Who would you vote off the island: the selfish ass or the generous spirit? The selfish ass, right? Rational.

WSU scientist Craig Parks along with Asako Stone set out to figure out exactly how much loutish behavior a group will tolerate before throwing the selfish out. What they discovered is far more interesting:

…we also observed a completely unanticipated and, we argue, more interesting result: Those who give much to the group effort yet take little of its subsequent reward are not applauded but rather targeted for expulsion. The effect was replicated across three subsequent studies. Two of these studies ruled out some rather mundane explanations for the finding (lack of understanding of the task by the benevolent other, the other behaving unpredictably), and a third suggested that people are motivated to expel the benevolent other either for self-image reasons or because the other is not adhering to common rules of behavior. In this article, we report on this series of studies.

What the hell. The authors go on to attempt to explain why:

These data, then, provide potential explanations for why people want to remove a benevolent individual from the group. In some cases, the individual makes others feel they look bad in comparison, and, in other cases, the person is seen as violating rules of social interaction for mixed-motive situations. As we solicited these explanations after the expulsion preference had been stated, it is certainly possible that they represent not motivations for removing a benevolent other but rather rationalizations for why subjects want the benevolent person removed.

If you were looking for an empiric basis for the “Keep the government’s hands off my Medicare” red state, federal subsidy dependent elderly white teapartier, this is a good place to start.

Sixteen thousand people volunteered for the study; unlike most, these weren’t people engaging in high risk behaviors like sex work or IV drug abuse. All received condoms, HIV prevention counseling, and an offer for HAART therapy if they became positive. Eight thousand received a placebo shot, the other half six doses of two distinct (and previously failed) HIV vaccines. About five years later, 74 of the placebo recipients were newly HIV positive. Twenty-three fewer, 51 total, among the vaccine recipients were now HIV positive.

After years of struggle, and some truly distressing failures, this is the one and only successful HIV vaccine trial.

It was definitely took an odd approach. Take two failed vaccines, combine them together, and see if they’ll work. The first vaccine stuffed into a tamed Canarypox virus some of the critical functional proteins of the HIV virus. (Canarypox is in the same broad family of viruses that includes Smallpox. Birds are the desired home of Canarypox; it’s capable of getting into human cells, but not properly replicating itself once in. As such, it has the ideal vaccine combination of really pissing off the human immune system while being incapable of causing injury.) The second, booster, vaccine was simply some of the purified and isolated surface protein (gp120) from the HIV virus. (This booster vaccine is a bit like going around the human immune system with a mugshot of the HIV virus. The isolated protein is incapable of causing disease, but gives the whiff of what the real deal is like.) When the study was first proposed, parts of the scientific community were non-plussed. Isn’t zero times zero still zero?

Nope, it’s one third. What do you do with a vaccine that only works sometimes, or only for some? For a vaccine to be considered clinically useful (i.e, after the shots are done, you can feel confident in telling someone they are vaccinated and protected against the infection), you’d hope to have at least 70-80% of those vaccinated to be protected. (Herd immunity takes care of the rest of the risk, eventually.) Further, this vaccine combination (bizarrely) failed to produce neutralizing antibodies even in the successfully vaccinated.

For the next few months and years, the results of this study will be torn into, trying to answer some of these questions. In the meantime, this is an extremely heartening sign–indicating a real potential to salvage other failed vaccines into successful combination therapies.

The United States power grid is currently (get it? get it!?) split into three distinct chunks: an Eastern interconnection, a Western interconnection (of which Seattle and Washington State are members) and Texas. Why is Texas separate from the rest? Why indeed.

Surplus power generated in one interconnection, at this time, cannot be transferred to another. Further, the parts of the continent most promising for wind, solar and geothermal power (i.e. the greenest power choices available right now) are far from where the bulk of power is consumed (the East and West coasts).

Enter the Tres Amigas project–a plant build a superconducting triangle of powerlines to connect these three grids. Using high temperature superconductors allows the power to be transmitted as direct current with similar efficiencies to alternating current. (Mashing together alternating currents from disparate grids is quite problematic, due to issues of phase. Using DC to connect the grids alleviates this problem. Superconductors alleviate some of the inefficiencies of transmitting DC over long distances.)

This is good news from the perspective of green energy. Connecting the East and West coasts to the areas most promising for wind and solar power will boost the economic viability of such projects in the near future. In the negative, this allows for all sorts of new games to be played by energy traders in the largely unregulated energy market.

(Illustration by Chris Rummell)

There really isn’t much to debate.

The US healthcare system, in its present state, is a failure. It fails those with and without coverage. We spend more, care for fewer and are sicker than the citizens of any other industrialized nation.

We’ve studied it. Americans of all socioeconomic strata are less healthy on every measured basis than their UK counterparts–before or after adjusting for the less healthy lifestyles of Americans. Putting it even more bluntly, the richest Americans, lavished with the finest private health insurance our nation can muster, in the epicenter of global medical and biological research, have more diabetes and higher blood pressure than the poorest of English citizens. Even within our country, Americans within the Veterans Affairs system, a little socialized corner of our healthcare system, are similarly healthier than their privately insured doppelgangers.

As far as the uninsured in this country, an unprecedented phenomenon in the industrial world, allow the independent Institute of Medicine to state the case:

Lack of health insurance causes roughly 18,000 unnecessary deaths every year in the United States. Although America leads the world in spending on health care, it is the only wealthy, industrialized nation that does not ensure that all citizens have coverage.

The case for socialized medicine in this country has been made, and it has won. Back in June of this year, an overwhelming supermajority of Americans were in favor of a public health plan option. After the long summer–filled with hideous farces of Town Hall meetings, Teabaggers and endless anti-reform propaganda–support remained at supermajority levels. The Senate vote on the package seems to be a fait accompli.

The core of the opposition is an all out appeal to selfishness. Think of the taxes you’ll pay. Seniors, think of what you’ll be forced to share with those younger than you. You might have to wait in line for care if anyone can get it. The hideous core throbbing at the center of all this summer’s hysterics is the toddlerization of Americans as selfish and self-centered consumers–relentlessly stripped of any sort of adult notions of empathy, responsibility for others, investment in the future or delayed gratification. The whole movement has been lead by paid-for shills for the moneyed interests endangered by healthcare reform.

The mob of mooks compelled by these appeals to selfishness–capable only of braying about ‘socialism’ and ‘the constitution’ with no sense of what either really represents–are the rhetorical equivalent of suicide bombers. This summer’s protests reminded me of nothing less than Kermit Roosevelt‘s handiwork, undoing Mosaddeq’s attempt to nationalize the Iranian oil industry. The intent was to drive terror into the hearts of the elected representatives Democratic supermajority–to generate the illusion of mass discontent. The absurdity of the arguments posed at the Town Halls–Death Panels! Marxism! Obama is Hitler for trying to provide Americans with healthcare!–was the entire point. The feeling of being strapped to a bomb generated by having these cretinous and credulous fools
as countrymen is best diffused by ignoring it as bad theater.

It’s worth considering why American doctors are so expensive, where the costs of drugs and medical devices arise. Healthcare reform is, astonishingly enough after nearly a century of struggle, about to happen. These are the points we should be debating and struggling with as the end details are being written.

Why are prescription drugs so damn expensive? Or that test your doctor ordered–requiring you to be contorted into some ornate machine–that costs thousands of dollars?

Layers of cost build up as we dive deeper and deeper into the life of a medical drug or device. At the shallowest depths are the most obvious additions to costs, the vast sums of money spent on marketing to consumers and doctors alike. Next down are the costly FDA trials, phase I, II and III that must be completed before a medical device or drug comes to market; it’s these studies that also ensure safety and efficacy. At the beating heart of all of this, typically, is in an idea from a publicly funded academic research lab.

The basic biological research done in the United States is the envy of the world. From the investments of the National Institutes of Health (NIH) an the National Science Foundation (NSF) and even more esoteric government sources (the Department of Energy largely bankrolled the Human Genome Project), legions of academic labs have been pumping out the foundation of the medical revolutions of the past few decades. The massive, freely accessible and well-curated libraries of genes, genomes, proteins and even entire metabolic pathways were built through US government funding. Simply put, it would not be possible to do modern biological or medical research at any level without these tools. It’s from these laboratories that we know how, say, cholesterol is absorbed, made processed, eliminated and even turned pathologic in the human body. This knowledge is how drug companies figure out how to test new drugs, measure their effects and safety.

It’s at this level, in academic labs, where the epiphanies behind new devices and meds occur. The discovery of a new pathway, the teasing apart of a bit of physiology, or simply a new understanding why some are protected from disease when others are not all lead to ideas of new drugs and devices. If it’s a really good idea, if the potential seems ripe, it becomes the core of a startup company.

The idea is teased out. If it really looks good in animals, the phase I human trials start at about this point. (Phase I trials are small scale, and focused on establishing safety and reasonable doses or ways of application.) Money is raised (the first big cut of cash taken by the parasitic financial industry). Most often, the goal is to make the idea look good enough for one of the supersized biotech companies (essentially a pile of money and lawyers blended into the equivalent of the Borg cube) to buy up the whole company, idea and all. (The next major step where the financial industry takes a cut.) Somewhere about this point, Phase II human trials begin (small scale, but now focused on both safety and efficacy.)

The last step before a drug or device can be sold is a phase III human trial, large scale and required to statistically demonstrate in a randomized and controlled trial efficacy and safety of the new idea. A typical phase III trial costs ring up at about a billion dollars. Only the Borg-cube level of biotech can really take them on. For a genuinely new idea–an entirely new kind of drug or device–this is the riskiest step. All sorts of unexpected things happen–sometimes for the better, sometimes for the worst. (Both Minoxidil and Viagra started as entirely new blood pressure pills; they worked terribly at controlling blood pressure, but excellently at helping old men feel better about themselves.) The payoff is an exclusive, time-limited, patent. For a new drug or device that genuinely solves a large and unaddressed problem, this adds up to tens of billions of dollars over the ensuing years of legalized monopoly.

The patents for drugs work as the founders intended; they’re just long enough to make the investment worth it, but not so long as to prevent real competition forming while the drugs are still useful. Generic drugs are those that have gone through this whole process, and been on the market long enough for their patent to expire. These copycats mimic the molecular structure of a drug already proven through the phase I, II and III human trials by someone else. Without the R&D costs (or marketing costs), they become instantly cheaper than their parents.

Most drugs on the market today, including new drugs, are actually based on old ideas. Prozac was followed by a dozen or so drugs that work in the same way. (Viagria was followed by Cialis and Levitra.) It’s here where consumers get soaked. As soon as a lucrative drug is about to go off patent, the parent biotech company will typically come out with a new, improved (in some minor way) version. The repeated phase III trial tends to be much cheaper, and with a near certain outcome. The new drug is then relentlessly marketed, driving as many customers as possible away from the imminent generic competition. For the big biotech companies (heavy on money and lawyers, light on genuine risk taking science), developing new ideas isn’t a strength. Instead, they devote vast sums of money into promoting these derivatives, certain that the government funded labs will keep churning out new ideas worth picking off in the future.

In a somewhat ugly way, the whole process works surprisingly well. At this point, most of the drugs most of us will need to take (statins like simbastatin to reduce cholesterol, ACE receptor antagonists and HCZ for blood pressure, SSRIs for depression) are available in generic form. They work well, are cheap and safe. Find a doctor who still reads, and doesn’t have to learn about new drugs from a rep paid to tout the newest (but not necessarily meaningfully better) and more expensive drug, and you can game it all fairly well. That’s to say, the problem of expensive drugs and devices is as much one of this system as that of the poor continuing medical education of many physicians.