Shut up.

I don't like when people misinterpret my facetious belligerence as hostility and consequently tell me to relax.

I also don't like when people start conversations with me while my back is turned. Inevitably, when I do turn around, it's someone I didn't want to speak to in the first place. And by then the effectiveness of scowling is greatly reduced.

That is all.

A Delayed Reaction to the Gawande Column

My trail of thought following the Atul Gawande column.

First off, claiming that Africans won't be able to administer medicine properly because the majority of them don't own watches? Aaaarrrrgh!

It's refreshing to hear this perspective from someone with as much experience and success as Gawande. Certain professions do come with moral obligations, and medicine is undoubtedly one such profession. Journalism is another. More on that later.

So I'm thinking as far as drugs are concerned, we're facing some simple economic problems that get increasingly complicated by legal issues. Basically, there is a limited supply and lack of competition. The biggest issues that result tend to be (a) a shit product, e.g. Microsoft, and/or (b) more relevant to this case: right of the producer to charge whatever they bloody well feel like charging, e.g. Merck. Throw in issues of intellectual property and patent law and you have the big fucking mess that is the pharmaceutical industry.

This leads me believe that it makes very little sense to treat potentially life-saving drugs in the same manner as a Slinky. Were the industry structured along the investment bank model, employees would move freely between competitors bringing industry knowledge with them. Firms would be forced to rely on their ability to innovate and penetrate new markets for their profits, rather than a bullshit patent. But following the twisted path we've chosen, people now support the idea of gene patents.

Is the example above oversimplified? Sure. No one is denying the fact that it takes an enormous amount of human capital - graduates with highly specialized university degrees - to develop a new drug. Intellectual property surely has its place, but not when it begins to stifle much-needed innovation and competition within a market that needs it desperately. And certainly not when it begins to violate principles of basic human decency, as Abbott did with its blackmail of those who reproduced its HIV regimen.

I'll let you chew on that and get to the journalism bit later on. In the meantime, do your homework and read this.

Google and Facebook Can Read Your Mind

Go ahead and call me paranoid. Chances are, if you’re reading this, you know me and have already done so at some point. But seriously, am I the only person worried about this? It’s bad enough that the powers that be know how many times I’ve typed ‘fuck’ in the last hour…I don’t need them to know that I’m doing Google Image searches for James Franco as well.

Google defends its personalized services by saying that usage of iGoogle etc. is at the discretion of the user. Listen, just because I want Pacman on my Google screen doesn’t mean I want people to be able to screen and “customize” my searches.

I feel compelled to say that I don’t actually have Pacman on my homescreen; it was just an example. The most creative section of my iGoogle is the horoscope blurb.

Anyway, the defense goes something like this: if I have a history of having searched for the Eiffel Tower, when I subsequently enter “Paris” into the search engine, I will get results related to the city in France rather than a certain notorious home video. Seems practical enough. Still, I got to thinking- remember that scene in 1984 where they use Winston’s greatest fear (cockroaches) to torture him? Where did they get that information from, anyway? This philosophy seems like it’d make that job a whole lot easier…

Clearly this is all an exaggeration. I’m sure our friends at Google have honorable intentions…for now. Who would think to blame them, anyway, with that cute kid-friendly logo? But look at Facebook: these fun applications that are popping up were all developed by third parties. Everyone wants a piece of Facebook, and who can blame them? They’ve already brushed off $1 billion, not to mention it’s a fantastic way to break into the 18-25 demographic.

Too bad no one’s been able to successfully advocate the importance of voting within that age bracket. Hmmmph.

Going back to the point, there are nearly 700 members on the Facebook network (i.e. people who are employed by Facebook). The New York Times site has single-click functionality to allow you to post articles on your Facebook profile. On the train from Edinburgh to London, I heard three different people talking about posting pictures onto Facebook. It’s inescapable, and believe me, I tried to escape it for…I don’t even know, nearly three years? With this enormous base tied up in a “social utility” that is built up from personal information that so many people want (and so many are willing to post!), I find it hard to believe that privacy rights are given priority here. People will do anything if the price is right- upwards of a billion dollars, the promise of nubile virgins in paradise…you get the picture.

Maybe I’d be less paranoid if our government respected civil liberties. But as long as the mere mention of another 9/11 prompts people to forgo privacy in favor of ostensible security, the market will be ripe for firms willing to exploit that fear. And I doubt that every single one of the (nearly) 9,000 individuals working for Google and Facebook is exclusively motivated by his or her desire to maintain company integrity.

Right…I’m off to install the ‘Extended Info’ application to my Facebook profile.

Atul Gawande in the NY Times

Doctors, Drugs and the Poor

By ATUL GAWANDE

Published: May 17, 2007

It’s one of those questions no one tells you about when you enter medical practice. What do you do when patients come who can’t pay? Some doctors decline to see them. I have expenses to pay and a family to feed, they’ll argue.

But I grew up in a rural part of Ohio where an inordinate number of poor people live. My mother is a pediatrician there, and from the start, she could not imagine turning children away. Up to 20 percent of her patients have been without insurance, and more than half were on Medicaid, which paid terribly and was refused by other doctors. Some patients were not very grateful. Some were not as poor as they claimed. But we could count on my father’s better-paying urology practice to cross-subsidize. So that’s what she did.

The message from my parents was straightforward: We are in medicine and that comes with certain moral obligations. So I’ve understood that part of my job is to see those who can’t pay — even if sometimes it hurts.

I’ve been thinking about this as I’ve watched the arguments unfold about what pharmaceutical companies should charge in the developing world. The history of H.I.V. drugs has not been pretty. First, for almost a decade, we in the West ignored the possibility that antiretroviral drugs could be used in the developing world. (Remember the 2001 claim of U.S. government officials that Africans couldn’t learn to take the drugs on time because they didn’t have watches?) Then, under international pressure, drug companies made some discounts, but they were not deep enough. (A year’s supply was still more than $1,000 per patient.) Only when an Indian generic manufacturer provided a copycat three-drug regimen for $150 per year and major donors stepped forward did distribution effectively reach poor countries.

We’re now in the throes of another round of H.I.V. drug battles, this time over advanced, but even more expensive drug regimens from Merck and Abbott Laboratories. Last week, the Clinton Foundation endorsed decisions by Thailand and Brazil to break the companies’ patents and purchase cheaper, copycat versions of the drugs. Abbott retaliated by withholding seven new drugs from Thailand, including an antibiotic, a painkiller, and a medication for high-blood pressure. The fight has become vicious.

In a way, it’s hard to see how the confrontation could be avoided. The cost of developing a new drug now approaches $1 billion, and companies do need profit margins to recoup that cost and encourage new innovation. Yet, once a life-saving discovery is made, it is clearly grotesque to make millions suffer or die while waiting for a 20-year patent to expire.

The experience with H.I.V. drugs is oddly heartening, though. There is, in fact, a spectrum of behavior among pharmaceutical companies — just like with doctors. Gilead Sciences has granted licenses to generic manufacturers to supply its blockbuster H.I.V. drug, Viread, to the world’s hundred poorest countries at the reasonable royalty rate of 5 percent of sales. Bristol-Meyers Squibb licensed its second-line drug, Reyataz, completely free of royalties to generic manufacturers for India and southern Africa. And through the World Health Organization’s bulk vaccine purchasing arrangements, manufacturers have been able to make significant profits selling vaccines at low cost but large volumes. This is the progress we want to build upon.

Pressure to broaden these efforts will grow, and it should. Agreement on regional pricing tiers and distribution networks for H.I.V. drugs show likelihood of solidifying in ways that make drugs available and support innovation, but we have nothing like it for drugs for heart disease, lung disease, or cancer. Meanwhile, the world is changing. The No. 1 cause of death in India, China, and Vietnam is not H.I.V. It’s heart disease. Cancer is in the top 10. Their people need clot-busting drugs, chemotherapies, and EKG machines just like everyone else. Manufacturers need to show the same willingness to make these life-saving technologies available to the poor.

Some will argue, hey, companies just invent this stuff; it isn’t their job to make sure every country gets some. But that’s not right. As Arthur Caplan, the bioethicist, points out, “You aren’t manufacturing pantyhose when you’re in health care. There are special moral duties attached.”

And one of them is: If you’re building a lifeboat, you have to think about how many you can get inside.

Atul Gawande, a surgeon at Brigham and Women’s Hospital in Boston and a New Yorker staff writer, is the author of the new book “Better.” He is a guest columnist this month.

Campaign for Fair Trade

Yes, free trade is a good thing...in theory. Oxfam International has a great site detailing what's wrong with trade today, complete with animation:

Dumping, patent laws and more

And, a site for getting involved in the US:

Transfair USA

No T-shirts on the US site, though :(

Ruminations: Top 3 Moments on the Tube

All of the incidents below occurred during evening commutes on the Circle/Hammersmith Lines.

3. Screaming Racaille

I thought that was an appropriate title given Sarkozy’s ascension to the Elysee Palace.

A Zone 1 single cash fare has now risen to the astronomical price of £4.00/ride. By today’s conversion rate, that’s $7.92 to travel a distance that may well be less than a mile. So if you were homeless and/or otherwise desperate, would you want to spend that money trying your luck on a crowd of largely unsympathetic City workers?

That’s what I wanted to ask the guy who got on a westbound route from Liverpool Street Station to shout at commuters about how desperate he was. Maybe he would’ve netted positive had he got on a more student-friendly route, because it seems quite common that a person’s generosity is inversely proportional to the size of his or her funds. I think I saw one person on that train toss a silver coin in his direction; the others kept their newspapers held up firmly to their faces.

I should say that I’m not considering myself a typical City worker here, as I get paid significantly less than your average City worker. I kept my nose in my book simply because I don’t like being harassed by people with no common sense.

I sound like a Republican.

Seriously, though, I’m not a (total) asshole. I always give money to buskers (street musicians) because I think they, for the most part, are providing a pleasant service. I value the fact that they’re cultivating a skill, even if a lot of people have their earbuds so permanently fixed in place that they could miss something like this. Most folks don’t like to be accosted, but I think they do appreciate being inspired to take action. I do, anyway.

This could easily turn into a much more serious debate about those who lack even the basic resources to learn a skill, and are therefore in dire need of redistribution in some form, blah blah blah (again, then why are they spending £4 on a tube journey?). Anyway, that’s fair enough, but this post was meant to be a bit more light-hearted than all that. So that’s #3 on the list.

2. Fluorescent Green Eyeliner Bag Lady

I get on the Tube at Liverpool Street, so I’m usually lucky enough to get a seat before the trains get massively packed. On this particular occasion, I was a few stops into my journey and the seats had all filled when a short and stout woman got on the train with a ridiculous number of grocery bags. Oh yeah, and she was wearing hideous fluorescent green eyeliner. After scoping out the lack of available seats, she brought all her crap over close to where I was sitting, in the middle aisle. Why she would choose that spot instead of the more spacious one by the partitions, I don’t know; people seem to deal well enough when others leave their oversized luggage there. Seems to me that’s what a normal person would’ve done. Actually, I take that back: a normal person wouldn’t have gone grocery shopping during the evening rush with the intent of getting on the tube with that many bags afterward. Mistake #1.

Mistake #2: As the train got more and more packed, this lady decided to place a number of her plastic bags on my knees. At first I gave her the benefit of the doubt and shifted my stance so the bags would slide off. But no, she was determined to keep those bags planted firmly on my knees.

At this point, I decided that I’d been targeted by this seemingly harmless (and poorly made up) woman as the seated tube customer most likely to give up my spot when faced with this subtle assault. I wasn’t having it. I proceeded to draw up my legs so that the bags fell off entirely. She, as a result, made a huge (false) show of nearly falling into my lap.

Now I just sound passive-aggressive. But hey, that’s another trait people in this country are known for. And so is unexpected chivalry, which is why the man sitting across the aisle from me eventually offered his seat to that silly bat. I’m not sure whether he was observing her fake distress or my authentic distress, but I suppose it doesn’t matter. I stood my goddamn ground. Never trust someone with dodgy eye makeup.

1. Boozy Old Bugger

Again on the evening commute. It must’ve been just after 6 pm, and I was sporting a fab new coat purchased on a recent weekend jaunt. The train was more crowded than usual, but I did spot one open seat and made a beeline for it.

It didn’t take me very long to notice that the sleeping man seated next to me smelled really strongly of booze. He also moved around like a sack of bricks whenever the train took a curve. He woke up when the train gave a particularly forceful jolt, and proceeded to make these strange little noises. It took me a second to realize that he was trying to conceal a couple of dry heaves.

This was a dilemma: you really can’t make a scene in such situations if you don’t want to be perceived as a loud/obnoxious/unworldly foreigner. That goes double if you’re American. After all, it could’ve been that this old drunk was just trying to clear his throat. In the end, though, it was my coat that decided for me. I decided to get up and move to the other end of the car to spare it from an unthinkable fate.

Not a second too soon- as soon as I’d done so, this sloppy 70 year old lush puked all over the floor. And rather than leaning over, he looked up instead, so he ended up covered with a substantial amount of his own vomit. Luckily, it didn’t have enough velocity to projectile.

This is disgusting in and of itself, but it’s still not the weirdest part. Out of everyone in that car (and it was a packed car), the only people who made a move towards relative safety were myself and another girl. The girl let out a little shriek, and I was proud of myself for making my move deftly and quietly. At least that’s how I like to think of it. In any case, the other passengers looked up from their evening papers for maybe a second, and then promptly went back to reading. The lush continued to sit in his own vomit, similarly unperturbed. I know the Brits are famous (notorious?) for their ability to keep a stiff upper lip, but…this was just weird. Impressive, though, don’t you think?

When the train pulled into the next station, I ran out of that car and into the next one. The other girl followed suit, and we exchanged a quick glance of disbelief before going back to our own reading. See what joy and camaraderie public transportation can bring into your life?

Damages? Really?

So check this out.

If you were a star footballer, would you complain? I don't know . . . maybe they got offended because the size wasn't quite right.

They should've just called a spade a spade: a £34,000 endorsement.

This post may have lost its direction, just a tad

I cannot think of an expense that pains me more than dry cleaning.

I love spending money. The amount of pleasure I get from a new pair of shoes, or a new book, even something practical for the house (new closet organizer anyone?) is, maybe, not quite normal. But dry cleaning as a regular expense is just something I cannot get on board with. Finding myself consistently out about 50 quid for something I should be able to take care of for a fraction of the price at home (but can’t, because our 2 in 1 machine treats clothes in a manner not unlike the dhobis do back in the homeland) really ruins my day when I check my bank balance online.

Here’s the worst part:

Cost of dry cleaning one (1) man’s “shirt” = £1.50 at the local shop.
Cost of dry cleaning one (1) woman’s “blouse” = £5.00 at the local shop.

WTF?

Both of these are your standard 100% cotton collared shirts that you wear to the office. And, in 9 cases out of 10, the woman’s blouse will be smaller than the man’s shirt. Not that I think it’s practical to charge per square centimeter of fabric, but I think you get my point. To rub it in a bit more, all the dry cleaning shops boast their low prices for men’s shirts in the window display. Is this the case in the States, as well? If so, I think this issue needs to be at the forefront of the feminist platform. I don’t think I need to go into how much more expensive it is to be girl in the first place. Again, that's 9 cases out of 10; I can think of a few exceptional males. All of them are Indian. But that’s a story for another day…

HSBC Campaign in France

I had posted this on Facebook, but I think the link has since expired, so here it is again! Travel + history = clever.

A good ad is hard to find. What? What do you mean, that's not how the saying goes...

Welcome to Ramblish.

So. My only prior experience with blogging dates back to a history course sophomore year, when we were asked to post reactions to that week's reading before coming in to lecture. I didn't bother to post very often; I wasn't particularly concerned with padding my participation grade, and I realize in retrospect that I often took those discussions for granted. I miss them now that the majority of my work day revolves around analyzing statistics.

Today I fought with MS Word to insert a table of contents into a document. They provide you with a template to make it easier, but secretly, they're trying to frustrate all your attempts to line up a few titles and numbers. Once the template is set, the processor suddenly forgets all the things it used to know how to do without the template. After some futile attempts to cut and paste, you let loose a string of profanity and expose your grief to a colleague. He, of course, solves the problem in roughly 3 seconds.

That doesn't change the fact that Microsoft Office is crap, and will continue to be crap until it's flooded by competitors and forced to raise its game. Monopoly sucks. Say what you want about capitalism; you can't deny the fact that it forces better quality products/services.

Is it already obvious that I really like semicolons?

Hmm, I feel a bit guilty about slagging off Microsoft, what with Bill and Melinda Gates being the philanthropists that they are. Props to them for that; it's not nearly as prevalent as it needs to be among those in that financial echelon. They should start up a microfinance scheme for people with techie aspirations that grows and develops a worthy competitor to abysmal MS Office. That would definitely qualify as combating pure evil in my book. Isn't that philanthropy at its best?