Why not let rich people fund drug development directly?

That is, why not let ill rich people fund directly the research into a treatment that might cure them? That's the premise of this fascinating plutocratic proposal. That piece is very long, very detailed and walks you through almost all aspects of what is being offered. The essential idea is that, especially with cancers, there's a lot of weird ones that affect very few people. But there's quite a lot of rich people about and there's enough of them that, statistically, at least a few, a handful, of such rich people will get each and every one of those weird cancers.

This helps us to solve a certain problem that we've got with funding research into disease cures. We should, obviously, as a society be working on the low hanging fruit. A cure for something that kills 20,000 out of 100,000 people is worth a very great deal more in terms of human utility than a cure for something that kills 5 out of 100,000 people is. Tax funding of such research should therefore, again obviously, be concentrated on trying to find the cures for those widely suffered from diseases, not the weird and rare ones.

However, when we move from societal benefit to private benefit the numbers rather change. Someone suffering from one of those weird cancers is very interested indeed in a cure for that weird cancer. And some of those very interested people will be rich enough to fund the next step in the research. The step being talked about here is the movement of a likely looking treatment out of the lab and into Phase I clinical trials.

Those Phase I trials are where the first 10 or 50 people get given the treatment to see what it actually does to human beings. And there's a number of problems at this point. Neither tax money nor standard pharma investment cash is going to be very interested. One on the grounds that societal benefit will be greater with efforts made elsewhere, the other on the grounds that the final market simply isn't large enough to make it worthwhile. But of course rich people dying of the weird cancer face a different calculus.

The proposal is, at its simplest, just to allow said rich and ill people to pay for the Phase I trials (or some portion of them) in return for a guaranteed place on that very trial. They get this treatment that may cure them, 9 to 49 people get that same treatment without having had to pay anything and we all get the benefit of the advance in human knowledge.

Predictably this will cause howls of outrage in certain quarters. But we think that it's a fascinating idea: at the very least it's something that should be widely discussed and also in detail. No one is claiming that this is a perfect and final plan. Only that it's a very interesting one.

If we can harness the desire of rich people not to die to our goal of treating non-rich people dying of the same diseases then why the heck not?

Isn't this an interesting little finding about drugs?

Isn't this an interesting little assertion from one of the government's own reports?

Decriminalising drugs would have little effect on the number of people abusing illegal substances, a highly controversial Home Office report has said. ... The report – which sources said had caused “panic” within the Home Office – said: “There are indications that decriminalisation can reduce the burden on criminal justice systems.

“It is not clear that decriminalisation has an impact on levels of drug use.

"The disparity in drug use trends and criminal justice statistics between countries with similar approaches, and the lack of any clear correlation between the ‘toughness’ of an approach and levels of drug use demonstrates the complexity of the issue."

The point being, and this can be readily verified by anyone with even the most modest experience of social life in Britain, that all those who want to consume drugs are currently easily able to find the drugs they wish to consume. Meaning that the illegality isn't particularly affecting the availability of supply. Thus decriminalisation seems like a good idea as it's not going to lead to half the population toking itself into a stupor.

However, that decriminalisation isn't enough as we've mentioned around here before. For the major danger of drugs comes not from they themselves, but from the fact that purity and concentration are, given that they are illegal products, entirely unknown to the user. Overdosing is thus depressingly commonplace, as are all sorts of diseases and illnesses from the admixtures. Thus we need to be thinking very seriously about legalisation: not just decriminalisation of small amounts for personal use but the legalisation of supply and production. For that is how we would get brands, reliant upon their quality and consistency, and also get a transparent supply network that can be checked for quality.

It's not just the criminality of taking drugs that is causing our current problems, it's the illegality of supply as well.

From the Annals of Bad Research: rock stars die younger

Around here we're all culturally savvy enough to have heard of the 27 Club: the list of those rocks stars who have died or drink, drugs, suicide etc at the age of 27. We've always taken this to be a rather cheery finding: that if you give some 18 year old all the money, booze, drugs, success and sex they could possibly want then it still takes them 9 years to kill themselves through overindulgence. Rather puts into perspective the prodnoses complaining about our having a second glass of sherry before dinner. However, we've just had the release of a report indicating that popular musicians do indeed die younger, on average, than the general population. And thi8s really should be included in our compendious volume, The Annals of Bad Research. For the contention is that the average age at death of rock and roll, rock and pop, stars is lower than that of the general population. But as Chris Snowden points out, we cannot actually know that:

You see the problem here, I expect. Rock stars didn't exist until the 1950s and since many of them are still alive, we don't know what their average age of death is. It wouldn't be at all surprising if they die earlier on average, but the graph above tells us very little about whether this is so. When Chuck Berry (aged 88), Jerry Lee Lewis (aged 79) and Little Richard (aged 81) pop their clogs, the average is going to go up, especially if they keep breathing for another twenty years.

And, who knows? They might. Perhaps the higher risk when young is counter-balanced by the boost to longevity of having lots of money and the best healthcare in old age?

Be that as it may, you clearly can't work out the average lifespan of a rock star until at least the first generation of rock stars are dead.

Quite: you can only work out the average age of death of any particular cohort when all of that particular cohort are dead. If you try to do it before that has happened then you'll be counting all of those who die young but not all of those who don't: meaning that what you've actually calculated is the average age at death of those who die young. And, you know, people who die younger die younger isn't really all that amazing of a research finding.

Yes, the public health people are lying to us again

It would be useful if they could manage to keep their stories straight:

A landmark report by Public Health England (PHE) says lack of exercise is as dangerous as smoking - directly contributing to one in six deaths.

Officials warned that the UK population is now 20 per cent less active than it was in the 1960s, with half of women and one third of men damaging their health through lack of physical activity.

Given that weight is a straight function of calories consumed to calories expended we've the cause of our obesity epidemic right there. Calories consumed have fallen in that timescale but calories expended has fallen faster. We can thus junk 90% of the current public health programs over addictive sugar, trans-fats and all the rest as simply being nonsense. This part of the public health sector has told us what is really happening.

But it is, of course, worse than that. Our public health people do not seem to understand the economics, nor even the accounting, of public health:

Officials say that without major changes in the way people live their lives, the welfare state in Britain could collapse under the burden of self-inflicted diseases, which are fuelled by obesity, alcohol and smoking.

This simply isn't true. As we've pointed out many a time in these pages, fatties, boozers and puffers save the welfare system money.

Yes, there are public costs associated with the treatments for the diseases all three bring on. But in terms of medical care those costs are lower than the public costs of treating someone who does not die early. There are thus savings in public costs if someone pops an artery in their 60s rather than needing, a little later, a decade's worth of Alzheimer's treatment. When we include things like pensions savings the numbers are even starker. From the point of view of the finances of the welfare state we should be encouraging everyone to stuff themselves and to puff away and imbibe as they do so.

On the other hand of course there are substantial private costs to such early deaths: so we don't in fact go around doing that but just, if we've any liberality left at all, tell people so that they are informed of those costs: the benefits they already know of as it is pleasurable to eat, drink and smoke.

This does not mean therefore that there should be no information campaigns, no attempts to inform people that their health should be better if they stagger up off the couch for a walk for 30 minutes a day. That's all just fine. But what it does mean is that none of these campaigns or actions can be justified by reference to the costs to the welfare state or the public purse. It just ain't true that fatty, puffing boozers impose costs upon said welfare state: thus reducing the number of fatty, puffing boozers isn't going to save that welfare state any money.

The Daily Mail's actually right about NHS Wales here

It's ever so slightly uncomfortable top be agreeing with the Daily Mail here as they're being so nakedly politically partisan about the NHS, the Labour Party and Wales. However, it should be said that they're actually correct in what they're saying:

Today this paper publishes the first part of an explosive investigation which blows away Ed Miliband’s claim that his party can be trusted with the NHS.

Indeed, there is no need to imagine how the service might perform under Labour. For the evidence is before us in Wales, where the party has had full control of the funding and management of health care since devolution 15 years ago.

As Guy Adams exposes on Pages 8 and 9, a picture emerges of a Welsh NHS on the point of meltdown, in which the wellbeing and often the lives of patients are routinely sacrificed on an altar of Socialist ideology.

The Welsh NHS has of course complained and the Mail's response to those complaints is here.

We here at the ASI might not have put all of this into quite such politically loaded terms but the basic critique is correct, in that NHS Wales performs less well than NHS England. And we also know why this is so: NHS Wales has not adopted the last few rounds of a more market based structure as NHS England has. We've also known this for some years:

Some would argue that the drops in waiting times were driven by increased spending, rather than targets, patient choice and hospital competition. Hence the fears sparked by the McKinsey report of the possibility of massive cuts in services. However, money alone cannot explain why waiting times have dropped and equity has improved in England. During the same period that we examined waiting times in England in our study, Scotland and Wales, which both explicitly rejected market-driven reforms, have spent more per patient but have seen much smaller decreases in waiting times.

The more market orientated NHS England is both more equitable and more efficient than the less market orientated NHS Wales and NHS Scotland. Indicating that market based reforms are a pretty good idea: whatever that socialist ideology (although to be fair about it, it's really just an innate conservatism allied with the traditional British dislike of anything that smacks of trade rather than a principled socialism) might have to say about it.

Silicon Ovaries

It's only apt that Silicon Valley's new plan to tackle gender imbalance involves cutting-edge technology, a dose of futurism and flash-freezing things in sub-zero temperatures:

Apple and Facebook are offering to freeze eggs for female employees in an effort to attract more women on to their staff, according to US media reports.

Apple, the world’s most valuable brand, said it would offer the perk to US-based staff from January. “We want to empower women at Apple to do the best work of their lives as they care for loved ones and raise their families,” the company said in a statement to ABC News. “We continue to expand our benefits for women, with a new extended maternity leave policy, along with cryopreservation and egg storage as part of our extensive support for infertility treatments.”

Facebook offers up to $20,000 (£13,000) for egg freezing for female employees. The company also offers adoption and surrogacy assistance and “a host of other fertility services for male and female employees”, the company said. (The Guardian)

Even though the schemes are unlikely to have huge take up, it's an idea with a commendable sentiment behind it. The tech world is notorious for its lack of female representation and lingering sexism, and women make up only 30% of Apple and Facebook's workforce. Their support of 'cryopreservation' will benefit both the firms and their employees.

It's damn inconvenient that the years in which women are able to best forge a career are often also those of peak fertility. This not only creates huge opportunity costs when selecting a career/family/income combination, but restricts the pool of talent available to employees. Being able to keep young eggs on ice (and being aided financially to do so) expands the range of work/child  options women have, and makes some of the tradeoffs a little less binary and severe.

 There are a number of ways we try to reduce the 'costs' of raising a child, from statutory maternity pay and free childcare to paternity leave and work crèche schemes. All of these actions shift part of the cost of child-rearing from one figure (usually the mother) to another actor, such as the state, an employer or a partner. It's usually a good thing that these costs are shared out amongst others, but it would be even better if the costs were simply reduced. Something like fertility preservation does that— it uses technology to augment the options available to women and reduces the opportunity cost of pursuing a career— without the need for state intervention, relying on a partner, or for social behaviours and cultural shifts to occur. If a woman voluntarily choses to use her 29-year old self's eggs at the age of 39, everybody wins.

Of course, Apple and Facebook have chosen to foot the bill here, and no firm should be forced to provide such procedures for their employees. But these leading companies clearly think that $20k is a small price to pay to attract and retain top female talent. Certainly, a firm which signals that it is prepared to help employees overcome obstacles to their life choices (amongst many other generous perks) will be a draw for many, and can help women to achieve the success they've always been capable of.

Naturally, there will be those who recoil in horror at the idea of Facebook laying a frosty, calculating hand on their employees' ovaries. Some consider it a neanderthalic and clumsy way of improving women's standing in the workplace, whilst others worry that supporting such technology gives a strong and unpleasant message to women that forging a career whilst raising a family is a faux pas.

Cryopreservation's hardly going to become a mainstream phenomenon any time soon, and for now is only really an option for a small number of women. Were employers to start actively encouraging the treatment or making employment decisions based upon it, then we would need to have a serious conversation about the way in which it was used. Egg freezing's also in no way a panacea. If Silicon Valley really wants to boost the women in its ranks, there's plenty of other things which they can do, like offer more schemes for current parents, and foster a more female-friendly everyday culture.

Ultimately, egg storage is another medical innovation which — like the pill— affords women a greater range of life choices. And far from establishing expectations of what a female employee should do with her womb, Facebook and Apple's support of the proceedure indicates a commitment to heterogeneity and flexibility. It is smart of them to support such a range of lifestyle and career choices, and with luck initiatives like these will help to enrich the lives and bolster the careers of the women who've chosen to work there.

The NHS: bread and circuses

Juvenal, as every schoolboy used to know, coined the term “panem et circenses” almost exactly two millennia ago to describe the way politicians bought votes with little regard for important issues of state. What goes around comes around: this party conference season has seen Labour, Lib Dem and Conservative Parties trying to outbid one another in their promises for the NHS.  I am not suggesting that the NHS is mere entertainment even if party conferences are.  The point is that NHS spending is becoming a bribe in the same way bread and circuses were.

Any amount of money can be thrown at the NHS, just as it could at the Roman games.  And consuming more increases the appetite for more again.  Somehow questions of value for money, compared with other ways in which our money can be spent, need to be honestly and realistically addressed.  Does a Health service need to pay for people’s life choices or how they wish to look?  Does it need to accommodate elderly, but healthy, people who have nowhere else to go?

Does it need to fund legions of lawyers, managers and compensation claims for real and exaggerated errors?  Harold Wilson started this problem in the 1960s when patients became customers and could suddenly claim.  Until then the only customer was the state and we all had to take our chances.

Emotional wool seems to cloud all NHS discussion.  As it is all free to us individuals, we, naturally enough, only want the best even when the merely good would be good enough.  For, roughly, the same treatment, big hospitals cost double cottage hospitals which double GPs.  Scale does have benefits for specialism but also diseconomies. Only the hassle of big hospital visits, and car parking charges. keep us local.

The cutting edges of medicine, technology and techniques always cost more but some means of rationing will have to be found.  Alternatively, alcohol, tobacco and fatty foods should be prescribed as bread and circuses were.  Dying younger would keep NHS costs down and morale up.

The latest attempt from the booze wowsers

We do love this latest attempt at justifying minimum alcohol prices:

Minimum alcohol pricing of 45 pence per unit would be 50 times more effective in targetting harmful drinking than current policies which only ban the selling of alcohol as a loss leader, research suggests.

Really?

Researchers at the University of Sheffield compared the effects of the two policies on public health using a mathematical model alongside General Lifestyle Survey data to estimate changes in alcohol consumption, spending, and related health harms among adults.

What did that model look at?

In their findings, published by bmj.com, they estimated that below cost selling would increase the price of just 0.7 per cent of alcohol units sold in England, whereas a minimum unit pricing of 45p would increase the price of 23.2 per cent of units sold.

They estimated that below cost selling would reduce harmful drinkers' mean annual consumption by just 0.08 per cent - or around three units per year. By contrast, a 45 pence minimum unit price would reduce consumption by 3.7 per cent or 137 units a year - a 45 times greater effect.

So they plugged the price change into their estimate of the elasticity of demand and found that....wait for it, wait for it....higher prices reduce demand and or consumption?

Gosh, do we really need a team of highly trained and expensive alcohol researchers to tell us that?

Unfortunately this latest paper fails to tell us the three things we'd actually like to know about minimum alcohol pricing.

This first being should we be attempting to reduce consumption in the first place? Current levels of booze taxation more than cover the public costs of boozing. There are, indeed, substantial private costs remaining: but those are being carried by the people doing the boozing which is just where they should be. Is there actually a reason or justification left for public policy action in this case?

The second is whether that rise in prices actually reduces harmful drinking, or just deters the occasional tippler from a small pleasure. There is, after all, fairly convincing evidence that the addict will always feed their addiction while the diletante is more amenable to price signals.

And thirdly, even if the above can be answered in a manner that leads to our wanting to increase the price, why on earth would anyone want to have minimum pricing? Not only is it illegal under EU law but it puts the extra cash into the hands of the retailers and manufacturers. Rather than into the Treasury as would be the case if prices were raised through higher taxation.  Minimum alcohol pricing just doesn't make sense.

On Ed Miliband's new tax on tobacco profits

Ed Miliband has decided that there should be higher taxes on the profits of cigarette companies. The argument being that smoking costs the NHS money and that thus some cash should come from the one activity to cover the other. However, that activity of smoking already more than covers the public costs associated with it. As is helpfully pointed out here:

Estimates for the amount spent on tobacco in the UK in 2011 range from £15.3bn to £18.3bn. The cost of smoking to the NHS is put at between £2.7bn and £5.2bn.

The Treasury earned £9.5bn in revenue from tobacco duties in the financial year 2011-12.

When even The Guardian is pointing out the mathematical difficulties with a Labour Party leader's promises then it would be fair to say that it's not really going to fly, wouldn't it?

And that is rather the point about smoking. The activity is already sufficiently taxed that it pays for all of the public costs associated with it and more (and that's to ignore the fact that shorter lifespans as a result save the NHS money). There are substantial private costs of course: but public taxation isn't the correct way to deal with such private costs either.

How did we end up being ruled by the ignorant?

It always comes as something of a shock to us to see public policy being decided upon the basis of information that simply isn't true. We expect a bit of political argy bargy, of course we do, for different people weight different outcomes, err, differently. Equity and efficiency, inequality and economic freedom, we might agree or disagree on those weights that different people place upon them but can still regard such opinions (for opinions they are and no more than that) as being valid. But that's very different from our being told pure porkies, having supposed facts deployed, facts which just are not a reflection of reality. As the Original Tax Dodger in Chief himself pointed out, comment is free but facts are sacred. And so it is that we come back to a favourite subject of ours, the relationship between the prevalence of obesity and the costs of it to the NHS.

Mr Stevens, who took up post last April, said: ‘Obesity is the new smoking, and it represents a slow-motion car crash in terms of avoidable illness and rising health care costs.

‘If as a nation we keep piling on the pounds around the waistline, we'll be piling on the pounds in terms of future taxes needed just to keep the NHS afloat.’

The problem with this is that it simply is not true. Obesity does not cost the NHS money: on balance it saves it. This is something we've been pointing out for a number of years now. The source is here and the finding is:

Obesity is a major cause of morbidity and mortality and is associated with high medical expenditures. It has been suggested that obesity prevention could result in cost savings. The objective of this study was to estimate the annual and lifetime medical costs attributable to obesity, to compare those to similar costs attributable to smoking, and to discuss the implications for prevention. …. Although effective obesity prevention leads to a decrease in costs of obesity-related diseases, this decrease is offset by cost increases due to diseases unrelated to obesity in life-years gained. Obesity prevention may be an important and cost-effective way of improving public health, but it is not a cure for increasing health expenditures.

When someone's arteries explode at the age of 60 from that 15 cheeseburger a day habit then the NHS doesn't have to pay for another 25 years' worth of hip replacements. This saves the system money as a result of the shorter lifespan.

This is well known: and yet we have the CEO of the NHS telling us the opposite. And further, he's demanding public action that he should know will make his financial problems worse, not better.

All of which leaves us with that essential question: how did we end up being ruled by the ignorant?