedy there is a profiteer. Maybe it’s the guy who short-sells some stock. Maybe it’s the person selling the life rafts, or the person running the only decent company still standing in the ruined industry. Maybe it’s the people in Utah who will own beachfront property if the polar ice caps melt.

    Since you seem to think that western civilization and its economic institutions are on the verge of collapse, could you identify who will profit from this? Better yet, will you put your money where your mouth is and invest in the businesses likely to profit from the downfall of the decadent west?

  95. Then again, profiting from the downfall of the decadent west would just be more hyper-individualism, wouldn’t it? I suppose you can say that you’ve chosen to suffer in solidarity with us, to enjoy the collectivized experience that you yearn for.

  96. Thoreau-
    I, personally, would invest in all-electric rental properties outfitted with solar paneling, but bear in mind I believe in peak oil.

  97. gaius marius,

    I would submit that many of the problems you point out are the fault of government, rather than the fault of hyperindividualism. Not that that’s surprising, being as I’m a libertarian, but still.

    The rules have been changed in midstream quite often in the last century or so. Progressives have very often argued that, in the name of humanity, we have to protect people from the consequences of their actions, and that since people shouldn’t feel bad about taking government charity, have worked to remove social stigmas. If it’s too easy to run up debt in this country, maybe that’s partially because it’s too easy (and too lacking in shame) to declare bankruptcy, and escape the consequences of your actions. My ex-wife did just that, and though her wages were heavily garnished, she could have avoided even that by declaring Chapter 11 instead of Chapter 7 (IIRC). On the other hand, while we were married we ran up a large amount of debt, which in the end amounted to about $15k, all in my name (as she was bankrupt). Yet I paid it off, working at minimum wage jobs, with the help of some friends.

    The problem, you see, isn’t hyperindividualism. It’s in trying to create a society that has no consequences. And that has in large part been driven by communitarians, not individualists. We are a selfish people in many ways, but that’s not a problem in a well-working capitalist society. We have government to restrain us when we intrude on others’ rights, and we are forced to work for others’ gain by the nature of capitalism.

    I notice you’ve quoted Locke. I believe Locke’s response to our “hyperindividualism” would be less government, not more. When we are protected from all dangers by an omnicompotent government, we are free to act as adolescents, because there are few consequences to our actions. Mommy and Daddy, in the form of the government, are there to bail us out. When we are left to make it on our own, hopefully with the help of friends, then we can actually make a free society where people will take into account others’ needs and problems.

  98. gaius,

    Being a hedge fund guy, I assume you know that household debt as a fraction of income (or of assets) is not especially higher in the US than in any other industrialized country, right?

    The real savings rate in the US is very low, and that is a problem not explainable by the household debt figures.

  99. don’t subscribe to the fantasy that people make rational decisions as a matter of course.

    Oh yeah, this is the other matter I was going to take issue with. I’d have to agree that people are animals – but they are rational animals. People very nearly always make decisions they think are rational. Their data may be very, very flawed, but they are making the decision that they think benefits them. That’s all that rational means in this context. Sure, smoking may kill me in fifty years, but given my choices right now – a very uncomfortable withdrawal or continued smoking – the rational thing to do is continue smoking (not directly applying to me, but you get the idea). People stay in bad marriages, not because they’re irrational, but because their flaws tell them that doing so is the rational choice. Battered women think that they deserve it, or at least many of them do. Given that you’re a worthless scumbag, who deserves to be beaten, isn’t the rational thing to do staying in the marriage/relationship? Changing the flawed premise to better accord with the real world will result in behavior that is in better accord with reality, but nonetheless, this person is behaving rationally.

    Yes, we are still to a large degree trapped by our animal nature. So many things are conditioned by millions of years of evolution, so many things that we’re only now beginning to realize how many. But we are moving closer and closer to a world where we are not slaves to that nature, but rather masters of it. Just because we have not yet fully escaped doesn’t mean that we are still fully imprisoned.

  100. “don’t subscribe to the fantasy that people make rational decisions as a matter of course.”

    Aren’t those the ones that elect government? Can one expect them to be rational during elections and not when it comes to their own health? Or am I being redundant?

  101. Ok, it needs to be said:
    Free direct to consumer advertising from all restrictions.
    Abolish prescription drugs.
    Abolish the FDA.
    People should be allowed to buy whatever drugs they want, whenever they want, for whatever they want. Before the screaming starts, just let me say this: I volunteered, of my own free will, after careful consideration, to be a human guinea pig for an experimental drug. If the drug works for me (which it does), why should anyone else have any right at all to tell me whether or not I can have it? And don’t tell me it’s because I don’t know what to do for my own disease. I’ve lived with it for most of the time I’ve been alive. My doctor advises me about the best course of treatment, but the ultimate decisions about what to do have always rested with me. The risks are mine, and mine alone, and so are the benefits. Why should any other human being have any right, ever, to say that they should decide if the costs of a treatment outweigh the benefits for me? Who can possibly know that better than I can? To say otherwise is to say that someone else is somehow fit to decide whether I suffer or not, because I don’t deserve to make some of the most important choices that need to be made in my own life.

  102. grylliade has it right.

    The problem is not that we need laws and regulations to protect others from our actions (with the legitimate exception where those actions represent clear, immediate, and direct harm to another), the problem is that the current social system has effectively repudiated the concept of personal responsibility (you know, the word that sends most liberals running screaming from the room).

    Virtually all of the social costs that are presented as justification for the various interferences in the lives of individuals are a direct result of government action pandering to the concept that we have to protect ‘society’ from it’s members.

    The argument goes, “We want to protect members of society, so we’ll construct vast webs of social programs to implement that protection, and we’ll suck resources from everyone to pay for it. And now, because everyone has to pay for it, we’ll use that as additional justification for our actions because we can claim that the actions of an individual may unfairly burden the rest of the people paying for this social framework.” It’s a circular argument.

    If people were put in the position of having to completely live with the results of their own actions, it would not only provide the proper self correcting mechanism for irresponsible behaviour, it would almost certainly create a more effective social structure than one imposed from without.

    BTW, LisaMarie is also right

  103. TM Lucas,

    There actually is a market solution to the problem of antibiotic resistance. Since the company that owns the patent will cease making money on it if the antibiotic becomes useless, perhaps they will voluntarily require prescriptions in order to buy the product.

    Of course, for medications which do not have resistance issues, it would be silly to require prescriptions.

  104. Let’s talk specific example of DTC marketing.

    The two commericials that have seemed ubiquitous this weekend are the “One Touch” glucometer spot with BB King and the “neulasta” spot for cancer patients starting chemotherapy.

    I’m fine with the DTC ad for the glucometer. It brings the consumer’s attention to a product that performs a necessary task better than previous products (it measures blood sugar without the need for painful fingersticks — important if you’re a diabetic jabbing yourself 2-3 times a day). Maybe a busy GP isn’t going to make sure all of his/her patients have one without some prompting.

    The neulasta ad, though, seems predatory. Marketed to people who have just received presumably life-threatening diagnoses, the ads state that prophylactic use of neulasta will help prevent infection. This has not been borne out by the bulk of studies on its use. Moreover, the drug is not without hazzards and it is hugely expensive. Amgen is counting on the fact that some percentage of frightened patients will demand the drug and that some percentage of oncologists who initially thought it not indicated will concede to use it — perhaps to avoid confrontation, perhaps to avoid litigation (just ’cause the neulasta wouldn’t have prevented neutropenia and infection doesn’t mean the patient’s family won’t sue in the event of a bad outcome). Almost certainly, however, the patient will not be helping the oncologist by reminding him/her that this option exists — the oncologist knows this already. Yeah, ideally MDs wouldn’t get persuaded to make a bad decision by a patient. Maybe most won’t, maybe some do. If Amgen gets even 5% of the target population on this expensive drug, though, they make back their ad money.

    BTW, why is it that Amgen doesn’t bother to ID themselves as the maker of neulasta in this spot? Is it b/c they know how dirty this ad is?

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