Maintaining Optimism in the Face of Reality. Occasional observations on the state of the world, society, business and politics. Usually anchored by facts, always augmented by opinion.

Why George Bush and the Republicans Should Start Liking Public Radio  | e-mail post

I should state that I get the vast majority of my medium-depth news from public radio. In contrast I find the web much better for headlines and in depth research of an issue. I personally feel that if you don't listen to an NPR affiliate, you probably should. If you don't know your NPR affiliate, you can find it here. It humors most people to know that I get my sports news exclusively from public radio. Needless to say, I don't fare too well in the office NCAA pool.

Beyond the sports coverage, the main reason I like public radio is because I find it to be some of the fairest coverage of the news that I see or hear. For example, I find most news outlets seem to have a fairly negative slant on the situation in Iraq. There's no question that the situation over there is not ideal. The impression I seem to get from most major news outlets is that we shouldn't be there, the Iraqis are at best tolerating us, and that the whole situation is basically hopeless.

In contrast, NPR was the only place I learned about a British survey of the Iraqi population that basically said most Iraqis seem at least moderately positive about the U.S.-led war and the U.S. occupation. Given an either-or choice between governance by Saddam or the U.S., only 7% would take Saddam. Not to say this survey is all positive by any means, but it was interesting to actually hear about the positives. Other than other NPR listeners, no one I know had heard of this survey from July. A very brief web search showed no mention of this turning up in any mainstream American news. In fact, John Zogby had the audacity to claim in the L.A. Times and the Zogby website just a couple of days ago: "In August, I conducted the first serious public opinion survey of Iraqis since the end of the war." Maybe this was simply a barb at Zogby's competitor YouGov whom BBC Channel 4 and The Spectator commissioned for their earlier poll. I think it's more likely it reflects the fact that this news just didn't play outside of the UK and Zogby had no idea he was dead wrong when he wrote that.

And if you're thinking I heard about it on the BBC World Service, I didn't. I heard about it on All Things Considered. Even Fox News who are, you know, the "Fair and Balanced" ones, didn't even make mention of this survey in their web news anyway. (I'd encourage you to buy Al Franken's latest book just to spite Fox, by the way.)

NPR is also where nearly every day I've heard Iraqis interviewed that say they want the U.S. to stay and that they don't expect things to be better overnight or that we're doing a pretty good job. (And of course I hear Iraqis with very different sentiments as well.) Or tonight when they had two guests being interviewed on ATC who summarily regarded as absurd the idea that the situation in Iraq can reasonably be referred to as a quagmire or in any way comparable to Vietnam. Did NPR host Robert Siegel chortle, guffaw, or question the credibility of their claim? No, he simply asked, in a completely neutral manner (and I am paraphrasing here), "What would you tell people who feel it may be a quagmire to help them understand why it isn't?" Both individuals pointed out the obvious numerical differences in both duration and casualties and the interview moved on.

A final example that springs to mind is the reporting several weeks back by one of their Iraq correspondents that although power distribution in Baghdad was in worse shape, this was because power that had previously been appropriated from the outlying areas of Iraq to support Baghdad was being more fairly distributed throughout the country, and that on a national basis, power distribution was probably more equitable overall than before the war. Personally, I don't see a media filter here. If anything, it's more complete coverage.

And it's not just with their war reporting. I find their reporting to be genuinely balanced. Even listening to a recent local public radio interview program about a typical liberal cause celebre like organized labor, I was struck by the incredible neutrality of the interviewer as well as his command of the facts when dealing with both guests and callers.

Certainly there's no doubt that I find many of their commentators at times to be jaw-clenchingly liberal (or maybe it's just Daniel Schorr's voice, although I feel bad writing that). However, commentary pieces are segmented off in a manner analogous to that of a newspaper's editorial page; there is never any confusion about news versus opinion.

I guess my points are:

First, if the Bush administration really wants to get around the media filter, I think they should be going on NPR instead of (or in addition to) their focus on local media outlets.

Second, and Fox is going to hate this, if you really want fair and balanced reporting, you should tune into public radio. Oh, and if you decide you like it, don't be a free-rider; give them money; become a member.

e-mail post | Link Cosmos | [Permalink]  |  | Wednesday, October 29, 2003

I Could Get Behind This If It Made Them Smarter  | e-mail post

This July, the FDA did a rather interesting thing. They approved Eli Lilly's Humatrope, a Human Growth Hormone (hGH) supplement, for use in treating "short stature" in children who do not suffer from hGH deficiency. Strictly, they approved it for "idiopathic (of unknown origin) short stature." (As a side note "Idiopathic" is rapidly becoming my new favorite word, but is regrettably difficult to use in casual conversation.)
For the details, you can read the FDA release for some specifics.

Two questions: what exactly do I mean, and why on earth do I care?

Some background may help. The FDA has for some time recognized the use of hGH supplements to treat children, reasonably enough, who suffer from an actual hGH deficiency. Because hGH is important to growing bodies, this deficiency usually presents itself by a child being of short stature. Without getting into the definitions, which you can read about in the FDA document, this is the shortest 2.3% of children within their age and sex group. Pediatricians (pediatric endorcrinologists, specifically) have been prescribing Humatrope "off-label" to children who had normal hGH levels, but whose parents apparently felt they were simply too short. (Wow, way to go Mom & Dad, rather than helping develop your child's self-esteem, validate the fear that they are freakishly short!). This sort of off-label use is legal, but insurance companies, not unreasonably, do not cover off-label usage. A full treatment protocol can run up to $200,000. For reference, Eli Lilly sold $93.5 million in Humatrope in their most recent quarter, up 12% from last year.

So, what's my problem with this?

I think categorizing short stature as being an "indication," i.e. a disease, seems somewhat wrong. We are not talking about some type of dwarfism here. We are talking about an adult male who is 5'3" or an adult female who is 4'11". I'm not a real tall guy myself, and I'll admit 5'3" is pretty short, but I have a difficult time thinking of it as an ailment.

Now, if we can agree that this isn't an ailment, per se, there is an ethical question of whether we should be prescribing medications for the purpose of human "enhancement." This is a far bigger debate than I would want to entertain here, and I think that I am in general comfortable with the idea of such uses of medicine. I am troubled in this particular case because it inherently involves adults making decisions about enhancing their children rather than individuals making decisions for themselves. I see this is a clear leading indicator of the genuine market demand for pre-birth genetic enhancement in the future. I'm not talking about the world depicted in Gattaca or anything on that scale, but it does give me pause.

My biggest issue with this new indication, however, is that because it is now an official indication, and has an official diagnosis code (783.43, if you're curious), there will be substantial pressure on insurance companies to cover the treatment of this new indication. Oh, and what does that cost? Lilly claims it runs $10,000 - $25,000 per year of treatment. However, Harvey John Guyda, a pediatric endocrinologist from McGill University, told the panel that each centimeter of growth could cost "40-odd thousand dollars per centimeter" for kids with no hormone deficiency. Now McGill's in Toronto, so maybe he's talking Canadian dollars, but still. Given that even 5 centimeters is only a couple of inches, this is an expensive way to grow a basketball team. And, in all seriousness, average height gains under this treatment are only around 1.5 inches. That's a lot of money for still being pretty short.

You can read the FDA transcript if you'd like. Guyda's testimony is about midway through the transcript.

I am genuinely troubled to think about insurance companies paying for this treatment, for which something on the order of one million or more children apparently would be candidates. This becomes a very expensive entitlement that insurers, and ultimately governments and businesses, will have to pay for, and thus will we all. Think about it this way: even one-tenth of the low-end of the population at the lowest cost estimate by Lilly would total up to a billion per year. A larger patient population at more broadly acknowledged prices quickly surpasses the $10billion mark annually. My concern amplifies when I contemplate that this may be a watershed event in the use of "healthcare" dollars.

And if you think that insurance companies won't be paying for it, I'd be curious about your explanation for Lilly's "Humatrope Access Program". In this program, for qualified patients, Lilly will provide all or part of the treatment for up to twelve months. Of course, "During this time, the Humatrope Reimbursement Center will attempt to find sources of reimbursement for the cost of Humatrope for this patient." Maybe Lilly has a corporate mission to make people taller. I'm betting they are confident that they will be able to wrangle insurers into reimbursing in that time. Also, bear in mind that the treatment duration in the studies for approval of the Idiopathic Short Stature indication was 4.4 years and 6.5 years.

Interestingly, Lilly doesn't seem to make much mention of Humatrope. Their third-quarter results press release didn't mention the FDA approval for Idiopathic Short Stature, although it mentions three others. They also didn't issue a press release about the approval, nor do they say much at all about Humatrope. This is somewhat strange given that it is now generating almost two-thirds as much revenue for them as Prozac does. Maybe they are somewhat uncomfortable with the ethical quandary this approval represents. They arguably have a corporate responsibility to pursue this opportunity, particularly given the apparent demand from the off-label use of the product. At the same time, Lilly seems to be a company that prides itself on an elevated level of ethical behavior, and I imagine they may have misgivings about this.

Of course, if we had this drug 200 years ago, possibly Napoleon would have been a well-adjusted minor noble like his parents and tens of thousands of European lives would have been spared. On the other hand, this would have deprived France if its liberation from Britain and its sole demonstration of military capability or even couilles, as the French call them.
e-mail post | Link Cosmos | [Permalink]  |  | Tuesday, October 28, 2003

The MPAA's Marketing Deal of the Century  | e-mail post

This week the Motion Picture Association of America (MPAA) scored an enormous coup (in principle at least) in their war on digital piracy by enlisting the corps of Junior Achievement volunteers to spread the message of the evils of exchanging copyrighted materials in classrooms across America. You can read a news item about it here or read JA's press release.

To my mind, the most disturbing aspect of this affair is just how cheaply the MPAA was able to buy out Junior Achievement, an organization that as a businesperson I held in some level of regard for the value of its mission. Yet they sold out to the MPAA for a mere $100,000. They expect to reach 900,000 students with this message.

Think of it, for about 11 cents per student, the MPAA gets at least an hour (probably more) of communicating their party line to a captive audience of American youth; and from an "authority figure" no less! Either Jack Valenti is a brilliant negotiator, or JA is really hard up for cash. In any event, I think other organizations should really look into this as an option. VPs of Marketing and Corporate Communications, lend me your ears; this is a completely tax-deductible opportunity to clearly send your message to the youth of America. I can imagine:

These are all exceedingly valuable lessons, and arguably all more germane to the mission of JA than the morality play the MPAA is financing.

All kidding aside, I can sympathize with the MPAA and its music counterpart the RIAA. Their memberships are composed of companies that are primarily (especially in the case of RIAA) in the business of distributing content through means which are more or less inefficient compared to simply using networks to deliver the content directly to the consumer. They are simply resisting the inevitable. They should be spending more time identifying ways to incorporate these lower-cost technologies into their distribution models. You may remember how much the MPAA also fought against the video recorder. Can the studios even imagine how much lower their revenues would be without home distribution like DVDs?

Will there always be theft of intellectual property? I have a difficult time imagining there will not be some, but I genuinely believe most people are fairly honest, and if they are provided with a legitimate, straightforward and fairly-priced mechanism for licensing digital content, they will do it. Apple's iTunes Music Store is just getting started, relatively speaking, and it is already demonstrating that on the music side.

In any event, I'm not certain the MPAA didn't actually overpay for this program. After 20 years in business, the D.A.R.E. program (Drug Abuse Resistance and Education), which reaches an astonishing 36 million students annually has succeeded in reducing drug use by high school seniors by a whopping six percent. Of course, they have also presided over a near doubling in usage among eigth and tenth graders.1

Hopefully for the MPAA this JA program won't just educate the kids who didn't know they could download their very own copy of a movie in several times the time it takes to go to Blockbuster and rent it.

1 Read about trends in teenage drug use at: Monitoring the Future's web site.
e-mail post | Link Cosmos | [Permalink]  |  | Saturday, October 25, 2003

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