Incentives Matter in Medicine, But Profit is Not the Problem


AnemiaEPOdoseGraph.gif      Source of graphic:  online version of the NYT article quoted and cited below.

 

In the article excerpted below, the profit motive in medicine is painted as the villain of the piece.  But the problem is not the profit motive.  The problem is that government occupational licensing and regulation in medicine raises barriers to entry for low-cost competitors to enter, innovate, and compete. 

 

(p. A1)  Two of the world’s largest drug companies are paying hundreds of millions of dollars to doctors every year in return for giving their patients anemia medicines, which regulators now say may be unsafe at commonly used doses.

The payments are legal, but very few people outside of the doctors who receive them are aware of their size. Critics, including prominent cancer and kidney doctors, say the payments give physicians an incentive to prescribe the medicines at levels that might increase patients’ risks of heart attacks or strokes.

Industry analysts estimate that such payments — to cancer doctors and the other big users of the drugs, kidney dialysis centers — total hundreds of millions of dollars a year and are an important source of profit for doctors and the centers.

 

For the full story, see: 

ALEX BERENSON and ANDREW POLLACK.  "Doctors Reap Millions for Anemia Drugs."  The New York Times  (Weds., May 9, 2007):  A1 & C4. 

 

   Bernice Wilson’s kidney dialysis treatment includes the anti-anemia drug Epogen.  Source of photo:  online version of the NYT article quoted and cited above.


Biodiversity Can Survive Rain Forest Logging

 

The passage below is excerpted from a WSJ summary of a New Scientist article dated May 12, 2007.

 

While rain forests are being burned and cut down by loggers and farmers at a rapid rate, the damage is far from irreversible, say Helene Muller-Landau of the University of Minnesota in Minneapolis-St. Paul and Joseph Wright of the Smithsonian Tropical Research Institute in Panama. Many tropical species can survive in isolated patches of forest after a mass clearing and then flourish once trees regrow. What’s more, they say, as people continue to abandon rural areas and migrate to cities, forests are likely to regrow in their wake.

They predict that extinction threatens less than 20% of the tropical Americas’ forest species, 21% to 24% of Asia’s and 16% to 35% of Africa’s, far below the 80% figure predicted by other studies.

 

For the full summary, see: 

"Informed Reader; ENVIRONMENT; If Trees Fall in Rain Forest, Biodiversity Can Survive."  The Wall Street Journal  (Fri., May 11, 2007):  B5.

 

Sweden’s Welfare State Destroys Work Ethic

 

SicknessBenefitsGraph.gif   Source of graphic:  online version of the WSJ article cited below.

 

(p. A1)  LULEA, Sweden — Lotta Landström is allergic to electricity — so says her doctor. Along with hundreds of other Swedes diagnosed with the condition in recent years, she came to rely on state-funded sick pay.

But last year, Sweden’s famously generous welfare system cut off Ms. Landström, a 35-year-old former teacher. Electro-hypersensitivity isn’t widely recognized elsewhere in the world as a medical diagnosis. The decision to end her two years of benefits was part of a broad effort to crack down on sickness and disability benefits, according to Swedish welfare officials.

Swedes are among the healthiest people in the world according to the World Health Organization. And yet 13% of working-age Swedes live on some type of disability benefit — the highest proportion on the globe. To explain this, many Swedish policy makers, doctors and economists blame a welfare system that is too lax and does little to verify individual claims.

At a time when low-cost competition from Asia is clobbering Europe’s markets and straining its generous welfare states, governments from Finland to Portugal are trying to cut back and get more people to work. Sweden’s bloated sick bay, which includes (p. A15) roughly 744,000 people on extended leave, has caused soul-searching about whether the system coddles Swedes and encourages them to feel sick.

"If we don’t look out, we will end up with only two-thirds [of the labor force] in work, and one-third out, living on different kinds of subsidies," said Sweden’s new prime minister, Fredrik Reinfeldt, in an interview earlier this year.

At a time when low-cost competition from Asia is clobbering Europe’s markets and straining its generous welfare states, governments from Finland to Portugal are trying to cut back and get more people to work. Sweden’s bloated sick bay, which includes roughly 744,000 people on extended leave, has caused soul-searching about whether the system coddles Swedes and encourages them to feel sick.

"If we don’t look out, we will end up with only two-thirds [of the labor force] in work, and one-third out, living on different kinds of subsidies," said Sweden’s new prime minister, Fredrik Reinfeldt, in an interview earlier this year.

. . .

Most of Sweden’s boom in sickness absenteeism since the late 1990s is about more than simple fraud. Sick leave for psychological conditions such as depression, burnout or panic attacks has rocketed. Over 20% of the population complain of anxiety syndromes. "We are actually the safest country in the world," says David Eberhard, chief psychiatrist at St. Göran’s hospital in Stockholm. But "people are feeling psychologically worse and worse."

Assar Lindbeck, one of Sweden’s best-known economists, says the lenient welfare state has changed the country over the past generation. In place of the old Protestant work ethic, it has become acceptable to feel unable to work and to live on benefits, he says. "I would not call it cheating," Prof. Lindbeck says. "I would call it a drift in attitudes and social norms."

By being so accommodating, the Swedish system has encouraged Swedes to treat life’s tribulations as clinical issues requiring sick leave, posits Anna Hedborg, a former Social Democrat cabinet minister: "As time has passed, we have medicalized all sorts of problems."

 

For the full story, see:

MARCUS WALKER.  "Rx FOR CHANGE; Sweden Clamps Down On Sick and Disability Pay; Once Freely Dispensed, Benefits Face Scrutiny; Ms. Lanström Is Cut Off."  The Wall Street Journal  (Weds., May 9, 2007):  A1 & A15.  

(Note:  ellipsis added.)

 

LandstromLottaElectricityAllergy.gif  A former Swedish teacher who had been receiving government disability payments for being allergic to electricity.   Source of photo:  online version of the WSJ article cited above.

 

Invention as a Form of Criticism

 

The toughest part of inventing isn’t solving problems. It’s figuring out which problems are worth the effort.

"A few years ago, an inventor patented a device that caused an electric motor to rock a chair," wrote Raymond F. Yates in 1942. "Now imagine, if you will, the sad spectacle of anybody too lazy to rock his own chair! No wonder he could not make money. If he had expended the same effort on something that was actually needed, he might be wealthy today instead of being sadder but wiser."

Mr. Yates, a self-taught engineer, inventor and technical writer, tried to nudge other inventors in the right direction with his book, "2100 Needed Inventions." Published by Wilfred Funk Inc., Mr. Yates’s book was a list of ways people could alleviate certain nuisances and defects of life and get rich for their trouble.

. . .

"Invention is really a systematic form of criticism," Mr. Yates wrote, and people tend to criticize the things that annoy them in their daily lives. Mr. Yates, for example, seems to have found most commonplace devices excessively noisy.

 

For the full story, see: 

CYNTHIA CROSSEN.  "DEJA VU; An Inventor in 1940s Gave Tips on Going From Smart to Rich."  The Wall Street Journal  (Mon., May 21, 2007):  B1.  

 

Kirkcaldy’s Current Native-Son Would Do Well to Remember Kirkcaldy’s 18th Century Native Son

 

In Kirckcaldy, Gordon Brown, the man on the right, tries to persuade the natives to vote for the Labor Party.  Source of the photo:  online version of the NYT article cited below.

 

Many years ago, we took the train from Edinburgh to spend a few hours in Kirkcaldy, the birthplace of Adam Smith.  I was surprised at how little there was to honor Smith in the town where he was born and raised.  There was a small cafe/theatre named after Smith.  A small crystal shop sold some shot glasses with Smith’s image engraved on them.  And there was a small plaque, above a no-parking sign, on the main street, at the spot where Smith’s family home had been. 

I remember asking a very polite young father with two or three small children in tow, why there was so little of Smith in Kirckaldy?  With a twinge of something like regret, he said that everyone in that part of Scotland supported Labor, and they saw Smith as supporting capitalism, and so did not like him much.

It was a crowded Saturday shopping day when Jeanette took my picture in front of the small plaque.  Incredulous passers-by turned and glanced in my direction, probably wondering why the crazy American wanted his picture taken next to a no-parking sign.  

For the sake of Kirkcaldy, and Britain, let us hope that Gordon Brown has read a bit of the work of his fellow Kirkcaldy native son:

 

(p. A10) KIRKCALDY, Scotland, April 30 — Gordon Brown, Britain’s presumed prime minister-to-be, is usually associated with a somewhat dour manner and a mastery of statistics. But here, he displays other skills — a bolt-on smile and a ready handshake to work sparse crowds between the discount stores on the High Street, asking parents with strollers whether their new babies are keeping them awake at night, and inquiring whether the men support the local Raith Rovers soccer team.

. . .

“This is a big choice on Thursday, between those who want to break up Britain and those who want to build up Scotland,” Mr. Brown, currently Britain’s chancellor of the exchequer, told students at Adam Smith College, named for the 18th-century economist who was born here.

. . .

Mr. Brown, who is not standing in these elections, came to town, alongside the choppy waters of the Firth of Forth, to support the Scottish Labor campaign and resist the nationalists.

“I do not think the Scottish people want to see the breakup of the union” that makes up Britain, he said here in Kirkcaldy (pronounced kerr-CUDDY).

But advocates of independence say it would propel Scotland to a bright future, as viable as any other small European state.

 

For the full story, see: 

ALAN COWELL.  "Elections in Britain Reveal a Scottish Line in the Sand."  The New York Times  (Weds., May 2, 2007):  A10.

(Note:  ellipses  added.)

 

 KirkcaldyScotlandMap.jpg   Source of the map:  online version of the NYT article cited above.

 

   Art Diamond in Kirkcaldy in 1994 at location (I think on High Street) where  Adam Smith’s boyhood home used to be.  (Photo by Jeanette Diamond.)

 

Sturm und Drang Schumpeterianism

 

I am conflicted about how to evaluate Zachary’s Schumpeterian article in a recent Sunday New York Times.  On the one hand he says much that is true and useful about Schumpeter and capitalism.  On the other hand he seems to relish the destructive side of creative destruction, extending it beyond what Schumpeter intended, to include disasters such as war and environmental crises.

My view, on the other hand, is that the destructive side is usually over-estimated, can be reduced further, and is an unfortunate cost of innovation and progress.

Here is a part of the Zachary op-ed piece that I like:

 

An Austrian economist who taught at Harvard, Mr. Schumpeter in 1942 coined the term ”creative destruction” to describe what he viewed as the engine of capitalism: how new products and processes constantly overtake existing ones. In his classic work, ”Capitalism, Socialism and Democracy,” he described how unexpected innovations destroyed markets and gave rise to new fortunes.

The historian Thomas K. McCraw writes in his new biography of Schumpeter, ”Prophet of Innovation” (Belknap Press): ”Schumpeter’s signature legacy is his insight that innovation in the form of creative destruction is the driving force not only of capitalism but of material progress in general. Almost all businesses, no matter how strong they seem to be at a given moment, ultimately fail and almost always because they failed to innovate.”

Mr. Schumpeter’s concept of creative destruction is justly celebrated. The economics writer David Warsh calls it the most memorable economic phrase since Adam Smith’s ”invisible hand.” Peter Drucker, the late business guru, went so far as to declare Mr. Schumpeter the most influential economist of the last century.

Clearly, any quick survey of technological change validates Mr. Schumpeter’s essential insight. The DVD destroyed the videotape (and the businesses around it). The computer obliterated the typewriter. The automobile turned the horse and buggy into an anachronism.

Today, the Web is destroying many businesses even as it gives rise to others. Though the compact disc still lives, downloadable music is threatening to make the record album history.

”Schumpeter’s central idea is just as important now as ever,” says Louis Galambos, a business historian at Johns Hopkins University. ”The heart of capitalism and its claim as an efficient economic system over the long term is the role that innovation plays.”

 

For the full commentary, see:

G. PASCAL ZACHARY.  "PING; The Silver Lining to Impending Doom."  The New York Times, Section 3  (Sun., May 6, 2007):   3.

 

Global Warming Allows Growing Subtropical Plants Further North

 

   Source of graphic:  online version of the NYT article quoted and cited below.

 

(p. A1)  Forget the jokes about beachfront property. If global warming has any upside, it would seem to be for gardeners, who make up three-quarters of the population and spend $34 billion a year, according to the National Gardening Association. Many experts agree that climate change, which by some estimates has already nudged up large swaths of the country by one or more plant-hardiness zones, has meant a longer growing season and a more robust selection. There are palm trees in Knoxville and subtropical camellias in Pennsylvania.

 

For the full story, see: 

SHAILA DEWANSHAILA DEWAN.  "Feeling Warmth, Subtropical Plants Move North."  The New York Times  (Thurs., May 3, 2007):  A1 & A20.