Sunday, October 13, 2013
The Soaring Cost of a Simple Breath
The kitchen counter in the home of the Hayes family is scattered with the inhalers, sprays and bottles of pills that have allowed Hannah, 13, and her sister, Abby, 10, to excel at dance and gymnastics despite a horrific pollen season that has set off asthma attacks, leaving the girls struggling to breathe.
Asthma — the most common chronic disease that affects Americans of all ages, about 40 million people — can usually be well controlled with drugs. But being able to afford prescription medications in the United States often requires top-notch insurance or plenty of disposable income, and time to hunt for deals and bargains.
The arsenal of medicines in the Hayeses’ kitchen helps explain why. Pulmicort, a steroid inhaler, generally retails for over $175 in the United States, while pharmacists in Britain buy the identical product for about $20 and dispense it free of charge to asthma patients. Albuterol, one of the oldest asthma medicines, typically costs $50 to $100 per inhaler in the United States, but it was less than $15 a decade ago, before it was repatented.
“The one that really blew my mind was the nasal spray,” said Robin Levi, Hannah and Abby’s mother, referring to her $80 co-payment for Rhinocort Aqua, a prescription drug that was selling for more than $250 a month in Oakland pharmacies last year but costs under $7 in Europe, where it is available over the counter.The Centers for Disease Control and Prevention puts the annual cost of asthma in the United States at more than $56 billion, including millions of potentially avoidable hospital visits and more than 3,300 deaths, many involving patients who skimped on medicines or did without.
“The thing is that asthma is so fixable,” said Dr. Elaine Davenport, who works in Oakland’s Breathmobile, a mobile asthma clinic whose patients often cannot afford high prescription costs. “All people need is medicine and education.” (...)
Unlike other countries, where the government directly or indirectly sets an allowed national wholesale price for each drug, the United States leaves prices to market competition among pharmaceutical companies, including generic drug makers. But competition is often a mirage in today’s health care arena — a surprising number of lifesaving drugs are made by only one manufacturer — and businesses often successfully blunt market forces.
Asthma inhalers, for example, are protected by strings of patents — for pumps, delivery systems and production processes — that are hard to skirt to make generic alternatives, even when the medicines they contain are old, as they almost all are.
The repatenting of older drugs like some birth control pills, insulin and colchicine, the primary treatment for gout, has rendered medicines that once cost pennies many times more expensive.
“The increases are stunning, and it’s very injurious to patients,” said Dr. Robert Morrow, a family practitioner in the Bronx. “Colchicine is a drug you could find in Egyptian mummies.”
Pharmaceutical companies also buttress high prices by choosing to sell a medicine by prescription, rather than over the counter, so that insurers cover a price tag that would be unacceptable to consumers paying full freight. They even pay generic drug makers not to produce cut-rate competitors in a controversial scheme called pay for delay.
Thanks in part to the $250 million last year spent on lobbying for pharmaceutical and health products — more than even the defense industry — the government allows such practices. Lawmakers in Washington have forbidden Medicare, the largest government purchaser of health care, to negotiate drug prices. Unlike its counterparts in other countries, the United States Patient-Centered Outcomes Research Institute, which evaluates treatments for coverage by federal programs, is not allowed to consider cost comparisons or cost-effectiveness in its recommendations. And importation of prescription medicines from abroad is illegal, even personal purchases from mail-order pharmacies.
“Our regulatory and approval system seems constructed to achieve high-priced outcomes,” said Dr. Peter Bach, the director of the Center for Health Policy and Outcomes at Memorial Sloan-Kettering Cancer Center. “We don’t give any reason for drug makers to charge less.”
And taxpayers and patients bear the consequences.
by Elisabeth Rosenthal, NY Times | Read more:
Image: Josh Keller and Graham Roberts
The Others: On Being Foreign
[ed. See also: Japan: some impressions.]
The most generally satisfying experience of foreignness—complete bafflement, but with no sense of rejection—probably comes still from time spent in Japan. To the foreigner Japan appears as a Disneyland-like nation in which everyone has a well-defined role to play, including the foreigner, whose job it is to be foreign. Everything works to facilitate this role-playing, including a towering language barrier. The Japanese believe their language to be so difficult that it counts as something of an impertinence for a foreigner to speak it. Religion and morality appear to be reassuringly far from the Christian, Islamic or Judaic norms. Worries that Japan might Westernise, culturally as well as economically, have been allayed by the growing influence of China. It is going to get more Asian, not less.Even in Japan, however, foreigners have ceased to function as objects of veneration, study and occasionally consumption. Once upon a time, in the ancient and medieval worlds, to count as properly foreign you had to seek out a life among peoples of a different skin colour or religion. They were probably an impossibly long distance away, they might well kill you when you got there, and if you went too far you might fall off the edge of the world.
At the dawn of the travelling age, writing an imaginary legal code for a Utopian society that he called Magnesia, Plato divided foreigners into two main categories. “Resident aliens” were allowed to settle for up to 20 years to do jobs unworthy of Magnesians, such as retail trade. “Temporary visitors” consisted of ambassadors, merchants, tourists and philosophers. Broaden that last category to include all scholars, and you have a taxonomy of travellers that held good until the invention of the stag party.
To be foreign got much more straightforward from the 17th century onwards, when Europe adopted a political system based on nation states, each with borders, sovereignty and citizenship. Travel-papers in hand, you could turn yourself into an officially recognised foreigner simply by visiting the country next door—which, with the advance of mechanised transport, became an ever more trivial undertaking. By the early 20th century most of the world was similarly compartmentalised.
The golden age of genteel foreignness began. The well-off, the artistic, the bored, the adventurous went abroad. (The broad masses went too, as empires, steamships and railways made travel cheaper and easier.) Foreignness was a means of escape—physical, psychological and moral. In another country you could flee easy categorisation by your education, your work, your class, your family, your accent, your politics. You could reinvent yourself, if only in your own mind. You were not caught up in the mundanities of the place you inhabited, any more than you wanted to be. You did not vote for the government, its problems were not your problems. You were irresponsible. Irresponsibility might seem to moralists an unsatisfactory condition for an adult, but in practice it can be a huge relief.
by The Economist | Read more:
Image: C. Corr
Saturday, October 12, 2013
The Forest Mafia
An ambitious real estate developer, David Nilsson hoped to ink joint venture agreements with the regional government of Loreto province and the leaders of the indigenous Matses community to preserve vast thickets of the tribe's remote rainforest. Under a global carbon-trading program, he wished to sell shares of the forest's carbon credits to businesses that hope to mitigate, or offset, their air pollution.
Located a six-day ride from the frontier city of Iquitos, the jungle’s vegetation, soils, and looming trees store an immense amount of carbon dioxide—roughly one ton, the equivalent of one UN-backed carbon credit, per tree.
In an ideal scenario, this is how it's supposed to work: A community in a developing country works with an NGO or developer to design a plan to protect a large swathe of forest and thus prevent the release of the harmful chemical compound into the atmosphere, in accordance with the United Nations’ program called REDD (Reducing Emissions from Deforestation and forest Degradation). Then, it can get the emissions reductions certified by a third-party auditor and sell the resulting carbon credits to corporations in developed countries interested in reducing their own carbon footprints. (Deforestation accounts for roughly 17 percent of all global greenhouse gas emissions.) (...)
Though Nilsson's cons were extreme, international law enforcement authorities and environmental advocates say that the carbon markets are extremely vulnerable to financial fraudsters like him, especially when it comes to forest projects. Their shell games can also be hard to spot. As William Magrath, the World Bank's lead natural resource economist for rural development in Asia, once put it in a pun in a memo to his colleagues: "It's a jungle out there." In a meeting he attended with Interpol officials a few years ago, Magrath recalled, one man leaned back in his chair and called carbon "a con man's dream." The product is invisible, poorly understood, and regulation is extremely limited.
Despite the risks, carbon is the "world's fastest growing commodities market" valued at about $176 billion in 2011, according to the World Bank. The European Union Emission Trading Scheme (EU ETS), the highest volume compliance market, accounts for $148 billion of that. Countries in Europe legally require top polluters to remain under certain government-issued emissions allowances, but companies who emit less can trade those credits to those who need more. Beyond those allowances, companies can purchase carbon credits, or offsets, which are linked to emissions reductions projects, like factory retrofits or other energy efficiency projects. If the U.S. decided to establish its own cap-and-trade market, the value of the trades could reach as high as $2 to $3 trillion. Credits from forest projects, like Nilsson's would have been, have not yet been approved for the compliance markets, but they are actively sold on a second kind of market for voluntary buyers interested in offsets.
by Ryan Jacobs, Atlantic | Read more:
Image: Rebecca Spooner/Survival International
Thoughts on Digital Streaming and Creativity
Not surprisingly, streaming looks to be the future of music consumption – it already is the future in Scandinavia, where Spotify (the largest streaming service) started, and in Spain. Other countries are following close behind. Spotify is the second largest source of digital music revenue for labels in Europe, according to the International Federation of the Phonographic Industry (IFPI). Significantly, that's income for labels, not artists. There are other streaming services, too – Deezer, Google Play, Apple and Jimmy Iovine of Interscope has one coming called Daisy – though my guess is that, as with most web-based businesses, only one will be left standing in the end. There aren't two Facebooks or Amazons. Domination and monopoly is the name of the game in the web marketplace.
The amounts these services pay per stream is miniscule – their idea being that if enough people use the service those tiny grains of sand will pile up. Domination and ubiquity are therefore to be encouraged. We should readjust our values because in the web-based world we are told that monopoly is good for us. The major record labels usually siphon off most of this income, and then they dribble about 15-20% of what's left down to their artists. Indie labels are often a lot fairer – sometimes sharing the income 50/50. Damon Krukowski (Galaxie 500, Damon & Naomi) has published abysmal data on payouts from Pandora and Spotify for his song "Tugboat" and Lowery even wrote a piece entitled "My Song Got Played on Pandora 1 Million Times and All I Got Was $16.89, Less Than What I Make from a Single T-shirt Sale!" For a band of four people that makes a 15% royalty from Spotify streams, it would take 236,549,020 streams for each person to earn a minimum wage of $15,080 (£9,435) a year. For perspective, Daft Punk's song of the summer, "Get Lucky", reached 104,760,000 Spotify streams by the end of August: the two Daft Punk guys stand to make somewhere around $13,000 each. Not bad, but remember this is just one song from a lengthy recording that took a lot of time and money to develop. That won't pay their bills if it's their principal source of income. And what happens to the bands who don't have massive international summer hits? (...)
Is there a fair solution? And does it matter? Historically, musicians who weren't among the top pop stars were never well-paid – isn't that just the way it goes if you decide to make music your calling? Like writers and fine artists, most of them will never make a living doing exclusively what they love doing? Is this griping equivalent to Metallica's complaint about Napster – viewed by many as the moaning of a bunch of fat cats who were out of touch? Were recording artists simply spoiled for a few decades and now those days are gone? Even Wagner was always in debt and slept with rich women to get funding – so nothing's new, right? I know quite a few fine artists who teach – presumably to make ends meet and to allow them the freedom to do what they want. But I don't see hordes of band-members getting comfy spots in universities anytime soon.
The larger question is that if free or cheap streaming becomes the way we consume all (recorded) music and indeed a huge percentage of other creative content – TV, movies, games, art, porn – then perhaps we might stop for a moment and consider the effect these services and this technology will have, before "selling off" all our cultural assets the way the big record companies did. If, for instance, the future of the movie business comes to rely on the income from Netflix's $8-a-month-streaming-service as a way to fund all films and TV production, then things will change very quickly. As with music, that model doesn't seem sustainable if it becomes the dominant form of consumption.
Paid Apps Aren't Dead, But They Are on Life Support
Perfect Weather, Contrast's latest app, was timed around the release of iOS 7. The app was featured in a number of iOS 7 app lists (including ours) and managed to reach #6 on the Paid Apps rank in the U.S. App Store, quite a feat in the competitive world of app rankings.
When it came to revenues for the app, however, Barnard was shocked. Perfect Weather launched at $2.99, the same price as his last app, Launch Center Pro. Both apps managed to hit #6 on the paid apps chart in the U.S. Perfect Weather got an added bump by being featured in iTunes's "Designed for iOS 7" section.
Yet when it came time to compare numbers for first day sales, it turns out that Launch Center Pro grossed four timeswhat Perfect Weather grossed in the U.S. App Store.
Hitting the paid app charts, in other words, doesn't mean what it used to.
Barnard isn't alone. Mashable has spoken with half a dozen high-profile iOS developers who have all reported seeing lower sales from their paid applications — regardless of how well the app ranks on the charts.
Some, including Tapity's Jeremy Olson, are going as far as saying that paid apps (as opposed to free apps that generate revenue through in-app purchase) are dead.
Barnard, who often writes about his experiences in the indie app development space on his blog, isn't ready to go that far. But he does see that the market surrounding paid apps is shifting.
"Last year the strategy was to build up to a big launch, spike high in the charts, and make most of your money in the first month or so," Barnard told Mashable. "That's exactly what happened with Launch Center Pro. Launch Center Pro made as much in its first month as it did in its subsequent 10 months."
Are users spending less money on applications? According to the latest statistics from analytics companies such as App Annie and Distimo, app revenues for Apple's App Store and Google Play continue to be on the rise.
So what's going on? Chalk it up to a shift in consumer behavior, thanks in part to the rise of in-app purchases in games and other applications.
by Christina Warren, Mashable | Read more:
Image: Christina Ascani
How Spike Jonze Made the Weirdest, Most Timely Romance of the Year
The print, by the artist Todd Hido, hangs on a wall near a giant rectangular dining-and-conference table in the loft where Spike Jonze lives and works when he’s in New York. Several years ago, Jonze saw it in a gallery and felt stirred by what he calls “the beautiful mysteriousness of it. And also, you know, the memory of it.”
Around a corner from where we’re standing, a bedroom glows behind a wall of curtained glass, but the flow of Jonze’s sunsplashed Lower East Side living space allows him to pad barefoot from where he writes to where he plays music to where he has meetings to where he eats to where he hangs out. Jonze grew up on the East Coast but has recently spent much of his time in Los Angeles, and the loft feels capacious enough to accommodate his many selves—one can imagine the skateboard brat of the eighties heel-flipping across the floor while the subversive-music-video prodigy of the nineties blasts the Beastie Boys and the still precocious but mature film artist of the last ten years shuts out the noise and works alone at his desk. His home is large enough to accommodate a crowd, but it’s designed for a party of one. Specifically, for a grown-up who wants room to think.
“It feels like a memory,” he says, raising his fingers toward the photograph. “The mood of a day without the specifics. A memory of this girl, in this beautiful, funny forest.” (...)
The movie that grew from that gesture will have its world premiere as the closing-night attraction of the New York Film Festival on October 12 and will open in New York on December 18. Her is not about the woman in the photo so much as it is about the man longing, perhaps hopelessly, to connect with that woman. It may be the most personal film yet from a director who has long juggled so many personae that his actual identity remains deliberately elusive, even after twenty years in the spotlight. The film, a wistful adult romantic drama set in a near-future L.A., is the first Jonze has written on his own as well as directed. Like his other work, it is searching, disarmingly sincere, and melancholy in surprising places. Her springs from a notion that could be played as rimshot contemporary satire: A sensitive, lonely guy (Joaquin Phoenix) coming off a rough divorce falls head over heels for a woman who’s literally custom-made for him—the artificially sentient female voice of his new computer operating system. But just as he did in Being John Malkovich and Adaptation, Jonze uses the gimmick to unlock a door to unsmirky human feeling. The result is not just a cautionary meditation on romance and technology but a subtle exploration of the weirdness, delusiveness, and one-sidedness of love. For all his imaginative conceits, Jonze is, in his way, a realist; he’s less interested in playing with the technologically extraordinary than he is in demonstrating the ways in which it can burrow into our most private selves. (...)
Jonze wrote Her almost three years ago over a long New York winter. He worked from dozens of pages of his own notes, as well as the memory of a brief interaction he had with an artificial-intelligence computer program a decade ago in which “for the first 30 seconds, I had that buzz, like, It’s responding to me! Then it quickly fell apart and you realize, Here are the tricks, here’s how this works. But what if I could sustain that forever? What would that be like? I wanted to take that idea as far as I could possibly imagine and feel.”
by Mark Harris, Vulture | Read more:
Image: Brigitte Lacombe
Friday, October 11, 2013
Networking into the Abyss
At this year’s SXSWi, I met several such types. At a bar called Javelina, I ran into a twenty-five-year-old employee of a social media startup, backed by Marc Andreessen’s high-flying venture capital firm. We were both attending yet another party hosted by yet another tech firm. When I told her I was a journalist, she showed her disgust by pantomiming a hand job. Why, she asked me, speech slurred almost beyond intelligibility, do we need journalism when we have social media?
I met another person at an otherwise anodyne dinner for Israeli startups, where a dozen or so entrepreneurs presented their companies to potential investors and partners, along with a few journalists. To protect the guilty, I’ll call him Brian. In his late twenties and hailing from South Florida, Brian had the kind of hazy résumé that defines a number of unaffiliated SXSW participants. (While many SXSWi attendees, buoyed by expense accounts, are sent by their employers, 37 percent paid full freight this year.) He was some sort of entrepreneur or consultant, or a serial entrepreneur, someone who had helped launch others’ startups and was now working on his own.
I learned this in fragments. When Brian first sat down at our table, gulping from what would be one of at least five glasses of red wine, I asked him what he did.
“What do I do? I do many things,” he said, before flashing a wide smile, pleased with himself.
“I prefer to ask people what they’re passionate about,” he said. “What are you passionate about?”
It was a line he used on anyone who had the ill fortune to approach our table. He delivered it—and a windy, opaque explanation of the community-building website he was developing—with the stilted pacing of someone trying to make a much-practiced speech seem off the cuff.
By the end of the evening, I still had little idea what Brian’s company did, though it sounded like some version of Facebook’s Pages feature. He hadn’t honed the sort of logline that is de rigueur at SXSW: “It’s like Twitter but for videos”; “It’s Tumblr meets Airbnb—but for business”; “It’s a place where people can meet and exchange career advice.” Like LinkedIn? “Yeah, but better.”
I never learned what he was passionate about. None of us could stomach flipping the question around, as he clearly wanted us to. Finally, he stood up and reached out to shake hands.
“Follow me on Twitter,” he said. “I’ll follow you back.”
He stumbled to the door. I saw him enter the hallway and spin around, confused. A fleeting look of sadness appeared on his face, before he found the stairs and was gone. That evening, as I unloaded the day’s haul of business cards out of my pocket and left them on a table, likely never to be examined again, I imagined Brian doing the same. Perhaps he called his wife and told her he had made some important contacts. More likely, he passed out with his shoes on.
In fairness, many of the people I met in Austin were nothing like this. From the Belgian startup founder working on a new kind of courier service to the average attendee in the convention center elevator, SXSWers were often friendly and solicitous—a style of self-presentation entirely consistent with the festival’s networking ethos. But these aren’t the encounters that stick. And the attitudes reflected above—the condescension and privilege, the irrational self-belief and contempt for opposing views—indicate something wrong at the heart of the tech industry’s preeminent festival of ideas. More broadly, they’re part of a rotten culture that garishly celebrates itself while remaining divorced from the concerns of its customers. During SXSW, Austin becomes a money-soaked mélange of hyper-consumerism and techno-utopianism. In the bazaar of terminally bad ideas—amid the panels on DJ epistemology, the hackathons, and the Spotify parties—it was completely unexceptional, say, for a VP from Demand Media, the notorious content farm, to be preaching from his designated panel (which was, of course, called “Perfection: Algorithms to Optimize Human Existence”) that ubiquitous sensors “will usher in a new golden age of humanity.” (The event’s Twitter hashtag provided its own unwitting miniaturist commentary on the self-regarding folly of it all: #perfect.)
by Jacob Silverman, Baffler | Read more:
Image: Michael Duffy
Thursday, October 10, 2013
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Death of a Salesman
Once called the “friend of every insomniac in Southern California,” Cal Worthington haunted the nether regions of broadcast programming for more than sixty years. Judging by the frequency of his appearances, their consistency, and their longevity, Worthington might have been the biggest television star in the history of the West. That makes him as much a deity as anything California culture has seen in its short history. But he wasn’t an actor or a journalist or a politician. His church was a chain of car dealerships and his prophesies a series of madcap advertisements. For better or worse, everyone who lived in Southern California had to reckon with him.
Worthington’s long-running series of self-produced spots never deviated from a formula. The slender cowboy—six foot four in beaver-skin Stetsons and a custom Nudie suit—always preceded his hyperactive sales pitch with a gambol through the lot of his Dodge dealership, accompanied by an escalating succession of exotic animals. Originally it was an ape, then a tiger, an elephant, a black bear, and, finally, Shamu, the killer whale from SeaWorld—each of which was invariably introduced as Cal’s dog, Spot. Not once did he appear with a canine. The banjo-propelled jingle (set to the tune of “If You’re Happy and You Know It”) exhorted listeners to “Go see Cal, go see Cal, go see Cal,” a catchphrase that became the basis for the most infamous mondegreen in Golden State history. To this day, Pussycow remains a nostalgic code word exchanged among Californians who came of age in the era before emissions standards.
Worthington himself became a figurehead for the omnipresence of advertising in modern life; for some, he personified the new, invasive capitalism of the television era. The ads always began with the same hasty introduction—“Here’s Cal Worthington and his dog Spot!”—as though he was always there, hiding behind the curtain of commercial breaks, waiting to ambush us and sell, sell, sell. When Worthington died last month, at ninety-two, it wasn’t shocking because it was sudden but rather because, for the great majority of Californians, Worthington wasn’t someone who appeared on television—he was a character who seemed to live inside television. (...)
In one of his infamous columns for the Los Angeles Free Press, Charles Bukowski pined for his hometown while on a trip to Utah. “No transport, no racetrack, no beer, no Cal Worthington,” he griped. “The general calm madness of Hollywood and Los Angeles will have to wait.” Around the same time, Frank Zappa skewered Worthington in his fifteen-minute rock opera, “Billy the Mountain.” He later said in an interview, “People in fifty years’ time should have documentation of monsters like Cal Worthington.”
A monster? Worthington’s commercials were incessant, but they weren’t insidious and ruthless in the manner of contemporary corporations. “My dog Spot” wasn’t the result of computer-generated market research. Worthington was an improviser who kept a running notepad of ideas on him at all times (presumably it contained a long list of animals), and he broke all of the New York advertising industry’s imperious dictums. His commercials repudiated well-groomed tacticians like David Ogilvy, who once wrote, “It pays to give a product a high class image instead of a bargain basement image. Also you can get more for it.” All told, Worthington sold half a million autos with his personal vision of Western absurdism. Could an Ogilvy idea have done better?
by Sam Sweet, Paris Review | Read more:
Image: uncredited
The 9 Kinds of Physics Seminar
[ed. As a recent attendee at one of my son's Physics seminars at the University of British Columbia, I'd suggest one other graph: Clueless Parent, Filled with Pride.]
The “Typical” starts innocently enough: there are a few slides introducing the topic, and the speaker will talk clearly and generally about a field of physics you’re not really familiar with. Somewhere around the 15 minute mark, though, the wheels will come off the bus. Without you realizing it, the speaker will have crossed an invisible threshold and you will lose the thread entirely. Your understanding by the end of the talk will rarely ever recover past 10%.
The “Ideal” is what physicists strive for in a seminar talk. You have to start off easy, and only gradually ramp up the difficulty level. Never let any PhD in the audience fall below 50%. You do want their understanding to fall below 100%, though, since that makes you look smarter and justifies the work you’ve done. It’s always good to end with a few easy slides, bringing the audience up to 80%, say, since this tricks the audience into thinking they’ve learned something.
by Matthew Rave, Many Worlds Theory | Read more:
Images: Matthew Rave
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