Thursday, March 24, 2011

Why Fukushima Will Change Less Than You Think

Some needed perspective on all the anti-nuclear hype over the past couple of weeks.

Amplifyd from www.theatlantic.com

From virtually the moment that reports first hit the international media that there were problems at the Fukushima nuclear plants, speculation about the impact that the accident would have upon the future of nuclear power overwhelmed accurate information about the actual nature and severity of the accident.

Even in the worst case, involving the full meltdown of multiple reactors and a significant breach of containment, there are no credible scenarios wherein the Fukushima accident could conceivably have racked up a similar human, economic, or environmental toll. Nonetheless, Fukushima was the worst nuclear accident since Chernobyl and anti-nuclear activists were quick to make the comparison. Never mind that the Chernobyl disaster resulted from an explosive fire at an uncontained reactor of a far more dangerous design that exposed vastly more people to vastly more radiation than Fukushima could ever possibly result in.

Yet lost in the hyperbolic claims of nuclear opponents, the defensive reactions of the nuclear industry, and the carefully calibrated repositioning of politicians and policymakers is the reality that Fukushima is unlikely to much change the basic political economy of nuclear power.

Absent Fukushima, developed world economies were not going to build much new nuclear power anytime soon. The deliberations in Germany have involved whether to retire old plants or extend their lifetimes, not whether to build new plants. The decade long effort to restart the U.S. nuclear industry may result in the construction of, at most, two new plants over the next decade.

By contrast, even a much more serious accident would have been unlikely to delay the construction of new nuclear plants in the developing world for long. For major emerging economies like China and India, energy is still too scarce and expensive for much of their populations and economies and they will likely continue to build new nuclear plants as fast as they can in the coming decades.

In the end, what it all looks like is business as usual, for nukes specifically and the global energy economy more generally. Despite the claims of proponents, present day renewables remain too expensive and undependable for any economy in the world to rely upon at significant scale. So Germany, despite its vaunted solar feed in tariffs, will rely more heavily upon coal, which it has in abundance, as it retires its aging nuclear fleet. The US, already in the midst of a natural gas boom, will use more gas. And China and India, desperate for every kilowatt of power they can produce, will develop every available energy resource they have as fast as they can, including nuclear.

In the short term, we may see a modest uptick in carbon emissions in some developed economies. A recent Breakthrough Institute analysis concluded that Germany would see a four percent increase in its annual carbon emissions if it phased out its nuclear fleet. The US would see a one percent increase if it phased out its Mark 1 reactors and replaced them with gas and a five percent increase if it replaced all of its reactors.

Acceptance of, and even vocal support for, nuclear power under such circumstances would have been unthinkable even a decade ago. But as many leading greens have come to terms with the potentially catastrophic risks of climate change, they have begun to reconsider the far more modest risks associated with nuclear power. There is no credible path to global emissions stabilization absent enormous quantities of new nuclear power. It is, quite simply, the only low carbon energy technology available today capable of producing large quantities of low carbon baseload power on the scale that the rapidly growing global economy demands. Unfortunately, to meet that demand, nuclear as usual will not suffice. What we will need in order to actually displace the world's enormous and rapidly growing fossil fueled infrastructure is nuclear power that is faster, safer and cheaper. While the Fukushima accident hasn't improved the prospects for that in the short term, the generational shift in attitudes toward nuclear power that the reaction to the accident has revealed may provide a much more hospitable climate for nuclear innovation in the long term.

Read more at www.theatlantic.com

Wednesday, March 23, 2011

Prescription Drug Prices: What to do?

For those who have heard about that drug that just got a 100-fold price increase, here is some interesting background. Basically, a company got regulatory approval for a new use of an orphan drug, so what was originally an off-label use for $15 is now a regulatory approved used for $1500, at least for a period of exclusivity granted by the FDA. The article only explains the situation; it doesn't really offer solutions.
Amplifyd from pipeline.corante.com

Makena's Price: What to Do?

The situation with KV Pharmaceuticals and the premature birth therapy Makena has been all over the news in the last couple of days. Briefly, Makena is an injectable progesterone formulation, given to women at risk of delivering prematurely. It went off the market in the early 1990s, because of side effect concerns and worries about overall efficacy, but since 2003 it's made an off-label comeback, thanks largely to a study at Wake Forest. This seemed to tip the risk/benefit ratio over to the favorable side.
KV has decided that the price will now be about $1500 per patient, as opposed to about $15 before under the off-label regime. The reaction has been exactly what one would expect, and why not? Here, then are some thoughts:
Unfortunately, this should not have come as a surprise. It seems to have, though. The news stories are full of quotes from patients, doctors, and insurance companies saying that they never saw this coming. Look, though, at what happened recently with colchicine. Same situation. Same price jump. Same outrage, understandably. As long as these same incentives exist, any no-name generic company that comes along to adopt an old therapy and bring it into the modern regulatory regime can be assumed to be planning to run the price up to what they think the market will bear. That's why they're going to the trouble.
KV seems to have guessed correctly about the price. You wouldn't think so, with a hundred-fold increase. And the news stories, as I say, are full of (understandably) angry quotes from people at the insurance companies who will now be asked to pay. But (as that NPR link in the first paragraph says), Aetna, outraged or not, is going to pony up. It's going to cost them $20 to $30 million per year, most of which is going to go directly to KV's bottom line, but they're going to pay. And the other big health insurance providers seem to be doing the same. Meanwhile, the company has announced a program to provide low-cost treatment to people without insurance. From what I can see, it looks like basically everyone who had access to the drug before will have it now, the main difference being that the payers with deeper pockets will now be getting hammered on by KV. This is not a nice way to run a business, and it's not something I would sleep well on after having done myself. But there it is.
How much is regulatory approval worth, anyway? That seems to be what we're really arguing about. After all, patients are getting the same drug, in the same formulation, dosed the same way as before. But now it's **FDA Approved**. For new substances, I think regulatory approval is worth quite a bit. There are all kinds of things that can go wrong. But how about drugs that have been dosed in humans for years? And already run through the equivalent of Phase II trials by other people? The main thing that's being added is some confirmation that yes, the dose that everyone's been using is about right, and yes, the effects that are being seen are, in fact, real. And that's not worthless, not at all - but how much is it worth, really? The agency itself seems to place a pretty high value on it - seven years of market exclusivity, to be exact, and we can see by example just what that goes for on the market.
This does the drug industry no good, either. We have a bad enough reputation as it is, wouldn't you think? What's irritating, to someone like me who works at a "find a new drug" type of company, is that these no-name generic outfits (KV in this case, URL Pharma for colchicine) are doing pretty much what critics of the industry think that we all do, all the time. That is, walk up to situations where other people have done a lot of the work, a good amount of it with public/NIH money, and step right in and profit. Now it's true that these companies have to basically run Phase II/Phase III trials to take the data to the FDA, and that's a significant amount of money. But their risks in doing so have been watered down immensely by the history of these drugs in the medical community. When a research company closes its eyes, holds its breath, and jumps into the clinic with a new molecule, that's one thing. And that's where those 90% failure rates come from. But the failure rate of drugs that have been used for years in human patients already, and already studied under clinical conditions, is not anything like 90%. Is it zero per cent? Has anyone failed yet, taking one of these old medications back to the FDA? Even once?
The company picked its target carefully. I will say this, that KV's trials have presumably clarified the question of whether progesterone therapy actually does help. You'd think that the 2003 study would have answered that, and as it turned out, it had. A review of the field in 2006 concluded that it was a worthwhile therapy, from a cost/benefit standpoint, as did another review in 2007. (Mind you, that wasn't at any $1500 a throw, was it?) But a Cochrane review from last year concluded that there still wasn't enough evidence to recommend the whole idea. And progesterone therapy doesn't seem to help with twin or tripletpregnancies or with some other gestational problems. No, the 2003 study seemed fairly strong, and has the greatest relevance to public health, so that's what the company went for. From one viewing angle, the system worked.
Read more at pipeline.corante.com

A Writer’s Thoughts on Paywalls

Some interesting thoughts on media paywalls by someone who actually gets paid to write.
Amplifyd from techcrunch.com
By erecting paywalls, the psychological economics change. If I write a column for the unpaywalled TechCrunch – or the Guardian – I know I’ll be paid a certain fee and my words will be available to certain millions of people. By contrast, if I write for the paywalled Times – either the London or New York strain – the fee isn’t that much better or worse, but the potential reach will be restricted. That gap in audience and visibility has to be filled by something else. And that ‘something’ is likely to be prestige.
Does the inherent prestige of saying I write for either of the Timeses make up for what I lose by not writing the same thing for almost anywhere else? Frankly, yes:  just being able to list the Times in my portfolio of work is a feather in my cap. A feather which, to screw the metaphor, can open doors to other lucrative commissions, talking head gigs and even book deals.
For other publications, though, the answer isn’t so clear. If the San Francisco Chronicle or – I dunno – TechCrunch – went behind a paywall tomorrow, would they still be able to attract a high caliber of contributors, without hiking their fees? Would even a hack like me be as happy writing for them? I’d guess probably not. And in any case, fee hiking is not really something most publications can afford to do.
The point is this: the establishment of a paywall at both the London and New York Times might be a dismal and embarrassing failure. But even if it’s a huge success, we should probably view that success less as a ghost of media yet to come, and more as one of the unique benefits of being a paper of record.
Read more at techcrunch.com

Tuesday, March 8, 2011

$1,000,000,000 for Windows Phone 7

So, now we know what it costs to make Nokia go with Windows Phone 7 over Android. Sounds like Nokia got a pretty good deal; we will see whether it is good for Microsoft. At the least, it demonstrates a pretty significant commitment on Microsoft's part to try and make WP7 competitive, as opposed to the Kin...
Amplify’d from windowsphonesecrets.com
According to Bloomberg, Microsoft is paying Nokia $1 billion to adopt Windows Phone.
Microsoft Corp. will pay Nokia Oyj more than $1 billion to promote and develop Windows-based handsets as part of their smartphone software agreement, according to two people with knowledge of the terms.
Nokia will pay Microsoft a fee for each copy of Windows used in its phones, costs that will be offset as Nokia curtails its own budget for software research and development, said one of the people, who declined to be identified because the final contract hasn’t yet been signed. The agreement runs for more than five years, the people said.
A spokeswoman for Nokia said the final contract hasn’t been signed and the company will share further details when they are complete.
The agreement also has Microsoft paying Nokia for the right to use its patent portfolio, one of the people said.
Read more at windowsphonesecrets.com

Monday, March 7, 2011

Is It Worth Abandoning a Product You Lov

The full title is

"Is It Worth Abandoning a Product You Love Due to Bad Customer Service?"

Way more than 40 characters, and obviously a poor way to start a conversation. ;-)

Amplify’d from lifehacker.com
While this is far from the end of the world, the customer service at Dot's has never been stellar and this incident made me wonder why I've ever bothered giving them my money. I do like the product, but I hate supporting businesses that don't care about their customers. I feel like I'm better off without the cupcakes all together (which is a lot healthier, too). Ultimately what it comes down to is this: should be tougher on businesses that treat us poorly, even if we like what they sell, or does setting the bar too high essentially rule out the majority of businesses we'll interact with in our lives?
Read more at lifehacker.com

"Multiliteracy"

This is a picture of my daughter's award from the Delaware DOE for "Multiliteracy". (Is "Multiliteracy" a word?)  ...