Tuesday, January 30, 2007

The Doctor Won't See You Now

According to this article, many reps make in the range of 200,000 dollars a year!!!
Bye-bye Big Pharma sales rep. A host of forces is now converging to clamp down on hard-driving, gift-toting pharmaceutical pitchmasters who have been ambushing physicians for the last decade. Doctors, consumer groups, and government regulators have all had enough. And now, pharma CEOs are questioning whether the hard sell even pays off.
The changes could also help repair the drug industry's damaged reputation. In a survey released on Jan. 9 by PricewaterhouseCoopers, 94% of physicians, hospital execs, and other health-care stakeholders said they think drug companies spend too much money promoting their products. And 94% of consumers said these companies can be too aggressive in promoting unapproved, "off-label" uses of their products--an illegal tactic. It's not just that pharma companies have been known to deploy as many as a half-dozen reps to hit the same doctor for the same product. The industry also spends $4 billion each year beaming their messages directly into consumers' homes. "Clearly, the public thinks the drug industry's focus is on increasing prescriptions rather than improving patients' health," says Peter Claude, a partner in Pricewaterhouse's pharmaceutical practice. "That's a turnoff."

Consider the profile of the typical pharma sales rep. He or she is often recruited straight out of college, lured by lush compensation and a company car. Top recruits are prized not so much for their scientific prowess--science degrees are rarely required--but for their movie-star looks, charisma, and talent in cheerleading new products.

Simple eye test can diagnose severe malaria

[NAIROBI] Cerebral malaria can be diagnosed by a simple eye examination, a method that is both quick and cheap and could save thousands of lives in malarial regions, a new study shows.

Diagnosing cerebral malaria — a severe complication of malaria in which the Plasmodium falciparum parasite infects capillaries that flow through the tissues of the brain — can be difficult, as patients can be unconscious and have a number of other illnesses.

Now researchers have found that certain changes on the retina, the light sensitive tissue at the back of the eye, are unique to severe forms of malaria.

Tremendous Rise In Syphilis in China

In 1993, the reported total rate of cases of syphilis in China was 0·2 cases per 100 000, whereas primary and secondary syphilis alone represented 5·7 cases per 100 000 persons in 2005. The rate of congenital syphilis increased greatly with an average yearly rise of 71·9%, from 0·01 cases per 100 000 livebirths in 1991 to 19·68 cases per 100 000 livebirths in 2005.

Is Using Lasers on Eye Gunk Worth It?

January 30,2007 | FALLS CHURCH, Va. -- Some people call them floaters. Eye doctors call them "vitreous opacities." Emily Flynn called hers "a little fuzzball," and she flew halfway around the world to have it removed. After more than 100 pinpoint zaps from a laser beam during a half-hour visit to a northern Virginia office park, the fuzzball was gone, obliterated within the clear, gelatinous goo that fills the eyeball.

The surgeon, John Karickhoff, has done the same procedure more than 1,400 times over the past 15 years and claims a success rate of better than 90 percent, with minimal risk of complications. Still, many ophthalmologists have never heard of the procedure -- and most would recommend against it. The procedure has drawn regulatory scrutiny in Florida.

Sunday, January 28, 2007

Incendiary guitar for your Sunday am

Three incredibly virtuostic guitarists performing "Mediterranean Sundance."

Thursday, January 25, 2007

PEOPLE BEFORE PATENTS: A Message from Doctors Without Borders

Pharmaceutical company Novartis is taking the Indian government to court. If the company wins, millions of people across the globe could have their sources of affordable medicines dry up.

Novartis was one of the 39 companies that took the South African government to court five years ago, in an effort to overturn the country's medicines act that was designed to bring drug prices down. Now Novartis is up to it again and is targeting India.

India produces affordable medicines that are vital to many people living in developing countries. Over half the medicines currently used for AIDS treatment in developing countries come from India and such medicines are used to treat over 80% of the 80,000 AIDS patients in Médecins Sans Frontières projects.

Wednesday, January 24, 2007

How Thinking Can Change the Brain

The Dalai Lama, who had watched a brain operation during a visit to an American medical school over a decade earlier, asked the surgeons a startling question: Can the mind shape brain matter?
At the University of Toronto, Dr. Mayberg, Zindel Segal and their colleagues first used brain imaging to measure activity in the brains of depressed adults. Some of these volunteers then received paroxetine (the generic name of the antidepressant Paxil), while others underwent 15 to 20 sessions of cognitive-behavior therapy, learning not to catastrophize. That is, they were taught to break their habit of interpreting every little setback as a calamity, as when they conclude from a lousy date that no one will ever love them.

All the patients' depression lifted, regardless of whether their brains were infused with a powerful drug or with a different way of thinking. Yet the only "drugs" that the cognitive-therapy group received were their own thoughts.

The scientists scanned their patients' brains again, expecting that the changes would be the same no matter which treatment they received, as Dr. Mayberg had found in her placebo study. But no. "We were totally dead wrong," she says. Cognitive-behavior therapy muted overactivity in the frontal cortex, the seat of reasoning, logic, analysis and higher thought. The antidepressant raised activity there. Cognitive-behavior therapy raised activity in the limbic system, the brain's emotion center. The drug lowered activity there.

With cognitive therapy, says Dr. Mayberg, the brain is rewired "to adopt different thinking circuits."
Through attention, UCSF's Michael Merzenich and a colleague wrote, "We choose and sculpt how our ever-changing minds will work, we choose who we will be the next moment in a very real sense, and these choices are left embossed in physical form on our material selves."

The discovery that neuroplasticity cannot occur without attention has important implications. If a skill becomes so routine you can do it on autopilot, practicing it will no longer change the brain. And if you take up mental exercises to keep your brain young, they will not be as effective if you become able to do them without paying much attention.
Prof. Davidson then used fMRI imaging to detect which regions of the monks' and novices' brains became active during compassion meditation. The brains of all the subjects showed activity in regions that monitor one's emotions, plan movements, and generate positive feelings such as happiness. Regions that keep track of what is self and what is other became quieter, as if during compassion meditation the subjects opened their minds and hearts to others.

More interesting were the differences between the monks and the novices. The monks had much greater activation in brain regions called the right insula and caudate, a network that underlies empathy and maternal love. They also had stronger connections from the frontal regions to the emotion regions, which is the pathway by which higher thought can control emotions.

In each case, monks with the most hours of meditation showed the most dramatic brain changes. That was a strong hint that mental training makes it easier for the brain to turn on circuits that underlie compassion and empathy.

"This positive state is a skill that can be trained," Prof. Davidson says. "Our findings clearly indicate that meditation can change the function of the brain in an enduring way.

Tuesday, January 23, 2007

The Challenge of Global Health

Foreign affairs has a comprehensive article on global health

followed by a roundtable discussion

Paul Farmer in particular (one of my heroes in healthcare) makes some excellent points...

NEJM also has an article on global health

(via metafilter)

Monday, January 22, 2007

Get Me a Neurosurgeon, Stat

When I first returned to the States I didn't see what the big deal was with regard to taking emergency call. Although as a retina specialist, I thought that we should be on a separate call schedule as general ophthalmologists, since we are in essence always on call as many retina patients are emergencies. In fact, I think that we should append the moniker to "emergency" to the practice name, given how many urgent or emergent patients get added on to our schedule on a daily basis.

But this article makes some valid points that resonate with my concerns about taking call as an ophthalmologist: namely the local monopolistic hospital has decided that only some specialities deserve to be paid for taking emergency call, and ophthalmology is not among them. Second, in this litiginous society, taking call is a huge risk for any doctor...

Modern maladies. So where have all the specialists gone? They've been driven away, observers say, by three modern maladies of American healthcare: too much work, too little pay, and the fear of malpractice lawsuits. "Put all those things together, and who would want to be in this business?" asks Todd Taylor, who teaches emergency medicine at Vanderbilt University in Tennessee.

And it doesn't pay. The federal Emergency Medical Treatment and Active Labor Act, enacted in 1986 to prevent discrimination against the poor, requires that emergency departments screen all patients and ensure they are not in an immediate medical crisis, regardless of their ability to pay. That means hospitals need to maintain a roster of on-call specialists. But the law has also pushed hospitals to pressure doctors to provide on-call services for nothing in return for hospital affiliation. Doctors used to agree to this deal because they needed hospitals as places to perform surgery, and the workload wasn't too heavy. But as the workload spiraled up, surgeons spent more time answering ER calls and less time dealing with their own practices and paying patients. If they were affiliated with more than one hospital, as many doctors are, both hospitals made demands.

Recently, "office-based surgery and free-standing surgical clinics have given orthopedists and plastic surgeons and others a way out," says Rick Cameron, project manager of the Emergency Department Management Group in Palm Beach County, Fla., a partnership of county hospitals trying to solve the specialist shortage that has dogged that region. "Many don't need to be affiliated with hospitals to do their jobs."

Finally, there's fear of being sued. On-call surgeons worry there's more chance of getting sued by a stranger whom they rush to treat in an ER than by an established patient having elective surgery. "Anything can happen in an ER," says Jose Arrascue, a kidney specialist in Boynton Beach, Fla."If you have no rapport with the family, they may conclude you did something wrong, and you are wide open for a suit. That really concerns me." There have been calls for legislation exempting doctors on ER duty from lawsuits, but the idea of immunity from malpractice hasn't appealed to federal or state lawmakers.

To minimize risk, many doctors stop taking ER calls. Or, Valadka says, surgeons may limit the types of operations they do in regular practice, which means they won't be called in for emergencies that are beyond those limits. For example, some neurosurgeons—ironically—have stopped doing brain surgery and focus only on the spine.

The Limits of Democracy

The elections in Iraq had wondrous aspects, but they also divided the country into three communities and hardened the splits.

"The percentage of countries designated as free has failed to increase for nearly a decade and suggests that these trends may be contributing to a developing freedom stagnation," writes Freedom House director of research Arch Puddington in an essay released with the rankings.

Regimes across the world are closing down nongovernmental organizations, newspapers and other groups that advocate for human rights. And, I would add, what is most striking is that these efforts are not being met with enormous criticism. Democracy proponents are on the defensive in many places.

What explains this paradox—of freedom's retreat, even with a U.S. administration vociferous in promoting democracy? Some part of the explanation lies in the global antipathy to the U.S. president. "We have all been hurt by the association with the Bush administration," Saad Eddin Ibrahim, the Egyptian activist, told me last month. "Bush's arrogance has turned people off the idea of democracy," says Larry Diamond, co-editor of the Journal of Democracy.

But he goes on: "There's a lot more to it than that. We need to face up to the fact that in many developing countries democracy is not working very well."

Diamond points to several countries where elections have been followed by governmental paralysis, corruption and ethnic warfare. The poster child for this decline has to be Nigeria, a country often lauded for its democracy.

Africa: War on the Rescuers

Darfur: The newest targets in the territory's widening violence are the aid workers keeping its people alive.

Jan. 29, 2007 issue - Last Sept. 11 was a momentous day in Darfur, too. After unidentified militiamen attacked aid workers from the Nobel Prize-winning Médecins sans Frontières at a roadblock on that date, most of the international aid groups ministering to Darfur's 6 million people stopped using the roads. On Dec. 18, in the southern town of Gereida, unrelated gunmen attacked the compounds of Oxfam and Action Contre la Faim. More than 70 aid workers subsequently pulled out of the refugee camp there—Darfur's largest, with 130,000 people—leaving only 10 Red Cross employees behind. Yet at the time no one revealed what had really sparked the dramatic pullbacks. In both cases, international staff, including three French aid workers, were either raped or sexually assaulted in territory controlled by the Sudanese government and its allies.

Wednesday, January 17, 2007

What $1.2 Trillion Can Buy

The way to come to grips with $1.2 trillion is to forget about the number itself and think instead about what you could buy with the money. When you do that, a trillion stops sounding anything like millions or billions.

Religious Moderates are Kidding Themselves

This should be interesting...

Best-selling atheist Sam Harris and pro-religion blogger Andrew Sullivan debate the merits of faith.

The Making and Unmaking of a Child Soldier

This is a compelling account of a child soldier in Sierra Leone, who describes how he was able to kill without mercy, but still retained an underlying guilt, which haunted him once he was removed from the frontlines and withdrew from "brown brown," (a mixture of cocaine and gunpowder), and other drugs...It is a tragic story, which echoes the sorts of experiences of those I worked with and interviewed on my trip to Sierra Leone several months ago. What really amazed me in my interviews is how many of these young people seemed to be psychologically healthy, despite undergoing unspeakable trauma...seeing pregnant women being sliced open and the babies falling from the bellies, while the killers laughed at the dying mother and child; being given a choice between being killed or watching one's wife get gang-raped, living for a month in the jungle with a broken leg and subsisting on a single papaya after a rebel attack etc...As Mohammed described to me, he became so emaciated after a month of a single papaya that when he finally returned to his family...they were unable to recognize him... They thought he was a ghost.

The other issue is that there is now a whole generation of youngsters (who were given blanket amnesty) after the war, who have not been educated. Many are also still hooked on "brown brown." It is frightening indeed to imagine that these will be the future adults in this country, which is already in such dire straits---no electricity for 40 years, few passable roads, endemic corruption etc...

Much of the history, economic dynamics, and yes, natural beauty of the country is captured in the movie, "Blood Diamond," which I highly recommend.

During that time, a lot of things were done with no reason or explanation. Sometimes we were asked to leave for war in the middle of a movie. We would come back hours later after killing many people and continue the movie as if we had just returned from intermission. We were always either on the front lines, watching a war movie or doing drugs. There was no time to be alone or to think. When we conversed with one another, we talked only about the movies and how impressed we were with the way either the lieutenant, the corporal or one of us had killed someone. It was as if nothing else existed.

The villages that we captured and turned into our bases as we went along and the forests that we slept in became my home. My squad was my family, my gun was my provider and protector and my rule was to kill or be killed. The extent of my thoughts didn’t go much beyond that. We had been fighting for more than two years, and killing had become a daily activity. I felt no pity for anyone. My childhood had gone by without my knowing, and it seemed as if my heart had frozen. I knew that day and night came and went because of the presence of the moon and the sun, but I had no idea whether it was a Sunday or a Friday.

Tuesday, January 16, 2007

5 Ideas for Stressful Living

I’ve compiled a short list of ideas for those who wish to add a dash of stress into their lives — all fairly easy to implement, not to mention widely encouraged by society at large and often easily observed in the behavior of those around you.

Why Do Today What You Can Put Off Until Tomorrow

I am a moderate procrastinator. Even when I believe that I would be best served by finishing a task (say, filing this story), I will occasionally put it off in favor of some short-term reward (like a much needed caffeine fix). This tendency on my part to delay what is in my long-term interest can now be explained by a simple mathematical equation, according to industrial psychologist Piers Steel of the University of Calgary.

Steel developed the equation U = E x V / I x D, where U is the desire to complete the task; E, the expectation of success; V, the value of completion; I, the immediacy of task; and D, the personal sensitivity to delay, as a way of mathematically mapping a given individual's procrastination response. So, for example, my desire to finish this article is influenced by my relative confidence in writing it well and the prospect of a paycheck as well as a looming deadline and my inherent desire to go home at the end of the day. "You're more likely to put something off if you're a very impulsive individual," Steel says. But, "if you only work at the last minute, time on task tells."

Car Washes and Genocide - New York Times

President Bush and other world leaders have dropped the ball on Darfur. But that vacuum of moral leadership has been filled by university students, churches and temples, celebrities like George Clooney and Mia Farrow, and armies of schoolchildren.

Their arsenal — green armbands, phone calls to the White House, bake sales to raise money — all seem pallid. How can a “Save Darfur” lawn sign in Peoria intimidate government-backed raiders in Sudan or Chad who throw babies into bonfires?

Yet, finally, we see evidence that those armbands and lawn signs can make a difference. Last week, the Save Darfur Coalition — the grass-roots organization that puts out those lawn signs — sponsored a trip by Bill Richardson, the New Mexico governor, to Khartoum to negotiate with President Omar al-Bashir.

A Rifle in Every Pot

IT’S a phenomenon that gives the term “gun control” a whole new meaning: community ordinances that encourage citizens to own guns.

What Shamu Taught Me About a Happy Marriage

This was one of the top ten emailed articles of 2006 from the New York Times, in which an author on animal training techniques uses similar techniques to modify the behavior of her husband....

So, like many wives before me, I ignored a library of advice books and set about improving him. By nagging, of course, which only made his behavior worse: he'd drive faster instead of slower; shave less frequently, not more; and leave his reeking bike garb on the bedroom floor longer than ever.

We went to a counselor to smooth the edges off our marriage. She didn't understand what we were doing there and complimented us repeatedly on how well we communicated. I gave up. I guessed she was right — our union was better than most — and resigned myself to stretches of slow-boil resentment and occasional sarcasm.

Then something magical happened. For a book I was writing about a school for exotic animal trainers, I started commuting from Maine to California, where I spent my days watching students do the seemingly impossible: teaching hyenas to pirouette on command, cougars to offer their paws for a nail clipping, and baboons to skateboard.

I listened, rapt, as professional trainers explained how they taught dolphins to flip and elephants to paint. Eventually it hit me that the same techniques might work on that stubborn but lovable species, the American husband.

Monday, January 15, 2007

Gem War

The diamonds pictured below are real -- only they cost about 15% less than other stones of similar size and quality. The reason: They were produced in a lab. How a new generation of high-quality diamonds is shaking up the jewelry world. By

Courses on the Net

Massive Resource List for All Autodidacts

What Oprah Can't Forget

The Oprah pasting that took place over the New Year's holiday, in reaction to the pressapalooza surrounding her Oprah Winfrey Leadership Academy for Girls in South Africa, reveals a lot about the venality, racism and hypocrisy of the talk-show host's critics, yes. But less remarked upon and equally interesting is what the explosive news cycle -- one that notably seemed to veer free of Winfrey's usual iron-fisted control -- reveals about the talk show host's own frailties, not as a philanthropist or educator, but as one of the United States' most powerful, unlikely, anomalous and isolated success stories.

Winfrey's unguarded comments about the opening of her school revealed the degree to which arguably the most influential woman in the United States is still driven by the specter of her own beginnings as a poor, sexually abused child in Mississippi, and her seemingly endless spiral of desire to set the world right not simply for other young women, but for her own prepubescent self. For a moment, her self-spin veered out of control, and we got a brief snapshot not just of Winfrey's good intentions, but of the loneliness and solitude experienced by a woman who is historically and culturally unique in her power, wealth, life story and position in the world.

Ordinary Oprahs

January 11, 2007 · We were interested in the hullabaloo surrounding the opening of Oprah Winfrey's Leadership Academy for Girls in South Africa. We stumbled onto a story, actually. We realized that two people we see all the time are doing what Oprah has just done, and let me tell you, they don't have Oprah-sized pockets.

Saturday, January 13, 2007

Rod Dreher: "Hadn't the hippies tried to tell my generation this"?

I read Rod Dreher regularly at his blog site...I also have his book, "Crunchy Con" sitting on my bookshelf, but haven't read it. I respect his thought processes greatly...

Rod Dreher is as conservative as it gets -- a contributor to National Review and the Corner, a current columnist for The Dallas Morning News, a self-described "practicing Christian and political conservative."

Today, Dreher has an extraordinary (oral) essay at NPR in which he recounts how the conduct of President Bush (for whom he voted twice) in the Iraq War (which he supported) is causing him to question, really to abandon, the core political beliefs he has held since childhood.

Dreher's essay is extreme and intense but also increasingly commonplace and illustrative. The disaster of unparalleled magnitude that President Bush and his integrity-free and bloodthirsty administration and followers wrought on this country will have a profound impact not only on American strength and credibility for a long, long time to come, but also on the views of Americans towards their political leaders and, almost certainly, towards the Republican Party.

One of the very few potential benefits of the Iraq tragedy is that it may raise the level of doubt and cynicism with which Americans evaluate the claims of the Government when it tries -- as Dreher put it -- "to send them to kill and die for noble-sounding rot."

Here is the link to the NPR interview: http://www.npr.org/templates/story/story.php?storyId=6817201

Mystical Morning

Mystical Morning
Originally uploaded by ~The Olis In 'Consin~.
As an ophthalmologist, I have a weakness for eyes...but eyes in the sky--what a trip!

David Torn

One of my favorite modern music composers/creators has just put up a website. I normally am not a fan of flash websites, but the otherworldly, intriguing aspect of this site is reflective of the musical muse that is David Torn. Explore some of the musical selections as well...

Friday, January 12, 2007

Guitar never seemed so hard

Guitar never seemed so hard...or so beautiful....

Guitar never seemed so hard

Brain scans predict shoppers' purchasing choices

The possibilities are limitless...It would be cool to be able to image a brain scan of someone you are talking to so you could have an idea if you are e.g., coming together or moving futher apart in a negotiation...

NEW YORK (Reuters Health) - Scientists can now look into the brains of people making a purchase decision and predict whether or not they will buy.

When people see something they want to purchase, a portion of the brain called the nucleus accumbens "lights up" on a brain scan. If the price is too high, another region of the brain called the insula is activated and the mesial prefrontal cortex (MPFC) is deactivated, Dr. Brian Knutson of Stanford University in California and colleagues report.

Based on the activation and deactivation of these regions, Knutson and his team were able to predict whether or not people would purchase something before they were conscience of making a decision.

Saturday, January 06, 2007

M.I.T. OpenCourse Ware

M.I.T. will be placing on all its courses on line for free as part of an open source movement...

A free and open educational resource (OER) for educators, students, and self-learners around the world. It is true to MIT's values of excellence, innovation, and leadership.


* Is a publication of MIT course materials
* Does not require any registration
* Is not a degree-granting or certificate-granting activity
* Does not provide access to MIT faculty

Thursday, January 04, 2007

On Evil

I have long been preoccupied by the problem of evil. Not being a philosopher, I have no satisfactory explanation of evil to offer, nor even, indeed, a satisfactory definition of it. For me, evil is rather like poetry was for Doctor Johnson: easier to say what it isn’t than what it is. All I know for certain is that there’s a lot of it about - evil, I mean, not poetry.

Why? Is the heart of man irredeemably evil, or at any rate inclined to evil? What are the conditions in which evil may flourish?

My medical practice, admittedly of a peculiar kind, in a slum and in a prison, convinced me of the prevalence of evil. ...
I have seen so much, both at home and abroad, that I am not easily taken aback. When you have heard of baby-sitters who impale babies on railings in order to quieten them during a televised football match, or of men who suspend their girlfriends by their ankles from the fifteenth floor balcony, and this kind of thing daily for many years, you develop a kind of emotional carapace. One almost begins to take a pride in one’s own unsociability, which one takes to be a kind of sophistication. It is a form of spiritual pride, I suppose. Still, I nevertheless read a book that shocked me. It was about the Rwandan genocide, called A Time for Machetes, by a French journalist called Jean Hatzfeld. He interviewed several men who had taken part in the genocide, probably the most murderous in human history, at least in terms of numbers of deaths per day while it lasted, and were now imprisoned...

the participation of the general population in the slaughter was its most remarkable feature: usually in mass murder, it is the state that does the killing, or rather the state’s agents, since the state is an abstraction without an existence independent of those who work for it.

There is no real remorse for what they did, only regret that it landed them in their current predicament. They feel more sorry for themselves than for their victims, or the survivors. They are not even altogether unhappy in prison, and look forward to resuming their lives where they left off (before the genocide) as if nothing too much had really happened - or should I say been done by them? They hoped for, and expected, forgiveness on the part of the survivors, amongst whom they would have to return to live, because resentment and bitterness are useless emotions and because they (the perpetrators) had all been gripped by a collective madness. This, of course, absolved them in large part from personal responsibility.

One of the most haunting things in this book, if it is possible to pick anything out in particular, is that many of the victims did not so much as cry out when caught by the murderous genocidaires: they died in complete silence, as if speech and the human voice were now completely worthless, redundant, beside the point. I have often wondered why the people went into the gas chambers silently, without fighting back, but I suppose that when you witness absolute human evil committed by the people with whom you once lived, and who, at least metaphysically, are just like you, you see no point in the struggle for existence. Non-existence, perhaps, seems preferable to existence.

via Crunchy Con blog

Free Will: Now You Have It, Now You Don’t

bevy of experiments in recent years suggest that the conscious mind is like a monkey riding a tiger of subconscious decisions and actions in progress, frantically making up stories about being in control.
Daniel C. Dennett, a philosopher and cognitive scientist at Tufts University who has written extensively about free will, said that “when we consider whether free will is an illusion or reality, we are looking into an abyss. What seems to confront us is a plunge into nihilism and despair.”

That is hardly a new thought. The German philosopher Arthur Schopenhauer said, as Einstein paraphrased it, that “a human can very well do what he wants, but cannot will what he wants.”

Einstein, among others, found that a comforting idea. “This knowledge of the non-freedom of the will protects me from losing my good humor and taking much too seriously myself and my fellow humans as acting and judging individuals,” he said.

How comforted or depressed this makes you might depend on what you mean by free will. The traditional definition is called “libertarian” or “deep” free will. It holds that humans are free moral agents whose actions are not predetermined. This school of thought says in effect that the whole chain of cause and effect in the history of the universe stops dead in its tracks as you ponder the dessert menu.


But most of the action is going on beneath the surface. Indeed, the conscious mind is often a drag on many activities. Too much thinking can give a golfer the yips. Drivers perform better on automatic pilot. Fiction writers report writing in a kind of trance in which they simply take dictation from the voices and characters in their head, a grace that is, alas, rarely if ever granted nonfiction writers.


Dr. Libet found that brain signals associated with these actions occurred half a second before the subject was conscious of deciding to make them.

The order of brain activities seemed to be perception of motion, and then decision, rather than the other way around.

In short, the conscious brain was only playing catch-up to what the unconscious brain was already doing. The decision to act was an illusion, the monkey making up a story about what the tiger had already done.

Dr. Libet’s results have been reproduced again and again over the years, along with other experiments that suggest that people can be easily fooled when it comes to assuming ownership of their actions. Patients with tics or certain diseases, like chorea, cannot say whether their movements are voluntary or involuntary, Dr. Hallett said.

Dr. Wegner of Harvard said: “We worry that explaining evil condones it. We have to maintain our outrage at Hitler. But wouldn’t it be nice to have a theory of evil in advance that could keep him from coming to power?”

He added, “A system a bit more focused on helping people change rather than paying them back for what they’ve done might be a good thing.”

Dr. Wegner said he thought that exposing free will as an illusion would have little effect on people’s lives or on their feelings of self-worth. Most of them would remain in denial.

“It’s an illusion, but it’s a very persistent illusion; it keeps coming back,” he said, comparing it to a magician’s trick that has been seen again and again. “Even though you know it’s a trick, you get fooled every time. The feelings just don’t go away.”

In an essay about free will in 1999, Dr. Libet wound up quoting the writer Isaac Bashevis Singer, who once said in an interview with the Paris Review, “The greatest gift which humanity has received is free choice. It is true that we are limited in our use of free choice. But the little free choice we have is such a great gift and is potentially worth so much that for this itself, life is worthwhile living.”

Wednesday, January 03, 2007

Inside Abbott's Tactics To Protect AIDS Drug

In the fall of 2003, Abbott Laboratories grew worried about new competition to its flagship AIDS drug, Kaletra. Then it seized on an unusual weapon that helped Kaletra's global sales top $1 billion a year, even as it exposed Abbott to criticism that it was endangering patients.

The weapon was an older Abbott AIDS drug called Norvir. It is a key part of drug regimens that include rival companies' pills. Previously undisclosed documents and emails reviewed by The Wall Street Journal show how Abbott executives discussed ways to diminish the attraction of Norvir, with the goal of forcing patients to drop the rival drugs and turn to Kaletra.

At one point the executives debated removing Norvir pills from the U.S. market and selling the medicine only in a liquid formulation that one executive admitted tasted like vomit. The taste would discourage use of Norvir and competitors' drugs, the executives reasoned, and Abbott could claim it needed Norvir pills for a humanitarian effort in Africa. Another proposal was to stop selling Norvir altogether.

A third proposal carried the day: quintupling the price of Norvir. One internal document warned the move would make Abbott look like a "big, bad, greedy pharmaceutical company." But the executives expected a Norvir price hike would help Kaletra sales, and they bet any controversy would eventually die down.

They were right. Kaletra sales in the U.S. rose 10% over the next two years. Some objected that the price hike made it harder for patients who needed drug combinations pairing Norvir with non-Abbott pills to get their medicine. After an initial burst, the criticism faded, partly because Abbott exempted government health plans and AIDS drug-assistance programs from the Norvir price increase.

Tuesday, January 02, 2007

Insurer hits millions of seniors with drug cost hike

December 31, 2006

The more than two million senior citizens nationwide who signed up last year for Humana Inc.'s least expensive Medicare prescription drug plan face average premium increases of 60 percent -- and in seven states, increases of 466 percent -- starting tomorrow . The higher prices will affect about 50,000 seniors in Massachusetts, where premiums are going up by 130 percent, from $7.32 to $16.90 a month.

"You have to state the obvious," said David Shove , a stock analyst with Prudential Equity Group in New York. "You sell something cheaply and get a lot of customers, and then you raise the price to improve the profitability."

Shove said the start-up of the Medicare prescription drug benefit "was a once-in-a-lifetime opportunity" for Humana to attract new customers.

Steve Findlay , a healthcare analyst with Consumers Union, the publisher of Consumer Reports, called Humana's price increases a "bait and switch" tactic.

"That's not an acceptable inflationary increase in prices," he said. "That's sucker them in and you just start raising the prices."
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